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Travellers walk with their luggage at Beijing Capital International Airport, on Dec. 27.TINGSHU WANG/Reuters

China’s thinly resourced countryside is racing to beef up medical facilities before millions of factory workers return home for the Lunar New Year holiday next month from cities where COVID-19 is surging.

Having imposed the world’s strictest COVID regime of lockdowns and relentless testing for three years, China reversed course this month towards living with the virus, leaving its fragile health system overwhelmed.

The lifting of restrictions, following widespread protests against them, means COVID is spreading largely unchecked and likely infecting millions of people a day, according to some international health experts.

China officially reported one new COVID death for Wednesday, down from three on Tuesday, but foreign governments and many epidemiologists believe the numbers are much higher, and that more than 1 million people may die next year.

China has said it only counts deaths of COVID patients caused by pneumonia and respiratory failure as COVID-related.

In the southwestern city of Chengdu, funeral parlours were busy late into the evening on Wednesday, with a steady stream of cars entering one that was heavily guarded by security personnel.

A van driver working for the parlour said “huge numbers of people” were inside.

Hospitals and funeral homes in major cities have been under intense pressure but the main concern over the health system’s ability to cope is focused on the countryside.

At a Shanghai pharmacy, Wang Kaiyun, 53, a cleaner in the city who comes from the neighbouring Anhui province, said she was buying medicines for her family back home.

“My husband, my son, my grandson, my mother, they are all infected,” she said. “They can’t get any medicine, nothing for fever or cough.”

Each year, hundreds of millions of people, mostly working in factories near the southern and eastern coasts, return to the countryside for the Lunar New Year, which starts on Jan. 22.

The holiday travel rush is expected to last for 40 days, from Jan. 7 to Feb. 15, authorities said.

The state-run China Daily reported that rural regions were beefing up their medical capacities.

It said a hospital in a rural part of Inner Mongolia where more than 100,000 people live was seeking bidders for a 1.9 million yuan ($272,308) contract to upgrade wards into intensive care units.

Liancheng County Central Hospital in the eastern Fujian province was seeking tenders for ambulances and medical devices ranging from breathing machines to electrocardiogram monitors.

In December, tenders put out by hospitals for key medical equipment were two-to-three times higher than in previous months, according to a Reuters review,suggesting hospitals were scrambling to plug shortages.

The world’s second-largest economy is expected to suffer a slowdown in factory output and consumption in the near term as workers and shoppers fall ill. Its contact-intensive services sector was particularly hammered by the anti-virus curbs.

The re-opening also raises the prospect of Chinese tourists returning to shopping streets around the world, once a market worth $255-billion a year globally. But some countries have been taken aback by the scale of the outbreak and are sceptical of Beijing’s COVID statistics.

China’s official death toll of 5,246 since the pandemic began compares with more than 1 million deaths in the United States. Chinese-ruled Hong Kong has reported more than 11,000 deaths.

The United States, India, Italy, Japan and Taiwan said they would require COVID tests for travellers from China.

The United States issued a travel alert on Wednesday advising Americans to “reconsider travel to China, Hong Kong, and Macau” and citing “reports that the healthcare system is overwhelmed” along with the risk of new variants.

The main airport in the Italian city of Milan started testing passengers arriving from Beijing and Shanghai on Dec. 26 and found that almost half of them were infected.

Top health officials from the European Union were holding talks to try to coordinate very different views on how to respond to China’s decision to lift its COVID-19 restrictions and its wave of infections.

China has rejected criticism of its statistics as groundless and politically motivated attempts to smear its policies. It has also played down the risk of new variants, saying it expects mutations to be more virulent but less severe.

Omicron was still the dominant strain in China, Chinese health officials said this week.

Australia, Britain, France, Germany, Thailand and others said they would not impose additional restrictions on travel for now.

For its part, China, whose borders have been all but shut to foreigners since early 2020, will stop requiring inbound travellers to go into quarantine from Jan. 8.

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