BEIJING: The outbreak of Covid-19 in the northern Chinese border province of Ejin late last year showed a major roadblock to the country’s escape from its pandemic zero-tolerance policy.
Any big change away from Covid Zero — which in China has meant regular mass testing, fast quarantines, lockdowns, and locked international crossings — risks a public health calamity.
Several dozen diseases swiftly overloaded the two local hospitals in Ejin, a Chinese province bordering Mongolia with a population of roughly 30,000 people. According to local media, authorities had to transport more than 140 patients by rail to Hohhot, the province seat, which is approximately 1,000 kilometres (621 miles) away.
The Hohhot team was soon looking for assistance as well. Hohhot’s primary hospital for Covid recruited support from other hospitals to deal with the inflow of Covid cases, which included a one-year-old child, an 82-year-old, and a dozen extremely sick patients. In early November, a doctor supervising the reaction warned state media that the centre wasn’t “capable of handling this many patients all of a sudden.”
The incident demonstrates how vulnerable China’s enormous but patchwork medical network is to the virus, which is hampered by a lopsided distribution of resources and underinvestment.
Add to that the likelihood of unprecedented cases and deaths if China were to let the disease spread like it has in other parts of the world, in an environment where most people are vaccinated with less effective local shots, and it’s clear why the country is reluctant to embrace endemic Covid. Officials are said to plan on keeping the existing playbook through 2022, even as they signal a willingness to adjust policy marginally.
There is cause for concern.
China doesn’t have to go far to find reason to be concerned. The current Omicron epidemic in Hong Kong, which followed the mainland’s lead and implemented rigorous border controls and sent all positive patients to public isolation facilities, has already overburdened hospitals. Non-Covid and mild-Covid patients are gradually being transferred from government hospitals to private institutions. And this is one of the most advanced healthcare systems in Asia, comparable to Singapore and Japan.
“If the country reopens, the healthcare system would undoubtedly be severely tested,” Mia He, a senior healthcare analyst at Bloomberg Intelligence, said. China’s “stats on restricted access to healthcare resources foreshadow a system that would be severely strained,” she said, adding that investment in infectious-disease response has typically trailed behind more pressing issues such as cancer, diabetes, and hypertension.
During the worst Covid waves, hospitals in wealthy countries like the United States and Europe were inundated. While hospitals in Hong Kong have been compelled to relax some of their necessary isolation regulations as a result of record-breaking cases, China has committed to its tight containment techniques and has maintained control of growing clusters around the country in recent months.
methods and kept control of increasing clusters across the country in recent months.
“Preventing the healthcare system from collapse is a complicated undertaking even in developed countries,” said Jin Dongyan, a virologist at the University of Hong Kong. China’s long-standing containment-at-all-cost Covid approach has reflected a lack of confidence among officials in putting the healthcare system to the test, he said.
Communist Party leaders have reason to be wary of the loss of social stability and legitimacy that could come if China’s hospitals were inundated. Official rhetoric often highlights the country’s success in avoiding the fatalities and chaos Covid has wrought in other countries.
“If you multiply Covid’s infectivity rate and a large population, you’ll get a big absolute number for severe disease and death in a country of 1.4 billion people,” Liang Wannian, a seasoned epidemiologist who has overseen China’s Covid response from the beginning of the pandemic, told the state-run CCTV in early December. “That means it’s a major public health, social as well as political problem and must be put under control.”
In the past two years, China has reported fewer than 5,000 Covid deaths, compared with more than 950,000 in the US, which has about one-quarter the population size.
The desire to protect that track record can be seen in the incremental easing steps said to be considered now — like creating bubbles similar to the one used in the Beijing Olympics to allow foreigners to visit without quarantine. There has been little mention publicly of how China will gird the healthcare system for the inevitable increase in cases and deaths that will come from opening up.
Uneven access
China’s healthcare system was already a source of public discontent before the pandemic. While the government has expanded rural healthcare and state medical insurance coverage, there were fewer than three doctors per 1,000 people in 2020, behind major developed nations but also lagging Brazil, another populous emerging market that suffered a devastating Covid hit.
A key challenge is the uneven distribution of medical resources. For the 500 million or so Chinese living in rural areas, access to doctors and hospital beds is far worse than for those in cities. For every 1,000 people in rural China, there are fewer than two doctors and nurses together. In Beijing and Shanghai there are more than five doctors alone for every 1,000 people.
That’s resulted in a sort-of medical migration, with 40% of the patients at top hospitals in Beijing and Shanghai in recent years coming from other parts of the country, according to local media reports citing official data.
Model of an Infectious Disease
Most Chinese cities rely on authorised hospitals to manage everything from TB and HIV infections to hepatitis — and since late 2019, Covid has been one of them.
This concept complements the Covid-Zero strategy, in part because hospitals may focus their resources on a small number of patients. According to official data from China’s National Health Commission, no one has died from the virus since early 2021.
The number of cases in China has risen dramatically in recent weeks, with daily infections surpassing 500, a level not seen since the catastrophic outbreak in Wuhan. If the number of cases rises into the tens of thousands, there will likely be a shortage of treatment, and vulnerable individuals will die fast, as has already happened.
Risk of colossal outbreak
That seems guaranteed if China reopens. Statistical modeling by Peking University shows China could have a “colossal outbreak” with as many as 630,000 or so people infected in a single day if the country removes most of its restrictions as the US did.
The researchers said their projections were already optimistic because they assumed China’s domestic vaccines were as effective as the mRNA shots used widely in the US While more than 80% of Chinese have been fully vaccinated and over 554 million people have received boosters, studies have shown the local shots to be less potent, especially at stopping infections.
Even then, there would be more than 22,000 Covid patients needing hospitalization and expensive equipment like ventilators, according to the Peking University study.
China could quickly see an intensive-care crisis, with only 3.6 ICU beds for every 100,000 citizens, compared with 25.8 and 33.9 in the US and Germany, respectively.
Severe Covid preparedness
There’s also the issue of weaning the general people away from the Covid-Zero mindset. When the virus first appeared in Wuhan, video of people crowding hospitals and fainting out while waiting in lines for treatment went viral, spreading dread and terror. Since then, official media has emphasised the pandemic’s catastrophic consequences in other nations to justify Beijing’s insular approach.
While China quickly put up temporary hospitals and isolation facilities in the early days of the epidemic, the majority of them have already been demolished or abandoned.
Big hospitals have been urged to improve their capabilities to discover infectious diseases early and to control them, while treatments for patients should still be centralized at designated hospitals rather than at the point of discovery and diagnosis, according to a person familiar with the national health strategy who asked not to be identified discussing information that’s not public. If the need arises, China can again build makeshift hospitals for mild cases, the person said.
“Ultimately, whether you want a gentle or a harsh landing for Covid Zero is a question of preference,” said Huang Yanzhong, a senior fellow for global health at the Council on Foreign Relations in Washington, D.C. “To some extent, Hong Kong is demonstrating to the mainland what a hard landing looks like, and a soft landing is what you must invest in.”
