China’s Covid Tsunami Recedes, Bringing Relief, Grief and Anxiety

When China abruptly abandoned “zero Covid,” accelerating an onslaught of infections and deaths, many feared a prolonged tide rippling from cities into villages. Now, two months later, the worst seems to have passed, and the government is eager to shift attention to economic recovery.

Doctors who were mobilized across China to treat a rush of Covid patients say in phone interviews that the number of patients they are now seeing has fallen. Towns and villages that had hunkered down under the surge of infections and funerals are stirring to life. Health officials have declared that Covid cases “already peaked in late December 2022.”

“Now the pandemic is already being forgotten from people’s minds,” Gao Xiaobin, a doctor on the outskirts of a small city in Anhui Province in eastern China, said by telephone. “Nobody is wearing masks anywhere. That’s all gone.”

The true toll of the outbreak is hard to delineate, with infections and deaths shrouded by censorship and poor data collection. Officially, China has reported nearly 79,000 confirmed Covid-related deaths that occurred in hospitals since Dec. 8. But researchers say that is a drastic undercount because it excludes deaths outside hospitals.

The Communist Party hopes to bustle past such questions and focus on reviving China’s economy, battered by lockdowns. Restoring growth could help repair the image of its leader, Xi Jinping, bruised after three years of stringent “zero Covid” policies — which had largely contained the virus but strangled the economy — and then their abrupt, messy abandonment in December. His government’s standing will now rest heavily on whether it can create jobs, including for a large pool of unemployed youths and graduates.

Mr. Xi struck a positive note even as he has acknowledged that Covid outbreaks remain worrisome. “The dawn is just ahead,” he told the country in a speech on Jan. 20, shortly before the Lunar New Year holiday.

Provincial and city leaders have declared, one after another, that infections have peaked in their areas. Some of China’s economic powerhouse regions have issued plans for restoring business confidence. Speaking about economic revitalization last week to hundreds of officials, Huang Kunming, the Communist Party leader of Guangdong Province in southern China, did not mention the pandemic at all.

The government has sought to shape the public narrative about the outbreak by limiting information and censoring criticism of its response. Still, anger mounted over shortages of basic medicines and the government’s obfuscation of the death count from Covid while lines at funeral parlors grew and city morgues overflowed with bodies.

But for many Chinese people, the imperative to move past the pandemic and make a living in a hardscrabble society may, in the end, overshadow their grievances.

In phone calls to dozens of residents across China, many said they were more worried about finding work, rebuilding businesses and securing a future for their children.

“People don’t even talk about Covid anymore,” said Zhao Xuqian, 30, who said he lost his last job at a flour factory in the central Chinese city of Zhengzhou and returned to his home village in Anhui Province. He was thinking about finding a new job in the coming weeks.

“The new year has started,” he said. “We should forget the past and face forward.”

Even as Chinese medical officials signaled that infections have been falling, they have also warned that the country remains vulnerable to fresh outbreaks, especially in rural areas where medical services are much scarcer than in cities.

“A new peak in infections could emerge in the areas that lack doctors and medicine, those — less than 10 percent nationwide — that have not completed the full vaccination round,” Gao Fu, a former director of the Chinese Center for Disease Control and Prevention, told China Newsweek magazine earlier this month. “I still want to urge everyone to set aside the most important medical resources for the high-risk groups that are aged or have underlying illnesses.”

To limit the toll of any new outbreaks this year, China will also have to administer more vaccination jabs and booster shots, especially among the country’s older adults, and better equip hospitals to cope with patients who have not yet had Covid, several doctors and epidemiologists said.

The next wave may not be as massive, but it could concentrate its wrath on the vulnerable places and people that managed to avoid infection in the recent surge.

Some Chinese health officials estimate that as much as 80 percent of the country’s 1.4 billion people were infected in late 2022. (Other experts are skeptical of that estimate, saying that even with the swift transmissibility of the Omicron variant, it is unlikely that it could have infected so many people in such short order.)

“Future death projections will be partially determined by how well China could protect those who are of higher risks but are still hunkering down,” Xi Chen, an associate professor at the Yale School of Public Health who has monitored China’s Covid pandemic, wrote in emailed answers to questions.

Covid outbreaks in China multiplied late last year as the fast-spreading Omicron variant wore down armies of local officials enforcing lockdowns and travel restrictions. The surge grew into a tsunami after Mr. Xi lifted the pandemic restrictions, apparently shaken by protests across the country and the deepening economic slump.

What surprised some was how quickly Covid jumped to China’s countryside. Like many doctors, Wang Guocai expected his village in southern China to be hit with infections some weeks after the Omicron subvariant swept big cities. Instead, the outbreak seemed to arrive in full force mere days after it inundated Guangzhou, the provincial capital nearly 200 miles away, he said.

At first it was mostly young people who lined up at his rural clinic. Many were migrant workers and businesspeople who had recently returned. Then growing numbers of villagers in their 60s, 70s and 80s crowded the clinic every day, Dr. Wang said in a telephone interview.

In December, he was seeing dozens of patients each day and handing out tablets for fevers and coughs, he said, but now he is seeing only several a day. He said he was relieved that his village appeared to have avoided deaths.

“Our village was lucky in that, to date, it hasn’t had any fatal cases,” Dr. Wang said. Other villages nearby were less fortunate, he said, though he said he was unclear about the precise number of deaths. “They were all patients who had quite serious existing conditions.”

China’s official death toll falls far short of initial projections by experts such as Bill Hanage, an associate professor of epidemiology at the Harvard T.H. Chan School of Public Health. He had earlier estimated that China’s Covid eruption could cause 2 millions deaths.

“I don’t think we have any insight into what has actually happened, beyond the reasonable assumption that the true numbers are far larger than the official ones,” Professor Hanage said.

Instead, Chinese people have built up a mosaic of impressions and stories about how their hometowns have fared.

Lu Xiaozhou, a writer from Hubei Province in central China, wrote online that 10 to 20 older residents had died in his home village of several thousand people during the recent Covid wave, and that “counts as very lucky.” Li Jing, a farmer and former migrant worker from Yulin, a rural area of northwest China, said that even though his own family’s older relatives survived the outbreak, other families were not as fortunate.

“There have been a lot of funerals in the county lately, I’ve seen them,” he said by telephone. Asked about the future, he said: “Now I don’t feel anything. I just want everything to go back to normal, that’s all.”

The resumption of normal life poses the risk of another surge of infections, especially after the one- or two-week-long Lunar New Year break, when many rural migrants who had traveled to their hometowns for family reunions start to return to cities. As people start moving again, so could the virus, and those who have avoided infection up to now may be exposed.

In the following months, the protection offered by recent vaccinations or immunity developed from infections will wear off, exposing people to renewed risks from Covid unless they receive more shots. There is also the potential danger of new subvariants, possibly less virulent but more transmissible.

“My other family members were all infected, but not me,” Wang Xiaoyan, a resident of Ankang, a city in northwest China, said by telephone.

She said she had stayed in her own house and kept a distance from relatives returning to their home village in December. She only joined her extended family for Lunar New Year feasts of dumplings, stews and fish after the relatives among them who had Covid had recovered. Now she fretted about what might come next.

“I’m worried — worried about getting infected,” she said. “I still wear a mask now, though basically nobody else does.”