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Hong Kong CNN  — 

China’s abrupt and under-prepared exit from zero-Covid could lead to nearly 1 million deaths, according to a new study, as the country braces for an unprecedented wave of infections spreading out from its biggest cities to its vast rural areas.

For nearly three years, the Chinese government has used strict lockdowns, centralized quarantines, mass testing and rigorous contact tracing to curb the spread of the virus. That costly strategy was abandoned earlier this month, following an explosion of protests across the country against stringent restrictions that have upended businesses and daily life.

But experts have warned that the country is poorly prepared for such a drastic exit, having fallen short on bolstering the elderly vaccination rate, upping surge and intensive care capacity in hospitals, and stockpiling antiviral medications.

Under the current conditions, a nationwide reopening could result in up to 684 deaths per million people, according to the projections by three professors at the University of Hong Kong.

Given China’s population of 1.4 billion people, that would amount to 964,400 deaths.

The surge of infections would “likely overload many local health systems across the country,” said the research paper, released last week on the Medrxiv preprint server and which has yet to undergo peer review.

Simultaneously lifting restrictions in all provinces would lead to hospitalization demands 1.5 to 2.5 times of surge hospital capacity, according to the study.

But this worst case scenario could be avoided if China rapidly rolls out booster shots and antiviral drugs.

With fourth-dose vaccination coverage of 85% and antiviral coverage of 60%, the death toll can be reduced by 26% to 35%, according to the study, which is funded partly by the Chinese Center for Disease Control and Prevention (CDC) and the Hong Kong government.

A health worker waits for people to take swab samples to test for Covid-19 in Shanghai on December 19, 2022.

On Monday, Chinese health authorities announced two Covid deaths, both in the capital Beijing, which is grappling with its worst outbreak since the start of the pandemic.

They were the first officially reported deaths since the dramatic easing of restrictions on December 7, although Chinese social media posts have pointed to a surge in demand at Beijing’s funeral homes and crematoriums in recent weeks.

An employee at a funeral home on the outskirts of Beijing told CNN they were swamped by the long queues for cremation, and customers would need to wait until at least the next day to cremate their loved ones.

On Baidu, China’s dominant online search engine, searches for “funeral homes” by Beijing residents have hit a record high since the pandemic began.