As China grapples with its first-ever national COVID-19 wave, emergency wards in small cities and towns southwest of Beijing are stunned as they attempt to reel with the massive influx of critical cases.
Emergency rooms are turning away ambulances, relatives of sick people are searching for open beds, and patients are slumped on benches in hospital corridors and lying on floors for lack of beds.
In more than three decades of emergency medicine, Beijing-based doctor Howard Bernstein said, he has never seen anything like this.
Patients are arriving at his hospital in ever-increasing numbers; almost all are elderly, and many are very unwell with COVID and pneumonia symptoms, he said.
Bernstein's account reflects similar testimony from medical staff across China who are scrambling to cope after China's abrupt U-turn on its previously strict COVID policies this month was followed by a nationwide wave of infections.
It is by far the country's biggest outbreak since the pandemic began in the central city of Wuhan three years ago.
Beijing government hospitals and crematoriums also have been struggling this month amid heavy demand.
"The hospital is just overwhelmed from top to bottom," Bernstein told Reuters at the end of a "stressful" shift at the privately owned Beijing United Family Hospital in the east of the capital.
"The ICU is full," as are the emergency department, the fever clinic and other wards, he said.
"A lot of them got admitted to the hospital. They're not getting better in a day or two, so there's no flow, and therefore people keep coming to the ER, but they can't go upstairs into hospital rooms," he said. "They're stuck in the ER for days."
In the past month, Bernstein went from never having treated a COVID patient to seeing dozens a day.
"The biggest challenge, honestly, is I think we were just unprepared for this," he said.
Furnaces at crematoriums 'burning overtime'
At the Zhuozhou crematorium in the Hebei province bordering Beijing to the north, furnaces are burning overtime as workers struggle to cope with a spike in deaths in the past week, according to one employee.
A funeral shop worker estimated it is burning 20 to 30 bodies a day, up from three to four before COVID-19 measures were loosened.
“There’s been so many people dying,” said Zhao Yongsheng, a worker at a funeral goods shop near a local hospital. “They work day and night, but they can’t burn them all.”
At a crematorium in Gaobeidian, about 20 kilometres south of Zhuozhou, the body of one 82-year-old woman was brought from Beijing, a two-hour drive, because funeral homes in China’s capital were packed, according to the woman’s grandson, Liang.
“They said we’d have to wait for 10 days,” Liang said, giving only his surname because of the sensitivity of the situation.
Liang’s grandmother had been unvaccinated, he added, when she came down with coronavirus symptoms and had spent her final days hooked to a respirator in a Beijing ICU.
Over two hours at the Gaobeidian crematorium on Thursday, AP journalists observed three ambulances and two vans unload bodies.
A hundred or so people huddled in groups, some in traditional white Chinese mourning attire. They burned funeral paper and set off fireworks.
“There’s been a lot!” a worker said when asked about the number of COVID-19 deaths before funeral director Ma Xiaowei stepped in and brought the journalists to meet a local government official.
As the official listened in, Ma confirmed there were more cremations but said he did not know if COVID-19 was involved. He blamed the extra deaths on the arrival of winter.
“Every year during this season, there’s more,” Ma said. “The pandemic hasn’t really shown up” in the death toll, he said, as the official listened and nodded.
Medical staff forced to work even with COVID symptoms
Sonia Jutard-Bourreau, 48, chief medical officer at the private Raffles Hospital in Beijing, said patient numbers are five to six times their normal levels, and patients' average age has shot up by about 40 years to over 70 in the space of a week.
"It's always the same profile," she said. "That is most of the patients have not been vaccinated."
The patients and their relatives visit Raffles because local hospitals are "overwhelmed", she said, and because they wish to buy Paxlovid, the Pfizer-made COVID treatment, which many places, including Raffles, are running low on.
"They want the medicine like a replacement of the vaccine, but the medicine does not replace the vaccine," Jutard-Bourreau said, adding that there are strict criteria for when her team can prescribe it.
Jutard-Bourreau, who, like Bernstein, has been working in China for around a decade, fears that the worst of this wave in Beijing has not arrived yet.
Elsewhere in China, medical staff told Reuters that resources are already stretched to the breaking point in some cases, as COVID and sickness levels amongst staff have been particularly high.
One nurse based in the western city of Xian said 45 of 51 nurses in her department and all staff in the emergency department had caught the virus in recent weeks.
"There are so many positive cases among my colleagues," said the 22-year-old nurse, surnamed Wang. "Almost all the doctors are down with it."
Wang and nurses at other hospitals said they had been told to report for duty even if they tested positive and had a mild fever.
Jiang, a 29-year-old nurse on a psychiatric ward at a hospital in Hubei province, said staff attendance has been down more than 50% on her ward, which has stopped accepting new patients.
She said she is working shifts of more than 16 hours with insufficient support.
"I worry that if the patient appears to be agitated, you have to restrain them, but you cannot easily do it alone," she said. "It's not a great situation to be in."
COVID death toll numbers 'political'
The doctors who spoke to Reuters said they were most worried about the elderly, tens of thousands of whom may die, according to estimates from experts.
More than 5,000 people are probably dying each day from COVID-19 in China, Britain-based health data firm Airfinity estimated, offering a dramatic contrast to official data from Beijing on the country's current outbreak.
The Chinese government has reported only seven COVID-19 deaths since restrictions were loosened dramatically on 7 December, bringing the country’s total toll to 5,241.
There were no COVID deaths on the mainland for the six days through Sunday, the Chinese Centre for Disease Control and Prevention said on Sunday, even as crematories faced surging demand.
Last Tuesday, a Chinese health official said that China only counts deaths from pneumonia or respiratory failure in its official COVID-19 death toll -- a narrow definition that excludes many deaths that would be attributed to the virus in other places.
Experts have forecast between a million and 2 million deaths in China through the end of next year, and a top World Health Organisation official warned that Beijing’s way of counting would “underestimate the true death toll”.
"It's not medicine, it's politics," said Jutard-Bourreau. "If they're dying now with COVID, it's because of COVID. The mortality rate now it's political numbers, not medical."