Millions of lives are at stake as the country prepares to relax its Covid strategy.
China is in the midst of its largest Covid-19 wave yet after three years of a strict zero-Covid policy. But rather than impose another round of lockdowns, the national government is reportedly considering easing the Covid mitigation measures that have governed its people’s lives since January 2020.
It is an abrupt pivot for President Xi Jinping, who has prided himself on controlling the novel coronavirus’s spread compared to the United States and other Western countries. Though Xi himself hasn’t commented on the policy changes, it’s possible that he and the rest of China’s leadership may have felt they had little choice in the face of widespread protests opposing the zero-Covid rules.
But reopening the country does not mean the risk has passed. Experts anticipate an enormous so-called “exit” wave if China permits people to continue going about their lives even as Covid-19 is spreading in the community, rather than lock down entire blocks or even neighborhoods as in the past. While there is much uncertainty about how such a scenario would play out, one projection of what would happen if the strict zero-Covid rules are lifted anticipated as many as 279 million cases and 2.1 million deaths in just three months, the dead being mostly older unvaccinated adults.
The Chinese population is more vulnerable than places where the virus has spread widely for the past few years. Though vaccination rates are pretty high, around 90 percent, the vaccines China deployed are not as effective as those used in the US and Europe. And a much smaller proportion of the population has been infected by the virus, which does confer another layer of protection for people. The virus should find it easier to move from person to person.
For most people, Covid-19 will look like it has for their peers, in terms of age and health, across the rest of the world. But China has one additional vulnerability: the elderly, among whom vaccine uptake for critical booster doses has been particularly low. In most countries, vaccination rates have been lower among younger age groups. In China, the opposite has happened — and it could make the country’s exit wave out of zero Covid more dangerous and deadly.
A fair number of those elderly people with no Covid-19 immunity would end up in the hospital if the virus spreads widely. Experts fear those hospitals wouldn’t be able to handle the surge in patients while also caring for the rest of their patients who need hospital-level care. China has invested substantially in the physical infrastructure of its health system, but its workforce is still catching up. As in the US, staff shortages as much as a lack of beds or equipment could lead to the kind of crisis triaging that leads to deaths. It already happened in Wuhan’s 2020 wave.
“It’s very easy to strain resources and crash the health system,” Xi Chen, a health economist at the Yale School of Public Health, told me. “Reopening will generate a lot of stress.”
China’s zero-Covid policy up till now has arguably been a success, with one major asterisk. Outside of Wuhan, further outbreaks had been minimal until spring waves this year in Shanghai and Hong Kong that were at that point the largest of the pandemic. Jennifer Bouey, an epidemiologist who leads China studies for the Rand Corporation, told me that, aside from the large exception of the initial cover-up of Covid-19’s existence, she didn’t think China had necessarily had a bad pandemic response.
But Covid-19, especially in its evolved form, is so highly contagious that zero Covid was never going to last forever. Hundreds of millions of people are facing for the first time the possibility of widespread Covid-19 infections in their community.
“People are worried,” Bouey, who communicates with friends and relatives in China regularly over WeChat, said. They’ve asked her if they are going to experience a big wave.
“I said yes. Every country had to go through that.”A lot of people in China could get sick with Covid-19
To date, China has reported less than 4 million Covid-19 cases and about 16,000 people have died. (Bouey said these days she tends to trust the numbers from China, subject of dispute early in the pandemic.) The US has recorded almost 99 million cases and is now approaching 1,090,000 deaths.
Even accounting for some asymptomatic cases and other undercounting, with more than 1.4 billion people, China is home to hundreds of millions of people who have not yet been exposed to the novel coronavirus.
Most of those people have been vaccinated, about 90 percent according to the official data. But there are two reasons that isn’t necessarily as much protection as it may sound like.
First, China developed its own vaccines, which rely on dead virus rather than the mRNA technology mostly used in the US and Europe.
