China braces for Covid surge as JN.1 variant spreads around the world

JN.1 likely to become the prevailing strain throughout the country, in part driven by Lunar New Year travel
Cases expected to put pressure on struggling health services in rural areas

Coronavirus China

Josephine Ma

Published: 9:12pm, 29 Dec 2023

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Chinese health authorities are calling for vigilance over the holidays as the country braces for a rise of Covid-19 cases caused by JN.1, a new variant of the coronavirus dominating in the United States and spreading rapidly elsewhere.

The US Centres for Disease Control and Prevention said earlier this month that JN.1 was first detected in the US in September and although it was likely to be more transmissible than other variants, it did not appear to cause more severe illnesses.

In China, the most prevalent variant is EG.5 but health authorities are expecting a rise in JN.1 because of an increase in imported cases, as well as mass travel over the Lunar New Year holidays in early February.

“Due to continued stream of imported cases of JN.1 and the mass movement of people before and after the Lunar New Year, the JN.1 variant is likely to become a prevailing variant in the country, and that will cause an increase in Covid-19 cases,” Li Zhengmao, from the National Administration of Disease Prevention and Control, said on Friday.

Li added that China was bracing for an uptick in multiple respiratory diseases during the winter.

“[The rise in JN.1 cases] will increase the risks of severe cases and deaths among elderly and vulnerable people with underlying diseases. It will also create pressure on the health system in rural areas as they are less able to treat the infected,” he added.

Li said the bureau would closely monitor the spread of the variant, and step up vaccination of at-risk groups with shots developed from the XBB strain.

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According to the World Health Organization and scientific studies by the medical community, vaccines developed to counter the XBB variant in the Omicron family are still effective against JN.1.

Li said China would also pay special attention to weak links in the rural health system and allocate more resources to enable effective diagnosis to ensure hospitals were not inundated with less severe cases.

China’s health system was strained earlier this year with a spike in hospitalisations for various respiratory diseases, especially among children.

It was first hit by a surge of mycoplasma pneumoniae in May, then respiratory syncytial virus, adenovirus and influenza virus, from October.

Health authorities and scientists said the spike was caused by a lack of immunity against other common respiratory diseases following three years of mask requirements. Many other countries also saw an increase in respiratory diseases after Covid-19 restrictions were lifted.

But the unusually high rate of serious mycoplasma pneumoniae cases was also blamed on drug resistance.

Respiratory diseases often increase in winter as most people stay indoors. In China, that trend is exacerbated by mass travel around the Lunar New Year – as was the case with the rapid spread of sudden acute respiratory syndrome in 2003 and the Omicron variant in 2022.

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JN.1 evolved from the BA2.86 Omicron subvariant and by mid-December was responsible for about 44 per cent of Covid cases in the United States, according to the US CDC.

The WHO identified it as JN.1 as a variant of interest on December 19, saying it was on the rise in various countries, but the threat of an additional global public health risk was low.

The number of new cases of Covid-19 rose by more than half in the 28-day period to 17 December 2023, with more than 850,000 new cases reported, the WHO said.

But the number of new deaths fell by 8 per cent as compared to the previous 28-day period, with more than 3,000 new fatalities reported.