‘A very hard road forward’ for China as COVID-19 cases spiral

BAZHOU, China — Nearly three years after it was first recognized in China, the coronavirus is now spreading by means of the huge nation. Experts predict tough months forward for its 1.4 billion folks.

China’s unyielding “zero-COVID” method, which aimed to isolate all contaminated folks, purchased it years to arrange for the illness. But an abrupt reopening, which was introduced with out warning on Dec. 7 within the wake of anti-lockdown protests, has caught the nation under-vaccinated and brief on hospital capability.

Experts have forecast between one million and a couple of million deaths subsequent year. Predicting deaths has confirmed tough all through the pandemic, since it’s influenced by assorted components and China presents an particularly difficult case due to opaque info sharing.

It’s not clear precisely how giant the present outbreak is, as China has diminished testing and stopped reporting most gentle cases. But in cities and cities round Baoding and Langfang, in Hebei province, an space that was among the many first to face an unchecked outbreak, Associated Press reporters noticed hospital intensive care models overwhelmed by sufferers, and ambulances being turned away. Across the nation, widespread stories of absences from work, shortages of fever-reducing medication, and workers working time beyond regulation at crematoria recommend the virus is widespread.

China belongs to a small membership of nations that managed to cease most home transmission of the virus in 2020, but it surely’s the final to finish restrictions. Experiences of ending fluctuate: Singapore and New Zealand achieved excessive vaccination charges and bolstered medical methods throughout restrictions, and reopened comparatively easily. Hong Kong, the place omicron overcame defenses whereas many aged folks have been unvaccinated, suffered a disruptive COVID-19 wave in 2022. Nearly 11,000 folks died of the sickness this year within the metropolis of seven.4 million, with 95% of them older than 60, in response to Hong Kong’s division of well being. Data from town confirmed a 15% fatality rate for these older than 80 and unvaccinated, stated Jin Dong-yan, a virology skilled at Hong Kong University.



China has greater vaccination charges than Hong Kong did on the time of its omicron outbreak, however many individuals are weak to an infection, particularly the aged.

The nation has solely used domestically made vaccines, which depend on older technology than the mRNA vaccines used elsewhere which have proven one of the best safety in opposition to an infection.

A research carried out in Hong Kong, which has administered each an mRNA vaccine and Sinovac’s CoronaVac, steered that CoronaVac requires a 3rd shot to offer comparable safety, particularly for the aged. An abnormal course of the vaccine is 2 photographs, with an non-obligatory booster later.

Most folks vaccinated in China have acquired both CoronaVac or an identical vaccine produced by SinoPharm, however the nation has administered at the very least 5 different vaccines. Comparable real-world information isn’t out there for these vaccines.

While China counts 90% of its inhabitants vaccinated, solely round 60% have acquired a booster. Older persons are particularly prone to haven’t had a booster vaccine. Over 9 million folks older than 80 haven’t had the third vaccine, in response to China’s official Xinhua News Agency.

Vaccination charges have elevated over 10-fold, to over one million doses administered a day, because the begin of the month. But Dr. Gagandeep Kang, who research viruses at India’s Christian Medical College in Vellore stated prioritizing the aged could be key. Unlike different international locations, China prioritized vaccinating the extra cell younger to stop the virus from spreading, stated Ray Yip, the founding director of the U.S. CDC office in China. A marketing campaign focusing on these older than 60 began in December, however it’s unclear how profitable it has been.

They “did not pay enough attention to assure everyone gets full vaccine protection,” Yip stated. “How well do they perform this particular catch up effort might determine some of the outcome.”



Around Baoding and Langfang, hospitals have run out of intensive care beds and workers as extreme cases surge. Patients lay on the ground, whereas others drove from hospital to hospital looking out for beds for relations Wednesday.

The National Health Commission stated China had 10 intensive care beds for each 100,000 folks on Dec. 9, a complete of 138,000 beds, up from 4 for each 100,000 folks on Nov. 22. That means the reported variety of beds greater than doubled in slightly below three weeks. But this quantity “is likely to be flawed,” said Yu Changping, a doctor at the Department of Respiratory Medicine of People’s Hospital of Wuhan University. “It is impossible that the number could have jumped sharply within such a short time,” Yu said.

Even taken at face value, the increase in intensive care beds doesn’t mean the health system is prepared for a surge in cases since the pressure point, as seen globally, is often the availability of specialized doctors and nurses who can treat patients who need intensive care, said Chen. China only has 80,050 doctors and 220,000 nurses for its critical care facilities, and another 177,700 nurses who the National Health Commission says could potentially work in those units.

“If you look at intensive care unit beds, China is… in a great shortage,” he said.

Yu said he’s seen growing numbers of COVID-19 patients in recent weeks, and that almost all the doctors in the department have been infected. “We’re under pressure because we are receiving a large number of patients within a short time,” said Yu.

China has also not announced a clear triage plan, a system where hospitals prioritize giving treatments to the very sick to ration limited resources. Moreover, China’s health system is focused on large hospitals, which typically treat even the mildly ill, said Chen.

Potential shortages would depend on how quickly cases increase, and if those with mild symptoms don’t stay at home to ration resources for the very sick hospitals could still get overwhelmed, said Chen.

“That could easily crash the system,” he said.

To try to protect its health system, Beijing has converted temporary hospitals and centralized quarantine facilities to increase the number of fever clinics from 94 to 1,263. But rural areas may suffer, as the vast majority of China’s ICU beds are in its cities.

The use of digital tools and telemedicine may offer some breathing room to hospitals: Over a third of hospitals use some form of telemedicine, and around 31% used digital tools in their health care, found a nationwide survey of 120 public and private hospital executives in urban areas conducted by LEK Consulting in Shanghai.

China approved Pfizer’s drug Paxlovid for COVID-19 earlier this year, and two domestic therapies: an antiviral used for AIDS made by Genuine Biotech that has been repurposed for COVID-19 and a cocktail of virus-blocking antibodies made by BriiBio. But it is unclear how widely available these drugs are.



Scientists aren’t sure, since mortality depends on factors like vaccination rates, how people behave and efforts to bolster hospitals.

The Institute for Health Metrics and Evaluation at the University of Washington in Seattle predicts deaths could reach a million by the end of 2023 if the virus spreads unchecked. But Ali Mokdad, a professor of health metrics sciences at the institute, said the government would likely be able to reduce this toll with renewed social distancing measures.

Another study, from Hong Kong University, also predicts nearly a million deaths in a scenario in which the virus spreads throughout the country and authorities can’t provide vaccine boosters and antiviral treatments. Bill Hanage, co-director of the Center for Communicable Disease Dynamics at Harvard T.H. Chan School of Public Health estimated 2 million deaths in a Dec. 14 call with reporters.

“China has got a very, very hard road ahead of it in the coming months,” Hanage said. “But in the absence of vaccination, it would be much, much worse.”

Will a surge in China spill over into the rest of the world? Neighboring India has asked its state governments to remain alert, and not let genomic sequencing efforts wane. Jeremy Luban of University of Massachusetts Chan Medical School said large surges in infections increase the potential for a more dangerous mutation to arise. Luban has seen “no specific reason to be concerned” about any alarming variants already simmering in China, “except for the fact that a lot of infections are bad.”

Luban added: “The more the rate of transmission could be controlled in China the better.”


Ghosal reported from New Delhi, and Wu reported from Taipei, Taiwan. Associated Press journalist Carla K. Johnson in Seattle and video producer Olivia Zhang in Beijing contributed to this report.


The Associated Press Health and Science Department receives assist from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely accountable for all content material.

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