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World

Post-zero-Covid: What the return of Chinese tourists means for the global economy

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Hong Kong
CNN
 — 

In the years before Covid, China was the world’s most important source of international travelers. Its 155 million tourists spent more than a quarter of a trillion dollars beyond its borders in 2019.

That largesse fell precipitously over the past three years as the country essentially closed its borders. But, as China prepares to reopen on Sunday, millions of tourists are poised to return to the world stage, raising hopes of a rebound for the global hospitality industry.

Although international travel may not return immediately to pre-pandemic levels, companies, industries and countries that rely on Chinese tourists will get a boost in 2023, according to analysts.

China averaged about 12 million outbound air passengers per month in 2019, but those numbers fell 95% during the Covid years, according to Steve Saxon, a partner in McKinsey’s Shenzhen office. He predicts that figure will recover to about 6 million per month by the summer, driven by the pent-up wanderlust of young, wealthy Chinese like Emmy Lu, who works for an advertising company in Beijing.

“I’m so happy [about the reopening]! ” Lu told CNN. “Because of the pandemic, I could only wander around the country for the past years. It was difficult.”

“It’s just that I’ve been stuck inside the country for a little too long. I’m really looking forward to the lifting of the restrictions, so that I can go somewhere for fun! ” the 30-year-old said, adding that she wanted to visit Japan and Europe the most.

As China announced last month it would no longer subject inbound travelers to quarantine starting January 8, including residents returning from trips abroad, searches for international flights and accommodations immediately hit a three-year high on Trip.com

(TCOM).

Bookings for overseas travel during the upcoming Lunar New Year holiday, which falls between January 21 and January 27 this year, have soared by 540% from a year ago, according to data from the Chinese travel site. Average spending per booking jumped 32%.

The top destinations are in the Asia Pacific region, including Australia, Thailand, Japan and Hong Kong. The United States and the United Kingdom also ranked among the top 10.

“The rapid buildup in … [bank] deposits over the past year suggests that households in China have accumulated significant cash holdings,” said Alex Loo, a macro strategist for TD Securities, adding that frequent lockdowns have likely led to restraints on household spending.

There could be “revenge spending” by Chinese consumers, mirroring what happened in many developed markets when they reopened early last year, he said.

That’s good news for many economies battered by the pandemic.

“We estimate that Hong Kong, Thailand, Vietnam and Singapore would benefit the most if China’s travel service imports were to return to 2019 levels,” said Goldman Sachs analysts。

Hong Kong — the world’s most visited city with just under 56 million arrivals in 2019, most of them from mainland China — could see an estimated 7.6% boost to its GDP as exports and tourism income increase, they said. Thailand’s GDP may be boosted by 2.9%, while Singapore would get a lift of 1.2%.

Elsewhere in the world, Cambodia, Mauritius, Malaysia, Taiwan, Myanmar, Sri Lanka, South Korea and Philippines are also likely to benefit from the return of Chinese tourists, according to research by Capital Economics.

Hong Kong has suffered particularly acutely from the closure of its border with mainland China. The city’s pillar industries of tourism and real estate have been hit hard. The financial hub expects GDP to have contracted by 3.2% in 2022.

The city government announced Thursday that up to 60,000 people would be allowed to cross the border daily each way, starting Sunday.

Several other Southeast Asian countries reliant on tourism have kept entry rules relatively relaxed for Chinese tourists, despite the record Covid-19 outbreak that has swept through China in recent weeks. They include Thailand, Indonesia, Singapore and the Philippines.

“This is one of the opportunities that we can accelerate economic recovery,” Thailand’s health minister said this week.

New Zealand has also waived testing requirements for Chinese visitors, who were the second largest source of tourist revenue for the country before the pandemic.

But other governments are more cautious. So far, nearly a dozen countries, including the United States, Germany, France, Canada, Japan, Australia and South Korea, have mandated testing.

The European Union on Wednesday “strongly encouraged” its members states to require a negative Covid test for visitors from China before arrival.

There is clearly “conflict” between the tourism authorities and the political and health officials in some countries, said Saxon, who leads McKinsey’s travel practice in Asia.

Airlines and airports have already blasted the EU’s recommendations for testing requirements.

The International Air Transport Association, the airline industry’s global lobby group, together with airports represented by ACI Europe as well as Airlines for Europe, issued a joint statement on Thursday, calling the EU move “regrettable” and “a knee-jerk reaction.”

But they welcomed the additional recommendation to test wastewater as a way of identifying new variants of the disease, saying it should be an alternative to testing passengers.

Besides restrictions, it will take time for international travel to fully rebound because many Chinese must renew their passports and apply for visas again, according to analysts.

Lu from Beijing said she was still considering her travel plans, taking into consideration the various testing requirements and the high price of flying.

“The restrictions are normal, because everyone wants to protect people in their own country,” she said. “I’ll wait and see if some policies will be eased.”

Liu Chaonan, a 24-year-old in Shenzhen, said she had initially wanted to go to the Philippines to celebrate the Chinese New Year, but didn’t have time to apply for the visa. So she switched to Thailand, which offers quick and easy electronic permits.

“Time is short and I need to leave in about 10 days. People may choose some visa-friendly places and countries to travel to,” she said, adding that she plans to learn scuba diving and wants to buy cosmetics. Her total budget for the trip could exceed 10,000 yuan ($1,460).

Saxon said he expected China’s outbound international travel to fully recover by the year end.

“Generally, individuals are pragmatic and countries will welcome Chinese tourists due to their spending power,” he said, adding that countries may remove restrictions quickly when the Covid situation improves in China.

“It will take time for international tourism to get going, but it will come rushing back, when it happens.”

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Health

MIS-C has been more common and more severe than previously reported, study finds

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CNN
 — 

Although still rare, MIS-C after Covid-19 has been more common and more severe than previously reported, and there are significant racial disparities in cases, according to a study published Thursday in JAMA Network Open.

Multisystem inflammatory syndrome in children – which primarily emerges after a Covid-19 infection – causes inflammation in various parts of the body and can affect major organs including the kidneys, brain, lungs and heart. It can be serious, or deadly.

The US Centers for Disease Control and Prevention currently has relied on voluntary case reporting from local health departments for MIS-C surveillance. Through November, they’ve logged a total of about 9,000 cases and 74 deaths from MIS-C out of the millions of Covid-19 cases among children.

A formal diagnosis code was established for MIS-C in 2021, and the new research analyzed records collected by the Agency for Healthcare Research and Quality from thousands of hospitals representing more than three-quarters of the US population.

It found that for every 100 children hospitalized with Covid-19 in 2021, there were about 17 MIS-C hospitalizations. MIS-C hospitalizations were typically younger and more likely to occur in male children than were Covid-19 hospitalizations.

The more organs affected, the worse outcomes were. As the number of organ systems affected increased from two to six or more, mortality increased from 1% to 6%, according to the new research. The length of stay in the hospital doubled from four to eight days and adverse medication events more than tripled from 5% to 18%.

Overall, more than 60% of children hospitalized with MIS-C had more than two organ systems affected. Of them, about 8% of patients had at least six organ systems affected.

Racial disparities in Covid-19 outcomes are well-established, and this new research found even starker differences in MIS-C outcomes.

MIS-C hospitalizations were twice as likely among Black children as they were among White children. And while Black children represented about 24% of all MIS-C cases, they represented 32% of the most severe cases that affected at least six organ systems.

The researchers also found that the “severity of MIS-C for Black children was likely exacerbated by socioeconomic factors,” with those living in the most socially vulnerable communities typically spending an extra day in the hospital. They did not find the same connection in regards to Covid-19 hospitalizations.

These findings “increase our knowledge of MIS-C and COVID-19 disparities and outcomes, shedding light on the risks and impacts of increasing organ system dysfunction,” according to a commentary on the study from pediatricians and researchers from the University of Colorado School of Medicine.

But they raise even more critical questions, including specific reasons for the vast racial disparities.

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US

XBB.1.5 may be ‘most transmissible subvariant of Omicron to date,’ scientists warn

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CNN
 — 

Health experts voiced concern Wednesday over the rapid growth of the new Omicron sublineage XBB.1.5, advising the public to stay informed but not alarmed as they work to learn more.

Over the month of December, the percentage of new Covid-19 infections in the United States caused by XBB.1.5 rose from an estimated 4% to 41%.

“That’s a stunning increase,” Dr. Ashish Jha, the White House Covid-19 response coordinator, wrote in a Twitter thread.

Officials at the World Health Organization shared similar thoughts Wednesday.

“We are concerned about its growth advantage,” said Maria Van Kerkhove, an epidemiologist who is the WHO’s technical lead on Covid-19.

Van Kerkhove noted that XBB.1.5, which was first detected in the United States, has spread to at least 29 countries and “is the most transmissible form of Omicron to date.”

“We do expect further waves of infection around the world, but that doesn’t have to translate into further waves of death because our countermeasures continue to work,” she said.

Jha noted that effective tools to avoid severe Covid-19 infections include rapid tests, high-quality masks, ventilation and filtration of indoor air, oral antiviral pills and updated vaccines.

“We will soon have more data on how well vaccines neutralize XBB.1.5,” Jha said, suggesting that research to determine vaccine effectiveness against the new sublineage is underway.

Jha said XBB.1.5 is probably more able to slip past our immune defenses and may be more contagious. But he said it’s still not clear whether it causes more severe disease, something that was also stressed by Van Kerkhove.

She said WHO is working on a risk assessment for this sublineage and hopes to publish it within the next few days. The group’s technical advisers are looking at both real-world data on hospitalizations and lab studies to assess severity.

Jha said that although he is concerned about XBB.1.5, he doesn’t think it represents a huge setback in the fight against Covid-19.

“And if we all do our part,” he wrote, “We can reduce the impact it will have on our lives.”



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Business

From the unwinding of zero-Covid to economic recovery: What to watch in China in 2023

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Editor’s Note: A version of this story appeared in CNN’s Meanwhile in China newsletter, a three-times-a-week update exploring what you need to know about the country’s rise and how it impacts the world. Sign up here.


Hong Kong
CNN
 — 

After a tumultuous end to a momentous and challenging year, China heads into 2023 with a great deal of uncertainty – and potentially a glimpse of light at the end of the pandemic tunnel.

The chaos unleashed by leader Xi Jinping’s abrupt and ill-prepared exit from zero-Covid is spilling over into the new year, as large swathes of the country face an unprecedented Covid wave.

But the haphazard reopening also offers a glimmer of hope for many: after three years of stifling Covid restrictions and self-imposed global isolation, life in China may finally return to normal as the nation joins the rest of the world in learning to live with the virus.

“We have now entered a new phase of Covid response where tough challenges remain,” Xi said in a nationally televised New Year’s Eve speech. “Everyone is holding on with great fortitude, and the light of hope is right in front of us. Let’s make an extra effort to pull through, as perseverance and solidarity mean victory.”

Xi had previously staked his political legitimacy on zero-Covid. Now, as his costly strategy gets dismantled in an abrupt U-turn following nationwide protests against it, many are left questioning his wisdom. The protests, which in some places saw rare demands for Xi and the Communist Party to “step down,” may have ended, but the overriding sense of frustration has yet to dissipate.

His New Year speech comes as China’s lockdown-battered economy faces more immediate strain from a spiraling outbreak that has hit factories and businesses, ahead of what is likely to be a long and complicated road to economic recovery.

Its tightly-sealed borders are gradually opening up, and Chinese tourists are eager to explore the world again, but some countries appear cautious to receive them, imposing new requirements for a negative Covid test before travel. And just how quickly – or keenly – global visitors will return to China is another question.

Xi, who recently reemerged on the world stage after securing a third term in power, has signaled he hopes to mend frayed relations with the West, but his nationalist agenda and “no-limits friendship” with Russia is likely to complicate matters.

As 2023 begins, CNN takes a look at what to watch in China in the year ahead.

The most urgent and daunting task facing China in the new year is how to handle the fallout from its botched exit from zero-Covid, amid an outbreak that threatens to claim hundreds of thousands of lives and undermine the credibility of Xi and his Communist Party.

The sudden lifting of restrictions last month led to an explosion of cases, with little preparation in place to deal with the surging numbers of patients and deaths.

The country’s fragile heath system is scrambling to cope: fever and cold medicines are hard to find, hospitals are overwhelmed, doctors and nurses are stretched to the limit, while crematoriums are struggling to keep up with an influx of bodies.

And experts warn the worst is yet to come. While some major metropolises like Beijing may have seen the peak of the outbreak, less-developed cities and the vast rural hinterland are still bracing for more infections.

As the travel rush for the Lunar New Year – the most important festival for family reunion in China – begins this week, hundreds of millions of people are expected to return to their hometowns from big cities, bringing the virus to the vulnerable countryside where vaccination rates are lower and medical resources even scarcer.

The outlook is grim. Some studies estimate the death toll could be in excess of a million, if China fails to roll out booster shots and antiviral drugs fast enough.

The government has launched a booster campaign for the elderly, but many remain reluctant to take it due to concerns about side effects. Fighting vaccine hesitancy will require significant time and effort, when the country’s medical workers are already stretched thin.

Beijing’s Covid restrictions have put China out of sync with the rest of the world. Three years of lockdowns and border curbs have disrupted supply chains, damaged international businesses, and hurt flows of trade and investment between China and other countries.

As China joins the rest of the world in living with Covid, the implications for the global economy are potentially huge.

Any uptick in China’s growth will provide a vital boost to economies that rely on Chinese demand. There will be more international travel and production. But rising demand will also drive up prices of energy and raw materials, putting upward pressure on global inflation.

“In the short run, I believe China’s economy is likely to experience chaos rather than progress for a simple reason: China is poorly prepared to deal with Covid,” said Bo Zhuang, senior sovereign analyst at Loomis, Sayles & Company, an investment firm based in Boston.

Analysts from Capital Economics expect China’s economy to contract by 0.8% in the first quarter of 2023, before rebounding in the second quarter.

Other experts also expect the economy to recover after March. In a recent research report, HSBC economists projected a 0.5% contraction in the first quarter, but 5% growth for 2023.

Despite all this uncertainty, Chinese citizens are celebrating the partial reopening of the border after the end of quarantine for international arrivals and the resumption of outbound travel.

Though some residents voiced concern online about the rapid loosening of restrictions during the outbreak, many more are eagerly planning trips abroad – travel websites recorded massive spikes in traffic within minutes of the announcement on December 26.

Several Chinese nationals overseas told CNN they had been unable or unwilling to return home for the last few years while the lengthy quarantine was still in place. That stretch meant major life moments missed and spent apart: graduations, weddings, childbirths, deaths.

Some countries have offered a warm welcome back, with foreign embassies and tourism departments posting invitations to Chinese travelers on Chinese social media sites. But others are more cautious, with many countries imposing new testing requirements for travelers coming from China and its territories.

Officials from these countries have pointed to the risk of new variants emerging from China’s outbreak – though numerous health experts have criticized the targeted travel restrictions as scientifically ineffective and alarmist, with the risk of inciting further racism and xenophobia.

As China emerges from its self-imposed isolation, all eyes are on whether it will be able to repair its reputation and relations that soured during the pandemic.

China’s ties with the West and many of its neighbors plummeted significantly over the origins of the coronavirus, trade, territorial claims, Beijing’s human rights record and its close partnership with Russia despite the devastating war in Ukraine.

The lack of top-level face-to-face diplomacy certainly didn’t help, neither did the freeze on in-person exchanges among policy advisers, business groups and the wider public.

At the G20 and APEC summits, Xi signaled his willingness to repair relations with the United States and its allies in a flurry of bilateral meetings.

Communication lines are back open and more high-level exchanges are in the pipeline – with US Secretary of State Antony Blinken, French President Emmanuel Macron, Dutch Prime Minister Mark Rutte and Italy’s newly elected Prime Minister Giorgia Meloni all expected to visit Beijing this year.

But Xi also made clear his ambition to push back at American influence in the region, and there is no illusion that the world’s two superpowers will be able to work out their fundamental differences and cast aside their intensifying rivalry.

In the new year, tensions may again flare over Taiwan, technological containment, as well as China’s support for Russia – which Xi underlined during a virtual meeting with Russian President Vladimir Putin on December 30.

Both leaders expressed a message of unity, with Xi saying the two countries should “strengthen strategic coordination” and “inject more stability into the world,” according to Chinese state media Xinhua.

China is “ready to work” with Russia to “stand against hegemonism and power politics,” and to oppose unilateralism, protectionism and “bullying,” said Xi. Putin, meanwhile, invited Xi to visit Moscow in the spring of 2023.

Beijing has long refused to condemn Russia’s invasion of Ukraine, or even refer to it as such. It has instead decried Western sanctions and amplified Kremlin talking points blaming the US and NATO for the conflict.

As Russia suffered humiliating military setbacks in Ukraine in recent months, Chinese state media appeared to have somewhat dialed back its pro-Russia rhetoric, while Xi has agreed to oppose the use of nuclear weapons in Ukraine in meetings with Western leaders.

But few experts believe China will distance itself from Russia, with several telling CNN the two countries’ mutual reliance and geopolitical alignment remains strong – including their shared vision for a “new world order.”

“(The war) has been a nuisance for China this past year and has affected China’s interest in Europe,” said Yun Sun, director of the China Program at the Washington-based think tank Stimson Center. “But the damage is not significant enough that China will abandon Russia.”

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Health

Respiratory viruses could surge following the holidays, public health experts warn

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CNN
 — 

There is growing concern among infectious disease and public health experts that the US could face even more respiratory infections in January.

It is “highly likely” that respiratory viruses could spread even more following holiday gatherings and New Year’s Eve celebrations, Dr. William Schaffner, a professor in the Division of Infectious Diseases at Vanderbilt University Medical Center and medical director of the National Foundation for Infectious Diseases, told CNN on Monday.

“These are highly contagious viruses – and people have generally put Covid-19 and Covid vaccination behind them. They haven’t been all that attentive to flu. They’re not wearing masks,” Schaffner said. “And if you’re close together with other people, it’s an opportunity for all three of these viruses – flu, Covid, and even RSV – to spread from one person to another. So, we do expect a post-holiday surge in these viruses.”

At the same time, across the country, there has been a wave of flight cancellations and families stuck at the airport during their holiday travels.

When that happens, “People are together for very long periods of time, and they’re not wearing masks, and they’re weary and tired and stressed, and those are occasions where people are more apt to spread the virus,” Schaffner said, adding that his own granddaughter had four flights canceled over the holidays. He recommends masking up while in the airport and on an airplane.

“I think all of us in infectious diseases and public health would recommend that masks are not perfect, but they are an additional layer of protection,” Schaffner said.

Some local health officials are bracing for a possible surge in respiratory illnesses following the winter holidays since that was seen recently following Thanksgiving, Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials, said in an email to CNN on Monday.

“After the Thanksgiving holiday period, we saw an uptick in COVID cases by about 58% through the beginning of the Christmas holiday on December 21,” Freeman wrote. “Deaths from COVID also rose during that same time period by about 65%.”

Flu also surged after Thanksgiving, with more than a third of all flu hospitalizations and deaths at the time this season being reported in the first full week of data post-Thanksgiving, and cases also jumped nearly as much.

Currently, seasonal flu activity remains high in the US, but continues to decline in most parts of the country, according to data published Friday by the US Centers for Disease Control and Prevention. Despite improvements, flu may not have peaked yet.

CDC estimates that, so far this season, there have been at least 18 million illnesses, 190,000 hospitalizations and 12,000 deaths from flu.

As for the current state of Covid-19, increases appear to be relatively mild. Hospitalizations are ticking up in most states, although the overall rate is still just a fraction of what it was during other surges. New hospital admissions have jumped nearly 50% over the past month. Hospitalizations among seniors are nearing the peak from the Delta surge – and rising fast.

Freeman said it is expected that reports after the winter holidays will continue to show increases in Covid-19 cases and deaths, likely attributable to increased travel across the country, large family gatherings, fewer people being up to date on their Covid-19 vaccinations and flu shots, and fewer people following mitigation measures, such as masking and social distancing.

“Air travel is also back to pre-pandemic levels and there are no more restrictions on mask wearing on airplanes or in airports where viruses can easily circulate. Same for bussing,” Freeman said. “Fortunately, we are seeing less RSV in children from our high points earlier in December, so that respiratory illness is stabilizing and becoming less of a part of the triple threat of COVID, flu, and RSV.”

As health officials brace for a possible surge in respiratory viruses in the coming weeks, it might not be just flu, Covid-19 and RSV that sickens people, said Dr. Georges Benjamin, executive director of the American Public Health Association.

“We’re focusing on those three, but there are others out there – the common cold and others,” Benjamin said.

Overall, “we should expect more respiratory diseases,” he said. “The best way to reduce your risk is of course to get fully vaccinated for those that which we have a vaccine, so influenza and Covid, with the new bivalent version, are the two most important right now.”

Benjamin added that it also remains important to wash your hands often, wear a mask during holiday travels and stay home when sick.

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World

Leaked notes from Chinese health officials estimate 250 million Covid-19 infections in December: reports

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Hong Kong
CNN
 — 

Almost 250 million people in China may have caught Covid-19 in the first 20 days of December, according to an internal estimate from the nation’s top health officials, Bloomberg News and the Financial Times reported Friday.

If correct, the estimate – which CNN cannot independently confirm – would account for roughly 18% of China’s 1.4 billion people and represent the largest Covid-19 outbreak to date globally.

The figures cited were presented during an internal meeting of China’s National Health Commission (NHC) on Wednesday, according to both outlets – which cited sources familiar with the matter or involved in the discussions. The NHC summary of Wednesday’s meeting said it delved into the treatment of patients affected by the new outbreak.

On Friday, a copy of what was purportedly the NHC meeting notes was circulated on Chinese social media and seen by CNN; the authenticity of the document has not been verified and the NHC did not immediately respond to a request for comment.

Both the Financial Times and Bloomberg laid out in great detail the discussions by authorities over how to handle the outbreak.

Among the estimates cited in both reports, was the revelation that on Tuesday alone, 37 million people were newly infected with Covid-19 across China. That stood in dramatic contrast to the official number of 3,049 new infections reported that day.

The Financial Times said it was Sun Yang – a deputy director of the Chinese Center for Disease Control and Prevention – who presented the figures to officials during the closed-door briefing, citing two people familiar with the matter.

Sun explained that the rate of Covid’s spread in China was still rising and estimated that more than half of the population in Beijing and Sichuan were already infected, according to the Financial Times.

The estimates follow China’s decision at the start of December to abruptly dismantle its strict zero-Covid policy which had been in place for almost three years.

The figures are in stark contrast to the public data of the NHC, which reported just 62,592 symptomatic Covid cases in the first twenty days of December.

How the NHC came up with the estimates cited by Bloomberg and the Financial Times is unclear, as China is no longer officially tallying its total number of infections, after authorities shut down their nationwide network of PCR testing booths and said they would stop gathering data on asymptomatic cases.

People in China are also now using rapid antigen tests to detect infections and are under no obligation to report positive results.

Officially, China has reported only eight Covid deaths this month – a strikingly low figure given the rapid spread of the virus and the relatively low vaccine booster rates among the elderly.

Only 42.3% of those aged 80 and over in China have received a third dose of vaccine, according to a CNN calculation of new figures released by the NHC on December 14.

Facing growing skepticism that it is downplaying Covid deaths, the Chinese government defended the accuracy of its official tally by revealing it had updated its method of counting fatalities caused by the virus.

According to the latest NHC guidelines, only deaths caused by pneumonia and respiratory failure after contracting the virus are classified as Covid deaths, Wang Guiqiang, a top infectious disease doctor, told a news conference Tuesday.

The minutes of the Wednesday closed-door NHC meeting made no reference to discussions concerning how many people may have died in China, according to both reports and the document CNN viewed.

“The numbers look plausible, but I have no other sources of data to compare [them] with. If the estimated infection numbers mentioned here are accurate, it means the nationwide peak will occur within the next week,” Ben Cowling, a professor of epidemiology at the University of Hong Kong told CNN in an emailed statement, when asked about the purported NHC estimates.

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US

Title 42: Appeals court rejects bid by GOP-led states to keep Trump-era border policy in force

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CNN
 — 

A federal appeals court on Friday rejected a bid by several Republican-led states to keep the so-called Title 42 rule in force, after a district court struck the controversial Trump-era border policy down.

The new ruling from the DC Circuit US Court of Appeals sets the stage for the case to go to the Supreme Court. The Biden administration is set to stop enforcing Title 42 – which allows for the expulsion of migrants at the US-Mexico border – on Wednesday.

The Republican-led states previously indicated that if the appeals court ruled against them, they’d seek the intervention of the Supreme Court.

In the new order, the DC Circuit denied the states’ request to intervene in the case and dismissed as moot the states’ request that it put the lower court’s ruling on hold.

The unsigned order was handed down by a circuit panel made up of an Obama appointee, a Trump appointee and a Biden appointee.

They wrote that the “inordinate and unexplained untimeliness” of the states’ request to get involved in the case “weighs decisively against intervention.”

The case is a lawsuit the American Civil Liberties Union, representing several migrants brought In January 2021 challenging the program. The appeals court noted on Friday that the Republican-led states had long known that their interest in keeping the policy in force would diverge from the Biden administration’s approach to the case.

The appeals court wrote that “more than eight months ago, the federal government issued an order terminating the Title 42 policy.”

“Yet these long-known-about differing interests in preserving Title 42—a decision of indisputable consequence—are the only reasons the States now provide for wanting to intervene for the first time on appeal,” the DC Circuit said. “Nowhere in their papers do they explain why they waited eight to fourteen months to move to intervene.”

The ACLU attorney representing the migrants praised the court’s decision.

“The states are clearly and wrongly trying to use Title 42 to restrict asylum and not for the law’s intended public health purposes,” the attorney, Lee Gelernt, told CNN in an email. “Many of these states were vigorously opposed to past COVID restrictions but suddenly believe there is a need for restrictions when it comes to migrants fleeing danger.”

White House spokesperson Abdullah Hasan said after the ruling that the administration has a “robust effort underway” for managing the border following the policy’s expected lifting next week.

“To be clear: the lifting of the Title 42 public health order does not mean the border is open. Anyone who suggests otherwise is doing the work of smugglers spreading misinformation to make a quick buck off of vulnerable migrants,” Hasan said in a statement. “We will continue to fully enforce our immigration laws and work to expand legal pathways for migration while discouraging disorderly and unsafe migration. We have a robust effort underway to manage the border in a safe, orderly, and humane way when Title 42 lifts as required by court order.”

The White House also urged Republicans in Congress to agree to more border funding and work on comprehensive immigration reform. The Biden administration has asked Congress for more than $3 billion as it prepares for the end of Title 42 to help shore up resources for border management and technology.

The administration’s handling of Title 42, which the Trump administration put in place during the Covid-19 pandemic, has been the target of litigation from both supporters and opponents of the program.

Last month, US District Judge Emmet Sullivan struck down the program. But Sullivan put his ruling on hold for five weeks so that the Biden administration would have time to prepare for the policy’s wind down. The administration has also appealed the ruling, arguing that the program was lawful, even if federal public health authorities have determined it is no longer necessary.

As the December 21 deadline for Sullivan’s ruling to go into effect approaches, officials have been preparing for a surge of migrants. More than 1 million migrants have been expelled under the rule, which is a public health authority the Trump administration began using at start of the Covid-19 pandemic to expel migrants before they went through the asylum application process.

Republican-led states, in their attempts to intervene in the case, allege that allowing the policy to terminate would “cause an enormous disaster at the border.”

They have argued that the “greatly increased number of migrants that such a termination will occasion will necessarily increase the States’ law enforcement, education, and healthcare costs.”

The Biden administration opposed the states’ attempt to intervene and their request to keep the policy in place, calling the requests untimely and unjustified.

“The States could have sought to intervene after the CDC acted to terminate the Title 42 orders in April 2022,” the administration wrote.

The migrants who challenged the program in the case also opposed the states’ request, writing in a court filing that the states were “transparently interested in Title 42 as a restriction on immigration and asylum” rather than as a public health measure.

The Biden administration tried to wind down the Title 42 program in 2021, but a coalition of mostly GOP-led states – in a separate case filed in Louisiana – successfully sued to block the Department of Homeland Security from ending enforcement.

This story has been updated with additional details.

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World

Why people in China are panic buying canned yellow peaches as Covid surges

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Hong Kong
CNN
 — 

An unprecedented wave of Covid cases in China has sparked panic buying of fever medicines, pain killers, and even home remedies such as canned peaches, leading to shortages online and in stores.

Authorities said Wednesday they had detected 2,249 symptomatic Covid-19 cases nationally through nucleic acid testing, 20% of which were detected in the capital Beijing. CNN reporting from the city indicates the case count in the Chinese capital could be much higher than recorded.

Demand for fever and cold medicines, such as Tylenol and Advil, is surging nationally as people rush to stockpile drugs amid fears they may contract the virus.

Canned yellow peaches, considered a particularly nutritious delicacy in many parts of China, have been snapped up by people looking for ways to fight Covid. The product is currently sold out on many online shops.

Its sudden surge in popularity prompted Dalian Leasun Food, one of the country’s largest canned food manufacturers, to clarify in a Weibo post that canned yellow peaches don’t have any medicinal effect.

“Canned yellow peaches ≠ medicines!” the company said in the post published Friday. “There is enough supply, so there is no need to panic. There is no rush to buy.”

The People’s Daily, the mouthpiece of the Communist Party, also tried to set the record straight. It published a long Weibo post on Sunday urging the public not to stockpile the peaches, calling them “useless in alleviating symptoms of illness.”

Authorities also pleaded with the public not to stockpile medical supplies. On Monday, the Beijing city government warned residents that it was facing “great pressure” to meet demand for drug and medical services because of panic buying and an influx of patients at clinics.

It urged the public not to hoard drugs or call emergency services if they have no symptoms.

The rising demand and shortage of supply of Covid remedies have fueled bets on drugmakers.

Shares of Hong Kong-listed Xinhua Pharmaceutical, China’s largest manufacturer of ibuprofen, have gained 60% in the past five days. The stock has so far jumped by 147% in the first two weeks of this month.

“Our company’s production lines are operating at full capacity, and we are working overtime to produce urgently needed medicines, such as ibuprofen tablets,” Xinhua Pharmaceutical said Monday.

Ibuprofen is an anti-inflammatory drug used to treat pain and fever. It is also known as Advil, Brufen, or Fenbid.

The drug shortage has spread from mainland China to Hong Kong, a special administrative region which has a separate system of local government. On Sunday, the city’s health chief urged the public to refrain from panic buying cold medicines they do not need and urged residents “not to overact.”

In some Hong Kong drugstores, fever drugs such as Panadol, the local brand name for Tylenol, have sold out. Most of the buyers were sending the medicines to their families and friends in the mainland, sales representatives told CNN.

Shares of Shenzhen-listed Guizhou Bailing Group Pharmaceuticals, known for making cough syrup, have gained 21% this week and risen 51% so far this month. Yiling Pharmaceutical, the sole producer of Lianhua Qingwen, a traditional Chinese medicine recommended by the government for treating Covid, has also jumped more than 30% in the past month.

Even providers of funeral services and burial plots have gotten a huge boost. Shares in Hong Kong-traded Fu Shou Yuan International, China’s largest burial service company, have soared more than 50% since last month.

There is “strong pent-up demand for burial plots” in 2023, analysts from Citi Group said in a recent research report, adding that they’ve noticed increasing investor interest in the sector.

They cited the existence of hundreds of thousands of cremated remains, which are being temporarily stored in government facilities awaiting burial. Lockdowns across much of the country have halted funeral services, they said.

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Business

Covid-19 vaccine boosters for kids age 5 and under

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CNN
 — 

Last week, the US Food and Drug Administration authorized the bivalent Covid-19 booster for children 6 months to 5 years old. The US Centers for Disease Control and Prevention has since recommended the booster, and now everyone 6 months and older is able to receive the updated coronavirus vaccine except kids who got three doses produced by Pfizer/BioNTech.

Which young children are now eligible to receive the booster? What if kids haven’t started or completed the full series — do they now get the updated booster or the original monovalent vaccine? Can parents and guardians choose between the updated booster and the original shot? What are possible side effects? What if kids had Covid-19 already? And which families should consider the updated booster now and who could wait?

To help us answer these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician, public health expert, and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of “Lifelines: A Doctor’s Journey in the Fight for Public Health” and the mother of two young children, ages 2 and 5.

CNN: Let’s start with what has just changed in the recommendations: Which young children who received either the Pfizer or Moderna vaccine are now eligible to receive the booster?

Dr. Leana Wen: There are two vaccines authorized for young children: Moderna and Pfizer. For the youngest age group, the Moderna vaccine was designed to be a two-dose primary vaccine, while the Pfizer version was designed to be a three-dose primary vaccine. That means young children are considered to have completed their primary series if they completed two doses of the Moderna vaccine or if they completed three doses of Pfizer.

As a reminder, there is now a bivalent booster available for older children and adults. This combines the original (also called monovalent) vaccine with a vaccine that specifically targets the BA.4 and BA.5 Omicron subvariants. Because Omicron subvariants constitute virtually all new infections, the hope is that the bivalent booster will provide better, more directed protection.

What federal health officials have now said is that children 6 months through 5 years old who received both doses of the original Moderna vaccine are able to get the updated bivalent vaccine — if it has been at least two months since they completed the primary vaccine series.

For children who received the Pfizer vaccine, the guidance is a little different, because the primary series already involves three doses. Federal health officials have said that children 6 months through 4 years old who have not yet completed their three vaccine doses can receive the third dose as the bivalent vaccine. Let’s say a child has started this series and has had one or two doses of the original Pfizer vaccine. The third dose can now be the updated booster.

CNN: What if kids haven’t started or completed the full series — do they now get the updated booster or the original monovalent vaccine?

Wen: The answer is different for Moderna vs. Pfizer. For Moderna, the primary series is two doses, so a child needs to complete the two initial shots with the original formulation. The booster — the third dose — is the bivalent vaccine. For Pfizer, the primary series is three doses. The first two doses still need to be the original formulation, but the third shot is now the bivalent vaccine.

CNN: What about young children who completed three doses of the Pfizer vaccine — are they eligible for a fourth dose?

Wen: No. The FDA explicitly says that children 6 months through 4 years old who have completed their three-dose primary series with the original Pfizer vaccine are not eligible for a fourth shot of the bivalent booster. That’s because the primary series of three vaccine doses is still expected to have strong protection against severe illness to Omicron. This recommendation will be reevaluated as new data comes out.

CNN: Can parents and caregivers who have not completed the primary series of Moderna choose the bivalent vaccine as their second dose?

Wen: No. The FDA authorization for the adult primary series for Moderna — the two doses — is for the original monovalent vaccine. Similarly, there is no choice for which vaccine formulation is administered as the booster for Pfizer in adults. Only the bivalent booster is available as the third shot, not the original monovalent, which is still given as doses one and two. This mirrors the authorization given for adults — the primary series is the monovalent vaccine, with the only booster for Pfizer and Moderna for adults being the updated booster.

CNN: What are possible side effects from the updated booster?

Wen: It’s expected that children who get the updated booster will have similar types of side effects to the original vaccines. These side effects tend to be mild and short-lasting, usually resolving in the first 24 hours after inoculation. Adverse reactions can include pain and swelling in the injection site, fatigue, crankiness, sleepiness, headache, muscle aches and sometimes fever. Many children experience no side effects. The risk of serious side effects, such as myocarditis (an inflammation of the heart muscle), is expected to be exceedingly rare in this younger age group.

CNN: What if kids had Covid-19 already?

Wen: People who had Covid-19 can wait three months until after they have recovered from the coronavirus to receive another vaccine dose, according to the CDC. They probably have very good protection against infection in this period.

Many studies have shown that hybrid immunity — recovery from Covid-19 combined with vaccination — conveys very strong protection, arguably even more so than vaccination and boosters alone. In my opinion, I believe a case can be made that if a young child received the primary series and already had Covid, they could wait to receive another booster dose. This is especially true if they had Covid recently, in the last year. To my knowledge, there is no research that shows additional benefit of boosters to young children who recently had Covid-19 infection and who have received their primary vaccinations.

CNN: Which families should consider the updated booster now and who should wait?

Wen: First, I think it’s important to point out that the uptake of the primary series of the Covid-19 vaccines among young children is very low. According to the CDC, less than 5% of kids 5 and younger are fully vaccinated. That means we are referring to a very small pool of kids newly eligible for the updated boosters.

There’s one group that I would definitely recommend getting the updated booster. That’s the group of kids who received their first one or two doses of the Pfizer vaccine. These kids need to complete their primary series. The third dose of that series is now the updated bivalent booster. There’s no reason for families of these children to wait; they should complete the primary series, and it’s a bonus that the third dose is updated to target Omicron.

For children who received the two doses of the Moderna vaccine, I think the decision-making is different and will depend on families’ individual circumstances. Some families are very concerned about Covid-19 infection. Perhaps their child has underlying medical conditions, or they live with someone who is elderly, immunocompromised or otherwise very vulnerable to severe outcomes from Covid-19. Perhaps the family is welcoming a newborn soon, and that baby will be particularly vulnerable to coronavirus infection. I think it’s reasonable to decide that, since Covid-19 cases are rising, this is the time to get their young child the updated booster.

I also think it’s reasonable to wait. My children (ages 2 and 5) received the Moderna vaccines over the summer. They are eligible to be boosted, but I am holding off because the protection that they have against severe illness remains strong. The booster will convey additional protection against symptomatic infection, but that effect is probably short-lasting, according to a June study.

To be clear, I believe it’s crucial for older adults and vulnerable individuals to receive the updated booster. I also think it’s generally a good thing that people can choose the booster if they wish, as there are compelling individual reasons for different households.

Parents and caregivers who have questions should consult their pediatrician to decide the best course of action for their family’s specific circumstances. Finally, families whose children have yet to receive any Covid-19 vaccines should consider starting, especially if their kids are not known to have had Covid-19.

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Health

Dr. Sanjay Gupta: After two years of Covid-19 vaccines, here’s why they’re still vital

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CNN
 — 

In the United States, approximately 658 million Covid-19 vaccine doses have been administered since they were first distributed exactly two years ago Wednesday.

Framing the significance of preventive measures like vaccines can be challenging, which is why a new report from the Commonwealth Fund and Yale School of Public Health made headlines: According to their modeling of disease transmission across all age demographics and taking into account the existing health conditions in so many Americans, Covid vaccines prevented an estimated 3.2 million deaths and 18.5 million hospitalizations from their introduction in December 2020 to November 30, 2022.

That is why it is surprising to hear, according to a Kaiser Family Foundation analysis of data from the US Centers for Disease Control and Prevention, that from April through August – the last month included in the analysis – there were more vaccinated than unvaccinated people dying of Covid. The vaccinated categories include people who were vaccinated with the primary series and people who had been vaccinated and received at least one non-bivalent booster.

According to a CNN analysis of additional CDC data for September, 12,593 people died of Covid. A CDC sample of the deaths found 39% were unvaccinated, and 61% were vaccinated.

This phenomenon has many people – especially vaccine skeptics, but even stalwart vaccine supporters – confused and wondering if Covid vaccines and boosters are still effective and warranted.

The short answer is yes – but understanding why requires a crash course in statistics. We enlisted the help of Jeffrey Morris, a professor and the director of the Division of Biostatistics at the Perelman School of Medicine at the University of Pennsylvania, who helped us define three key reasons more vaccinated than unvaccinated people are dying of Covid.

One of the main reasons we see more vaccinated than unvaccinated people dying of Covid is a basic one. At this point in time, there are simply many more people who are vaccinated.

Think of it like this: If we round the September deaths to 13,000 and use the CDC sampling percentages, approximately 7,800 were vaccinated and approximately 5,200 were unvaccinated. The conclusion might be that you are far more likely to die if you are vaccinated. And, mathematically that would be true based on the raw numbers alone. If you stopped your analysis at this point, you will have committed a statistical error known as a base rate fallacy.

If instead, you take the extra step of accounting for the total number of fully vaccinated adults 18 and older in the United States (around 203 million) versus the total number of unvaccinated adults (around 55 million), a very different picture emerges.

Among the vaccinated population, 7,800/203 million died in September, which equals a rate of 38 deaths for every 1 million people. For the unvaccinated population, 5,200/55 million died, which equals a rate of 95 deaths for every 1 million people. That means an adult who is unvaccinated is roughly 2.5 times more likely to die than one who is vaccinated.

“You have to take into account the size of those groups,” explained Morris, who also publishes a blog, COVID-19 Data Science, to “just communicate what the emerging data suggest.”

There is another important difference when looking at the vaccinated versus unvaccinated populations in the United States. The vaccinated population skews older and has more health conditions. These are the same groups that are much more likely to have worse outcomes, like hospitalization and death, when infected with SARS-CoV-2, the virus that causes Covid-19. For example, CDC data show more than 90% of deaths through mid-November have been in those 65 or older.

“So those things lead to a higher risk of death and also a higher probability of being vaccinated,” Morris said. “That’s the key: if the vaccine uptake of those high-risk groups is high enough, then we can have a majority of the hospitalized or fatal cases be higher in the vaccinated population.”

You are more likely to die if you are older, and also more likely to be vaccinated if you are older. It does not mean vaccination is more likely to lead to death.

So if age isn’t taken into account when assessing vaccine efficacy, it can lead to something known as Simpson’s paradox, where a trend can appear to be the opposite of reality.

Morris said those kinds of errors not only result in a serious underestimation of the benefit of vaccines but also to downright wrong conclusions, even flipping the results – in this case, making it appear that vaccines increase the risk of death.

This happened in August 2021, with a study out of Israel – a highly vaccinated country – showed 60% of those hospitalized with severe Covid were fully vaccinated, causing misinterpretation and raising questions about the continued value of vaccination.

Morris said he has also seen Simpson’s paradox when people look at the rate of Covid deaths before vaccines were rolled out in 2020 versus since then, or comparing countries with higher vaccination rates to countries with lower vaccination rates.

“It’s a lot more subtle, but the pandemic has provided a number of pure examples of it. So the bottom line with all of that is, we can’t accurately assess the effects of vaccines from simple summaries,” Morris said, however “seemingly intuitive” they may appear.

A more telling and accurate comparison is between the death rate per 100,000 among unvaccinated people compared to the death rate of vaccinated people, adjusted for age.

CDC data show that for the week of September 25, people age 12 and older who were unvaccinated had a death rate of 1.32 per 100,000. Those who were vaccinated (but without an updated, bivalent booster) had a death rate of 0.26 per 100,000. And those who were vaccinated and boosted had a death rate of 0.07 per 100,000.

Broken down further by age, the numbers are even starker: The death rate during that week for those in the oldest age group, 80 and above, was 14.16 per 100,000 for the unvaccinated, 3.69 for those who were vaccinated but had not received the bivalent booster, and 0.0 for those who were vaccinated and boosted.

Overall, the CDC estimates that for the whole month of September, among those 12 and older, there was an almost 15 times lower risk of dying from Covid-19 for the vaccinated and boosted compared to the unvaccinated.

Unfortunately, uptake of the booster is low: Only 13.5% of the US population 5 and older is vaccinated and has gotten the new updated (bivalent) booster. Among those 65 and older, that percentage is 34.2%.

It’s not to say that vaccines are entirely risk free. For example, in people – especially males – between the ages of 5 and 39, there were 224 verified cases of myocarditis or pericarditis, inflammation of the heart and lining, reported to the CDC after vaccination with an mRNA vaccine between December 14, 2020, and May 31, 2022. But that was out of almost 7 million vaccine doses administered.

A study examining those figures found myocarditis/pericarditis occurred within seven days approximately 0.0005% of the time after the first dose, 0.0033% of the time after the second dose of the primary series, and 0.002% after the first booster – but it varied by age and sex, and was much more common among 16- to-17-year-old males after a second shot or a booster.

According to a separate analysis of nearly 43 million people in England, the researchers found that for younger men, the Moderna vaccine in particular had the highest rates of post vaccine myocarditis – although this number was still very low, 97 per million people exposed (0.0097%) – leading some to suggest a different vaccine for that age group or a longer interval between vaccine doses.

Statistical optical illusions aside, the fact is, there are more so-called breakthrough cases among the vaccinated. They have always existed. Since December 2020, we have known these vaccines are not 100% effective at preventing severe illness and death, let alone infection. When vaccines were first introduced, their efficacy was estimated to be an astonishing 95% against severe illness and death. They even protected people at a very high rate against infection.

But the efficacy keeps ticking downward. Part of it is waning immunity: Over the course of several months, antibody levels fade away – that’s just how the body works – even though there is still some protection, thanks to B cells and T cells. Getting boosted – or catching Covid – can help increase antibody levels for a few months at least. Between those two options, it’s far safer and less disruptive to get a booster than to risk illness.

Meanwhile, new variants keep cropping up, and they are increasingly able to evade our immune system. Unlike earlier variants, including the highly transmissible Delta variant, descendants of the Omicron lineage are escape artists.

“The emergence of Omicron at the end of 2021 was a game changer, as Omicron and its subsequent subvariants demonstrated strong immune evasion properties, with mutations in the spike protein and especially the [receptor binding domain] that reduced the neutralizing ability of the vaccine-induced antibodies,” Morris noted. The result is a great reduction in vaccine efficacy against infection, as well as against severe and fatal disease.

This actually means it’s more important to get boosted, especially if you are in a high-risk category, and as the weather gets colder and we gather indoors to spend time together.

The newest booster – the bivalent booster – is designed to protect against the original SARS-CoV-2 virus and against the more recent Omicron subvariants, although how much and for how long is still unknown.

Covid cases, and deaths have slowed down in recent months, but those numbers are trending up like they’ve done during the holidays in previous pandemic years. For the week of December 7, weekly new cases topped 65,000 and Covid claimed the lives of almost 3,000 people. Both represent an increase of around 50% from the week before, according to CDC data.

All of this is happening at a time when hospitals are already full of patients sick with the flu and RSV.

I know we’re all tired of hearing that we need to roll up our sleeves and get yet another Covid-19 booster.

But remember, many of us get the flu shot every year: We don’t assume we are protected from a flu vaccine a year ago. We get the shot even in seasons when the flu vaccine is much less effective than the Covid vaccine (the latest one appears to be a good match). We don’t call it a booster – it’s just the annual flu vaccine. And we don’t track the rate of so-called breakthrough flu infections; unlike Covid, we don’t routinely test people for flu unless they are demonstrably sick, so we have no way of knowing how many people, vaccinated or not, are infected and asymptomatic or mildly ill.

For some diseases, like measles, a single vaccine or a previous infection provides us with a near lifetime of protection. Even though we hoped for a one-and-done scenario when the Covid vaccines rolled out two years ago, the virus didn’t lend itself to that. Newer vaccines are being studied that could offer far more durable protection.

Analyzing all of this data without falling into the trap of a base rate fallacy or Simpson’s paradox isn’t easy, as you can see. And it is also clear the overall effectiveness of the vaccines have waned over time and with new variants.

However, two years later, a more thorough statistical analysis of vaccine effectiveness shows they are still cause for celebration.

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