​​​​The Upcoming Lunar New Year Holiday Threatens a Grim COVID Toll in China

Harry Li is conflicted. Ideally, the law student wants to spend the Lunar New Year holiday in his home village in northern China’s Hebei province, but he is afraid of spending more than 12 hours on crowded trains and buses lest he brings COVID-19 to his elderly parents, who have not been vaccinated. “It’s been three years since I’ve been home [for Lunar New Year],” says Li, 20, who studies some 700 miles from home in Shanghai. “I was vaccinated nine months ago but everyone around me is still getting sick.”

This week, millions of Chinese face a similar conundrum. Before the pandemic, China’s Lunar New Year holiday was renowned as humanity’s largest annual migration, when hundreds of millions of working-age people travel from jobs typically on China’s freewheeling coast back to ancestral villages to feast and toast with elderly kin. During the pandemic, strict controls and state-led incentivization schemes—comprising cash, shopping vouchers, and movie tickets—put the brakes on holiday travel. But, on Dec. 9, China began completely dismantling its testing and quarantine apparatus, allowing the virus to spread like wildfire across the world’s largest population of 1.4 billion.

Officials, who have stopped counting infections, said on Saturday that nearly 60,000 people with COVID-19 died between Dec. 8 and Jan. 12. Still, that figure is believed to be a gross undercount due to strict new reporting criteria that only include victims who died in hospital following a pneumonia diagnosis and exclude all those with underlying health conditions. Meanwhile, social media images of crowded hospital wards, overflowing morgues, and long queues outside crematoriums and funeral parlors point to a burgeoning health crisis. Around 900 million people in China had been infected as of Jan. 11, according to a study by Peking University, amounting to some 64% of the population. Projections for the final death toll range from one million to over two.

On Saturday, Jiao Yahui, chief of the medical administration bureau of China’s National Health Commission, announced that the “national emergency peak has passed.” But Yanzhong Huang, a public health expert at the New York-based Council on Foreign Relations, says that any estimates should be taken “with a grain of salt.” He says some local governments may be incentivized to announce higher infection rates to shift their focus onto economic recovery as soon as possible. “With the dismantling of the testing regime, they cannot be expected to provide accurate information.”

Much hinges on what unfolds this week. Lunar New Year officially begins Sunday, but for many the grand peregrination has already begun. The combination of millions of people crammed onto public transport traveling to a predominately elderly, under-vaccinated population in villages with rudimentary healthcare threatens to be a perfect storm. Zeng Guang, ex-head of the Chinese Center for Disease Control, has warned that it is “time to focus on the rural areas.” Meanwhile, Prof. Guo Jianwen, a member of the State Council’s pandemic prevention team, urged people “don’t go home to visit” elderly relatives if they had not yet been infected. “You have all kinds of ways to show you care; you don’t necessarily have to bring the virus to their home.”

It’s another example of China’s chaotic reopening since a spate of anti-lockdown protests that erupted across the country in early November spooked the ruling Chinese Communist Party (CCP). Maintaining zero-COVID required diverting legions of doctors and nurses from their specialties into the mind-numbing task of conducting billions upon billions of PCR tests, while vaccinations were sadly an afterthought, not least since jingoistic propaganda lorded the state’s success banishing the virus. As of Dec. 14, only 42% of over-80s had received three doses of a vaccine, according to government figures.

Worryingly, those figures are also heavily skewed towards elderly living in cities, meaning those awaiting the Lunar New Year arrival of sons and daughters, nephews and nieces, are disproportionately vulnerable. While precise figures for rural COVID vaccine uptake are difficult to find, annual flu vaccination rates are typically 1.1% in China’s villages compared to 2-3% in cities, says Xi Chen, a professor of public health and economics at Yale. “It’s a problem of supply and also demand,” he says.

Despite significant strides reforming China’s health system, coverage remains uneven, and village dwellers will often travel several hours to the nearest big city to seek medical care rather than visit poorly funded neighborhood clinics. Since publishing its latest health-reform plan in 2016, China has spent billions on improving community-level facilities in the knowledge that an effective primary-care system reduces the strain on urban hospitals. Yet it’s a work in progress that has been stalled by the tremendous burden of lockdown measures.

More from TIME

After three years of shelling out for testing and quarantine measures, local health authorities are broke. The testing regime alone was costing up to $250 billion per year, or 9% of China’s 2021 fiscal income, according to Dongwu Securities. Local governments have admitted that funds allocated for poverty alleviation and infrastructure had to be diverted to finance mass testing. In September, the nation’s main testing firms were complaining about billions of dollars in unpaid debts. By early November, local authorities began charging the public for the PCR tests they were obliged to take every day or few days.

The financial crunch was another driver to finally jettison zero-COVID. For the first two years of the pandemic, the policy kept China the best performing of any major economy. But that all changed with the onerous lockdowns of 2022 spurred by the hyper-transmissible Omicron variant. China’s economy grew by only 3% in 2022, it was announced Tuesday, its lowest rate in decades and missing Beijing’s comparatively modest target of 5.5%.

Dismantling zero-COVID was seen as key to driving domestic consumption, which still lags given trepidation over slumped real estate and stock markets as well as declining exports. But according to Vincent Brussee, an analyst for the Berlin-based Mercator Institute for China Studies, reopening may be a “precondition” but isn’t “sufficient” to boost consumption alone. “Things like social security, labor rights for especially migrant workers, are also important,” says Brussee. “At the moment, if you live in China, it’s almost a necessity to save a lot of money.”

The grim irony is that China’s chaotic reopening has only reinforced that fact. While ordinary people are now spared the expense of constant PCR tests, many are scrambling to buy antiviral medication on the black market, pay for hospital beds, or afford inflated crematorium costs to bury relatives. A limited social safety net stymies the urge to splash out. And with local coffers nearing empty, that situation is not likely to change soon, not least since China’s leader has hardly set a glowing example.

Despite Xi Jinping insisting in his new year’s address that the CCP has “put life first all along,” it has emerged that China is refusing to pay even the reduced price that multinational biotech firm Pfizer charges lower middle-income countries for its effective antiviral Paxlovid. “They are the second highest economy in the world and I don’t think that they should pay less than El Salvador,” Pfizer CEO Albert Bourla said Jan. 10.

Instead, Lunar New Year migrants will have to take responsibility for themselves. Prof. Chen advises travelers to get a booster and bring fever and cough medication to their villages, and even pulse oximeters that measure blood oxygen levels and can indicate when cases are becoming acute. “This year’s migration is unstoppable,” says Prof. Chen. “But it’s never too late to flatten the curve.”

—With reporting by Amy Gunia/Hong Kong.