“The big threat in an exit wave is just the sheer number of cases in a short space of time. I would be reluctant to say there is a scenario in which an exit wave doesn’t cause problems for the healthcare system. That is difficult to imagine.”
— Ben Cowling, professor of epidemiology at the University of Hong Kong
China’s doctors have a blunt message for Xi Jinping: the country’s healthcare system is not prepared to deal with a huge nationwide coronavirus outbreak that will inevitably follow any easing of strict measures to contain Covid-19.
The warning for China’s leader was delivered by a dozen health professionals interviewed by the Financial Times this month, and echoed by international experts.
“The medical system will probably be paralysed when faced with mass cases,” said one doctor in a public hospital in Wuhan, central China, where the pandemic started nearly three years ago.
The warning also serves as a reality check for many in China and around the world hoping that Xi will end his hallmark zero-Covid policy. Experts said the policy meant China had failed to prioritize building robust defenses for a mass outbreak, instead focusing its resources on containment.
At the heart of the problem that Beijing has created for itself is what many see as an inevitable “exit wave”, a rapid surge in infections as the country unwinds its heavy-handed pandemic restrictions.
That wave threatens to overwhelm the country’s healthcare services unless Xi and his top lieutenants make radical changes to the zero-Covid policy in preparation.
China’s official case counts are at their highest in six months, including a record number of infections in the capital Beijing and the southern manufacturing hub of Guangzhou.
The zero-Covid strategy involves lockdowns — of buildings, suburbs or entire cities — as well as mass testing, quarantines and electronic contact tracing. While successful in suppressing outbreaks, the policy has exacerbated problems in China’s healthcare system and left a large chunk of the population deeply fearful of the virus.
China’s elderly have resisted taking a vaccine to prevent it. Only 40 per cent of those over 80 have had three shots of a domestically made vaccine, the dosage required to gain high levels of protection against the Omicron variant.
Jin Dong-yan, a virologist at the University of Hong Kong, said Chinese hospitals could be overwhelmed by an influx of unvaccinated elderly patients if there was a mass outbreak, replicating a crisis in Hong Kong this year when hospitals and morgues ran out of space at the peak of an outbreak.
“A Hong Kong-style outbreak is avoidable if they increase elderly vaccination coverage and stockpile antivirals, both things Hong Kong failed to do going into the outbreak,” he said.
Still, over recent weeks, some equity market analysts and traders have reacted with excitement to perceived signs of Beijing pivoting to a “reopening” plan — a change of course that they hope will reboot confidence in the world’s biggest consumer market and ease disruptions that have sporadically roiled global supply chains. Optimism increased last week after Beijing eased quarantine requirements for close contacts and international travelers.
According to frontline staff, nearly three years into the pandemic, China’s healthcare system is far more strained than at the start. Scarce funding, staff and medical resources have been redirected towards pandemic controls instead of preparations to treat the most vulnerable.
“Over the past few years, the Chinese healthcare system has completely limped along, putting all its manpower, funding and support into Covid prevention and control,” said a health official in southern China’s Guangdong province. “This is unsustainable.”
These concerns, the official said, have been relayed to Beijing.
“Unfortunately, the central government has still not made any substantial adjustments in the general direction,” the official added.
“Most local officials and healthcare workers are very often at the mercy of rigid administrative orders, which is what makes the tragedy of patients not being able to get medical attention in time happen time and time again,” said another doctor in Wuhan.
During a lockdown in Shanghai in April, frontline medical personnel struggled to cope with the increased workload after many staff were redirected to conduct citywide testing.
“The medical system is not ready for a large-scale reopening,” said another doctor working in a county-level hospital in Inner Mongolia, northern China.