Research by Fudan University in May estimated that there would have been 112 million symptomatic cases, 2.7 million intensive care unit (ICU) admissions, and 1.6 million deaths if restrictions were lifted. Vaccination rates have improved since then but not by enough in a country where only 67 per cent of the 264 million people aged over 60 is fully vaccinated due to limited public awareness campaigns, and past vaccine scandals.
“This will lead to a massive spike in cases,” says Dr Leong Hoe Nam, an infectious disease specialist at the Rophi Clinic in Singapore. “Especially in a population with poor vaccination that is using a less effective vaccine such as the inactivated vaccines.”
More than 80 per cent of the older population has had two shots of China’s inactivated Sinovac and Sinopharm vaccines, but clinical trial data shows the shots are only 51 to 79 per cent effective at preventing symptomatic disease after two shots compared to 90 per cent for Western mRNA vaccines such as Pfizer and Moderna. A Hong Kong study found a third shot of the Chinese-made vaccines would boost their effectiveness at preventing severe disease to 90 per cent, but only 40 per cent of people aged over 80 have had their booster.
The National Health Commission is now rolling out a door-to-door vaccine campaign but entrenched scepticism remains. Authorities have pinned their hopes on the Omicron strain being less severe than previous variants. They have made that message the key component of a huge narrative shift that has moved like whiplash through Chinese state media over the past week. In November, Omicron spelt death and destruction unless zero-COVID was “resolutely adhered to”. By December, it was no worse than a common cold even as it stretched better-resourced health systems in the United States and Australia.
Leong is not convinced.
“Unfortunately, the procrastination in vaccination and opening up will lead to a double whammy,” he says.
“The poorly vaccinated population and the cold winter months will lead to an unprecedented number of COVID cases in China. It would have been better if this was delayed till the spring months from May onwards, but the unrest forced the Chinese government to do it now instead. This is the worst time to fight the battle of COVID.”
Chinese hospitals are not ready for the wave that is about to break. There are only an estimated 3.6 ICU beds for every 100,000 people, compared to 11.4 in Singapore, or 9.1 in Australia.
China’s massive manufacturing capacity means it can quickly scale up equipment supplies, but it faces shortages on two fronts.
In previous outbreaks, doctors were called in from the regions to help staff major crisis centres. “But now all the doctors will have to fight fires in their own hospitals,” says Leong. “There will be no reinforcements.”
Secondly, the government has not used its time in zero-COVID to train enough ICU nursing specialists. “It takes a long time to train ICU competent healthcare workers,” says Leong. “Hardware without the software to run it is still useless.”
Leong describes the prognosis as “awfully bleak”.
Until last week, China’s 90 per cent vaccinated youth was paying the price to keep the under-vaccinated elderly safe. Now their roles have been reversed. The old will die to keep the economy afloat.
“The Chinese economy will not stand anymore if the lockdown is not lifted,” Chu the construction worker, says.
“If COVID control continues until the second half of next year, my restaurant will go bankrupt,” says Jin.
Dr Yan Long, a specialist in health politics and sociology at the University of California, Berkeley, said the economic crisis had driven young Chinese workers to the wall.
“The younger generation, they’re facing a very different future [to their parents],” she told the Zhengfawei Chinese politics forum on Thursday. “The protesters found a common outlet.”
So did local authorities who had been frustrated by being forced to take on the economic burden of zero-COVID for the national government, forcing Beijing’s hand much faster than many had anticipated.
“I think the local government probably utilised the protests as a bargaining chip against the central government. The fiscal pressure the whole zero-COVID policy has placed on them was just incredible,” said Yan.
“They used [the protests] to tell the central government that okay, this is the edge, we cannot do it anymore.”
The optics are challenging for the impervious Chinese Communist Party and its leader Xi Jinping.
“This wave of protests happened less than two months after the National Party Congress, this is a huge blow to the legitimacy of the current regime domestically and internationally,” said Yan.
The population effectively endured three years of what French philosopher Michel Foucault called “biopolitics” where their bodies had become obedient to an endless cycle of politically driven COVID compliance.
“Even children would automatically open their mouths whenever they saw a big white,” said Yan, referring to the hazmat-suited COVID authorities.
“But even given all that effort, now we’re seeing people’s agency, autonomy, and their desire for freedom. I think those are incredibly powerful signals for the current regime, not just for them, but also for the international audience in terms of what people really want.”
In the first two months of the pandemic, Wuhan doctor Li Wenliang tried repeatedly to warn Chinese authorities of a “mysterious pneumonia” that was swamping the local health system. Li died from COVID aged 33 in February 2020, a month after he was punished for “spreading rumours” and two weeks after Wuhan went into lockdown, plunging China into three of its darkest years.
On Thursday, residents posted on his memorial page on Weibo.
“Three years, Dr Li, do you know? We finally embraced the dawn.”
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