New Coronavirus News from 11 Nov 2022

Protection from previous natural infection compared with mRNA vaccination against SARS-CoV-2 infection and severe COVID-19 in Qatar: a retrospective cohort study [The Lancet, 11 Nov 2022]

Authored by Hiam Chemaitelly, Houssein H Ayoub, Sawsan AlMukdad, Peter Coyle, Patrick Tang, Hadi M Yassine, Hebah A Al-Khatib, Maria K Smatti, Mohammad R Hasan, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F Abdul-Rahim, Gheyath K Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A Butt, Hamad Eid Al-Romaihi, Mohamed H Al-Thani, Abdullatif Al-Khal, Roberto Bertollini and Laith J Abu-Raddad.

Summary
Background
Understanding protection conferred by natural SARS-CoV-2 infection versus COVID-19 vaccination is important for informing vaccine mandate decisions. We compared protection conferred by natural infection versus that from the BNT162b2 (Pfizer–BioNTech) and mRNA-1273 (Moderna) vaccines in Qatar.

Methods
We conducted two matched retrospective cohort studies that emulated target trials. Data were obtained from the national federated databases for COVID-19 vaccination, SARS-CoV-2 testing, and COVID-19-related hospitalisation and death between Feb 28, 2020 (pandemic onset in Qatar) and May 12, 2022. We matched individuals with a documented primary infection and no vaccination record (natural infection cohort) with individuals who had received two doses (primary series) of the same vaccine (BNT162b2-vaccinated or mRNA-1273-vaccinated cohorts) at the start of follow-up (90 days after the primary infection). Individuals were exact matched (1:1) by sex, 10-year age group, nationality, comorbidity count, and timing of primary infection or first-dose vaccination. Incidence of SARS-CoV-2 infection and COVID-19-related hospitalisation and death in the natural infection cohorts was compared with incidence in the vaccinated cohorts, using Cox proportional hazards regression models with adjustment for matching factors.

Findings
Between Jan 5, 2021 (date of second-dose vaccine roll-out) and May 12, 2022, 104 500 individuals vaccinated with BNT162b2 and 61 955 individuals vaccinated with mRNA-1273 were matched to unvaccinated individuals with a documented primary infection. During follow-up, 7123 SARS-CoV-2 infections were recorded in the BNT162b2-vaccinated cohort and 3583 reinfections were recorded in the matched natural infection cohort. 4282 SARS-CoV-2 infections were recorded in the mRNA-1273-vaccinated cohort and 2301 reinfections were recorded in the matched natural infection cohort. The overall adjusted hazard ratio (HR) for SARS-CoV-2 infection was 0·47 (95% CI 0·45–0·48) after previous natural infection versus BNT162b2 vaccination, and 0·51 (0·49–0·54) after previous natural infection versus mRNA-1273 vaccination. The overall adjusted HR for severe (acute care hospitalisations), critical (intensive care unit hospitalisations), or fatal COVID-19 cases was 0·24 (0·08–0·72) after previous natural infection versus BNT162b2 vaccination, and 0·24 (0·05–1·19) after previous natural infection versus mRNA-1273 vaccination. Severe, critical, or fatal COVID-19 was rare in both the natural infection and vaccinated cohorts.

Interpretation
Previous natural infection was associated with lower incidence of SARS-CoV-2 infection, regardless of the variant, than mRNA primary-series vaccination. Vaccination remains the safest and most optimal tool for protecting against infection and COVID-19-related hospitalisation and death, irrespective of previous infection status.

Nearly 60% in Japan unaware of relaxed COVID-19 mask guidelines [Kyodo News Plus, 11 Nov 2022]

By Eduardo Martinez

Nearly 60 percent of people in Japan were unaware of government guidance that wearing masks outdoors for protection against the coronavirus is unnecessary in most cases, recent survey results have shown.

Although the guidelines were issued in May and the government's position on mask-wearing has since remained unchanged, the survey found that 18.4 percent of respondents had no knowledge the guidance even existed, while 40 percent knew of it but not the specific details, according to data by polling firm Laibo Inc.

Compared with the 58.4 percent overall who were unaware, 41.6 percent said they knew of the guidance and its content, according to the survey.

Wearing a mask remains the norm in Japan, despite 72.7 percent saying they are in favor of dropping the practice. Among the respondents, 33.9 percent said they were in favor of shedding masks, while 38.8 answered they were "somewhat" in favor.

The survey conducted online from Oct. 12 through 17 garnered sample responses from 1,011 working adults, with 52.5 percent saying that government explanations on guidance have been insufficient, including information that mask-wearing is also optional in quiet and spacious indoor areas.

Among the reasons why people favored mask-wearing, some cited the ongoing pandemic and coronavirus-related deaths. Others said they wear a mask for protection against influenza in winter and hay fever in spring as well as COVID-19.

Coronavirus cases have been recently rebounding throughout Japan.

Meanwhile, some responded that they were now "uncomfortable" taking their mask off in public as they have been accustomed to wearing masks for more than two years.

While Japan no longer has an official mask mandate in place, some respondents said they would be more encouraged to stop wearing masks if the government issued a uniform rule on their usage.

Masking up is still commonplace in other Asian countries such as Singapore and South Korea, despite their governments fully lifting outdoor mask mandates in March and September, respectively.

In China, which still has a strict "zero-COVID" policy in place, people are asked to wear masks on subway trains and in shopping malls.

In contrast, some Western nations were quick to forego masks due to the improving pandemic situation in many parts of the world.

Some survey respondents felt that Japan should keep in step with other countries, with the increase in international arrivals due to borders reopening to individual foreign tourists.

Daniel Barter, an Australian tourist currently visiting Tokyo, said masks were rarely seen anymore in his home country.

The 30-year-old said people "knew pretty quickly" that wearing a mask was no longer mandatory thanks to "really clear messaging" from the authorities through social media as well as on television.

On making sense of mask etiquette upon arriving in Japan, Barter said "it was not made clear at all," eventually assuming it would be best to wear one by observing those around him.

"It was announced as we landed that you need to wear (a mask) on the train and in the airport terminal, and that was the last I heard of it," he said.

Chinese are criticizing zero-Covid — in language censors don't understand [CNN, 11 Nov 2022]

By Jessie Yeung

Hong KongCNN —
In many countries, cursing online about the government is so commonplace nobody bats an eye. But it’s not such an easy task on China’s heavily censored internet.

That doesn’t appear to have stopped residents of Guangzhou from venting their frustration after their city – a global manufacturing powerhouse home to 19 million people – became the epicenter of a nationwide Covid outbreak, prompting lockdown measures yet again.

“We had to lock down in April, and then again in November,” one resident posted on Weibo, China’s restricted version of Twitter, on Monday – before peppering the post with profanities that included references to officials’ mothers. “The government hasn’t provided subsidies – do you think my rent doesn’t cost money?”

Other users left posts with directions that loosely translate to “go to hell,” while some accused authorities of “spouting nonsense” – albeit in less polite phrasing.

Such colorful posts are remarkable not only because they represent growing public frustration at China’s unrelenting zero-Covid policy – which uses snap lockdowns, mass testing, extensive contact-tracing and quarantines to stamp out infections as soon as they emerge – but because they remain visible at all.

Normally such harsh criticisms of government policies would be swiftly removed by the government’s army of censors, yet these posts have remained untouched for days. And that is, most likely, because they are written in language few censors will fully understand.

These posts are in Cantonese, which originated in Guangzhou’s surrounding province of Guangdong and is spoken by tens of millions of people across Southern China. It can be difficult to decipher by speakers of Mandarin – China’s official language and the one favored by the government – especially in its written form.

And this appears to be just the latest example of how Chinese people are turning to Cantonese – an irreverent tongue that offers rich possibilities for satire – to express discontent toward their government without attracting the notice of the all-seeing censors.

In nearby Cantonese-speaking Hong Kong, anti-government demonstrators in 2019 often used Cantonese wordplay both for protest slogans and to guard against potential surveillance by mainland Chinese authorities.

Now, Cantonese appears to be offering those fed-up with China’s strict zero-Covid policies an avenue for more subtle displays of dissent.

Jean-François Dupré, an assistant professor of political science at Université TÉLUQ who has studied the language politics of Hong Kong, said the Chinese government’s shrinking tolerance for public criticism has pushed its critics to “innovate” in their communication.

“It does seem that using non-Mandarin forms of communication could enable dissenters to evade online censorship, at least for some time,” Dupré said.

“This phenomenon testifies to the regime’s lack of confidence and increasing paranoia, and of citizens’ continuing eagerness to resist despite the risks and hurdles.”

Perfect for satire, and protest Though Cantonese shares much of its vocabulary and writing system with Mandarin, many of its slang terms, expletives and everyday phrases have no Mandarin equivalent. Its written form also sometimes relies on rarely used and archaic characters, or ones that mean something totally different in Mandarin, so Cantonese sentences can be difficult for Mandarin readers to understand.

Compared to Mandarin, Cantonese is highly colloquial, often informal, and lends itself easily to wordplay – making it well-suited for inventing and slinging barbs.

When Hong Kong was rocked by anti-government protests in 2019 – fueled in part by fears Beijing was encroaching on the city’s autonomy, freedoms and culture – these attributes of Cantonese came into sharp focus.

“Cantonese was, of course, an important conveyor of political grievances during the 2019 protests,” Dupré said, adding that the language gave “a strong local flavor to the protests.”
He pointed to how entirely new written characters were born spontaneously from the pro-democracy movement – including one that combined the characters for “freedom” with a popular profanity.

Other plays on written characters illustrate the endless creativity of Cantonese, such as a stylized version of “Hong Kong” that, when read sideways, becomes “add oil” – a rallying cry in the protests.

Protesters also found ways to protect their communications, wary that online chat groups – where they organized rallies and railed against the authorities – were being monitored by mainland agents.

For example, because spoken Cantonese sounds different to spoken Mandarin, some people experimented with romanizing Cantonese – spelling out the sounds using the English alphabet – thereby making it virtually impossible to understand for a non-native speaker.

And, while the protests died down after the Chinese government imposed a sweeping national security law in 2020, Cantonese continues to offer the city’s residents an avenue for expressing their unique local identity – something people have long feared losing as the city is drawn further under Beijing’s grip.

Falling silent
For some, using Cantonese to criticize the government seems particularly fitting given the central government has aggressively pushed for Mandarin to be used nationwide in education and daily life – for instance, in television broadcasts and other media – often at the expense of regional languages and dialects.

These efforts turned into national controversy in 2010, when government officials suggested increasing Mandarin programming on the primarily-Cantonese Guangzhou Television channel – outraging residents, who took part in rare mass street rallies and scuffles with police.

It’s not just Cantonese affected – many ethnic minorities have voiced alarm that the decline of their native languages could spell an end to cultures and ways of life they say are already under threat.

In 2020, students and parents in Inner Mongolia staged mass school boycotts over a new policy that replaced the Mongolian language with Mandarin in elementary and middle schools.
Similar fears have long existed in Hong Kong – and grew in the 2010s as more Mandarin-speaking mainlanders began living and working in the city.

“Growing numbers of Mandarin-speaking schoolchildren have been enrolled in Hong Kong schools and been seen commuting between Shenzhen and Hong Kong on a daily basis,” Dupré said. “Through these encounters, the language shift that has been operating in Guangdong became quite visible to Hong Kong people.”

He added that these concerns were heightened by local government policies that emphasized the role of Mandarin, and referred to Cantonese as a “dialect” – infuriating some Hong Kongers who saw the term as a snub and argued it should be referred to as a “language” instead.

In the past decade, schools across Hong Kong have been encouraged by the government to switch to using Mandarin in Chinese lessons, while others have switched to teaching simplified characters – the written form preferred in the mainland – instead of the traditional characters used in Hong Kong.

There was further outrage in 2019 when the city’s education chief suggested that continued use of Cantonese over Mandarin in the city’s schools could mean Hong Kong would lose its competitive edge in the future.

“Given Hong Kong’s rapid economic and political integration, it wouldn’t be surprising to see Hong Kong’s language regime be brought in line with that of the mainland, especially where Mandarin promotion is concerned,” Dupré said.

Speaking ‘without fear’
It’s not the first time people in the mainland have found ways around the censors. Many use emojis to represent taboo phrases, English abbreviations that represent Mandarin phrases, and images like cartoons and digitally altered photos, which are harder for censors to monitor.

But these methods, by their very nature, have their limits. In contrast, for the fed-up residents of Guangzhou, Cantonese offers an endless linguistic landscape with which to lambast their leaders.

It’s not clear whether these more subversive uses of Cantonese will encourage greater solidarity between its speakers in Southern China – or whether it could encourage the central government to further clamp down on the use of local dialects, Dupré said.

For now though, many Weibo users have embraced the rare opportunity to voice frustration with China’s zero-Covid policy, which has battered the country’s economy, isolated it from the rest of the world, and disrupted people’s daily lives with the constant threat of lockdowns and unemployment.

“I hope everyone can maintain their anger,” wrote one Weibo user, noting how most of the posts relating to the Guangzhou lockdowns were in Cantonese.

“Watching Cantonese people scolding (authorities) on Weibo without getting caught,” another posted, using characters that signify laughter.

“Learn Cantonese well, and go across Weibo without fear.”

China Return to Normal to Take at Least a Year, Analysts Say [Bloomberg, 11 Nov 2022]

• Most analysts expect reopening to begin sometime after March
• Likely to be at least six months of adjustment after that

China’s exit from the Covid pandemic could run through the end of next year, with reopening only starting sometime from April and a slow return to normality likely weighing on investors’ hopes for a quick economic recovery, according to a survey of economists.

Almost half of the 23 economists surveyed by Bloomberg News said they think reopening from Covid Zero will begin in the second quarter of 2023, after the parliamentary meeting which usually happens in early March. Another seven said it will start in the July-September period, while two don’t expect change until sometime in 2024, which would be at least four years after the virus was first reported in Wuhan.

China Covid News: Beijing Cases Jump to the Most in More than a Year [Bloomberg, 11 Nov 2022]

China Covid Cases Top 10,000, Beijing Highest in Over a Year
• Local infections nationwide are the highest since late April
• Country’s leaders unveiled a new policy easing restrictions

China’s daily infection rate exceeded 10,000 for the first time since April, with Beijing’s cases at the highest level in more than a year, as the country’s top leaders unveiled a new policy easing its strict Covid Zero measures.

The capital reported 114 new cases for Thursday, the municipal health commission said in a statement. Four of the infections were found outside the government-run quarantine system, stoking concern the virus continues to circulate within the community. Nationwide, there were 10,243 new infections, the highest since April 28.

China Covid: Beijing eases some curbs despite rising cases [BBC, 11 Nov 2022]

By Frances Mao

China has slightly relaxed some of its Covid restrictions even as case numbers rise to their highest levels in months.

Quarantine for close contacts will be cut from seven days in a state facility to five days and three days at home.

Officials will also stop recording secondary contacts - meaning many people will avoid having to quarantine.

The slight easing comes weeks after Xi Jinping was re-instated as party leader for a historic third term.

Mr Xi held his first Covid meeting with his newly elected Standing Committee on Thursday.

China's zero-Covid policy has saved lives in the country of 1.4 billion people but also dealt a punishing blow to the economy and ordinary people's lives.

There is increasing public fatigue over lockdowns and travel restrictions.

Stories of suffering and desperation have also circulated on social media, fuelling many outbursts of civic anger.

China's National Health Commission (NHC) insisted the changes did not amount to "relaxing prevention and control, let alone opening up", but were instead designed to adapt to a changing Covid situation.

The NHC also said it would develop a plan to speed up vaccinations.
• The politics driving China's hellish lockdowns
• China outcry over death of girl sent to quarantine
• Lockdown delayed potentially life-saving treatment

On Friday, the changes were announced even as the country grapples with its worst wave of Covid in months.

The cities of Beijing, Guangzhou and Zhengzhou are currently seeing record numbers.

On Thursday, China recorded over 10,500 new Covid cases - the highest daily total since April when China shut down its largest city Shanghai to combat a wave there.

People in China, and analysts watching the country, have been waiting for some indication from the government that strict Zero-Covid measures might be eased.

On the one hand, Beijing is not officially backing down from its commitment to its current strategy, but it has announced a series of measures it has described as "adapting" to the situation rather than "relaxing" the policy.

For Chinese people who have become exhausted by Zero-Covid it doesn't really matter if the government finds the need to save face semantically, as long as the changes are real and that they are.

The moves announced today may not seem like much if you are not living in China but, inside the country, three years into a crisis, with no indication of when or how an off ramp may appear, any steps towards re-opening are steps which are not going backwards.

Ending the punishment for airlines carrying infected passengers will mean more flights, more seats, cheaper inbound tickets, and an end to abrupt Covid-induced cancellations. This is significant.

A reduction of seven days in hotel quarantine plus three days at home to five days plus three is only a small alteration but the expectation is that this could continue to come down at some point in the future.

Again, for a country with an economy being smashed by Zero-Covid, baby steps are better than no steps.

Raising the bar for centralised quarantine inside China will also ease tensions for ordinary people, if only because it provides a glimmer of light at the end of the Covid tunnel.

It is hard to explain to people in other countries just how fed up with Zero-Covid locals have become. They were living through this crisis well before the rest of the world and while other countries have now found a way to move on, they're still stuck with it, as if China has been frozen in a massive 2020 time block.

Despite the small changes however, most restrictions still remain in place. Mr Xi has insisted on sticking to a stringent zero-Covid policy involving lockdowns even as the rest of the world has moved on.

That means in many cities residents have been subject to sudden restrictions on their movement and disruptions to work and schooling.

For example, this week in Guangzhou - the current epicentre of the Covid wave in China - locals in one district were barred from venturing outside and only one member of each household was allowed outside to grocery shop.

Public transport has been suspended while schools and workplaces are also shut down.

In Zhengzhou, another Covid centre at the moment, lockdowns there prompted many workers living at a vast factory owned by Taiwanese iPhone-maker Foxconn to flee the area on foot to escape restrictions.