‘We are not ready’: Covid ‘exit wave’ threat hampers China’s reopening efforts

China’s doctors have a blunt message for Xi Jinping: The country’s healthcare system is unprepared to deal with a huge nationwide coronavirus outbreak that will inevitably follow an easing of strict Covid-19 containment measures.

The warning for China’s leaders was issued by a dozen health professionals – including frontline doctors and nurses and local government health officials – who were interviewed this month by the Financial Times and echoed by international experts.

“The medical system will likely be paralyzed when faced with mass cases,” said a doctor at a public hospital in Wuhan, central China, where the pandemic began almost three years ago.

The warning also serves as a reality check for many in China and around the world who hope Xi will end his signature zero-Covid policy. Experts said the policy means China has failed to prioritize building robust defenses for a mass outbreak, instead focusing its resources on containment.

At the heart of the problem Beijing has created for itself is what many see as an inevitable “exit wave,” a rapid rise in infections as the country lifts its tough pandemic restrictions.

That wave threatens to overwhelm the country’s health services unless Xi and his top lieutenants make radical changes to the zero-Covid policy in preparation.

“The big threat in an exit wave is just the sheer number of cases in a short period of time,” said Ben Cowling, a professor of epidemiology at the University of Hong Kong. “I would hate to say that there is a scenario where a wave of exits doesn’t cause problems for the healthcare system. It’s hard to imagine.”

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China’s official case numbers are at their highest in six months, including a record number of infections in the capital Beijing and the southern manufacturing hub Guangzhou.

The zero-Covid strategy includes lockdowns – of buildings, suburbs or entire cities – as well as mass testing, quarantines and electronic contact tracing. Policies, while successful in suppressing outbreaks, have exacerbated problems in China’s healthcare system, leaving a large segment of the population in great fear of the virus.

China’s elderly have resisted taking a vaccine to prevent it. Only 40 percent of those over 80 have received three shots of a domestically made vaccine, the dose needed to achieve a high level of protection against the Omicron variant.

Jin Dong-yan, a virologist at the University of Hong Kong, said that in a mass outbreak, Chinese hospitals could be overwhelmed by an influx of unvaccinated elderly patients, echoing a crisis in Hong Kong this year when hospitals and morgues ran out of space the peak of an outbreak.

“A Hong Kong-style outbreak is preventable if they increase vaccination coverage for the elderly and stockpile antiviral drugs, both things Hong Kong wasn’t doing before the outbreak,” he said.

Still, some stock market analysts and traders have reacted enthusiastically in recent weeks to perceived signs that Beijing is moving towards a “reopening plan” — a change of course they hope will reignite confidence in the world’s largest consumer market and the Disruption is alleviated by sporadically disrupted global supply chains. Optimism mounted last week after Beijing eased quarantine requirements for close contacts and international travelers.

A Chinese woman receiving a Covid vaccine
Only 40% of Chinese over 80 have received three shots of a domestically made vaccine © AFP/Getty Images

After nearly three years of the pandemic, China’s healthcare system is far tighter than when it started, according to frontline workers. Scarce funding, human and medical resources have been diverted to fighting the pandemic rather than preparing to treat the most vulnerable.

“In recent years, the Chinese health system has completely limped and has poured all its manpower, funding and support into the prevention and control of Covid,” said a health official in south China’s Guangdong province. “It’s not sustainable.”

Those concerns, the official said, have been relayed to Beijing.

“Unfortunately, the central government still hasn’t made any major adjustments in the general direction,” the official added.

A nurse in a remote town in Guangxi’s southern region said smaller hospitals “don’t have the manpower or equipment” to handle a large influx of patients.

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Local lockdowns have also left frontline workers stranded, with other workers working extra shifts to compensate for their stranded colleagues. A thick layer of bureaucracy focused on the coronavirus has also slowed everything down in an already sluggish system.

“Most of the local officials and healthcare workers are very often at the mercy of rigid administrative regulations, leading to the tragedy that patients cannot get timely medical help,” said another doctor in Wuhan.

During a lockdown in Shanghai in April, frontline medical workers struggled to cope with the increased workload after many workers were diverted to conduct citywide testing.

“The medical system is not ready for a large-scale reopening,” said another doctor who works at a county-level hospital in northern China’s Inner Mongolia.

A man is tested for the corona virus
Costly mass testing for coronavirus continues across China as part of its zero-Covid policy © Aly Song/Reuters

In preparation for major outbreaks, China has ordered local governments to undertake a huge construction effort to build field hospitals to isolate and treat mild and asymptomatic Covid cases since early 2020. It has also called for isolation facilities to accommodate both close contacts and positive cases.

Karen Grépin, a health systems expert at the University of Hong Kong, said that despite the hospital construction program, human resources “would be just as big, if not a bigger problem”.

“In the past they could move them around the country – one province helping the other – but that won’t be the scenario if Covid takes off everywhere at once,” she said.

“And it’s difficult to treat Covid patients when you’re also sick,” she added, noting that the city has relied on additional health workers from mainland China during Hong Kong’s deadly outbreak this year.

Experts said the Xi government must rely on prolonged enforcement of social distancing, including school closures and work-from-home measures, to slow the return to pre-pandemic normalcy.

China would also have to reserve hospitals and isolation facilities for severe cases only, and follow the rest of the world in allowing asymptomatic and mild cases to isolate at home to significantly ease the strain on its healthcare system.

Unless pressure on hospitals is eased and the availability of care services reduced, Hong Kong’s experience shows death rates from Covid will be much higher, Cowling warned.

“If we look at the data on the risk of death for people infected in Hong Kong in March compared to February, their risk of death was about double in March,” he said as health facilities there were overwhelmed.

Additional reporting by Wang Xueqiao and Thomas Hale in Shanghai

https://www.ft.com/content/392a603d-5f6f-4270-bec2-41e5da69cc67 ‘We are not ready’: Covid ‘exit wave’ threat hampers China’s reopening efforts

Adam Bradshaw

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