China’s care homes rush to protect elderly residents from Covid surge

AS Covid spreads rapidly across China, elderly care homes are barricading their doors in an attempt to save their vulnerable patients.

In cities including Beijing, Shanghai and Nanjing, local governments are enforcing on care homes the same closed-loop system that factories adopted during earlier outbreaks. No one comes, and no one goes. Staff are forced to live on site.

Time is running out. Evidence from around the world shows that facilities for seniors often see the biggest waves of deaths, which is why countries prioritized vaccinating care home occupants first.

That’s not been the case in China, where 38,000 homes provide beds for 8.2 million seniors according to 2020 data.only42percentofthoseagedover 80 have had booster shots. That’s well below the levels seen in other countries that reopened after abandoning strict approaches toward the virus.

“It’s just the start of a real tough time,” read a statement from Pudong Shinan Nursing Home in Shanghai explaining its new rules this week. “When the experts say 80 percent-90 percent of the population will eventually get infected, we are scared!”

National Health Commission officials last week gave rudimentary advice to care homes facing potential outbreaks of Covid. Minimize the risk of infection by improving ventilation, practicing hand hygiene, wearing masks and avoiding gatherings. They also urged the elderly to get vaccinated, without making shots mandatory.

Persuading the elderly has proven to be a tough task. Many older Chinese are reluctant to get vaccinated, said Feng Wang, a sociology professor at the University of California, Irvine. Forcing them to get vaccinated risks creating a backlash in a society that traditionally has emphasized respecting seniors, he said.

“It’s a tremendous gamble,” said Wang. “If an elderly person resists, I’m pretty sure there will be a lot of reluctance among the nurses, the local neighborhood committees and officials to force elderly people to take the vaccine.”

The cost of such hesitation may be large. China could see some 5 million people hospitalized and up to 700,000 deaths after abandoning Covid Zero, according to Bloomberg Intelligence chief pharmaceutical analyst Sam Fazeli.

When Omicron overwhelmed Hong Kong early this year, undervaccinated residents at care facilities accounted for many of the thousands of deaths that followed.

At Xiangfu Nursing Home in Shanghai, staff are settling in for the long haul.

“Faced with menacing outbreaks, we have to remain alert and respond anytime to what the government calls for, to ensure Covid control and safety of the elderly,” Xiangfu said in a statement.

‘Let it rip’ approach

MEANWHILE, China seems to be embracing a fast and explosive Covid reopening, a risky approach that’s worrying observers given the vast country’s vulnerabilities.

Since embarking on a landmark shift away from its zero-tolerance policy just a week ago, China has dismantled most of its internal restrictions, casting aside the stringent playbook used to eliminate the virus for the past three years.

The rapid reversal is resulting in an eruption of cases, particularly in Beijing where the once expansive PCR testing apparatus appears to have been abandoned. The spread is so significant it’s rendered official Covid statistics all but meaningless, and seen hospitals in the capital already overwhelmed.

“Logic doesn’t seem to apply here,” Bloomberg Intelligence’s chief pharmaceutical analyst Sam Fazeli said in a TV interview. China’s mindset since pivoting away from Covid Zero is “there’s not so much we can do, we’ve done the best we can. We’ve got the blueprint for what the West did and what happened, so let’s just let it rip—which is what I think is going on,” Fazeli said.

The unexpected about-turn— most economists, and Bloomberg Economics, were expecting a gradual, controlled exit from Covid Zero—is raising alarm given China is in the midst of a cold winter, its elderly vaccination rate is still well below other countries and the country’s healthcare system is under-resourced.

It’s unclear whether China has had time to stockpile anti-virals and other contingencies needed to handle what top Covid adviser, Zhang Wenhong, called a “massive” looming outbreak.

People’s frustration

THE rapid shift ref lects people’s frustration at Covid Zero, said Steven Lynch, managing director of the British Chamber of Commerce in China. Snap lockdowns, frequent mass testing and mandatory quarantine for all those exposed to Covid were hallmarks of the stringent approach, which worked during the initial wave in Wuhan, but became almost impossible to maintain as the virus became more contagious in 2022.

The tough measures weighed on the world’s second-largest economy and disrupted people’s lives, culminating in a remarkable weekend of protests across China’s major cities.

“I wasn’t expecting China’s exit strategy to be so rapid,” said Lynch. “I thought it would be a gradual process. But again, you know, this speaks to the outpouring of anger and anxiety that people have had around Zero Covid.”

Milder strain

WHILE it’s difficult to gain insight into Chinese government decisionmaking, President Xi Jinping may have calculated that the current Covid strain in circulation is mild enough to risk a rapid lifting of controls, said Drew Thompson, visiting senior research fellow at the Lee

Kuan Yew School of Public Policy at the National University of Singapore.

The pandemic has forced governments around the world to draw on different policymaking frameworks, and China is no exception, said Richard Mcgregor, senior fellow for East Asia at the Lowy Institute in Sydney.

“China doesn’t usually make such abrupt about turns—they usually stress test new policies in local experiments before rolling them out nationally,” he said. “The government now seems to have finally been convinced that the old approach was leading to disaster. The protests were important but I think the pivotal issue is the tanking economy.”

New Year risk

ECONOMISTS have had to quickly revise their forecasts for how China’s reopening may play out, as curbs fell away and cases surged.

China is now on track to be free of Covid restrictions by the end of March, Bloomberg Economics chief Asia economist Chang Shu wrote in a note Wednesday. That’s three months ahead of her earlier estimate, which presumed a more controlled exit.