In the past two days, one local government after another has announced it has already passed the peak of Covid-19 infections, and estimated daily new case numbers would start to decline. Given its transmissibility, it is not surprising the virus swept through the population in less than a month after China relaxed Covid restrictions. Chinese state media said earlier the basic reproduction number (R0) of the Omicron strains circulating in China was between 10 and 18, meaning without intervention a positive case could infect 10 to 18 people. A Xinhua article published on Sunday quoted Xu Wenbo, head of the China CDC’s National Institute for Viral Disease Control and Prevention, as saying the Covid R0 in China reached 21 – even more transmissible than measles, which supposedly has the highest R0. However, reaching the peak so quickly is not good news. Overseas experts have long urged Beijing to devise an exit strategy, especially as figures from other places, including Hong Kong, are available as a reference. An exit strategy aims to flatten the curve, allowing the virus to sweep across the population more slowly to avoid overwhelming hospitals. The survival rate could be much higher if the sick, especially the elderly, get sufficient care. But that hinges on the available capacity of the healthcare system. Although China had more time to prepare for a tsunami of cases than other countries, no measures were taken to flatten the curve, partly because the zero-Covid strategy ended so abruptly. The transmissibility of the virus also meant difficulty controlling its pace. But once Pandora’s Box was opened, controlling the virus was difficult. And, importantly, public patience had already worn out. China’s Covid-19 cases are dropping, but severe illness wave still on the way Public compliance is crucial to the success of social distancing and mitigation measures. Beijing only agreed to lift the controversial zero-Covid policy following protests against different parts of the policy, but that also meant it was difficult to ask the angry public to stick to any restrictions after three years of draconian measures. Having what might be the world’s most transmissible virus sweeping the country without intervention meant the curve was sharp. Although Omicron is less deadly than previous Covid-19 strains, a large number of deaths is inevitable given the size of the Chinese population. It is impossible to gauge the true scale of Covid-related deaths because Beijing made it clear it would only count those caused by respiratory illnesses. Without accurate data, people seeking an indication of the death rate can only rely on anecdotal evidence or associated evidence, such as overcrowded crematoriums across the country or reports of celebrity deaths. Among peripheral evidence used by internet users was the unusually high number of deaths among academicians, all in their 80s and 90s. In the last 10 days of December, 21 academicians passed away, compared with 28 in all of 2021. In the first 10 days of January, a further eight academicians died. There is no information about whether their deaths were Covid-related, but in a data vacuum desperate internet users hope to find clues to the number of deaths. Both Hong Kong University and the Institute for Health Metrics and Evaluation at the University of Washington estimated 1 million people in China would die, citing the low vaccination rate among elderly as a major concern. These estimates cannot be found in mainland media. Instead, official Chinese narratives focus on many places passing the peak of the first wave, as well as how well the past three years were spent because more than 80 per cent of people aged over 60 had two doses and over 60 per cent had a third dose. WHO-Europe backs travel rules for US arrivals as subvariant XBB soars However, waning immunity is a big concern. Most of the elderly received the second dose three to six months ago and only some 40 per cent of those over 80 had received a booster by November. All these point to the likelihood of a high Covid death rate in China. But with no official count it is a guessing game, and an important piece of information for scientific research will always be missing.