China must brace itself for dark Covid winter this Lunar New Year

As most developed economies learned years ago, reducing Covid-19 infection rates in high-risk populations takes self-distancing and other proactive measures
Such precautions are not an option for too many Chinese households, though, given the elderly’s role in child care and the state of health care in rural China

Nancy Qian

Published: 4:42pm, 6 Jan 2023

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Last month, China ended its “zero-Covid” policy, bringing a tumultuous end to restrictions after nearly three years. The suddenness of the move surprised nearly everyone.

The process could have been much more gradual, with a slower shift from mass lockdowns to more flexible policies such as voluntary self-quarantine and social distancing. Instead, the government has effectively thrown caution to the wind.

As a result, China is now having one of the worst outbreaks seen anywhere since the start of the pandemic. Hundreds of millions of people have been infected in the space of just a few weeks, and many experts now expect the death toll to exceed a million.

Social media is being flooded with harrowing accounts of personal loss and images of overwhelmed hospitals. While the exact infection and mortality figures are unclear, the big picture is undeniable: the Chinese people are fighting to survive.

The situation is reminiscent of what many other countries experienced in the first weeks of the pandemic. But unlike in most developed economies, key features of China’s social and economic structure make it especially difficult for ordinary households to grapple with the virus.

Reducing infection rates in high-risk populations, for example, requires self-distancing. This is why the elderly in advanced economies have voluntarily reduced interactions with their children and grandchildren. But China’s elderly cannot self-isolate so easily because many are their grandchildren’s primary carers.

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In 2013, the Shanghai Municipal Population and Family Planning Commission reported that 90 per cent of the city’s young children were being cared for by at least one grandparent. The rates are lower in other cities but still much higher than in the United States. More than 50 per cent of all Chinese grandparents provide care for their grandchildren, whereas around 4 per cent of American grandparents do.

This difference is partly a result of tradition. Many Chinese elderly live with their adult children, and retirement homes in the country are still rare.

But economic conditions also play an important role. In urban areas, parents increasingly need grandparents to help them with child rearing, owing to the taxing 996 work schedule – 9am to 9pm, six days per week – and a brutally competitive education system.

Moreover, China has experienced a tripling of grandparent-grandchild, or skipped-generation, households since 1990. Because the hundreds of millions of Chinese who migrate to cities for work are prohibited from bringing their families with them, some 60 million children remain in rural areas with grandparents and other relatives.

Many urban parents, too, have left their children behind. In cities, children often live with grandparents who own property in city centres, where one finds the best schools and other amenities. Today’s urban elderly were grandfathered into these sought-after locations, having been assigned housing by their work units before the reforms of the mid-1990s transferred ownership from the state to the occupants.

As urban housing prices skyrocketed, the beneficiaries’ adult children were forced out to more affordable suburbs. In Shanghai, where real estate prices are among the highest in the world, grandparents are the sole carers of half of the city’s young children.

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When Chinese people do become infected or fall dangerously ill, they seek emergency care as a last resort. But their access to effective care is much more limited than in higher-income countries.

As of 2021, China’s per-capita GDP was just US$12,556 – less than one-fifth that of the US$70,248 in the US. This large income gap is reflected in the provision of public health care, including in ways that are not always apparent.

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For example, although China and the US have a comparable number of hospital beds and physicians per person, such indicators mask a lower quality of care. Many Chinese hospital rooms are shared by many patients, which poses obvious problems in the case of a contagious outbreak. Worse, in 2022, China had only four intensive care unit beds per 100,000 people on average, compared to more than 30 per 100,000 in the US.

China’s limited public resources also are reflected in the high price of treatments. In the US, the government purchased 20 million courses of Paxlovid at US$530 each and provided them to Americans free of charge. In China, patients currently must buy Paxlovid at the market price of 2,980 yuan (US$427) per course, which amounts to about 8 per cent of the average Chinese person’s annual disposable income. For comparison, this would be like asking the average American to pay more than US$4,000.

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In the months ahead, these issues are likely to become more problematic as migrant workers spread the virus to the rural population when they return home for the Lunar New Year holiday. Home to some 500 million people, China’s rural areas have more multi-generational households and are generally poorer, with fewer beds per hospital and intensive care units. As such, many fear that rural China is heading for a “dark Covid winter”.

The Covid-19 pandemic began in China during the 2020 Lunar New Year holiday. Now, for the first time in three years, the Chinese people can see a small light at the end of the tunnel.

But the last mile will be gruelling. Households must do their best to protect themselves with limited access to some of the most important tools for fighting the disease. While there is little doubt that returning to normalcy is the right direction for China, the days and weeks ahead are going to be exceedingly difficult and full of sorrows.

Nancy Qian is professor of managerial economics and decision sciences at Northwestern University’s Kellogg School of Management and founding director of China Econ Lab. Copyright: Project Syndicate