China's decision to end its zero-COVID policy was a long time coming. They are worried that the country is not sharing enough information about the transition to a new relationship with the virus.

After protests, a sagging economy, and the extreme transmissibility of the virus, China dropped virtually all controls. A population with very low levels of standing immunity is the goal of the SARS- CoV-2. The country has stopped collecting basic epidemiological data, which makes it difficult to understand how the epidemic is unfolding.

If China ended zero COVID, models predicted a huge wave of infections and deaths. Crowds of patients in wheelchairs and on gurneys are seen in press reports and social media posts. The doctors and nurses are sick. The crematoriums are full. The official death toll in China is low. The monitoring plan unveiled last month doesn't have the power to detect new variant of the disease as it moves through one-fifth of the world's population.

China's daily counts of COVID-19 cases and deaths were usually thought to be accurate. They are anyones guess now. Mild symptoms are not encouraged to be tested. People who test positive at home don't have to report it.

According to the China Center for Disease Control and Prevention, there were more than 35,000 confirmed cases in the final week of December. According to the leaked notes, almost 250 million people in China may have caught COVID-19 in the first 20 days of December. According to a global health specialist at the Council on Foreign Relations, it is not unreasonable that 80% of Beijing residents have been exposed to the disease.

The death toll in China has always been inconsistent, with some regions reporting all deaths in which the disease was a factor, while others exclude people who died from other diseases. China's government decided in December to use a narrower definition.

There were just eight deaths for the last week of December, which is not matching media reports and what is being seen on social media. Hospital and intensive care admissions, as well as the average number of new infections stemming from each case, are not included. "These are critical data that would help health authorities get a handle on the surge and further the world's understanding of the Pandemic," said a public health scientist at the Yale School of Public Health.

There is concern that the wave will breed a new variant of the disease. George Gao, who stepped down as head of the China CDC in July 2022, believes that something may be emerging because of the large population in China. He told Science that there aren't any novel Mutants yet. According to the head of the National Institute for Viral Disease Control and Prevention, the BA.5.2 and BF.7 Omicron subvariants are the main cause of infections in China. The spread of BQ.1 and XBB has been limited in several provinces.

Some experts think that China is looking enough. Each of China's 31 provinces, municipalities, and regions has a designated hospital that is supposed to analyze samples from 15 outpatients, 10 severe cases, and all deaths every week. The sample size is too small. A stronger plan would consider province size and population density, instead of picking three cities in each. A study on how well 189 countries have detected new variant was published in November. It found that effective surveillance requires a small number of cases to be sequence. China's plan isn't likely to come close to that percentage

The program will pick up new variant quickly. The plan to sequence 2000 to 3000 genomes per week should be able to detect new variant and their transmission trends if the plan gets up to speed. China is sharing information from the outbreak on the world's largest database.

A Chinese epidemiologist who asked not to be identified said that research groups at more than 30 hospitals and universities are tracking the same variant of the disease. The source says that these groups will report if there is a dangerous variant.

The lack of reliable data is making people doubt China's handling of the outbreak. The United States and France are two of a dozen countries that will require pre- or post flight tests for air travelers from China. It's not likely to keep new variant out. Quiet diplomacy may work better than travel restrictions when it comes to persuading the Chinese to be more forthcoming about what is happening on the ground.

With reporting by Bian Huihui.