Until recently, China, the most populous country in the world, was also the last country to resist Covid. But in a few weeks it will be hit by a wave that a senior health official says could infect several hundred million people.
This week, Beijing took its biggest step toward living with Covid, all but abandoning an unpopular and costly “zero Covid” policy of mass lockdowns and quarantines that it hoped would wipe out infections. The abrupt pivot raised the specter of huge strain on a health care system that is overstretched even in normal times. It could get worse in a month, when people travel across the country to see family during the Lunar New Year holidays.
Feng Zijian, an adviser to China’s Covid task force, said this week the outbreak could infect 60% of the country’s 1.4 billion people, or more than 840 million people. For most Chinese, this will be their first encounter with Covid.
Like many countries, China is now dealing with Omicron variants that are highly contagious, but have so far been milder than previous iterations. Unlike the rest of the world, China has had almost three years to prepare for this surge. But he spent most of that time focusing on lockdowns rather than vaccinations and preparing people to live with Covid, a prospect many experts had warned would be inevitable.
“A tsunami of cases is coming whether they stick to zero Covid or not,” said Jin Dong-Yan, a virologist at the University of Hong Kong.
The question is how many cases will become serious and require more serious medical attention. Even the current image is unclear. According to official data released by the National Health Commission, there were 159 severe Covid cases nationwide as of Friday, an increase of around 60 since the start of the month.
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“This number is still very low because in reality there should be many more confirmed cases that are underreported now,” Jin said. Another difficulty: the definition of a “serious” case can vary from one city to another, he added.
What is clear is that the government is preparing for the wave to be big. On Friday, the authorities announced their intention to double the capacity of intensive care beds and to increase the number of doctors and nurses in these departments. Also in the works: upgrading the temporary facilities previously built to quarantine people considered close contacts, turning them into secondary hospitals. Officials further said community-level workers would categorize residents by level of risk – assigning color codes indicating risk based on vaccination status, age and other health conditions, a change per compared to surveillance that had tracked residents based on contact and infection tracing.
China wants to ration hospital beds for the worst cases, but authorities now have to convince the majority of those infected to stay home, despite having been told for years to fear Covid. A triage system has been put in place to direct Covid patients to community health centers, but most people are not used to seeing a doctor outside of hospital. The government relies on an army of volunteers to answer phone calls and deliver cold medicine and Covid test kits to the sick at home, but there are already 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 some level of shock as people unaccustomed to the virus flooded hospitals for help. But in places like Singapore and New Zealand, this change was more controlled. Authorities only removed restrictions after telling the public what to expect and when, giving hospital systems more time to prepare for the impending outbreak and citizens more time to get vaccinated.
“Singapore has taken a cautious approach with a gradual opening up,” said Paul Anantharajah Tambyah, a medical practitioner specializing in infectious diseases and president of the Asia Pacific Society for Clinical Microbiology and Infection. Mild and moderate cases were treated outside the hospital system, he added. “It helped communications a lot and was easier for the general population to accept than a drastic shift to a ‘business as usual’ approach.”
China is only now trying to step up a vaccination drive that had mostly stalled in the spring as resources were diverted to building and enforcing a national mass testing system. More than 600 million vaccinated people have yet to receive a booster shot, a necessary prerequisite to prevent severe cases among those who received China’s vaccines, which have been shown to be weaker, according to the World Health Organization. Among people age 80 and older, only 40% received reminders.
After the easing was announced on Wednesday, officials rushed to write new guidelines on everything from home isolation to rapid antigen testing and freeing up resources for a deluge of cases to come.
Dale Fisher, professor of medicine and head of the National Infection Prevention and Control Committee at Singapore’s Ministry of Health, said Chinese health officials should ensure that additional hospital beds are ready, ventilators on hand and redeployed medical personnel.
China has moved quickly in recent days to achieve this, more than doubling its critical care bed capacity to 10 beds per 100,000 people, from less than four just a month ago.
The National Health Commission also announced on Friday that it would redirect 106,000 doctors and 177,700 nurses to intensive care units. According to the most recent official figures reported in 2020, China has three registered nurses per 1,000 people and two practicing physicians per 1,000 people.
Some of the changes have caused confusion as authorities react quickly in response to the new measures. In cities like Beijing and Shanghai, authorities removed many testing booths almost as soon as Wednesday’s new guidelines called for limiting testing requirements. But on 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 result negative test is always required.
As cases surge in Beijing, many people are queuing up at hospitals and stocking up on fever medicine and home testing kits. Some townspeople have reported that hospitals are turning away people with symptoms, telling them their cases must first be reported by local authorities in the neighborhood.
Beijing resident Wakeman Wang said he had hoped to take his 7-year-old son to see a doctor after briefly choking on a fishbone earlier this week. But the boy had tested positive for Covid. Mr Wang’s local neighborhood worker – responsible for overseeing pandemic policies at the community level – told him that health workers were unable to arrange a closed-loop transfer to a hospital. and suggested that Mr. Wang either take the child to the hospital by himself or call family doctors.
Mr. Wang said his wife had tried calling several local family doctors who were quickly rounded up to help with medical issues in the community, but none of the numbers she tried had worked.
“I felt hopeless and guilty,” he said. “When my child was in danger, I couldn’t solve the problem and I couldn’t keep him safe.”
Scarlet Zhang, a resident of Fengtai, a district in the southwest of the city, said she tried to get to the hospital after testing positive with a fever of 100 degrees Fahrenheit.
She says she tried several times to call an ambulance, but the municipal emergency number, comparable to 911 in the United States, was always busy. A pharmacy near her home had run out of fever medication, she said.
“It’s my third day of fever, I can’t get professional advice and I don’t know what to do now,” she said.
Due to the previous hard line on the severity of the virus, Chinese authorities now face a big challenge in allaying public fears, Fisher said.
“The message to the public is really tricky when you’ve been saying for two to three years that it’s deadly, and now you’re saying, ‘If you get it, stay home and self-isolate,'” he said. added.