China’s covid explosion: How the country went from ‘zero-covid’ to millions of cases a day

The government says 39 people have died since a loosening of covid restrictions. The real number may be more than 250,000.

“China has a long and notorious history of delaying the reporting, or not reporting at all, of important epidemic information of international importance,” said Victoria Fan, a senior fellow in global health at the Center for Global Development. “Unfortunately, China’s recent actions are consistent with its past history of actions.”

The current reality — whatever the government says — is that China is in the throes of a voracious covid wave that is taking a toll on hospitals and families across the country. How bad is it? Using social media accounts, interviews with people in China’s major cities, epidemiological models and local data, Grid has tried to piece together as clear a picture as possible of a nightmarish sequel to zero-covid.

From “zero-covid” to hundreds of millions of cases

Before China abandoned its zero-covid restrictions, the country was reporting only tens of thousands of cases a day — a far lower figure than other countries have experienced in the omicron era (by way of comparison, the U.S., with one-third the population, had an average daily caseload of 800,000 at the peak of omicron last January — and that was also likely an undercount). Since early December, the spike in infections across China has surprised even seasoned public health experts — including some inside the country.

Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations, said, “I assume that now nationwide, very likely at least 50 percent of the population has been infected.”

“Every person I knew in Beijing got covid — every one of them — even the ones who were the most fervent supporters of the government’s policies got covid within one week,” Yiming, a Beijing-based investment analyst who spoke on the condition of partial anonymity, using his first name only, told Grid. He said he was working remotely in Shanghai as his friends and colleagues in Beijing were getting infected; when he returned to Beijing in December, he immediately got covid too.

“People were joking that covid was in the air,” he said. “As long as you were breathing, you would get covid.”

For some, a quick recovery

“They say that we have smoothly passed the viral peak,” said Huang, “so they make this sort of like an accomplishment.” He added that local governments may have an incentive to report that their covid surge is behind them so that they can focus on economic reopening, the party’s central task for the year ahead.

In any event, the price of China’s steep “viral peak” has likely been a death rate far higher than would have been the case had the transition from zero-covid been less sudden — as well as a punishing impact on the country’s hospitals.

A battered healthcare system

The torrent of cases in recent weeks has taken a heavy toll on China’s healthcare providers.

A medical professor at a hospital in Chengdu, who spoke on the condition of anonymity because of the sensitivity of the subject, told Grid, “It was a sudden reopening. There was a lack of preparation in many aspects.” Because it was focused on containment for three years, she said, “the medical system neglected research and treatment of the disease. After the reopening, there was no standard treatment plan in place.”

Jennifer Bouey, an epidemiologist and leader of China policy studies at the Rand Corporation, echoed the frustration over the government’s lack of foresight.

“I think the most disturbing fact is that the Chinese government didn’t do good preparation or any preparation at all before they changed the policy,” she told Grid. Officials didn’t lead a big vaccine push ahead of the change in rules, she added, and the government didn’t sufficiently stockpile antivirals and other medicines.

Yiming saw that firsthand in Shanghai and Beijing. “The first problem that we had when government reopened,” he said, “was that we didn’t really have easy access to those kinds of drugs because so many people are experiencing fever and coughing, but the shortage of available drugs made a lot of people suffer from the fever.”

Grid spoke to a source who said his 87-year-old relative had been in the hospital in Chengdu for more than 10 days with pneumonia from covid, and her condition hadn’t improved.

“The fever patients not only occupy the fever clinic, but also the internal medicine unit for the respiratory diseases,” said Bouey, “and then we see that the surgery, the OB-GYN wards, even the pediatric wards are all taken over by the covid patients.”

Counting the dead: obituaries and visits to crematoriums

Even though cases have peaked in many cities, international experience would suggest that China is still in for a rough stretch ahead, because severe cases and deaths typically continue to climb after overall cases peak.

Inside China, the sudden deluge of cases has been understandably shocking and dizzying, for a population that went almost overnight from “zero-covid” to covid afflicting millions.

“I would say that it was such a radical and abrupt shift from what [the government] had adhered to before that nobody really could get used to it,” said Yiming. “Unfortunately, what happened afterward was really kind of traumatic and tragic.”

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