Covid-19 caught the world unprepared three years ago, and since the early stages of the pandemic many people have been asking why the world handled the situation so badly despite many warnings about the risks of such an outbreak over the years. As the virus continues to mutate and sweep across the world, causing one wave after another, people and their governments have been looking for ways to cope, such as researching the behaviour of the virus and developing and promoting vaccines and cures. As China moves from being the last stronghold of a zero-Covid approach to learning to live with the virus , it is time to ask some important questions. First, how is the world going to live with the virus in the long term while minimising its harm to the population? Second, what have we learned from the past to help us prevent and manage another pandemic? Scientists have pointed out the risks of new infectious diseases emerging due to the expansion of human habitats, making the spillover of disease from animals to people more likely. Beijing’s attitude towards the virus has swung from one extreme to another. For almost three years it emphasised the risks of the virus and spent enormous resources guarding against its spread, but after abruptly lifting controls it is now trying to allay public fears by stressing that most infections are mild. Long Covid could be longer – and worse – than we thought, study finds In many countries, life has returned to pre-pandemic routines. However, the virus is still causing deaths and sickness among elderly on a large scale. In Japan, for example, the death toll hit a grim record of over 500 a day on January 11, while deaths and hospitalisations in the US are on the rise. China has put its death toll at 60,000, but the figure has been greeted by widespread scepticism from outside, given the huge disparity with modelling by both Chinese and overseas experts, as well as reports of overcrowded crematoriums and funeral homes. The rising deaths are fuelled by more infections caused by more transmissible variants with a higher ability to evade vaccines – although the pathogenicity of Omicron has not changed much. Scientists are watching how the XBB.1.5 variant, which is the most transmissible to date, will impact the epidemiological curves. Another variant being watched by some scientists is XAY.2, a Delta-Omicron recombinant variant, first discovered in Thailand earlier this month. But the World Health Organization says that so far there is no sign that the strain is worse than others. Scientists have called for vigilance in checking sewage water and monitoring the mutations of the virus worldwide since many requirements for PCR tests have already been removed. Such surveillance is necessary as there is no guarantee that the virus will not become stronger, though viruses that cause respiratory disease tend to become milder after settling in the human population. While economic and social activities should resume, policies specifically targeting the elderly, including vaccination programmes, should be ramped up. China’s internet censors launch crackdown on ‘fake news’ about Covid Hospital capacity should also be beefed up to provide care for the elderly if they become ill. Sufficient care, as well as the timely supply of antivirals and oxygen are the keys to recovery. China has displayed its capability to build makeshift hospitals, test millions of people and manufacture large amounts of protective kits and vaccines within a short period of time. The country should make use of such capability to beef up the resilience and capacity of its healthcare system, especially in the countryside. However, one limitation China faces now is that the government coffers are likely strained after they have spent billions of yuan on PCR tests and compulsory quarantine in the past three years. There should also be reflections about how to better prepare the country for any future outbreaks. What happened in the past three years shows that a system based on technology and social control cannot provide the best response to a healthcare crisis. Instead, good governance is made possible by data transparency, a vibrant science community who can speak freely, as well as public compliance based on trust in the policies and data. There is now a trust deficit in China following last year’s controversial insistence on zero-Covid, the sudden policy shift and a lack of transparency about death rates. This cannot be overcome just by repeating an official narrative. Instead, gradually rebuilding public trust through transparency would be the first step in enhancing the country’s preparedness for future public health crises.