Since China loosened its zero-COVID policy on December 7, tensions have escalated at the public hospital in Shanghai where Nora, a 30-year-old physician, works.

Patients and physicians argue for access to scarce medications, such as cough medicines and pain relievers. Due to a personnel shortage, sick personnel continues to work despite being overworked.

Nora, who did not disclose her full name due to the topic's sensitivity, stated, "The policy of controlling covid was abruptly relaxed." The hospitals should have been told beforehand to make the necessary preparations.

President Xi Jinping's sudden abandonment of zero-COVID in the face of protests and an escalating outbreak has left China scrambling to prevent the collapse of its public health system.

Drug and testing kit shortages and logistical difficulties are disrupting daily life. According to four hospital employees who spoke to Reuters, inadequate preparedness for the termination of zero-COVID left them in charge of a chaotic reopening.

Kenji Shibuya, a former senior adviser to the World Health Organization, stated, "I believe China believed its program was successful and that a smooth transition to the endemic phase was possible, but it was not."

More than a dozen global health experts, epidemiologists, residents, and political analysts interviewed by Reuters cited the failure to vaccinate the elderly and communicate an exit strategy, as well as an excessive focus on eradicating the virus, as the causes of the strain on China's medical infrastructure.

According to these individuals, the country has spent much on quarantine and testing facilities over the past three years rather than bolstering hospitals and clinics and training medical professionals.

According to Zuofeng Zhang, a professor of epidemiology at the University of California, Los Angeles, there is no transition period for the medical system to prepare for this. China would benefit from this policy adjustment if only a tiny percentage of the resources spent on COVID-19 testing and containment could be allocated elsewhere.

China's National Health Commission did not respond to requests for comment on the resiliency of the health system and the availability of medical personnel, whether there were contingency plans to deal with soaring hospital admissions, and whether strict coronavirus measures had impeded medical capacity improvements.

State-run media have maintained Beijing's strategy while recasting their narrative to stress the milder nature of the Omicron variety. In a review of China's COVID-19 replies, the official Xinhua news agency stated on December 9 that Xi had "done the right thing" by taking "decisive measures to halt the spread of the virus."

Official data

As the outbreak spreads, it is unlikely that official data on severe cases and mortality rates will accurately reflect the situation, according to specialists such as Mike Ryan, WHO's head of emergencies. Funeral businesses and crematoriums in Beijing are straining to fulfill demand.

Since the reopening, the National Health Commission has reported only a handful more COVID-related deaths, bringing China's official death toll from the pandemic to 5,241, which is extremely low compared to the rest of the world.

Meanwhile, a three-week-old effort to vaccinate the elderly has yet to produce fruit. According to government data, China's overall vaccination rate is greater than 90%, while the rate for adults who have received booster injections lowers to 57.9% and 42.3% for those aged 80 and older.

China has declined to distribute Western-made mRNA vaccinations, which, according to studies, are more effective than its own. According to more than a dozen experts, the inability to increase vaccination rates among the vulnerable could threaten China's health care system.

Hiroshi Nishiura, a member of Japan's COVID task team, stated, "As we have seen in Hong Kong, unvaccinated older people are at a particularly high risk of death, and healthcare capacity in China may soon be swamped by caseload demand."

In November, national protests occurred because of widespread discontent with China's regular lockdowns and stringent pandemic controls. Within days, Beijing abruptly relaxed its zero-COVID regulations.

Since then, there have been smaller protests at medical schools, with students who serve on the front lines seeking better protection and medical supplies. On December 14, the death of a 23-year-old medical student in Chengdu ignited public outrage over the strain on China's health system.

"We're at the bottom of the food chain at the hospital," claimed a 26-year-old medical student in northern China, afraid of official reprisal. If we're on the front lines, we don't have adequate protection: we've been requested to reuse face masks.

Slowed investment

Due to China's centralized medical system, people with even moderate symptoms were compelled to be hospitalized due to the country's efforts to eradicate COVID. The administration began allowing home quarantine on December 7.

While China's Centre for Disease Control and Prevention repeatedly warned that a widespread epidemic would have disastrous consequences for the health system, the insistence on eradicating the virus stretched medical resources.

Some experts, such as Hong Xiao, a researcher at the Fred Hutchinson Cancer Research Center in Seattle, asserted that zero-COVID was costly and dangerous to public health, as it diverted funds and medical personnel to the pandemic front line and prevented patients with other conditions from receiving treatment.

According to other researchers, the current threat to China's healthcare system has been overblown.

Chen Jiming, a researcher at China's Foshan University, opined that the country's medical system will likely be able to manage now that the quarantine for asymptomatic and moderate cases has been lifted.

He stated, "I now believe China can effectively limit the impending COVID-19 epidemic." Currently, the medical systems are under significant stress, but I believe the government can handle it.

Despite this, official records indicate that China's investment in medical resources such as hospital beds and the growth rate of medical staff declined during the epidemic. While overall health expenditures increased from 2019 to 2021, they decreased as a percentage of GDP for the first time in over six years, to 6.5% in 2021 compared to 7.1% in 2020 and 6.5% in 2019.

It is unknown how much was spent on quarantine facilities or testing. Still, analysts' estimates compiled by Reuters in May pegged China's COVID-related spending for this year at almost $52 billion.

In response to an increase in infections, authorities have attempted to catch up. According to a Reuters examination, the number of local government bids for the acquisition of ventilators and patient monitoring has increased. Between November 15 and December 15, 423 requests for ventilators were advertised, up from 283 the previous week and 200 before that.

Patients have flocked to hospitals and clinics following three years of government propaganda about the risks of the virus, even though the government has changed its message and now urges people to stay home unless they are incredibly ill.

Infected patients have reportedly camped outside clinics in Tianmen, a tiny city near Wuhan, while receiving intravenous drips, according to photographs provided by a local with Reuters.

Reuters got a film from Hanchuan, Hubei province, on December 14 showing patients receiving IV fluids through vehicle windows while seated in their cars.

In specific locations, the absence of clear guidelines regarding what to do when someone is sick contributes to confusion.

A top physician at a Beijing public hospital stated that all surgeries had been canceled except those in which the patient would likely die the following day.

"Up to 80% of doctors in Beijing's most prestigious hospitals are infected with the virus but are forced to continue working," he told Reuters anonymously because he was not authorized to speak with the media.

According to the World Health Organization, China has approximately two physicians per 1,000 individuals, compared to 4.3 in Germany and 5.8 in Britain. Moreover, it has 3.6 intensive-care beds per 100,000 people, compared to 34.7 in the United States, 29.0 in Germany, and 12.5 in Italy, according to data from the World Population Review.

No roadmap

China had other imperatives for implementing a rigorous zero-COVID approach this year, considering the risk posed by a significant outbreak to major events. Before the February Olympic Winter Games in Beijing, the government reinforced pandemic controls, and state media warned of the virus's hazards.

Ahead of an October Communist Party meeting when Xi sought to solidify his leadership for a third term, authorities reiterated that zero-COVID could not be deviated from despite the economic costs and warned of the dangers of any reopening.

"Once epidemic prevention and control are relaxed, a large number of people will be infected within a short period, and a large number of severe cases and deaths will occur, causing a shortage of medical resources," the People's Daily, the party's official newspaper, wrote in an October 12 commentary urging adherence to zero-COVID.

As Xi tightened his hold on power and focused on eradicating the virus at any cost, China's leadership did not reveal a plan to break free of its stifling constraints.

When the number of illnesses began to skyrocket in recent weeks, it became evident that the virus had overcome the zero-COVID safeguards.

However, due to Xi's abrupt U-turn, many businesses were unprepared with sick-leave policies or protective equipment. Many Chinese citizens, unaccustomed to treating COVID at home, swarmed pharmacies searching for cold and flu remedies.

Local media noted that workers with moderate symptoms might continue to work in certain places, adding to the confusion. This week, a Shanghai hospital informed its personnel to prepare for a "tragic struggle."

At least ten medical specialists who talked with Reuters anticipate a surge in illnesses during the next one to two months, around the Lunar New Year vacation beginning on January 21.

Keith Neal, emeritus professor of epidemiology of infectious diseases at the University of Nottingham, stated that a death toll comparable to that of Hong Kong earlier this year is "a good indicator of what may occur" in mainland China.

"The greatest problem will be a significant number of serious infections and deaths in a community that has not been infected or vaccinated," he said.

The Institute of Health Metrics and Evaluation at the University of Washington, based in the United States, predicted last week that the abrupt easing of China's COVID limitations will result in over one million fatalities by 2023.

Nora reported an increase in new infections at her Shanghai hospital, although the figures were not made public. Physicians are concerned about infecting patients and family members.

She remarked, "The hospital does not have a proper plan to deal with all the challenges, and the policy is constantly changing."