AFTER NEARLY three years of self-imposed isolation, China is opening up again. The domestic travel restrictions, mass-testing requirements and draconian lockdowns of the “zero-covid” policy were scrapped in early December. On January 8th China will reopen its borders, too. People arriving from abroad will no longer have to quarantine. More flights into China will be allowed. Visas will be granted to business travellers and students (though not yet to tourists). And Chinese nationals will be allowed to travel abroad without needing to provide the authorities with a reason.
But for a sense of how much the covid situation in China has changed look at Japan and India. They are now demanding that incoming Chinese travellers take a covid test first. In the span of a couple of months, China has gone from being a country with an incredibly small number of infections to, perhaps, the world’s largest covid hotspot.
It is hard to gauge how many Chinese people have been infected so far. The central government is probably modelling the outbreak, but the data it releases to the public are useless. It had been reporting only a few thousand new cases a day, nowhere near the real number. Some regional governments have provided more plausible estimates. Officials in Zhejiang, a wealthy eastern province with a population of about 65m, said on December 25th that they were seeing 1m new infections a day. They expect that number to double by around the new year.
Most of China’s population has never been exposed to covid and many old people are undervaccinated. So while the Omicron variant of the virus will cause relatively mild symptoms in most people, a large number of Chinese are still vulnerable to severe illness. The country’s weak health-care system is already under huge pressure. At a hospital in Beijing your correspondent saw elderly patients breathing from oxygen tanks on gurneys that spilled out into packed corridors and waiting rooms. Videos circulating online show similar scenes across China. There have been reports of patients being turned away from hospitals in smaller cities owing to a lack of beds. Officials say there are around 10 intensive-care unit (ICU) beds per 100,000 people in the country, well below what is needed. Medical staff are in short supply, too. A health official has warned that some regions are approaching the “critical point” in ICU-bed supply.
Drugs used to treat covid are in high demand. Many pharmacies have run out of fever medicine and painkillers. Paxlovid, an antiviral that helps prevent severe sickness, is especially sought after. Prices of the drug have surged; many hospitals are reportedly short of it. Some have sought unauthorised versions of Paxlovid sent in from abroad. Meanwhile, WeChat, a ubiquitous messaging app, has launched a function that tries to connect individuals in need of fever drugs and other supplies with those who have them.
According to the government, only 13 people have died from covid so far in December. The real toll is undoubtedly much higher. China only counts as covid deaths those who die from respiratory failure or pneumonia. But the virus often causes death by damaging other organs. (Britain, for example, counts anyone who dies after recently testing positive for the virus as a covid death.) China’s crematoriums are busy. Police have been stationed outside one in Beijing that has attracted reporters. Earlier this month Airfinity, a London-based data firm, estimated that over 5,000 people were probably dying of covid in China every day. Our model predicts that in a worst-case scenario 1.5m Chinese people will die from the virus in the coming months.
In China, as elsewhere, vaccination is the best tool for reducing mortality. Three shots of a Chinese vaccine provide reasonable protection against severe illness and death. But, as of late November, only 40% of those aged over 80 had received three shots. Some were jabbed so long ago that the effectiveness of the vaccine will be wearing off. As cases surged in early December, China stepped up its efforts. The average number of doses administered went up from under 1m per day to over 3m on December 21st. But since then the campaign appears to have slowed again. More effective foreign vaccines are still banned.
China could have done more to prepare for this moment, by stockpiling drugs, administering vaccines with more urgency and producing treatment guidelines. Now officials are trying to spin the situation. They have renamed the disease caused by the virus from the “novel coronavirus pneumonia” to the milder sounding “novel coronavirus infection”. At a news conference on December 27th Li Bin of the National Health Commission said that China is “fighting a battle that we prepared for. We’re absolutely not just passively letting go.”
But a hint of how poorly things are going can be detected in the actions of China’s supreme leader, Xi Jinping. When the virus was under control, Mr Xi was hailed as the “commander-in-chief” of the “people’s war” on covid. He spoke often about the need to persevere with zero-covid. Since cases began to surge, though, he has remained largely quiet, making only oblique references to the outbreak. On December 26th he said the country’s “epidemic prevention and control faces new circumstances and new tasks”. That is something of an understatement.
As the number of infections shot up in early December, the streets of Beijing and other large cities emptied. Now they are slowly filling up again. But the epidemic is far from over. In the coming weeks millions of people will travel back to their home towns for the lunar new year. They will spread the virus into rural areas with threadbare health systems. There are likely to be multiple waves of the virus. As bad as things are today in China, the real test is yet to come.■
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