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Overnight China has gone from having the world’s most restrictive Covid policy–0-Covid citywide lockdowns at the slightest sign of the virus–to no Covid policy at all.

And the predictable result is a wave of infection that virus models predict could produce at least 1 million Covid deaths in 2023.

Earlier this month, China dramatically loosened its strict 0 Covid policies after a wave of protests from residents fed up with years of lockdowns, mass testing, and centralized quarantines. Those strategies had become less effective with the emergence of new strains of the virus. The quick policy shift has left a huge vulnerable population with little immunity from exposure to the disease and low vaccination rates with often less effective vaccines. China’s official vaccination rate is 90%, but those vaccinations use domestically produced vaccines that use older technology and have lower efficacy rates than the RNA vaccines used in the United States. And they offer less protection against newer versions of the virus. Only 40% of Chinese older than 80 have received a booster shot.

A surge of 1 million deaths would put China’s death toll on a par with that in the United States where 1.1 million people have died of Covid-19 since the beginning of the pandemic.

As a sign of how bad the crisis is China’s government has reverted to its policy of not counting asymptomatic cases as instances of infection. And the government doesn’t seem to be counting most Covid-deaths at all. The official total of just 3 deaths is clearly out of step with anecdotal reporting. Those deaths were the first official deaths since December 7. The official count of just 2,000 infections a day is contradicted both by local residents and by the evidence of empty pharmacy shelves and over-whelmed health clinics.

Chinese health authorities have warned of successive waves of Covid infections over the coming months. Speaking at a conference in Beijing on Saturday, Wu Zunyou, the chief epidemiologist at the Chinese Centre for Disease Control and Prevention, said the current outbreak would peak this winter and run in three waves for about three months.

With official government lockdowns absent, Chinese residents of the country’s largest cities have begun self-directed stay-at-home efforts that have left streets n Bejing, Shanghai, and other cities very quiet.