In China, zero-COVID policy to zero COVID policies Premium

As the virus spreads through China’s population, Ananth Krishnan reports on the timeline of how three years of stringent restrictions and checks suddenly gave way to an abrupt and messy end, leaving the healthcare system in chaos

On December 20, almost two weeks since China’s sudden and unexpected scrapping of its stringent “zero-COVID” policy, the country officially reported a little over 3,000 COVID-19 cases. The real number of cases that day, estimated the National Health Commission (NHC) in an internal meeting, was closer to 37 million.

The commission, according to notes of an internal meeting that were subsequently leaked, estimated that in the first 20 days of December, China had seen roughly  250 million COVID cases — a remarkable speed of spread in a population with low immunity that had, for three years, been sheltered from COVID by a policy that had kept China isolated from a world that had, by then, come to live with the virus.

December — China’s first post zero-COVID month — saw a hospital system completely overwhelmed, as well as a wave of deaths among elderly Chinese that has remained unrecorded, evident only in the long lines outside crematoria around the country. In Beijing and Shanghai, some families had to wait as long as 10 days to get a slot in a cremation ground.

If China had more than two years to prepare for lifting its COVID curbs, the end of zero-COVID came so suddenly and abruptly that hospitals and medical workers were left stunned. As recently as on the evening of November 30, the first clear sign of a shift in policy came when Vice Premier and “COVID czar” Sun Chunlan met NHC officials and declared that Omicron was no longer threatening because of its “decreased pathogenicity”. Yet, officials in several Chinese cities, including Beijing, were even on that same day still scrambling to build more quarantine facilities, projects that were then suddenly halted.

Doctors in Beijing told  The Hindu that hospitals didn’t have time to even figure out how to deal with the influx of COVID patients and to separate them from those seeking other treatment. Some hurriedly set up makeshift fever clinics to ease the burden on emergency departments. Clinics saw long lines, because pharmacies in the city ran out of medicines within days of the policy being eased. They just had not been given time to stock up on supplies.

On December 1, authorities in Wuhan published a list of 42 fever clinics, but some closed shortly thereafter because the staff themselves became infected. Cross-infection in hospitals in Beijing and other cities spread rapidly, leading to other departments needing to close for disinfection. 

The strain on ICU beds has been the biggest worry. As of November, China had 12 million people above the age of 80 who were yet to complete three doses of Chinese vaccines needed to prevent large-scale hospitalisation and death, and 80 million above the age of 60. This is a sizeable vulnerable group in a country that had, as of 2020, 3.6 ICU beds for every 1,00,000 people, with a majority of beds concentrated in bigger cities.