Estimates of COVID-19 deaths in Mainland China after abandoning zero COVID policy.

backgroundChina witnessed a surge of Omicron infections after abandoning 'zero COVID' strategies on 7 December 2022. The authorities report very sparse deaths based on very restricted criteria, but massive deaths are speculated.

methodsWe aimed to estimate the COVID-19 fatalities in Mainland China until summer 2023 using the experiences of Hong Kong and of South Korea in 2022 as prototypes. Both these locations experienced massive Omicron waves after having had very few SARS-CoV-2 infections during 2020-2021. We estimated age-stratified infection fatality rates (IFRs) in Hong Kong and South Korea during 2022 and extrapolated to the population age structure of Mainland China. We also accounted separately for deaths of residents in long-term care facilities in both Hong Kong and South Korea.

resultsInfection fatality rate estimates in non-elderly strata were modestly higher in Hong Kong than South Korea and projected 987,455 and 619,549 maximal COVID-19 deaths respectively, if the entire China population were infected. Expected COVID-19 deaths in Mainland China until summer 2023 ranged from 49,962 to 691,219 assuming 25-70% of the non-elderly population being infected and variable protection of elderly (from none to three-quarter reduction in fatalities). The main analysis (45% of non-elderly population infected and fatality impact among elderly reduced by half) estimated 152,886-249,094 COVID-19 deaths until summer 2023. Large uncertainties exist regarding potential changes in dominant variant, health system strain and impact on non-COVID-19 deaths.

conclusionsThe most critical factor that can affect total COVID-19 fatalities in China is the extent to which the elderly can be protected.