The portable PCR testing booth dangled in the air over a dark Beijing street, captured on camera as it was winched away by a crane in the middle of the night. The image spread rapidly across Chinese social media, the perfect symbol of the bewilderingly rapid end of a draconian era. In the face of the most widespread national protests since the bloody crackdown on Tiananmen Square demonstrators in 1989, the Chinese government has abruptly abandoned its flagship zero-Covid policy. In Beijing, people prepared to go into shopping malls or on public transport without a recent negative test. Elsewhere, they were allowed to enter parks and supermarkets without checks, or told they could quarantine at home – rather than a government facility – if they had come into contact with a case. For nearly three years the authorities have battled to keep Covid out of the country, using every tool of technology, mass mobilisation and repression at their disposal, regardless of the tragic costs to individuals and the terrible damage to the national economy. China became a nation of vigilance, constantly on guard against the virus lapping at its shores. Xi Jinping, China’s most powerful leader since Mao Zedong, was champion of this isolationist approach. Now Beijing has decided to move on. Sun Chunlan, vice-premier and Covid chief, announced last week that the country’s health system had “withstood the test” of Covid-19 and China was in a “new situation”. After years of telling its citizens that the only way to stay safe from Covid was to avoid it entirely, the policy pivot required a new message. Beijing has opted for presenting the prevailing Omicron variant as a less lethal version of the original disease. Xi told visiting European Council president Charles Michel that China could look at easing restrictions because Omicron is less dangerous than the Delta variant, which was most common before. The problem, epidemiologists warn, is that Beijing’s stance does not reflect studies on the impact of Omicron, and the country is ill-prepared for a wave of deadly Covid infections that it may soon face. “China has to find a way out of this. So I think it’s quite helpful for them to be able to argue that the virus has evolved in some way that makes it easier to open up,” said Linda Bauld, professor of public health at Edinburgh University. “With Omicron, certainly from the studies [so far], there may be some small reduction in disease severity but not a huge one.” Omicron has proved less deadly as it spread across countries such as Britain, but by the time it had become dominant, about 95% of the UK population had some form of antibodies from vaccines or previous infections, Bauld said. China has relatively low vaccination and booster rates, particularly among the vulnerable elderly – only 40% of the over-80s have had booster shots. Almost no one has natural antibodies from previous infections. China’s healthcare system was weak and patchy even before the pandemic and has been undermined by years of fighting Covid. Doctors and hospitals were overwhelmed in 2020 as the disease swept through the city of Wuhan at the start of the pandemic and the grim scenes of those early days could be repeated if the virus surges through an unprotected population. A spring outbreak in Hong Kong, which has a much stronger healthcare system, offers a grim forecast of what China could face if it mishandles opening up. “There were a large number of deaths in Hong Kong, despite a relatively small outbreak,” said Martin Hibberd, professor of emerging infectious diseases at the London School of Hygiene & Tropical Medicine. “While the data suggests that Omicron is much less severe than Delta, we have seen in Hong Kong how deadly Omicron can be where there is no history of past exposure [infections] and limited vaccinations in the vulnerable groups such as the elderly.” In the largely unvaccinated elderly population, death rates were similar to those in the UK during the first wave of the pandemic, Julian Tang, a clinical virologist at Leicester University, said in the British Medical Journal in March. The Chinese government has launched a vaccination drive targeted at older citizens, but China is using only domestically developed vaccines, which guard less effectively against Covid than western alternatives. Beijing has so far refused to import foreign-made vaccines. Instead it is pushing for access to the technology, while domestic labs attempt to match the mRNA vaccines made by Pfizer and Moderna – but has not had success with either effort. Joe Biden’s vaccine chief, Ashish Jha, warned last week that Beijing needed “higher quality” vaccine options to manage the virus. Without them, China risks slipping towards the cycles of dangerous outbreaks and strict controls that many other countries endured in 2020 and 2021. “We’ve seen countless cases in the last few years when social resistance leads governments to relax measures before there is significant immunity in the population. The outcome has often been an unsustainable surge in infections that puts the health system at risk and then requires a longer, harsher period of restrictions,” said Thomas Hale, associate professor in global public policy at Oxford University’s Blavatnik School of Government. “China has avoided this ‘rollercoaster’ model so far, but recent shifts suggest it may not be so lucky going forward.” How China handles the bumpy road out of isolation will affect the rest of the world. Potentially at stake are the fortunes of a global economy already battered in recent years by shocks including the pandemic and Vladimir Putin’s invasion of Ukraine.For the first time in more than three decades, China’s economy will grow at a slower rate than its neighbours, the World Bank has forecast. Its role as the world’s factory means more lockdowns would cause disruption around the world, including to vital healthcare supplies. There may also be health implications. China’s easing of restrictions was welcomed by the World Health Organization, but its director general, Tedros Adhanom Ghebreyesus, also warned about the risks of new variants developing in any large population not protected by vaccination. “Gaps in testing ... and vaccination are continuing to create the perfect conditions for a new variant of concern to emerge that could cause significant mortality,” Tedros said on Friday. However the shift from zero Covid to living with Covid goes, one aspect of the next few months and years is certain. Xi will aim to take credit for any success and suppress or shift blame for any failures. The Communist party’s firm grip on China’s media has made it possible for Xi to present his abrupt U-turn last week as a victory, rather than a stunning and unexpected response to the extraordinary courage of ordinary citizens. The protests showed how many people in China are able to evade censorship and are willing to risk the punishment of an authoritarian state, but they have not been reported inside the country. “I don’t know that there is necessarily a huge political problem for Xi and party in terms of [messaging] as they are still very much in control of the domestic narrative,” said Prof Rana Mitter, director of the Oxford University China Centre. “The narrative they are pushing is that they can now shift direction, because the first phase [of Covid controls] was successful.”