China Braces for Deadly Covid Wave After Loosening Controls
Country didn’t prepare sufficiently to live with virus, experts say, citing strained hospitals, poor vaccination rates
China’s easing of its zero-tolerance Covid-19 restrictions is likely to open the door to a wave of infections that could cause chaos and upwards of a million deaths, public health experts said, with some warning of ramifications beyond the country’s borders.
China’s National Health Commission on Wednesday said it was dropping many of its quarantine and testing requirements, in addition to limiting the use of lockdowns—an acceleration of plans to dismantle the zero-Covid controls amid social unrest and escalating concerns over the health of the country’s economy.
The promise of regained freedom sparked celebration among some Chinese, but health researchers cautioned that the consequences for public health could be dire as the country tries to shift resources that had gone toward mass testing and quarantines toward treatment of severe cases.
“It will put unprecedented strain on the Chinese health system,” said Xi Chen, a public health scientist at the Yale School of Public Health, adding: “It is expected that at least in the next couple of months, things will get chaotic and painful.”
Despite subjecting itself to some of the world’s strictest Covid controls for three years to buy itself time, China didn’t prepare sufficiently to live with the virus, public health experts said, citing an undervaccinated elderly population and not enough intensive-care units to handle serious cases.
On Thursday, China’s National Health Commission reported around 21,000 new infections—a drop from the country’s all-time high of around 38,000 in late November that likely reflects reduced testing amid the easing of Covid-control measures.
Both online and bricks-and-mortar pharmacies in major cities were quickly running low on supplies of cold and pain medication, as well as rapid antigen test kits, as people anticipated getting infected.
While experts agree that the real case count will inevitably rise, there is no telling how big a wave China will be facing as it continues to relax Covid restrictions.
About 60% of the Chinese population might be infected when the first wave of large-scale infections reaches its peak, before the infection rate gradually plateaus, said Feng Zijian, former deputy director of the Chinese Center for Disease Control and Prevention, at a forum Monday, citing computer-modeling forecasts, according to an article by the state-run newspaper China Youth Daily.
Eventually between 80% and 90% of China’s population of 1.4 billion will be infected, Mr. Feng, a member of the central government’s advisory panel for Covid control, was quoted as saying.
To public-health officials and experts trying to forecast what the loosening of restrictions means, the example of Hong Kong looms as a cautionary tale. An Omicron outbreak in the former British colony at the start of the year caused nearly 6,000 deaths, with a Covid-19 death rate of 37.7 per million population in the first three months of 2022, among the highest anywhere.
The vaccination rate among the elderly in Hong Kong at the time was worse than in mainland China, where currently more than 20% of people over 80 are completely unvaccinated and only 40% have had the three shots deemed necessary for robust protection.
But Hong Kong’s hospitals were better equipped to handle serious cases. The mainland had 3.6 critical-care beds per 100,000 people compared with 7.1 in Hong Kong in 2020, according to a study published in the journal Critical Care Medicine.
Using Hong Kong as a proxy, London-based health analytics firm Airfinity estimated in late November that a lifting of zero-Covid measures in China could lead to anywhere between 1.3 million and 2.1 million deaths.
Overwhelmed hospitals and unacceptably high numbers of deaths in the coming weeks could cause further distrust and anger in the population, which in turn could spur local governments to hide or underreport Covid deaths, said Donald Low, a public policy expert with the Hong Kong University of Science and Technology.
Researchers disagreed over the threat posed to the rest of the world by a large wave of new infections in China. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said a surge in cases could have significant ramifications beyond China’s borders by giving the virus new opportunities to mutate.
“It could tip the balance globally with large numbers of cases and new variants,” said Dr. Osterholm. “If we’ve learned nothing else about Covid, we know these new variants are 210-mile an hour curveballs that keep coming at us.”
Others say the virus has little incentive to evolve to evade immunity because most of the population hasn’t been exposed to the most recent variant of the virus.
The National Health Commission asked local health officials across the country to form a first line of defense against the disease, speed up the expansion of intensive-care capacity and closely monitor the health conditions of vulnerable groups, including pregnant women and the elderly, according to guidelines it released to medical workers late Wednesday.
The commission gave local health officials until Dec. 20 to equip hospitals to handle a wave of patients.
Moving forward, China needs to try to establish a medical triage protocol, so that advanced medical resources are available for high-risk patients, said Yale University’s Mr. Chen.
On Thursday, Zhang Wenhong, one of China’s top infectious disease experts, told Chinese state media that 99.5% of all positive cases didn’t have to seek treatment in hospitals and should consult a medical professional in their residential compound, via phone or video instead. The story garnered 520 million views on Weibo within six hours.
Given a lack of natural immunity and low vaccination rates among the elderly, health officials last week refreshed the push for vaccinations—especially among the older population—and shortened the minimum interval between initial shots and boosters to three months from six for the elderly.
A hospital designated for Covid treatment in Hangzhou said it has stocked up three months of reserves of medicine to treat severe cases. “Medical workers have rich experience following three years of experience of battling Covid,” said Huang Jinsong, deputy Commuminist Party chief of the Xixi Hospital of Hangzhou. “We have confidence and must succeed in coping with [the wave].”
Some experts said the worst scenarios may not come to pass, as some pandemic control measures will stay in place. Even if China completely abandons its zero-Covid policy, many people who are accustomed to daily prevention measures, such as wearing masks, will continue to do so, potentially reducing the infections, said Yi Fuxian, a scientist at the University of Wisconsin-Madison.
Despite the reassurances from officials, many Chinese still have mixed feelings. Hongshen Zhu, who studies China’s Covid-19 policies at the University of Pennsylvania, said China’s Covid controls had largely benefited places that were less connected with the outside world and well-equipped.
“Reopening is the reverse: the outbreak risk will spread from large cities to other places, and the worst hit places will be those that have fewer medical resources and are less affluent,” he said.
Mr. Zhu said his 71-year-old grandmother, who lives in a county-level city in the central Chinese province of Anhui and had only undergone two PCR-tests in the past three years, still believed the virus to be deadly and was opposed to the recent relaxations.
But no matter whether one opposes or supports a loosening of controls, they will need to deal with the “hard cold reality” of China opening up, he said.