(Bloomberg) -- China seeing Covid infections start to pick up rapidly as zero-tolerance curbs are relaxed.  

With requirements for frequent lab testing dialed back significantly, anecdotal evidence suggests undetected cases are on the rise. Some health experts are predicting actual infections will far surpass the official tally. Just a week after the southern metropolis of Guangzhou abandoned the usage of Covid test results in most places, daily infections have dropped. On Wednesday, the city recorded about 2,500, down from about 7,000 before the loosening. The trend is similar in Beijing as well. 

“Until recently, case counts were a very good reflection of incidence of infections, because of the near-universal PCR testing,” said Ben Cowling, chair of epidemiology at the University of Hong Kong’s School of Public Health. “Not many infections were undetected. But now with the likely substantial reduction in testing intensity, most infections will not be laboratory confirmed.”

With easier rules for domestic travel set to boost movement of citizens, China is already bracing for a wave of infected people seeking medical care. Large hospitals have been asked to set aside special wards to treat vulnerable Covid patients, while the number of so-called fever clinics will be increased to identify cases. Authorities have also urged grassroots health-care institutions to help meet demand so hospitals aren’t overwhelmed. 

The abrupt U-turn in China’s approach follows three years of strict adherence to Covid Zero — a term that refers to wiping out the virus — which has hurt the economy, dragged down business and consumer confidence, and resulted in tragic incidents and misery for millions of people across the country.

In Beijing, for those who need to get tested, results are taking longer than usual to be returned to people. That’s sparked speculation that this was due to a high number of positive tests, forcing lab workers to re-test samples.

“Given the understanding we have now on how Covid spreads and the current situation, cases should be on the rise,” said Lu Mengji, a virologist at the University of Duisburg-Essen in Germany. “Whether it’s Beijing or Guangzhou, given it’s winter, more gatherings make the virus spread even faster. So the decline in reported cases doesn’t make sense.”

The accelerated pace of the rollback reflects pressure on President Xi Jinping to chart a path out of the crisis and quell public discontent after thousands took to the streets late November to protest against Covid Zero. 

Easing measures include accelerating vaccination among the elderly and stopping local officials from designating large areas as high risk, which had led to lockdown-like curbs in entire housing compounds and other places. A green health code on contact-tracing smartphone apps is no longer needed for domestic travel or to enter most venues. Authorities are also reining in unnecessary testing.

The policy relaxation is giving people more freedom after strict curbs upended their lives for months.

Patrick Guo, a civil servant, and his family live in Guangzhou’s Haizhu district, where a strict lockdown was in place until authorities lifted most of the restrictions, allowing restaurants and shopping malls to reopen. He said he hasn’t done any Covid tests since for more than a week.

“We are enjoying test-free life so much, life is finally back to normal,” Guo said. “There are, of course, a lot of unreported cases. I can hear sniffling and coughing all over, but that’s normal every winter. Who knows they are positive or negative if we no longer get tested?”

Faced with the prospect of spreading infections, panic buying of rapid test kits and drugs to treat fever and cold is also setting in. Though authorities and state media have recently been downplaying the severity of Covid, the fear is palpable among people who’ve been told until recently that the virus will likely kill them.

From conversations with residents in cities including Beijing and Shanghai, Bloomberg News has learned some neighborhoods are organizing group purchases of N95 masks, antigen test kits, sanitizers and vitamins in preparation for a potential outbreak.

China Pushes Elderly Vaccination as Reopening Pressure Grows

Among those stocking up on hundreds of yuan worth of medicines and other supplies is Irene Yang, a 35-year-old financial worker in Shenzhen. She said she’s concerned that hospitals may be overwhelmed, particularly by the elderly — a segment of the population with the least vaccination rate.

“I’m happy some ridiculous prevention measures have finally been lifted, we just can’t be locked forever,” said Yang. “I just wonder why there’s such a U-turn. It seems everything just comes in a rush without careful consideration.”

Yang, who received a vaccine booster about a year ago, is hoping authorities allow for another shot before full reopening, fearing she has low protection now.

Some medical workers share Yang’s anxiety as well. Kong, a Shanghai emergency-room doctor who declined to provide her full name for fear of reprisals, expects actual Covid infections will surge this month as more restrictions are lifted in the city.

“Without any significant improvement in vaccines and drugs, as well as more investment in medical resources, lifting the lockdowns only leads us from one hard mode to another,” Kong said. “So much money has been poured into Covid prevention measures instead of upgrading the country’s medical system. How can people feel safe to go out again?” 

Kong said she’s afraid to take her three-year-old daughter on public transportation after Shanghai lifted test requirements earlier this week.

Some community clusters of cases that appear to be Covid have been reported in Beijing. Notices sent by residential committees said some services had to be halted after multiple community workers were infected, according to statements seen by Bloomberg News. 

In the city of Baoding, a two-hour drive away from Beijing, about half of the roughly 200 workers in a factory got infected, according to a resident, whose family member works in the factory. They recovered after about a week of home quarantine. When medical workers came to conduct Covid tests later, most of them showed negative.

“There will be a spike in cases, even hospitalizations and deaths in the beginning, because the population isn’t adequately vaccinated,” Xiaolin Wei, chair of global health policy at the University of Toronto’s School of Public Health. “And because of the lack of testing, there will be even more cases than are reported.”

--With assistance from Michelle Fay Cortez, Dong Lyu, Lin Zhu, Claire Che and Li Liu.

©2022 Bloomberg L.P.