Until recently, China, the world’s most populous nation, was also the world’s last Covid holdout. But in a matter of 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 toward living with Covid, all but abandoning an unpopular and costly “zero Covid” policy of lockdowns and mass quarantines it had hoped would eliminate infections. The abrupt pivot has raised the specter of tremendous strain on a health care system that is overstretched even in normal times. That could get worse in a month, when people travel across the country to see their families during the Lunar New Year holiday.
Feng Zijian, an adviser on China’s Covid task force, said this week that the surge could infect 60 percent of the country’s 1.4 billion population — or more than 840 million people. For most Chinese, it will be their first encounter with Covid.
Like many countries, China is now facing Omicron variants that are highly infectious, but have so far been milder than earlier iterations. Unlike the rest of the world, China had nearly three years to prepare for this surge. But it spent most of that time focusing on lockdowns instead of on vaccinations and preparing the population for living with Covid, a prospect that many experts had warned would be inevitable.
“A tsunami of cases is coming no matter if they stick to zero Covid or not,” said Jin Dong-Yan, a virologist at Hong Kong University.
The question is how many cases will become severe 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 severe cases of Covid nationwide by Friday, an increase of about 60 from the start 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 going underreported now,” Mr. Jin said. Another difficulty: the definition of a “severe” case can vary from one city to another, he added.
What is clear is that the government is bracing for the wave to be big. Officials on Friday announced plans to double the capacity of critical care beds and to increase the number of doctors and nurses staffing such wards. Also in the works: to upgrade temporary facilities previously built to quarantine people deemed close contacts, turning them into secondary hospitals. Officials additionally said that workers at the community level would classify residents by risk level — assigning color codes denoting risk based on vaccination status, age, and other health conditions, a shift away from surveillance that had tracked residents based on contact tracing and infections.
China wants to ration hospital beds for the most severe cases, but officials now need to convince the majority of infected people to stay home, despite having told them for years to fear Covid. A triage system has been set up to funnel Covid patients to community health centers, but most people are unaccustomed to seeing a doctor outside the hospital. The government is relying on an army of volunteers to field phone calls and deliver cold medicine and Covid test kits to the sick at home, but there are already early signs of understaffing and of shortages of the necessary supplies.
To some extent, the complications China is facing as it opens up are not unique. Other countries that have shifted from strict pandemic controls to adapting to the virus have experienced some level of shock as people unused to the virus flooded hospitals for help. But in places like Singapore and New Zealand, that change was more controlled. Officials removed restrictions only after telling the public what to expect and when, allowing hospital systems more time to prepare for the oncoming surge, and citizens more time to get vaccinated.
“Singapore adopted a cautious approach with a gradual opening up,” said Paul Anantharajah Tambyah, a practicing infectious diseases doctor and president of the Asia Pacific Society of Clinical Microbiology and Infection. Mild and moderate cases were treated outside of the hospital system, he added. “That helped communications a lot and was easier for the general population to accept than a dramatic shift towards a ‘business as usual’ approach.”
China is only now trying to step up a vaccination campaign 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 not yet received a booster shot, a necessary prerequisite to prevent serious cases among those given the Chinese vaccines, which have been proven to be weaker, according to the World Health Organization. Among those 80 and older, only 40 percent have had booster vaccinations.
After the loosening was announced on Wednesday, officials hastened 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 National Infection Prevention and Control Committee of Singapore’s Health Ministry, said that Chinese health officials would need to ensure that extra hospital beds were ready, ventilators on hand and medical staff redeployed.
China has moved quickly in recent days to do this, more than doubling its intensive care bed capacity to 10 beds per 100,000 people, up from less than four just a month ago.
The National Health Commission on Friday also said 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 for every 1,000 people and two practicing physicians for every 1,000 people.
Some of the changes have created confusion as authorities act quickly in response to new measures. In cities like Beijing and Shanghai, the authorities removed many testing booths almost as soon as the new guidelines on Wednesday called for testing requirements to be limited. But by Friday, the National Health Commission said that testing sites should not be arbitrarily removed, and that they should be made available for those who need to enter nursing homes and medical facilities, where a negative test result is still required.
As cases mount in Beijing, many people have been lining up at hospitals and laying in supplies of fever-reducing medication and home test kits. Some city residents reported that hospitals were turning away people with symptoms, telling them that their cases must first be reported by local neighborhood officials.
Wakeman Wang, a resident in Beijing, said he had hoped to take his 7-year-old son to see a doctor after he had briefly choked on a fish bone earlier this week. But the boy had tested positive for Covid. Mr. Wang’s local neighborhood worker — tasked with overseeing pandemic policies at the community level — told him 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 tried calling several local family doctors who had been quickly assembled to help sort out community medical issues, 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 ensure his safety.”
Scarlet Zhang, a resident in 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 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 was out of fever medication, she said.
“It is my third day having a fever, I cannot get advice from a professional, and I don’t know what to do now,” she said.
Because of the hard line previously taken on the severity of the virus, Chinese officials now face a big challenge to assuage the public’s fears, Mr. Fisher said.
“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 are saying, ‘If you get it, just stay home and isolate yourself,’” he added.
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