(Bloomberg) -- After three years and countless lockdowns, China is finally moving toward rejoining the rest of the world in living with Covid-19. The about turn was swift, and hastened by extraordinary protests against the zero-tolerance approach that has limited fatalities but upended the economy and people’s lives. 

China now faces an unpredictable three to six months as it goes through the travails many other nations have experienced, but at a greater scale and with even greater ramifications given its place in the global economy. We asked Bloomberg global healthcare correspondent Michelle Cortez (MC) and senior China government reporter Colum Murphy (CM) to answer your questions on China’s sudden policy shift and its implications. Here’s what they had to say, lightly edited for length and clarity:

Was China’s pivot unexpected to you? If so, why?

CM:  I think we all knew that a pivot would have to come some time. What was surprising was that it came sooner than expected and the speed with which changes were rolled out. For much of November there were very few signs that Beijing was actively considering steps to press ahead with any meaningful relaxation. As we have seen, relaxation appears to be in full swing — even to the point where folks are beginning to ask: Are the Chinese authorities moving too fast?

MC:  I was absolutely shocked. More importantly, I don’t think local leaders – or indeed the Chinese people – were expecting it. Even after the first steps on Nov. 11, top health officials were saying it wasn’t a reversal of Covid Zero, but a more targeted, scientific approach. Clearly there has been a wholesale shift, and there wasn’t a lot of advance work that laid the groundwork for it.

When do you think infections will peak?

MC:  The curves have been consistent all over the world, rising exponentially for about three to four weeks and then falling at a similar rate. The experts I’ve talked to don’t expect anything different in China. It’s pretty clear that a month from now will be near the peak.  

Could we see rolling waves maybe starting in the cities and then flaring in the countryside later on?

MC:  That is what happened in the rest of the world. Outbreaks would flare up, and people would work to suppress them. But there were different rules everywhere. Vaccination levels varied, and so did mitigation measures. That’s what allowed for different rates of spread. If China consistently enforces its new rules, and vaccine levels stay about the same everywhere, there won’t be similar speed bumps.

Does the fact China pivoted on Covid policy straight after the protests mean demonstrators will be emboldened in China?

CM:  The Chinese government is going to lengths to deny that there was any link between the protests and the relaxation of Covid rules. Instead, authorities have been busy developing the narrative that the virus has evolved to a point where it no longer poses a huge medical threat to people. But make no mistake, many will be drawing a direct line between the people taking to the streets to vent their frustrations and the Covid policy pivot by Xi. The conclusion seems clear: Agitation on the streets was effective. It sets a precedent that will be hard to roll back.

Could we see more protests, on issues not to do with Covid?

CM:  Yes. It would be wrong to think that Covid Zero is the only dissatisfaction being felt by the Chinese people. Under Xi’s watch, disillusionment has been on the rise, especially among the younger generations. They’re fed up with even tighter censorship, less freedom to speak out, and dismal economic prospects. There’s plenty of unhappiness to go round.

What are the best and worst-case scenarios when it comes to deaths?

MC:  Most health experts don’t want to touch this one with a 10-foot pole, probably because the global experience thus far isn’t reassuring. One data set, from the London-based research firm Airfinity, has a range of 1.3 million to 2.1 million. Officials at the Institute for Health Metrics say that’s much too high. They are coming out with new numbers in the next few days.  I don’t see a scenario where China avoids the devastation we’ve seen in other places. Given its size, it’s likely to be scary. 

Colum, you’re normally based in Beijing. What’s the feeling on the ground there among your friends and family?

CM:  I left Beijing just before the protests and the subsequent pivot. My family and friends there tell me how difficult it is to get a PCR test these days — in stark contrast to just a few weeks ago when there were testing booths almost every few hundred meters. Some are incredulous about how things have transpired. Here we have a country that had some of the strictest Covid prevention measures in the world, then all of a sudden they’re all gone. That’s got people asking: Why there wasn’t some kind of middle-ground approach? Why did the response have to be so extreme? There are real concerns that the country isn’t properly prepared for what might come.

China’s challenges are great when it comes to reopening. How do the authorities manage expectations? 

CM:  The Chinese government is used to relying on state media to get their message across. The trouble is they now find themselves in a bit of a predicament — state media has been singing the praises of China’s Covid Zero up until very recently. Now publications like People’s Daily find themselves having to recalibrate their messaging, and that is glaringly obvious to a growing portion of Chinese society. I’d argue that China’s leaders will face a tough time managing expectations. How can people trust a government that appears to switch messaging to serve its purposes on a whim?

What do we know about China’s preparation for the inevitable Covid wave?

MC:  China’s leaders are talking a good game now when it comes to preparation, and they are taking some really smart steps — most notably, opening health-care facilities for the most vulnerable so they won’t have to fight the crowds in public hospitals. But there doesn’t seem to have been a lot of groundwork laid for this change. The bigger issue is preparing the population. There’s a lot of fear around Covid, and a focus on case counting. That needs to shift. Most people will do okay after they are infected, so a positive test shouldn’t cause immediate panic.

What  vaccines are most used in China now, and what’s the efficacy like on the current omicron strains? 

MC:  China has mainly relied on inactivated vaccines from Sinovac Biotech and Sinopharm. These shots use older technology than the mRNA immunizations from Pfizer, BioNTech and Moderna that we relied upon almost everywhere else. Early studies showed the ones used by China were less effective, making it more important to get at least three doses. But all of the shots do appear to offer strong protection against severe disease and death. The best news for China on the vaccine front might be the new inhaled immunization from CanSino. Details are still sparse but it may protect against infection itself, not just stop people from getting really sick.

Several world leaders faced backlash when reopening brought forth a wave of Covid. Will there be fallout for Xi?

CM:  Xi has made Covid Zero one of his core, defining policies. How the next few weeks and months play out in terms of the virus will reflect directly on him. Already, the protests and the subsequent U-turn on Covid are an embarrassment for him. If the virus brings about huge disruptions and loss of life, the negative repercussions for him will only grow.  He’ll probably stay in power, but he might find his almost limitless grip on power weaken. And a caveat: In the scenario where disruption is minimal and the economy bounces back fully and swiftly, Xi does stand a chance of coming out of this relatively unscathed.

Why hasn’t China forced older people to get vaccinated via a mandate?

MC:  I feel like Colum might be better for this one, because the answer is politics! Vaccine mandates work and they don’t have to be heavy-handed. In Hong Kong, if you want to go into a restaurant, you have to be vaccinated. The shots were mandatory for kids to go to school in the US, through university (that’s been rolled back in a lot of places). But there hasn’t been anything similar in China. It’s honestly baffling to the medical community.

How will we be able to gauge the severity of China’s outbreak if authorities hide the severity of the situation?

CM:  It’s going to be hard to know the precise extent of infections. If the current situation in Beijing is anything to go by, then the official data will be basically useless pretty quickly. In the absence of that, I’ll be relying on my personal contacts and sources in China: friends, family, manufacturers, other companies and Chinese social media. In short, best prepare for this to become a bit of an information black hole and try to get a handle on the scale of infection through these “creative” workarounds.

MC:  What’s important is how many people will be hospitalized (and ultimately die), and whether those facilities are prepared. That’s what we will be watching. The pressure points there will be the elderly and infirm. Nursing homes and rehabilitation centers will be critical to track. 

What’s the risk that a huge outbreak in China will spawn new variants that could spread globally?

MC:  This is by far the most important question health experts outside of China are watching, because it could have implications for the world. The risk is real. China has had almost no exposure to the virus, so there haven’t been mutations spawned among the population. The fear is that a new variant could emerge that will not only be more contagious than what we have now, but also be better able to evade the immunity on hand from natural infection and immunization. We are all praying this doesn’t occur.

What is the “pain threshold” that would cause authorities to impose stringent lockdowns once again?

CM:  If we agree that Covid Zero is done and dusted in China, then it’s hard to see how any more lockdowns in the future could be effective. Of course, effectiveness may not be the main factor for deciding to re-introduce lockdowns. What comes to mind immediately is if there’s a complete collapse of the health-care system. That could frighten authorities to the point that they put the brakes on relaxation.

Michelle, your timeline for how the big Covid wave will play out puts us right on Chinese New Year — a huge period for travel. Does that risk making what will already be a bad situation much, much worse?

MC:  Chinese New Year represents a real, national superspreader risk. It’s coming early this year, at the end of January. We’ve seen similar outbreaks everywhere in the world around holidays so it would be good to prepare for it. The government could pull back on its easing and clamp down on travel like it did in 2020. That would reduce the risk. But it may be that people will choose not to travel during the holidays, to protect their loved ones at home.

How long until China is back to normal, like where the US, UK and Singapore are now?

CM:  Realistically, if we expect a peak in the spring, maybe around summer time conditions might be more appropriate for opening up internationally. But it’ll also take time for foreign airlines to reintroduce capacity and other non-China considerations to kick in. So, maybe fall of 2023? Within China, things might look closer to normal sooner than that. I’m certainly looking forward to getting back on the road a bit more and traveling into the heartland to do a bit more reporting.

Did China lose the fight against the virus because of its unwillingness to use Western vaccines?

MC:  I don’t even know if we can say China lost the fight against Covid. It has by far the lowest infection and mortality rates of the entire world. It seems more like they are throwing in the towel because the cost of the fight is too high. Would omicron have overwhelmed those efforts eventually? Experts say yes, but we may never know. Clearly mRNA vaccines didn’t allow the West to win, either. It’s been a nightmare everywhere. Will Chinese residents — especially the elderly — pay a higher price because they didn’t have access to Western vaccines? The answer there is likely yes.

What’s your top piece of advice for people in China as they head into this scary new world?

MC:  My top advice? Attitude is everything. There is no doubt this will be a scary time, even for the young and healthy who come out the other side realizing their fears were overblown. But for others, the worst will come to pass. Do the best you can, every day. Give yourself and everyone else grace, wherever you can. And love and protect your people. In the end, that’s the most important thing we’ve got. 

©2022 Bloomberg L.P.