Dozens of hearses queued outside a Beijing crematorium on Wednesday, even as China reported no new Covid-19 deaths in its growing outbreak, sparking criticism of its virus accounting as the capital braces for a surge of severe cases.

Following widespread protests, the country of 1.4 billion people this month began dismantling its “zero-Covid” regime of lockdowns and testing that had largely kept the virus away for three years — at great economic and psychological costs.

The abrupt change of policy has caught the country’s fragile health system unprepared, with hospitals scrambling for beds and blood, pharmacies for drugs, and authorities racing to build special clinics.

Experts now predict China could face more than a million Covid deaths next year.

At a crematorium in Beijing’s Tongzhou district on Wednesday, a Reuters witness saw a queue of around 40 hearses waiting to enter, while the parking lot was full.

Inside, family and friends — many wearing white clothing and headbands as is tradition — were gathered around roughly 20 coffins awaiting cremation. Staff wore hazmat suits. Smoke rose from five of the 15 furnaces.

There was a heavy police presence outside the crematorium.

Reuters could not verify whether the deaths were caused by Covid.

Narrow definition

China uses a narrow definition of Covid deaths, reporting no new fatalities for Tuesday and even crossing one off of its overall tally since the pandemic began, now amounting to 5,241 — a fraction of what much less populous countries faced.

The National Health Commission (NHC) said on Tuesday only people whose death is caused by pneumonia and respiratory failure after contracting the virus are classified as Covid deaths.

Benjamin Mazer, an assistant professor of pathology at Johns Hopkins University, said that classification would miss “a lot of cases,” especially as people who are vaccinated, including with the Chinese shots, are less likely to die of pneumonia.

Blood clots, heart problems and sepsis — an extreme body response to infection — have caused countless deaths among Covid patients around the world.

“It doesn’t make sense to apply this sort of March 2020 mindset where it’s only Covid pneumonia that can kill you when we know that in the post-vaccine era, there’s all sorts of medical complications,” Mazer said.

Looming surge

The death toll might rise sharply in the near future, with state-run Global Times citing a leading Chinese respiratory expert predicting a spike in severe cases in Beijing over the coming weeks.

“We must act quickly and prepare fever clinics, emergency and severe treatment resources,” Wang Guangfa, a respiratory expert from Peking University First Hospital, told the newspaper.

Severe cases rose by 53 across China on Tuesday, versus an increase of 23 the previous day. China does not provide absolute figures for severe cases.

Wang expects the Covid wave to peak in late January, with life likely to return to normal by end-February or early March.

The NHC also played down concerns raised by the United States and some epidemiologists over the potential for the virus to mutate, saying the possibility of new strains that are more pathogenic is low.

Paul Tambyah, President of the Asia Pacific Society of Clinical Microbiology and Infection, supported that view.

“I do not think that this is a threat to the world,” he said. “The chances are that the virus will behave like every other human virus and adapt to the environment in which it circulates by becoming more transmissible and less virulent.”

Several leading scientists and World Health Organisation advisors told Reuters that a potentially devastating wave to come in China means it may be too early to declare the end of the global Covid pandemic emergency phase.

Economic Impact

The United States on Tuesday indicated it stands ready to assist China with its outbreak, warning an uncontrolled spread in the world’s second-largest economy may hurt global growth.

A major near-term concern for economists is the impact a surge in infections might have on factory output and logistics as workers and truck drivers fall ill.

The World Bank on Tuesday cut its China growth outlook for this year and next, citing the abrupt loosening of Covid measures among other factors.

Some local governments continue to relax rules.

Staff at the Communist Party and government institutions or enterprises in the southwestern city of Chongqing who have mild Covid symptoms can go to work if they wear a mask, the state-run China Daily reported.

Other Chinese media reported similar moves in several cities.