Until recently, China, the world’s most populous nation, was also the world’s last Covid holding company. But within weeks it will be hit by a wave that a top health official predicts could infect many hundreds of millions of people.
This week, Beijing took its biggest step towards living with Covid, almost abandoning an unpopular and costly ‘zero Covid’ policy of lockdowns and mass quarantines that it had hoped would eliminate infections. The abrupt pivot has created the specter of immense strain on a healthcare system that is overstretched even in normal times. That could get worse in a month, as people travel across the country to see their families during the Lunar New Year holiday.
Feng Zijian, an adviser to China’s Covid task force, said this week that the wave could infect 60 percent of the country’s 1.4 billion people — or more than 840 million people. For most Chinese, it will be their first encounter with Covid.
Like many other countries, China is now facing Omicron variants that are highly contagious but have so far been milder than previous iterations. Unlike the rest of the world, China had almost three years to prepare for this rise. But for most of that time it focused on lockdowns rather than vaccinations and preparing the population for living with Covid, a prospect many experts had warned would be inevitable.
“There is a tsunami of cases coming whether they stay at zero Covid or not,” said Jin Dong-Yan, a virologist at Hong Kong University.
The question is how many cases will become serious and require more serious medical attention. Even the current picture is unclear. According to official data released by the National Health Commission, there were 159 serious cases of Covid nationwide on Friday, an increase of about 60 since the beginning of the month.
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“That number is still very low because in reality there should be many more confirmed cases that are now underreported,” said Mr. Jin. Another difficulty: The definition of a “serious” case can vary from city to city, he added.
What is clear is that the government is bracing itself for a big wave. Officials on Friday announced plans to double the capacity of critical care beds and increase the number of doctors and nurses in such wards. Also in the works: to upgrade temporary facilities previously built to quarantine people considered close contacts, turning them into secondary hospitals. In addition, officials said community-level workers would classify residents by level of risk — assigning color codes that indicate risk based on vaccination status, age and other health conditions, a move away from surveillance that had tracked residents based on contact tracing and infections.
China wants to ration hospital beds for the most serious cases, but officials must now convince the majority of infected people to stay home, despite telling them for years to fear Covid. A triage system has been set up to direct Covid patients to public health centers, but most people are not used to going to a doctor outside the hospital. The government relies on an army of volunteers to handle calls and deliver cold medicines and Covid test kits to the home of the sick, but there are early signs of understaffing and shortages of needed supplies.
To some extent, the complications China faces as it opens up are not unique. Other countries that have moved from strict pandemic controls to adapting to the virus have experienced a degree of shock as people unaccustomed to the virus flooded hospitals for help. But in places like Singapore and New Zealand, that change was more controlled. Officials lifted restrictions only after telling the public what to expect and when, giving hospital systems more time to prepare for the oncoming wave and citizens more time to get vaccinated.
“Singapore took a prudent approach with a gradual opening,” said Paul Anantharajah Tambyah, a practicing infectious disease physician and president of the Asia Pacific Society of Clinical Microbiology and Infection. Mild and moderate cases were treated outside the hospital system, he added. “That helped communication immensely and was easier for the general population to accept than a dramatic shift to a ‘business as usual’ approach.”
China is only now attempting to ramp up a vaccination campaign that was largely stalled in the spring when resources were diverted to building and maintaining a national mass testing system. More than 600 million vaccinated people have not yet received a booster shot, a necessary condition to prevent serious cases among those who received the Chinese vaccines, which have been proven to be weaker, the World Health Organization said. Only 40 percent of people over the age of 80 have had a booster vaccination.
After the easing was announced on Wednesday, officials scrambled to write new guidelines on everything from home isolation to rapid antigen testing, and to free up resources for a coming deluge of cases.
Dale Fisher, a professor of medicine and the head of the Singapore Ministry of Health’s National Infection Prevention and Control Committee, said Chinese health officials should ensure extra hospital beds are ready, ventilators are ready and medical staff are retrained. deployed.
China has taken swift action to do so in recent days, more than doubling its intensive care unit bed capacity to 10 beds per 100,000 people, compared to less than four just a month ago.
The National Health Commission also said on Friday it would divert 106,000 doctors and 177,700 nurses to intensive care units. According to the most recent official figures of 2020, China has three registered nurses per 1,000 people and two practicing doctors per 1,000 people.
Some changes have caused confusion as authorities react quickly to new measures. In cities like Beijing and Shanghai, authorities removed many test booths almost as soon as new guidelines on Wednesday called for restrictions on testing requirements. But by Friday, the National Health Commission said testing sites should not be arbitrarily removed and should be made available to those who need to enter nursing homes and medical facilities, where a negative test result is still required.
As cases rise in Beijing, many people are queuing at hospitals and stockpiling fever-reducing drugs and home testing kits. Some city residents reported that hospitals turned people away with symptoms, telling them their cases should be reported first by local neighborhood officials.
Wakeman Wang, a resident of Beijing, said he had hoped to take his 7-year-old son to a doctor after briefly choking on a fishbone earlier this week. But because his son had tested positive for Covid, his local community worker — charged with overseeing community-level pandemic policy — told him to take care of his son at home.
Mr. Wang said his wife tried calling several local GPs who were quickly gathered to help solve community medical problems, but none of the numbers she tried worked.
“I felt desperate and guilty,” he said. “When my child was in danger, I couldn’t solve the problem and I couldn’t guarantee his safety.”
Scarlet Zhang, a resident of Fengtai, a district in the city’s southwest, said she tried to go to a hospital after testing positive with a fever of 100 degrees Fahrenheit.
She said she tried to call an ambulance several times, but the municipal emergency number, similar to 911 in the United States, was always busy. A pharmacy near her home was out of fever medication, she said.
“It’s the third day I’ve had a fever, I can’t get advice from a professional and I don’t know what to do now,” she said.
Due to the hard line previously taken on the seriousness of the virus, Chinese officials now face a major challenge in allaying the public’s fears, said Mr. Fisher.
“The messaging to the public is really tricky when you’ve been saying for two to three years that this is deadly, and now you’re saying, ‘If you get it, just stay home and self-isolate,'” he added.
