‘We’re not ready’: Threat of Covid exit wave hampers China’s reopening

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

The warning for the Chinese leader was voiced by a dozen health workers – including primary care doctors and nurses and local government health officials – who were interviewed by the Financial Times this month and echoed by international experts.

“The medical system is likely to become paralyzed when faced with mass falls,” said a doctor at a public hospital in Wuhan, central China, where the pandemic began nearly three years ago.

The warning also serves as a reality check for many in China and around the world, hoping Xi will end his trademark zero-Covid policy. Experts said the policy meant China had failed to prioritize building robust defenses for a massive 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 wave of infections as the country lifts its heavy-handed 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 simply 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 dare not say that there is a scenario in which an exit wave does not cause problems for the healthcare sector. That is hard to imagine.”

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The official number of cases in China is the highest in six months, including a record number of infections in the capital Beijing and the southern manufacturing center of Guangzhou.

The zero-Covid strategy includes lockdowns of buildings, suburbs or entire cities, as well as mass testing, quarantines and electronic contact tracing. While the policy has been successful in suppressing outbreaks, it has exacerbated problems in China’s healthcare system and left much of the population deeply afraid of the virus.

The elderly in China have resisted taking a vaccine to prevent it. Only 40 percent of people over 80 have had three injections of a domestically-made vaccine, the dosage needed to get high levels of protection against the Omicron variant.

Jin Dong-yan, a virologist at the University of Hong Kong, said Chinese hospitals could be overwhelmed by an influx of unvaccinated elderly patients if a massive outbreak were to occur. at the height of an outbreak.

“A Hong Kong-style outbreak is preventable if they increase vaccination coverage for the elderly and stockpile antivirals, both of which Hong Kong failed to do during the outbreak,” he said.

Still, some stock market analysts and traders have reacted with enthusiasm in recent weeks to perceived signs that Beijing was turning to a “reopen plan” – a course change that they hope will restore confidence in the world’s largest consumer market and ease the disruptions that have taken place. Reduce. sporadic coiled global supply chains. Optimism increased 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 had three injections of a domestically-made vaccine © AFP/Getty Images

Nearly three years into the pandemic, China’s health care system is under much more strain than it was at the beginning, according to frontline staff. Scarce funding, personnel and medical resources have been diverted to pandemic controls rather than preparations to treat the most vulnerable.

“In recent years, China’s health care system has completely floundered, pouring all its manpower, funding and support into the prevention and control of Covid,” said a health official in southern China’s Guangdong province. “This is unsustainable.”

These concerns, the official said, have been passed on to Beijing.

“Unfortunately, the central government has still not made any substantial 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 the equipment” to handle a large influx of patients.

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Local lockdowns have also left front-line staff stranded, with other workers working extra shifts to catch up with their stranded colleagues. A thick layer of coronavirus-focused bureaucracy has also slowed everything down in an already cumbersome system.

“Most local officials and health workers are very often at the mercy of rigid administrative orders, making the tragedy of patients not being able to get medical help on time happen again and again,” said another doctor in Wuhan.

During a lockdown in Shanghai in April, front-line medical staff struggled to cope with the increased workload after many staff were diverted to conduct tests across the city.

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

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

In preparation for larger outbreaks, China has ordered local governments to undertake a massive construction drive since early 2020 to build field hospitals to isolate and treat mild and asymptomatic Covid cases. It has also called for isolation facilities to house close contacts as well as positive cases.

Guo Yanhong, a senior official with China’s National Health Commission, told reporters in Beijing on Thursday that more large venues, including stadiums and exhibition centers, will be converted into makeshift hospitals to house asymptomatic patients and those with mild symptoms. Hours later, officials in Guangzhou announced plans to expand capacity in makeshift hospitals and other centralized quarantine facilities from 70,000 beds to nearly 250,000.

Karen Grépin, a health systems expert at the University of Hong Kong, said that despite the hospital construction program, human resources would become “equally important, if not more important, an issue”.

“In the past they have been able to move them around the country – one province helping another – but this will not be the scenario if Covid takes off everywhere at once,” she said.

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

Experts said Xi’s government should rely on long-term enforcement of social distancing, including school closures and work-from-home measures, delaying a return to pre-pandemic normality.

China should also reserve hospital and isolation facilities only for severe cases and follow the rest of the world in allowing asymptomatic and mild cases to be isolated at home, to significantly ease the strain on its healthcare system.

If pressure on hospitals is not relieved and less care is available, Hong Kong’s experience shows that death rates from Covid will be much higher, Cowling warned.

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

Additional reporting by Wang Xueqiao and Thomas Hale in Shanghai and Gloria Li in Hong Kong

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