‘A very tough road ahead’ for China as COVID-19 cases spiral

BAZHOU, China (AP) — Nearly three years after it was first identified in China, the coronavirus is now spreading across the vast country. Experts predict difficult months for its 1.4 billion people.

China’s hardline “COVID-zero” approach, which aimed to isolate all infected people, has taken years to prepare for the disease. But an abrupt reopening, announced without warning on Dec. 7 in the wake of anti-lockdown protests, has caught the nation under-vaccinated and short on hospital capacity.

Experts have predicted between one million and two million deaths next year. Predicting deaths has proved tricky throughout the pandemic, as it is influenced by various factors, and China has a particularly tricky case due to opaque sharing of information.

It’s unclear exactly how big the current outbreak is, as China has scaled back testing and stopped reporting milder cases. But in cities and towns around Baoding and Langfang in Hebei province, an area that was among the first to face an uncontrolled outbreak, Associated Press reporters saw hospitals’ intensive care units overwhelmed with patients. and the ambulances rejected. Across the country, widespread reports of absences from work, shortages of medicines to reduce fever and staff working overtime at crematoria suggest the virus is widespread.

China belongs to a small club of countries that managed to halt most domestic transmissions of the virus in 2020, but are the latest to end restrictions. Experiences of cessation vary: Singapore and New Zealand achieved high vaccination rates and strengthened medical systems during restrictions and reopened relatively smoothly. Hong Kong, where omicron outlasted defenses while many elderly people were unvaccinated, suffered a disruptive wave of COVID-19 in 2022. Nearly 11,000 people have died from the disease this year in the city of 7.4 million, with 95% over the age of 60, according to the Hong Kong health department. Data from the city showed a 15 percent death rate for people over the age of 80 who weren’t vaccinated, said Jin Dong-yan, a virology expert at the University of Hong Kong.



China has higher vaccination rates than Hong Kong at the time of its omicron outbreak, but many people are vulnerable to infection, especially the elderly.

The country has used exclusively domestically produced vaccines, which are based on older technology than mRNA vaccines used elsewhere and have shown the best protection against infection.

A study conducted in Hong Kong, which administered both an mRNA vaccine and Sinovac’s CoronaVac, suggested that the CoronaVac requires a third injection to provide comparable protection, especially for the elderly. An ordinary course of the vaccine is two shots, with an optional booster afterwards.

Most vaccinated people in China received CoronaVac or a similar vaccine made by SinoPharm, but the country has administered at least five other vaccines. Comparable real-world data is not available for these vaccines.

While China has 90% of its population vaccinated, only about 60% have received a booster. Older people are especially likely to have not received a booster vaccine. More than 9 million people over the age of 80 have not received the third vaccine, according to China’s official news agency Xinhua.

Vaccination rates have increased more than 10-fold, to over a million doses administered per day, since the beginning of the month. But Dr Gagandeep Kang, who studies viruses at India’s Christian Medical College in Vellore, said prioritizing the elderly would be key. Unlike other countries, China has prioritized vaccinating the most mobile youth to prevent the virus from spreading, said Ray Yip, founding director of the US CDC office in China. A campaign targeting those over 60 began in December, but it’s unclear how successful it has been.

“They haven’t paid enough attention to ensure that everyone gets full vaccine protection,” Yip said. “How well they perform this particular recovery effort could determine some of the outcomes.”



Around Baoding and Langfang, hospitals have run out of intensive care beds and staff due to the increase in severe cases. Patients lay on the floor, while others drove from hospital to hospital looking for beds for relatives on Wednesday.

The National Health Commission said China had 10 intensive care beds for every 100,000 people on Dec. 9, for a total of 138,000 beds, up from 4 for every 100,000 people on Nov. 22. This means that the reported number of beds has more than doubled in just under three weeks. But this number “may be wrong,” said Yu Changping, a doctor in the Department of Respiratory Medicine at Wuhan University People’s Hospital. “It is impossible that the number could have increased sharply in such a short time,” said Yu.

Even taken literally, the increase in intensive care beds does not mean that the healthcare system is prepared for a surge in cases as the pressure point, as seen globally, is often the availability of specialized doctors and nurses who can treating patients who need intensive care, Chen said. China has just 80,050 doctors and 220,000 nurses for its intensive care facilities, and another 177,700 nurses who could potentially work in those units according to the National Health Commission.

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

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

China also has not announced a clear triage plan, a system in which hospitals prioritize providing care to the seriously ill to ration limited resources. In addition, China’s healthcare system focuses on large hospitals, which typically treat even the mildly ill, Chen said.

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

“This 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 could be affected, as the vast majority of China’s ICU beds are in its cities.

Use of digital tools and telehealth can give hospitals some breathing space: Over a third of hospitals use some form of telehealth and about 31% have used digital tools in their healthcare, according to a nationwide survey on 120 public and private hospital managers in urban areas conducted by LEK Consulting in Shanghai.

China approved Pfizer’s Paxlovid drug for COVID-19 earlier this year as well as two national therapies: an AIDS antiviral made by Genuine Biotech that’s being repurposed for COVID-19, and a blocker antibody cocktail of the virus produced by BriiBio. But it’s unclear how widely available these drugs are.



Scientists aren’t sure, as mortality depends on factors such as vaccination rates, people’s behavior and efforts to support hospitals.

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

Another study, from the University of Hong Kong, also predicts nearly a million deaths in a scenario where the virus spreads across the country and authorities cannot provide booster vaccines and antiviral treatments. Bill Hanage, co-director of the Center for Communicable Disease Dynamics at the Harvard TH Chan School of Public Health, estimated 2 million deaths in a Dec. 14 phone call with reporters.

“China has a very, very tough 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 to the rest of the world? Neighboring India has called on its state governments to remain vigilant and not let genomic sequencing efforts fade away. Jeremy Luban of the University of Massachusetts Chan Medical School said large waves of infections increase the potential for a more dangerous mutation to emerge. Luban saw “no specific reason to be concerned” about any alarming variants already lurking in China, “except that many infections are bad.”

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


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


The Associated Press Health and Science Department receives support from the Science and Educational Media Group of the Howard Hughes Medical Institute. The AP is solely responsible for all content.

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