Chinese doctors have a clear message for Xi Jinping: the country’s health care system is ill-equipped to deal with the massive 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 dozens of health workers, including frontline doctors and nurses and local government health officials, who were interviewed by the Financial Times this month and echoed by international experts.
“The medical system will probably be paralyzed when faced with mass cases,” said a doctor at a public hospital in the central Chinese city of Wuhan, where the pandemic began nearly three years ago.
The warning also serves as a reality check for many in China and around the world who hope Xi will end his landmark zero-Covid policy. Experts said the policy did not prioritize China building strong defenses against a massive outbreak, instead focusing its resources on prevention.
At the heart of the challenge Beijing has created for itself is what many see as an inevitable “exit wave” — a rapid rise in infections as the country eases severe pandemic restrictions.
Unless Xi and his top lieutenants make radical changes to the zero-Covid policy in the run-up, the wave threatens to overwhelm the country’s health services.
Ben Cowling, a professor of epidemiology at the University of Hong Kong, said: “The big danger in the exodus is the large number of cases in a short period of time.” “I would hesitate to say that there is a scenario where the exit wave will not cause problems for the health care system. It’s hard to imagine.”
China’s official case count is the highest in six months, including a record number of infections in the capital Beijing and the southern manufacturing hub Guangzhou.
A zero-Covid strategy involves locking down buildings, suburbs or entire cities, as well as mass testing, quarantines and electronic contact tracing. Although successful in containing the disease, the policy has exacerbated problems in China’s health care system and left large sections of the population deeply afraid of the virus.
China’s elderly have resisted getting vaccinated to prevent this. Only 40 percent of those over 80 have received three doses of the locally produced vaccine, the dose required to achieve a high level of protection against the Omicron variant.
Jin Dong-yan, a virologist at the University of Hong Kong, said China’s hospitals could be overwhelmed by an influx of unvaccinated elderly patients if a massive outbreak occurs. hospitals and morgues have run out of space at the height of the epidemic.
“A Hong Kong-style epidemic can be avoided if it increases vaccination coverage of the elderly and increases the supply of antiviral drugs, both of which Hong Kong failed to do when it entered the epidemic,” he said.
Still, some stock market analysts and traders in recent weeks have reacted with excitement to perceived signs that Beijing is turning to a “reopening” plan – a change they hope will restore confidence in the world’s largest consumer market and stem the tide. Global supply chains are occasionally fluctuating. Optimism has increased since Beijing last week eased quarantine requirements for close contacts and international travelers.
Nearly three years after the pandemic, China’s health care system is more strained than it was at the beginning, according to frontline staff. Scarce funding, staffing and medical resources have been diverted to pandemic control instead of preparing to treat the most vulnerable.
“For the past few years, the Chinese health system has been completely paralyzed, devoting all its manpower, funding and support to the prevention and control of Covid,” said a health official in southern China’s Guangdong province. “It’s not sustainable.”
The official said that these concerns have been conveyed to Beijing.
“Unfortunately, the central government has not yet made any major changes in the general direction,” the official added.
Small hospitals “don’t have the manpower or equipment” to handle a large influx of patients, said a nurse in a remote town in the southern province of Guangxi.
Local lockouts have also frustrated frontline workers, with other workers pulling extra shifts to compensate for their locked-out colleagues. A thick layer of coronavirus-oriented bureaucracy has slowed things down in an already strained system.
“Most local officials and medical workers are often at the mercy of strict administrative orders, which causes the tragedy of patients not being able to receive timely medical care to occur from time to time,” said another doctor in Wuhan.
During a lockdown in Shanghai in April, frontline health workers struggled to cope with an increased workload after many staff were laid off. directed to conduct city-wide trials.
“The medical system is not ready for a large-scale reopening,” said another doctor who works at a county-level hospital in Inner Mongolia, northern China.
In preparation for larger outbreaks, China has ordered local governments to begin a major construction effort from early 2020 to build field hospitals to isolate and treat mild and asymptomatic Covid cases. He also called for isolation facilities to accommodate close contacts and positive cases.
Guo Yanhong, a senior official at China’s National Health Commission, told reporters in Beijing on Thursday that larger venues, including stadiums and exhibition centers, will be turned into temporary hospitals to accommodate asymptomatic patients and those with mild symptoms. Hours later, authorities in Guangzhou announced plans to expand capacity in makeshift hospitals and other centralized quarantine facilities from 70,000 beds to about 250,000.
Despite the hospital building program, human resources “will be more of an issue, if not more,” said Karen Grapen, a health systems expert at the University of Hong Kong.
“In the past, they’ve been able to move them across the country – one state helped another – but that won’t be the scenario if Covid goes 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 extra health workers from mainland China.
Experts said the Xi administration would have to rely on prolonged social distancing measures, including school closures and work-from-home measures, slowing the return to pre-pandemic normalcy.
China should also reserve hospitals and isolation facilities for severe cases only, and follow the rest of the world in allowing asymptomatic and mild cases to be isolated at home, to significantly ease the burden on the health system.
Cowling warned that if the pressure on hospitals is not reduced and the availability of medical care is reduced, the experience of Hong Kong shows that the Covid death rates will be higher.
“When we look at the data in terms of the risk of death of people infected in Hong Kong in March compared to February, their risk of death doubled in March,” he said, because medical facilities there were overcrowded.
Additional reporting by Wang Xueqiao and Thomas Hale in Shanghai and Gloria Lee in Hong Kong
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