Covid is rapidly spreading through Chinese households and offices after the country’s pandemic rules were unexpectedly unwound last week, sparking confusion on the ground as ill-prepared hospitals struggle to deal with a surge in cases.

Despite pleas from state media and health experts for people to self medicate and recover at home, many citizens — fearful of the virus after three years of propaganda that painted it as dangerous — are flocking to hospitals. Some facilities are struggling to find enough staff and others are suspending non-Covid treatments as health-care workers say they’re scrambling to meet demand for care following China’s Covid Zero reversal.

Scenes of disruption are easily visible in Beijing, where anecdotal evidence suggests the caseload is many times the government’s tally of 1,133 for Sunday. Long lines have formed outside of hospitals and people are struggling to find medicine, while delivery services have been interrupted as couriers become sick.

State media is urging people not to call the capital’s emergency medical hotline unless they are severely ill, cautioning that an influx of requests for help is preventing those in critical need of assistance from getting through. The city has more than tripled the number of fever clinics and pledged to open more, while officials asked residents to seek treatment at community clinics instead of going to major hospitals.

“It takes time to optimize control measures and a stable transition does not come easily,” Xu Hejian, the Beijing city government’s spokesman, said at a briefing on Monday, adding that the rapidly spreading outbreak has put significant short-term pressure on medical services and drug supplies. “It is our shared objective to return to normal life and production as soon as possible.”

Doctors and nurses in at least one Beijing hospital have been asked to keep reporting for duty even if they’ve caught Covid, if their symptoms are mild, said a medical worker, while health-care staff in another hospital in the city’s downtown area have been summoned back to work from holiday, according to another. The workers asked not to be identified as they’re not authorized to speak publicly.

Another worker at a separate facility in Beijing said they were surprised by the speed at which Covid controls have been eased, as it left hospitals with little time to make proper adjustments.

Directives issued to doctors and nurses have changed frequently over the past two weeks, while the intensity of testing of the facility’s staff has eased to two days per week from daily, said the person, who asked not to be identified because the information isn’t public. Infection has become all but inevitable, they said.

China’s Covid shift is playing out in different ways across the vast country, in a likely reflection of how the coming months will unfold. Some hospitals in large cities including Guangzhou, Wuhan and Shijiazhuang, near Beijing, reported staff shortages of as much as 20% as workers fall ill or are deployed to makeshift Covid hospitals, local media including Caixin reported. Facilities are delaying or suspending treatments such as dialysis or chemotherapy, it reported.

Elsewhere, a doctor at a private hospital in Shanghai, who asked not to be identified because he isn’t authorized to speak publicly, said he hasn’t seen a flood of patients and those he does see have only mild symptoms. The doctor said he reassures them and tells them to go home.

Most Chinese people seek care from public hospitals even for minor ailments, as their expenses will be reimbursed with state medical insurance that covers over 95% of the 1.4 billion-strong population. Meanwhile, urban elites with private insurance are more likely to go to private hospitals for relatively limited services. China’s State Council has urged medical institutions to offer services online, including 24-hour consultation services.

Intelligence from inside the health-care system points to a substantial increase in infections that has rendered official numbers — that show national infections at the lowest in a month — meaningless. As yet it’s unclear if the government is willing to disclose the true picture of its outbreak: officially, China hasn’t reported any Covid fatalities since the pivot began, and critical cases, which the National Health Commission, or NHC, reports every day, were at the low level of 141 for Sunday.

The turmoil unleashed by the government’s rapid reversal of three years of Covid Zero comes as sub-zero temperatures see the virus set to race through the population and as China’s elderly remain under-vaccinated, raising concerns that the country’s shift has come too quickly and with too little preparation. The government’s control infrastructure continues to be dismantled at a rapid pace, with a national mobile app that was previously used to track people’s travel history to be scrapped from Tuesday.

Some measures aimed at trying to ease the strain have faltered in the face of surging infections. While the NHC had asked hospitals to create buffer zones and special wards to prevent the virus rampaging through hospitals, local media including Caixin reported on-the-ground implementation has become all but impossible as the virus spreads through the patient and medical worker population.

One hospital in Beijing has asked hospitalized patients to sign disclaimers acknowledging that being admitted comes with the risk of getting Covid, said a medical worker who isn’t authorized to speak to the media. Hospitals in Shanghai are posting tips on their social media accounts telling people how to deal with Covid if infected, while also urging them not to come in unless they develop severe symptoms.

Even some of the China’s top celebrities have been drafted to soothe public fears of the virus, sharing their personal experiences of getting infected and how they recovered.

The about-turn in China has upended economists’ and investors’ expectations, complicating estimates for how its policy changes will affect economic growth. Chinese stocks slid on Monday amid some profit-taking following their sharp recent gains and investors are primed for market upheaval in 2023 as the country charts its reopening path.

“The speed of changes on the ground has surprised many, including us,” Goldman Sachs Group Inc.’s chief China economist Hui Shan wrote in a note Sunday. “Not even a month ago, official outlets were still emphasizing that ‘20 measures’ were about optimizing the implementation of dynamic zero-Covid policy, rather than abandoning it. A few short weeks later, many controls are removed, and the virus seems to be spreading quickly among the population.” – BLOOMBERG