New Coronavirus News from 28 Jan 2023

‘So broken’: virus exposes ‘serious deficiencies’ in Chinese healthcare [South China Morning Post, 28 Jan 2023]

• China spent enormous sums of money on building isolation facilities and makeshift hospitals, as well rolling out mass testing
• But after Beijing abruptly pivoted from zero-Covid, a surge in infections overwhelmed the medical system, highlighting deficiencies

China’s investment to fight the coronavirus, particularly the construction of makeshift hospitals, has exposed “serious infrastructure deficiencies in healthcare and pandemic prevention” and left those on the front line questioning why the medical system is still “so broken” after three years.

The country of more than 1.4 billion people spent enormous sums of money on building isolation facilities and makeshift hospitals, as well rolling out mass testing, over the course of its hardline zero-Covid strategy.

Guangdong province alone spent 71.1 billion yuan (US10.5 billion) on prevention and control last year, according to its fiscal report released in early January, an increase of 57 per cent on 2021. This almost doubled its cumulative spend for the last three years to 146.8 billion yuan.

Fujian province in southeast China also invested 13.04 billion yuan last year to tackle the coronavirus pandemic, up 56 per cent from 2021. Over the past three years, it has spent a total of 30.5 billion yuan, according to its fiscal report released in January.

China might have spent 25.4 billion yuan last year on the construction of makeshift hospitals, plus a total of 739.3 billion yuan on nucleic acid testing sites, which is higher than Luxembourg’s 2022 gross domestic product, according to a report by Minsheng Securities in May.

China, though, has a fiscal surplus of 2.4 trillion yuan and a 1 trillion yuan social security balance, which could guarantee coverage of Covid prevention, according to the report.

“Such coverage requires a prerequisite that the disruption to the economy from pandemic prevention does not deepen any further,” the report said.

“The pressure of pandemic prevention on fiscal revenues and expenditures will be in the short term, while more pressure will come from a decline in the revenue side of the equation.”

At the start of December, amid the latest surge in cases, the central government asked local authorities to ensure special needs beds made up 10 per cent of the total available when upgrading makeshift hospitals into sub-designated hospitals with medical resources.

"Our hospital was a mess, we didn’t know what was going on with the patients we were accepting" Dr Zhou

This followed a request for each province to establish at least two to three makeshift hospitals by the National Health Commission in March during the Omicron outbreak, when there were 33 makeshift hospitals with a total of 35,000 beds.

But after Beijing abruptly pivoted from its strict zero-Covid policy last month, a surge in infections overwhelmed hospitals and morgues, while many pharmacies also ran out of fever medication and painkillers.

The shortage of medical resources is “unlike anything I’ve seen in all my years in the medical field,” said Zhou, a doctor at a public hospital in a southern Chinese city, who declined to give his full name due to the sensitivity of the matter.

“We issued nearly 80 death certificates in one week, but we normally only issue one or two per month,” he said. “We even ran out of special paper for death certificates and had to write temporary copies.”

After zero-Covid was abandoned, Zhou said he and his colleagues were simply confused, as they had not systematically studied Sars-Covid treatment during the three-year pandemic.

“Our hospital was a mess, we didn’t know what was going on with the patients we were accepting and we were scrambling our ventilators when patients needed intubation,” said Zhou.

According to the doctor, the makeshift hospitals played a relatively effective role at the beginning of the pandemic, as they were able to quarantine infected patients to prevent the spread of the virus.

“But we haven’t established a medical system that can defend against the coronavirus in these three years, the role of the makeshift hospital is very limited since what the patients need more is actually oxygen masks and ventilators,” said Zhou.

“If China had spent more than 730 billion yuan on medicine [research and development], the expansion of ICU beds, and the recruitment and training of medical staff, the current medical system would not be so broken.”

A total of 63 makeshift hospitals were tendered for construction across China as part of the 20 measures Beijing announced in November to ease virus restrictions, with contracts worth nearly 393 million yuan, according to the Post’s calculations from Chinese government tender bidding website Qianlima. A total of 20 contracts were awarded.

After Beijing rolled out an additional 10 measures at the start of December, the Chinese government invited bids for construction of 46 more makeshift hospitals, worth 427 million yuan, with 18 winning bids.

The cost of a single bed in a makeshift hospital is 38,000 yuan, compared to around 95,000 yuan for a bed in a new hospital, which comes mainly from local finance or bank loans, according to a study by Huachuang Securities in April last year.

"Three years of pandemic have amply exposed China’s serious infrastructure deficiencies in healthcare" Yu Yongding

“China does not have a problem with overinvestment in infrastructure, and three years of pandemic have amply exposed China’s serious infrastructure deficiencies in healthcare and pandemic prevention,” said Yu Yongding, a member of the Chinese Academy of Social Sciences at a conference held by Renmin University on January 17.

Makeshift hospitals could be helpful if the policy aims to isolate infected patients, provide treatment and prevent onward transmissions, especially when containment is still achievable, according to Dr. Hui-Ling Yen, an associate professor at the School of Public Health at the University of Hong Kong.

“China has been very successful in keeping the virus at bay for a very long time,” said Yen, who believes the pandemic situation is difficult to gauge.

“People tend to follow the same strategies if they have been proven useful. This may be a good lesson to remind ourselves while preparing for the next pandemic.”