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A month after scrapping most of its zero-Covid restrictions, China is experiencing all at once what many other nations have been navigating for three years.

Infections have skyrocketed, medical facilities are stretched to their limits and the elderly and infirm are dying, although official government numbers are seen by public-health experts as vastly underestimating Covid-related deaths.

At the same time, parts of the economy are bouncing back as commuters pack subways and restaurants, workers resume normal routines and domestic tourists are once again on the move.

It is a combustible mix and the outcome is particularly difficult to predict. No other country instituted zero-tolerance measures as widely for as long—and few shed controls as abruptly.

Recent interviews with doctors, business owners and other urban and rural residents reveal both optimism and trepidation, as well as resentment among those with family members who have died, who blame the government for acting recklessly.

There are a wide range of possibilities for what comes next, from a relatively quick bout of infections followed by an economic rebound to a more serious public-health crisis, especially in poorer areas. How it plays out will have ramifications for Chinese leader Xi Jinping’s leadership for years to come.

One doctor on the front lines of the Covid-19 outbreak in Chongqing, a sprawling city on the Yangtze River, said she had been treating around 160 patients a day recently, four times the normal level. At the busiest point of the day, she said, she saw patients nearly every two minutes, many in their 70s and 80s and suffering respiratory illnesses tied to Covid.

“This situation is a huge contradiction,” said Xiao Yuan, 33 years old, who owns two coffee shops in Chongqing, including one adjacent to the emergency ward of a major hospital.

During recent lockdowns in the city, she said, business owners like her were desperate to reopen, questioning the wisdom of a government policy that deprived them of a living. Now, families of Covid patients had been stopping by for coffee. “We’re faced with this really sad thing,” she said. “We’re learning that old people in our friends’ families are dying because of the reopening.”

Before the December reopening, anger over the government’s zero-Covid approach sparked mass protests in Beijing and other cities, presenting the greatest public challenge to Mr. Xi in his decade-plus rule. Today, there is concern about a hidden surge of deaths as Covid-19 spreads across the countryside, where healthcare is less developed.

During the Lunar New Year holiday travel period, which runs from early January to mid-February, Chinese people are expected to crisscross the country, making more than two billion trips, as they travel home to see family, in some cases for the first time since the pandemic started. Many will carry the virus with them.

The government has made it clear that its priority is restoring the economy to the engine of growth it once was, with planners aiming for greater than 5% growth in gross domestic product this year. After years of dire warnings about Covid’s dangers, officials now are portraying the Omicron variant as significantly weaker than earlier strains, encouraging workers to get back to their normal routines, even, in some cases, if they are testing positive.

In his annual New Year’s Eve address, Mr. Xi acknowledged that some had suffered as a result of his Covid policies, but sounded an optimistic note, saying “the light of hope is right in front of us.”

Over the weekend, taking advantage of loosened travel restrictions, domestic tourists strolled around Chongqing’s historic sites and streamed into its teahouses, while thousands of revelers attended an outdoor light show.

Subway ridership was up across the country in the first week of January after plummeting in several cities in previous weeks, while road traffic had mostly recovered from a 20% drop in late December, according to data compiled by Goldman Sachs.

On Baidu Inc.’s search engine, however, queries for antiviral drugs such as Paxlovid soared at the end of December and remain elevated.

Before they stopped publicizing daily pandemic data on Jan. 9, health authorities were reporting fewer than 15,000 new Covid infections a day and daily deaths in the single digits—numbers that the World Health Organization criticized earlier this month as underestimating the toll.

Minutes from a Dec. 21 meeting show China’s top health officials inferred that almost 250 million people in the first 20 days of the month had been infected. On Monday, health officials in Henan said nearly 90% of the central Chinese province’s 100 million people had been infected as of the previous Friday.

The Omicron variant has been spreading fast through a population that had little previous exposure to the virus and limited access to cutting-edge vaccines or treatments. Few deaths are being officially attributed to Covid-19, but doctors and family members of those who have died blame the virus for long lines of bodies waiting to be processed at crematories.

London-based health analytics firm Airfinity estimated in late November that a lifting of zero-Covid measures in China could lead to between 1.3 million and 2.1 million deaths. That works out to between 92 and 150 deaths per 100,000, still lower than the 333 per 100,000 in the U.S.

Sherry Zhou was following developments in China from her home in the U.S. when she received a text message on Dec. 23 from her mother saying her 77-year-old father wasn’t doing well. Ms. Zhou knew that her father, who had been in a hospital in Shanghai for more than a year following a lung infection, had developed a fever that hit 104 degrees two days earlier, but she had been reassured by reports that antiviral drugs such as Paxlovid were available in China.

Ms. Zhou said she called her mother, who was sick with Covid and had trouble communicating. She then called the orderly taking care of her father, who also was sick with Covid. She recalled the orderly telling her: “Your dad might not make it,” and that the hospital was able to give him oxygen but had no antivirals.

Ms. Zhou and her sister, also in the U.S., scoured the internet for antivirals that could be administered to their father but came up empty-handed. Six hours after her mom’s text, Ms. Zhou’s father died.

Publicly released Chinese-government data show eight Covid deaths in China from the beginning of December to the day Mr. Zhou died. None were in Shanghai.

“Look at how little the regime did to prepare for opening up society,” said Ms. Zhou. “They knew the consequence of the shortage of lifesaving medications, but they still went ahead.”

In response to a request for comment, China’s National Health Commission referred to a press briefing in late December in which health officials described the reopening as well timed and said pharmaceutical companies in the country are stepping up efforts to manufacture cold medicines and develop drugs to treat Covid.

A delivery worker in Shanghai said he sees white flower wreaths every day hanging on the doors of the apartments where he makes deliveries, a sign that the family has had a death.

To earn a living, he said, he had been compelled to sleep outside during a monthslong lockdown in the city last year because apartment buildings wouldn’t allow residents to come and go. He said he also worked briefly as a zero-Covid enforcer, but lost his job when the policy was scrapped. He became infected himself and he had trouble breathing for 10 days, he said.

“This disease isn’t a common cold,” he said repeatedly, accusing authorities of hiding the scale of the virus’s toll.

Yin Yu, a 52-year-old office worker in the inland city of Lanzhou, said most of her family and friends had contracted the virus in recent weeks but recovered largely without needing medical help. “If you can’t control the virus, you might as well open up,” she said, adding that people couldn’t bear the lockdowns any longer. “The rest of the world has already moved on.”

State media portrays zero-Covid as a success and has played down the wave of new infections. Recent reports have stressed how current Covid-19 variants are less dangerous than earlier ones.

Derek Lin, a technology product manager in the southern city of Shenzhen, is among those who said they wish the government had relaxed its Covid-control policies sooner. He watched celebrations among his friends on the Chinese messaging platform WeChat when the government lifted Covid restrictions last month.

When Mr. Lin himself contracted Covid, he reflected on what many in China have come to see as wasted time. He said the government had long succeeded in curbing Covid, but was too slow to adapt when the more contagious Omicron variant emerged. “I felt I did nothing this year,” he said.

In Chongqing, subway ridership was up 30% to start the year. On a recent night, pedestrians packed a popular street lined with food stalls. Most tables at a local steakhouse were full.

Restaurant owner You Hui said business dropped by two-thirds after the loosening of Covid controls as many people grew sick or became scared to go out to eat. Since then, she said, business has partially recovered, and is now down by about a third.

Large but orderly crowds filled emergency rooms last week at several hospitals in Chongqing, with some patients requiring supplemental oxygen or intravenous drips. Pharmacies in the city appeared to be well-stocked with fever medicines that previously had run short in some places.

A potentially bigger challenge looms as the virus reaches more rural areas with inferior medical care. The Chongqing hospital doctor said she saw patients arriving at her hospital from the countryside because ventilators in rural counties were all in use.

In Fengdu County, 70 miles down the Yangtze River from central Chongqing, residents said the Lunar New Year migration was already under way. Teslas, Mercedes and a couple of Bentleys with out-of-town license plates from wealthier coastal regions are cruising its streets and country roads.

Source: Wall Street Journal January 12, 2023 | By Brian Spegele