Editor’s note: Editor’s note: A version of this story appeared in CNN’s news bulletin Meanwhile in China, a tri-weekly update exploring what you need to know about the country’s rise and its impact. on the world. Register here.
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China’s zero Covid policy, which has shut down the world’s second-largest economy and triggered a wave of protestsappears to be collapsing as city after city eases some of the draconian measures that ultimately failed to bring the virus under control.
But like some of the harsh controls that have dictated – and heavily restricted – everyday life for nearly three years start to get up piecemeal across the country, another reality is also clear: China is completely unprepared for the surge in cases it is likely to see now.
However, experts say much is still unknown about how the coming weeks and months will unfold, China lacked preparations such as boosting the vaccination rate of the elderly, increasing surge and intensive care capacity in hospitals, and stockpiling antiviral drugs.
While the Omicron variant is milder than previous strains and China’s overall vaccination uptake is high, even a small number of severe cases among vulnerable and under-vaccinated groups like the elderly could overwhelm hospitals if infections are rising by 1.4 billion across the country, experts say.
“It’s a looming crisis – the timing is really bad… China now has to relax a lot of its measures over the winter (overlapping with the flu season), so it wasn’t as planned” , said Xi Chen, an associate professor at Yale. School of Public Health in the United States, pointing to what was likely an acceleration of the transition in China, triggered by public discontent.
The extent of this potential crisis will depend on how quickly China eases its restrictions – and how quickly it prepares to prepare its healthcare system for a surge in cases after long focusing its efforts on maintaining its zero-Covid policy.
So far, local governments are leading changing, for example, lifting requirements for people to test for Covid-19 before taking public transport or entering certain public places. Some have also made changes to quarantine policies, according to state media, allowing some Covid-19 patients or close contacts to self-quarantine at home – a drastic change from the previously enforced central quarantine. .
Across the country, however, parts of residential communities and buildings designated high-risk by authorities are still locked down. And while senior Chinese health officials have reported that the country has has entered a “new stage” in its virus control, Beijing has yet to issue updated guidelines, creating more confusion.
“China has pursued this policy for so long that it is now between a rock and a hard place,” said William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center in the United States. “They don’t have good options either way anymore. They had really hoped that this epidemic would run its course globally and that they could survive without impact. And that didn’t happen.
As restrictions are eased and the virus spreads across the country, China “is going to have to go through a period of pain in terms of illness, serious illness, death and stress on the health system” as it is said. seen elsewhere in the world earlier in the pandemic, he added.
Since the global vaccination campaign and the emergence of the Omicron variant, health experts have questioned the membership in zero-Covid and underlined the strategy unsustainabilitywho attempted to use mass testing and surveillance, lockdowns and quarantines to stop a highly contagious virus.
But while some restrictions are being lifted, in what appears to be a haphazard transition after years of focusing on meticulous virus control, experts say changes could come before China has made the preparations its officials to health recognized as necessary.
“An uncontrolled epidemic (which only peaks when the virus begins to run out of people to infect) … will pose serious challenges to the health system, not only in terms of managing the small fraction of Covid cases that are serious, but also in the ‘collateral damage’ to people with other health conditions who delayed care as a result,” said Ben Cowling, professor of epidemiology at the University of Hong Kong.
But even with an easing of restrictions, Cowling said, it was “difficult to predict” how quickly infections would spread across China, as many measures are still in place and some people will change their behavior – like staying more often at home.
“And I wouldn’t rule out the possibility of tougher measures being reintroduced to tackle the rise in cases,” he said, adding that the piecemeal easing of restrictions in different cities could help prevent an increase in cases nationwide.
Experts agree that allowing the virus to spread nationwide would be a significant change for a country that has so far officially reported 5,235 Covid-19 deaths since the start of 2020 – a relatively low figure by comparison. global scale that has been a point of pride in China, where until recently state media trumpeted the dangers of the virus to the public.
Modeling by researchers from Fudan University in Shanghai published in the journal Nature Medicine in May predicted that more than 1.5 million Chinese could die within six months if Covid-19 restrictions were lifted and there was no access to antiviral drugs, which have been approved in China.
However, death rates could drop to about seasonal flu levels if almost all older people were vaccinated and antiviral drugs were widely used, the authors said.
Last month, China released a list of measures to strengthen health systems against Covid-19, which included guidelines to increase vaccination of the elderly, stockpile antiviral treatments and medical equipment and expand intensive care capacity. — efforts that experts say take time and are best done before an outbreak.
“(Is China ready?) If you look at surge capacity three years later and the stockpiling of effective antivirals – no. If you talk about the triage procedures – they are not strictly enforced – and if you talk about the vaccination rate of the elderly, especially those aged 80 and over, it is also broadly no,” Yanzhong Huang said. , senior researcher for global health. at the Council on Foreign Relations in New York.
Chinese authorities, he added, would likely weigh findings such as the death rate closely to decide what policy action to take in the future.
The United States has at least 25 intensive care beds per 100,000 people, according the Organization for Economic Co-operation and Development – in contrast, China has less than four for the same number, health authorities said last month.
The system also provides limited primary care, which could drive even moderately ill people to the hospital instead of calling a family doctor — putting more strain on hospitals, according to Yale’s Chen.
Meanwhile, weak medical infrastructure in rural areas could foster crises there, especially as testing is reduced and young people living in cities return to rural hometowns to visit older members. family over the Lunar New Year next month, he said.
While China’s overall vaccination rate is high, its elderly are also less protected than in some other parts of the world, where those oldest and most vulnerable to dying from Covid-19 have been prioritized for vaccination. . Some countries have already deployed fourth or fifth doses for at-risk groups.
According to Chinese accounting, more than 86% of China’s population over 60 is fully immunized, according to China’s National Health Commission, and recall rates are lower, with more than 45 million elderly people fully immunized. who have not yet received an additional vaccine. About 25 million older people who have not received any injections, according to a comparison of official population figures and vaccination data from November 28.
For the most-at-risk age group over 80, about two-thirds were fully vaccinated by Chinese standards, but only 40% had received boosters by Nov. 11, according to state media.
But as China refers to third doses for its widely used inactivated vaccines as booster shots, a World Health Organization vaccine advisory group last year recommended that older people taking these vaccines receive three doses in their initial treatment to provide sufficient protection.
The inactivated vaccines used in China have been found to elicit lower levels of antibody response compared to others used overseas, and many countries using the doses have combined them with more protective mRNA vaccines, including China has not approved the use.
Cowling said evidence from the Hong Kong outbreak, however, showed that China’s inactivated vaccines worked well to prevent serious illness, but it was essential that older people receive three doses during initial treatment, as recommended. the World Health Organization. They should then use an additional fourth dose to maintain high immunity, he added.
On Nov. 28, top health officials announced a new plan to bolster vaccination rates for the elderly, but such moves will take time, as will other preparations for a surge.
According to Cowling, minimizing the worst outcomes during a transition out of Covid zero depends on this preparation. From that perspective, he said, “it doesn’t seem like the right time to relax policies.”