China has told local health authorities to build more beds, train more personnel and be ready to support each other as the tidal wave of Covid-19 cases pushes some provinces to near “breaking point”. Jiao Yahui, director of the National Health Commission’s medical affairs department, said there were enough critical care beds in the system as a whole but provinces reaching a peak in cases were nearing capacity. “Provinces that are currently experiencing a peak in battling severe cases are strained at nearly breaking point. [They] need to expend more of their resources on critical care beds or accelerate the turnover of such beds,” Jiao said on Tuesday. A day earlier, China announced it would downgrade its response to Covid-19, putting management of the disease in the same category as that of HIV and viral hepatitis. In guidelines on how to live with Covid-19, the State Council said the focus now would be on “preventing serious illnesses” to “maximise the protection of people’s lives and health and minimise the impact of the epidemic on economic and social development”. It said centralised quarantine and testing on arrival in the country would be scrapped and foreigners would only need to declare a negative PCR test from the previous 48 hours. Since Beijing announced a sudden pivot from its zero-Covid policy to “living with the virus” earlier this month, the country has been engulfed in a wave of infections on a scale not seen since the pandemic erupted. According to a leaked NHC memo, which is yet to be independently verified, nearly 250 million people were estimated to have been infected in the first 20 days of the month. An online survey by the Sichuan Centre for Disease Prevention and Control found more than 65 per cent of its residents had been infected and Zhejiang province, home to 65 million people, is expecting cases to peak there this weekend with 2 million daily infections. Just days earlier, the NHC said it would stop counting asymptomatic cases, the bulk of daily infections, or report its daily tally. Yin Wenwu, an official with the Chinese Centre for Disease Control and Prevention, also said the centre would reduce its reporting of cases to once a month. The report would include the number of people hospitalised, severe cases, including those in critical care, and deaths. Sick doctors and nurses across the country have been asked to continue to report for duty and hospitals urged to deal with as many Covid-19 patients as possible as the strained health system struggles to reduce severe cases and deaths. Travel to China to get easier from January 8 as Covid barriers come down Jiao, from the NHC, said areas at different stages of the wave had different needs, with some dealing with acute demand at fever clinics while others were focused on treating severe illnesses. “The priority of the work now is to treat severely ill patients,” Jiao said. She said that throughout the country there were 288,000 invasive and non-invasive ventilators, and 58,000 high-flow oxygen generators. Chinese turn to black market for generic Indian Covid-19 drugs The NHC has asked the country’s top-tier hospitals to expand their capacity to treat severe cases by increasing the number of beds, equipment and personnel. “We have asked health authorities to set up regional support systems so that critical care resources can be deployed to improve the treatment of critically ill patients, depending on the needs of each area and the stage of the epidemic in those areas,” Jiao said. Demand is already surging at second-tier medical facilities, with 60 per cent of the 5.61 million beds occupied at community or county-level hospitals. In these facilities, critical care beds account for 181,000 of the total, amounting just 12.8 per 100,000 people. Jiao said that in rural areas, where the health system is even weaker, measures had been taken to ensure village clinics had access to medication and critical cases could be transferred to high-level hospitals. The sudden relaxation in the country’s Covid strategy caught residents and local authorities off guard, with the vaccination rate among the elderly still worryingly low. Over 90 per cent of the population have received a full course of vaccination but only 69 per cent of people aged 60 or over have had three doses of a Covid-19 vaccine. The rate is even lower – 42 per cent – for those aged 80 and above. The State Council guideline on management of Covid-19 said more effort had to be given to boosting vaccination among the elderly and people with chronic illnesses. Liang Wannian, head of the expert panel overseeing the national Covid-19 response, said the changes did not mean completely abandoning Covid-19 control, saying they were preparation for a smooth transition. At the same time, it was important to be confident about the new response. “Some parts of the country have survived or are surviving the impact of the first wave of the epidemic and there is no large-scale serious illness or deaths as we feared. This shows we need to have confidence,” Liang told state broadcaster China Central Television. But China needed to step up surveillance of the disease and mutation of the virus given its rapid spread, he said.