(CNN) — China’s abrupt and unprepared exit from the strategy of zero covid could cause nearly 1 million deaths, according to a new study, as the country braces for an unprecedented wave of infections that would spread from its biggest cities to its vast rural areas.
For nearly three years, the Chinese government has used strict lockdowns, centralized quarantines, mass testing, and rigorous contact tracing to slow the spread of the virus. That expensive strategy was abandoned earlier this month, following an explosion of protests across the country against the strict restrictions that have upended business and daily life.
But experts have warned that the country is ill-prepared for such a drastic exit, failing to bolster the vaccination rate for the elderly, increase intensive care capacity in hospitals and stockpile antiviral drugs.
Under current conditions, a nationwide reopening could result in as many as 684 deaths per million people, according to projections by three professors at the University of Hong Kong.
Given that China’s population is 1.4 billion people, that would equate to 964,400 deaths.
The rise in infections would “likely overload many local health systems across the country,” said the research paper, published last week on Medrxiv’s preprint server and which has not yet undergone peer review.
The simultaneous lifting of restrictions in all provinces would generate hospitalization demands of 1.5 to 2.5 times the maximum hospital capacity, according to the study.
But this worst-case scenario could be avoided if China quickly implements booster vaccinations and antiviral drugs.
With 85% fourth-dose vaccination coverage and 60% antiviral coverage, the number of deaths can be reduced by 26-35%, according to the study, funded in part by the Chinese Center for Control and Disease Prevention (CDC) and the Hong Kong government.
On Monday, Chinese health authorities announced two deaths from Covid, both in the capital Beijing, which is dealing with its worst outbreak since the start of the pandemic.
They were the first officially reported deaths since the dramatic relaxation of restrictions on December 7, though posts on Chinese social media have pointed to a surge in demand at Beijing funeral homes and crematoriums in recent weeks.
An employee at a funeral home on the outskirts of Beijing told CNN they were overwhelmed by the long lines for cremation and that customers would have to wait until at least the next day to cremate their loved ones.
On Baidu, China’s main online search engine, searches for “funeral homes” by Beijing residents have hit a record since the pandemic began.
Other major cities are also facing a surge in infections. In Shanghai’s financial hub, schools moved most classes online starting Monday. In the southern metropolis of Guangzhou, authorities have told students already taking online classes and preschoolers not to prepare for a return to school.
By contrast, in the southwestern megacity of Chongqing, authorities announced Sunday that public sector workers who have tested positive for Covid can go to work “as usual,” a notable change for a city that only a few years ago. weeks he had been in the midst of a mass lockdown.
It is difficult to judge the true scale of the outbreak from official figures. China stopped reporting asymptomatic cases last week and admitted that it was no longer possible to track the actual number of infections. These asymptomatic cases used to represent the majority of the country’s official cases. But the rest of the case count has also lost meaning, as cities scaled back mass testing and allowed people to use antigen tests and isolate at home.
Chinese experts have warned that the worst is yet to come. Wu Zunyou, chief epidemiologist at the Chinese CDC, said the country is being hit by the first of three waves of infections expected this winter.
Speaking at a conference in Beijing on Saturday, Wu said the current wave would last until mid-January. The second wave is expected to last from late January to mid-February next year, triggered by mass travel ahead of the Lunar New Year holiday, which falls on January 21.
Every year, hundreds of millions of people who have left their hometowns to build a life in China’s fast-growing cities hop on trains, buses and planes to see family, a known multi-week travel rush. as the largest annual human migration on Earth.
For three consecutive years, the authorities have discouraged these trips under the zero covid policy. And experts warn that with the lifting of domestic travel restrictions, the virus could spread into China’s countryside, where vaccination rates are lower and medical resources are lacking.
A third wave of cases would run from late February to mid-March when people return to work after the week off vacation, Wu said.