Less than a week after China lifted most pandemic restrictions, abandoning its tough zero-COVID response, a wave of cases is already building, which will severely test the country’s health care system.

Zhong Nanshan, China’s leading respiratory disease expert, told state media Sunday infections were already “spreading rapidly” and would likely be impossible to contain. A former top health official predicted at least 60 per cent of the population, some 847 million people, will get the virus in this current wave, with about 90 per cent infected in the months to come.

“It’s inevitable that most of us will get infected,” said Feng Zijian, one-time deputy director of the Chinese Center for Disease Control and Prevention.

Such calculations are familiar for many countries around the world, but they’re astonishing in China, where only a month ago the Communist Party leadership was vowing to “unswervingly adhere” to zero-COVID.

“Things are changing every day,” said Aleen Wang, who works in a film company in Beijing. “You wake up to find a new set of rules and it leaves you feeling dizzy.”

Shanghai resident Gao Yi said “the speed is unbelievable,” adding she wasn’t sure if the country was prepared for the swiftness of the easing of restrictions. “It’s like stopping a car without warning.”

But after living through her own city’s brutal months-long lockdown, and witnessing tragedies like a recent fire in Urumqi – the deadliness of which was blamed on COVID-19 restrictions – Ms. Gao said she was “thrilled” to see the end of tough pandemic measures.

Even as China’s leaders signalled their intention to relax zero-COVID measures in mid-November – due mainly to the increasing toll they were taking on the economy – most expected this to be a gradual process, especially given cases were already spiking as winter closed in, and the risk of mass infection during Lunar New Year holiday travel in January.

But anti-lockdown protests in multiple cities appear to have sped up plans significantly. That unrest, the largest in a decade, demonstrated a level of frustration and anger that seems to have taken Beijing by surprise, evidence of how a population that once embraced tough pandemic measures had come to resent the constant testing and lockdowns.

Propaganda messaging flipped soon after the protests, emphasizing the lower fatality rate from the Omicron variant and encouraging people to self-isolate if they were infected. On Monday, the country scrapped a health code app that has dominated people’s lives for much of the past years.

A new vaccination drive is also underway, targeting in particular older Chinese, who are among the least protected. According to official figures, 68.7 per cent of those over 60 have received three shots, dropping to just 40.4 per cent for the over 80s. In Hong Kong, which offers the same vaccinations as China along with more modern mRNA jabs, officials have for weeks been urging anyone over 50 to get a fourth shot to increase protection against Omicron.

Prior to the recent policy shifts, Chinese researchers had estimated the country would see between 1 and 2 million deaths if COVID-19 restrictions were lifted, out of around 200 to 300 million total infections.

Hospitals nationwide have been told to double the number of intensive care beds and increase staffing, while new 24-hour clinics are being opened and quarantine camps repurposed as temporary treatment centres. Colour codes, once used for contact tracing via app, will instead signal a person’s risk of serious infection, based on vaccination status, age and other traits.

This is all part of the government’s “carefully arranged plan of gradually relaxing the COVID-19 restrictions,” the state-run Global Times said Sunday, adding China can weather the surging cases ”in a relatively orderly manner compared to the West.”

Zero-COVID is closely associated with Chinese President Xi Jinping, and the country’s success in staving off mass infection and death in the first years of the pandemic was long a major point of pride. Managing reopening will be as much a propaganda challenge as a medical one, as China’s leaders continue to argue their approach is superior even as it converges with that followed by much of the rest of the world.

On Monday, China officially catalogued around 9,000 new cases, with just more than a thousand in Beijing and a few hundred in several other major cities. But on the ground, some businesses are experiencing staff shortages due to sickness and a few have had to close, and many people said they were isolating after returning positive results on at-home tests.

Using inputs such as web searches for “fever,” the Shanghai-based City Data Group said its modelling suggested the number of infected could already run into the hundreds of millions nationwide.

“I feel like more than half the people I know in Beijing are infected now,” said Ms. Wang. “I was told this morning that all the staff in the office area next to me tested positive, it’s possible that I’ll be the only healthy person in our zone tomorrow.”

In Shanghai, Ms. Gao said there were many empty tables at restaurants, either because people were sick or avoiding the wave they know is spreading through the city – even if the official numbers don’t show it.

“I think most people have accepted the fact that everyone will get sick and that everyone is possibly sick already,” she said.

The Globe and Mail, December 12, 2022