With China's zero-COVID policy abruptly scrapped last month, the pandemic virus is now ripping through the country's population, and health experts are bracing for a wave of devastation as peak transmission shifts from urban centers to more vulnerable rural communities. The dire situation is expected to be "dramatically enhanced" by mass travel later this month for celebrations of the Lunar New Year on January 22.

Multiple modeling studies have suggested that China could see around 1 million deaths in the coming weeks as the country reopens amid a raging outbreak. Last month, modeling by The Economist estimated that 96 percent of China's 1.4 billion people could catch the virus within the next three months, resulting in 1.5 million deaths. Of those deaths, 90 percent would be among people aged 60 and over.  Another modeling study, partly funded by China's Centers for Disease Control and Prevention, also estimated that 957,600 would die in the coming weeks if the country doesn't swiftly roll out fourth-dose COVID-19 vaccines.

Because China was previously able to keep COVID-19 waves at bay with its zero-tolerance policies, most of the country's immune protection derives from vaccination rather than prior infection or hybrid protection. Around 90 percent of China's population has had two shots of COVID-19 vaccines, but fewer than 60 percent have received a third shot as a booster dose. And even for those who have gotten a third dose, many of those doses were taken months ago, and peak protection has passed. Vaccination coverage among the elderly is particularly worrying. About 30 percent of people aged 60 and over have not gotten a third dose, and for people aged 80 and over, a startling 60 percent have not gotten a third dose.

"The [World Health Organization] is concerned about the risk to life in China and has reiterated the importance of vaccination, including booster doses, to protect against hospitalization, severe disease, and death," said WHO Director-General Tedros Adhanom Ghebreyesus in a press briefing Wednesday. "This is especially important for older people, those with underlying medical conditions, and others who are at higher risk of severe outcomes."

Lack of data

Tedros and other WHO officials were critical of China for not sharing more data about the current situation—and questioned the validity of some of the data it has shared. Officially, China has only reported 5,259 deaths in the entire pandemic so far, with just one death report on the mainland on Wednesday. But WHO officials said China's definition of a COVID-19 death is "too narrow" because it only counts those who die from respiratory failure associated with COVID-19, ignoring the other myriad ways the disease can present and lead to death, such as via blood clots, heart attacks, and sepsis.

"We believe that the current numbers being published from China underrepresent the true impact of the disease in terms of hospital admissions, in terms of ICU admissions, and particularly in terms of deaths," WHO Executive Director for Health Emergencies Mike Ryan said in the press briefing Wednesday.

The country has largely stopped reporting case numbers, and mass testing was abandoned last month.

While experts fear for China's vulnerable populations, there's also some international anxiety over whether mass infection in China will brew new variants that could mushroom out from its borders. Infection on such a large scale offers the virus a plethora of opportunities to mutate further. But with China's population having relatively little prior immunity to newer variants, the virus faces less pressure than it would elsewhere to become more immune-evasive.