China’s doctors have a strong message for Xi Jinping: The country’s health system is not prepared to deal with a massive nationwide coronavirus outbreak that will inevitably follow any relaxation of strict measures to contain Covid-19.
The warning to China’s leader was delivered by a dozen health professionals, including frontline doctors and nurses and local government health officials, interviewed by the Financial Times this month and echoed by international experts.
“The medical system will probably come to a standstill when faced with massive cases,” said a doctor at a public hospital in Wuhan, central China, where the pandemic began 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 signature zero-covid policy. Experts said the policy meant China had not prioritized building strong defenses for a massive 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 rise in infections as the country removes its strict pandemic restrictions.
That wave threatens to overwhelm the country’s health services unless Xi and his top lieutenants make sweeping changes to the zero-Covid policy in the pipeline.
“The big threat in an outflow wave is just the large number of cases in a short space of time,” said Ben Cowling, a professor of epidemiology at the University of Hong Kong. “I would be reluctant to say that there is a scenario in which a wave of departure does not cause problems for the health system. That’s hard to imagine.”
China’s official case count is at its 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 it succeeded in suppressing the outbreaks, the policy exacerbated problems in China’s healthcare system and left much of the population deeply fearful of the virus.
The elderly in China have resisted receiving a vaccine to prevent it. Only 40 percent of those over the age of 80 have received three shots of a domestically manufactured vaccine, the dose required to obtain 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 were a mass outbreak, replicating a crisis in Hong Kong earlier this year when hospitals and morgues ran out of space at the peak of a shoot.
“A Hong Kong-style outbreak is preventable if they increase vaccination coverage of the elderly and stockpile antivirals, both of which Hong Kong did not do before the outbreak,” he said.
Still, in recent weeks, some stock market analysts and traders have reacted enthusiastically to perceived signs that Beijing is pivoting toward a “reopening” plan, a reversal they hope will restart confidence in the stock market. largest consumer in the world and alleviate the interruptions they have had. sporadically rotated global supply chains. Optimism rose last week after Beijing simplified 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 it was at the beginning. Scarce funding, personnel and medical resources have been redirected towards controlling the pandemic instead of preparing to treat the most vulnerable.
“In recent years, the Chinese health system has completely limped forward, putting all its manpower, funds and support into the prevention and control of Covid,” said a health official in the southern Guangdong province. from China. “This is unsustainable.”
These concerns, the official said, have been passed on to Beijing.
“Unfortunately, the central government has not yet made any substantial adjustments in the general direction,” the official added.
A nurse in a remote town in the southern region of Guangxi said smaller hospitals “don’t have the manpower or equipment” to handle a large flow of patients.
Localized lockdowns have also left frontline staff stranded, with other workers putting in extra shifts to make up for their stranded colleagues. A thick layer of coronavirus-focused bureaucracy has also slowed everything down in an already cumbersome system.
“Most local officials and health workers are often at the mercy of rigid administrative orders, which is what makes the tragedy of patients not being able to receive medical care on time happen again and again,” he said. another doctor in Wuhan.
During a lockdown in Shanghai in April, frontline medical staff struggled to cope with increased workloads after many staff were redirected for citywide testing.
“The medical system is not ready for a full-scale reopening,” said another doctor who works at a county-level hospital in Inner Mongolia, north China.
In preparation for larger outbreaks, China has ordered local governments to undertake a major construction campaign from early 2020 to build field hospitals to isolate and treat mild and asymptomatic cases of Covid. Isolation facilities have also been called to house both close contacts and positive cases.
Guo Yanhong, a senior official with China’s National Health Commission, told reporters in Beijing on Thursday that larger venues, including stadiums and exhibition centers, will be transformed into makeshift hospitals to house symptomatic and asymptomatic patients. mild. Hours later, Guangzhou officials announced plans to expand the capacity of its makeshift hospitals and other centralized quarantine facilities from 70,000 beds to nearly 250,000.
Karen Grépin, a health systems expert at the University of Hong Kong, said that despite the hospital construction programme, human resources “would be just as much or more of a problem.”
“In the past, they have been able to move them around the country, one province helping another, but this will not be the scenario if Covid takes off everywhere at the same time,” he said.
“And it’s hard to treat Covid patients when you’re sick too,” he added, noting that during Hong Kong’s deadly outbreak this year, the city relied on additional health workers from mainland China.
Experts said Xi’s administration would have to rely on promoting the enforcement of social distancing, including school closures and work-from-home measures, which would delay any return to pre-pandemic normality.
China would also need to reserve hospitals and isolation facilities for severe cases only, and follow the rest of the world in allowing asymptomatic and mild cases to isolate at home, to substantially ease the burden on its healthcare system.
If the pressure on hospitals is not eased and the availability of care is reduced, Hong Kong’s experience shows that Covid death rates will be much higher, Cowling warned.
“When we look at the data in terms of the risk of death for people infected in March in Hong Kong compared to February, their risk of death in March was about double,” as health care facilities there were overwhelmed, he said. .
Additional reporting by Wang Xueqiao and Thomas Hale in Shanghai and Gloria Li in Hong Kong
