Aalmost after After three years of self-isolation, China is opening up again. Domestic travel restrictions, mass testing requirements and a strict “zero COVID” policy lockdown were lifted in early December. On January 8, China will also reopen its borders. People arriving from abroad will no longer need to quarantine. More flights will be allowed into China. Visas will be granted to business travelers and students (but not yet to tourists). Chinese nationals will be allowed to travel abroad without providing a reason to authorities.
But to get an idea of how much COVID-19 has changed in China, look to Japan and India. They now require Chinese tourists entering the country to be tested for the new coronavirus first. In the space of a few months, China has gone from a country with very few infections to what may be the world’s largest covid hotspot.
It is difficult to estimate how many Chinese people have been infected so far. The central government may be modeling the outbreak, but the data it releases to the public is useless. It reports only a few thousand new cases a day, far from the real numbers. Some regional governments provided more reasonable estimates. Officials in Zhejiang, a wealthy eastern province of about 65 million people, said on Dec. 25 that they were seeing 1 million new infections a day. They expect that number to double by the new year or so.
Most of China’s population has never been exposed to the new coronavirus, and many elderly people are not vaccinated. So while the Omicron variant of the virus causes relatively mild symptoms in most people, a large number of Chinese are prone to severe illness. The country’s weak healthcare system is already under enormous strain. In a hospital in Beijing, your reporter saw elderly patients lying on gurneys breathing oxygen tanks as they poured into crowded corridors and waiting rooms. Videos circulating online showed similar scenes across China. There have been reports of patients being turned away by hospitals in smaller cities due to a shortage of beds. About 10 intensive care units (ICU) of beds per 100,000 people in the country, well below the level needed. There is also a shortage of medical staff. Some regions are approaching ‘tipping points’, a health official warns ICU– Bed supply.
Drugs to treat COVID-19 are in high demand. Many pharmacies are sold out of fever reducers and pain relievers. Paxlovid, an antiviral drug that helps prevent serious illness, is especially sought after. Drug prices soared; many hospitals reportedly lacked it. Some seek unauthorized versions of Paxlovid sent from abroad. Meanwhile, WeChat, the ubiquitous messaging app, has rolled out a feature that tries to connect people who need fever-reducing medicine and other supplies with those who have them.
Only 13 people have died from COVID-19 so far in December, according to the government. Actual losses are no doubt much higher. China counts as COVID-19 deaths only those who die from respiratory failure or pneumonia. But the virus usually causes death by damaging other organs. (The UK, for example, counts anyone who died after recently testing positive for the virus as a COVID-19 death.) Crematoria in China are busy. Police are already stationed in a Beijing area that attracts journalists. Earlier this month, London-based data firm Airfinity estimated that more than 5,000 people in China could be dying from COVID-19 every day. Our model predicts that, in a worst-case scenario, 1.5 million Chinese will die from the virus in the coming months.
In China, as elsewhere, vaccination is the best tool for reducing mortality. Three doses of the Chinese vaccine provide reasonable protection against severe disease and death. But as of late November, only 40% of those over 80 had received three shots. Some people have been vaccinated so long ago that the effectiveness of the vaccine will wear off over time. As cases surged in early December, China ramped up its response. On December 21, the average dose of vaccinations increased from less than 1 million per day to more than 3 million. But since then, the campaign appears to have slowed down again. More effective foreign vaccines are still banned.
China could have done more to prepare for this moment, by stockpiling medicines, vaccinating with more urgency and developing treatment guidelines. Now, officials are trying to turn the tide. They renamed the disease caused by the virus from “new coronavirus pneumonia” to the milder-sounding “new coronavirus infection.” At a news conference on Dec. 27, Li Bin, the National Health Commission, said China was “fighting a prepared battle. We are definitely not passively letting go.”
But the actions of China’s top leader, Xi Jinping, show just how bad things are going. When the virus was brought under control, Xi was hailed as the “commander-in-chief” of the “people’s war” on COVID-19. He often talks about the need to stick to zero covid. Still, he has largely remained silent since cases began to surge, making only indirect references to the outbreak. On December 26, he said that the country’s “epidemic prevention and control is facing new situations and new tasks.” That’s an understatement.
As the number of infections surged in early December, the streets of Beijing and other major cities were deserted. Now they are slowly filling up again. But the epidemic is far from over. Over the next few weeks, millions of people will return to their hometowns for the Lunar New Year. They can spread the virus to rural areas with dilapidated sanitation systems. Multiple waves of virus may occur. As bad as things are in China today, the real test is yet to come.■
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