China: More than a million could die from COVID in 2023

When China relaxed its zero-COVID policy at the start of December, international observers warned there would be mass outbreaksin the Chinese population, which, it was estimated, lacks sufficient herd immunity or vaccine protection.

One statistical model published by healthdata.org predicts that 300,000 people could die from COVID-19 infections by April 2023 and 1.6 million people could die by the end of the year.

"Infections are steeply on the rise and hospitals are overwhelmed. It's quite [certain] that the situation is spiraling out of control, at least in Beijing and other big cities," said Björn Alpermann, a sinologist at the University of Würzburg in Germany.

COVID wave in China 'thermonuclear bad'

On December 19, a prominent epidemiologist, Eric Feigl-Ding, tweeted that the situation was "thermonuclear bad."

Feigl-Ding predicted "over 60% of China's and 10% of the Earth's population likely infected over the next 90 days. Deaths likely in the millions — plural."

In scenes reminiscent of the early months of the pandemic in 2020, Feigl-Ding posted a video of what looks like an overcrowded hospital, with patients lying close next to each other on the floor.

Other reports suggest morgues and crematoriums are overloaded, with backlogs running into the thousands. "The reports that crematoriums are working 24/7 are deeply disturbing," said Alpermann.

How accurate are the statistics?

It's not known how many people are currently infected with COVID-19 in China or the number of those who have recently died from the disease.

Oliver Radtke who lives in Beijing and is the chief representative of the Heinrich Böll Foundation, an independent political foundation affiliated with Germany's Greens, said it was impossible to know how severe the current COVID wave was by reading the official statistics.

"Judging strictly from personal evidence, scrolling through WeChat [social media] and having conversations with colleagues and friends, I reckon about one third in the city is sick, one third is taking care of the sick and one third simply doesn't dare to venture out," Radtke told DW.

Alpermann said the Chinese government had more or less admitted that its statistics were artificially low when it said that it would only count COVID deaths that had happened due to lung failure. That's Alpermann's personal assessment, but it suggests that those statistics tell only a partial truth.

The lack of accurate statistics about the current COVID situation in China makes predictions about deaths and illness difficult.

"There are so many moving parts in models, so there's a lot of guess work. The subvariant [of omicron, BF.7] circulating in China now isn't well studied, and we don't know how fast people will get boosters this winter," Alpermann said.

Booster campaign to target elderly

So, how are Chinese health authorities responding to the situation? Radtke said authorities had placed responsibility on individuals to keep safe.

"The official slogan these days is 'everybody is responsible for the prevention and control of the pandemic,'" he said.

But the Chinese National Health Commission (NHC) has initiated a large vaccination and booster campaign, especially for the elder and other high-risk groups.

Many health experts outside China have been critical about the effectiveness of Chinese vaccines from Sinovac and Sinopharm compared to mRNA vaccines, such as the BioNTech-Pfizer and Moderna jabs — and the NHC is only administering vaccines made in China.

However, reports suggest they may include new nasal spray vaccines in the booster program. The hope is that the new vaccine types will reduce COVID transmission as well as the risk of severe COVID-19 symptoms.

"Worries about grandparents and older parents are high. Especially regarding family members in the countryside and [remote] provinces, where Intensive Care Unit beds are rare or non-existent," said Radtke.

What caused the latest COVID outbreak in China?

Experts say that the current infection and death rates in China may be because the country has a lower level of population immunity than that in other countries. 

"The Chinese government boasted they won a victory against COVID with their zero-COVID strategy. For some time it looked that way in 2021, but with omicron the picture completely changed," said Alpermann.

China has pursued a zero-COVID policy since the pandemic began.

During zero-COVID, the government implemented mass testing, imposed strict lockdowns and quarantined those people with COVID-19 in special facilities.

Now that it has relaxed its lockdown rules, the population has been going out but with very little natural exposure to infection, especially the more contagious variants, such as omicron — because they were locked in for all that time. In any case, that is the theory you hear from health experts outside China.

Rates of booster vaccine uptake are estimated to be low in China, especially among older people who have a higher risk of developing severe symptoms — only about one-third of over-80s and two-thirds of over 60s have received their first booster shot, according to official data.

"In retrospect, it now looks like the Chinese government did not use the time during zero-COVID to their own advantage to get vaccination rates as high as they should have been. They did not import more advanced mRNA vaccines or approve mRNA vaccines created in China," Alpermann said.

The first of three waves

Speaking at a conference in Beijing on December 17, Zunyou Wu, a chief epidemiologist at the Chinese Center for Disease Control and Prevention, said that the current outbreak would peak this winter and run in three waves for about three months.

The modelling mentioned at the start of this article puts the potential death rate as high as 1.6 million people by the end of 2023. But that depends on whether COVID transmission can or will be contained with new lockdowns and by the success of vaccination programs.

"I am worried about what happens once the current wave reaches the lesser-developed parts of the country, especially in the western hinterland," said Radtke.

Whatever the exact figures, Chinese health authorities appear to be struggling to keep up with the spread of the disease, and that continues to cause concern outside of the country as well.

Edited by: Zulfikar Abbany