Three years in, people in China are finally feeling freedom from the country’s most rigorous COVID-19 protocols. But some worry that freedom is sending COVID-19 cases surging, putting pressure on subpar health care systems with the potential to stall growth. What then happens to the world’s second largest economy?

For the first time, people in China with mild cases will be allowed to isolate at home instead of at a quarantine center. People visiting many public places will no longer need to prove they tested negative or inform whether they’ve been in an area with high risk of infection. With less stringent testing protocols, official COVID-19 cases are going down, but experts predict the actual rate of infection is rising behind the scenes.

Before the newly-announced reopening – which China claims has nothing to do with widespread protests – economists expected growth to start picking up. Now, economists say growth will lag behind expectations, significantly missing its target of 5.5% for this year and dragging for the first half of next year. At this time, economists’ consensus is that China’s gross domestic product will grow 3.2% in 2022, the slowest rate of growth since the 1970s excluding 2020.

President Xi Jinping’s “zero-COVID” pivot has caught the country by surprise. Beijing is reportedly already running out of even the most basic medical supplies, like ibuprofen, while new modeling analyzed by the Financial Times shows China risks one million COVID-19 deaths with a winter wave.

China’s failure to fully vaccinate millions of elderly Chinese and its refusal to use more effective mRNA vaccines is in sharp focus now as it tests reopening. Previous stringent restrictions may have kept case numbers low, but it also prevented the public from developing natural immunity. While “zero-COVID” clearly harmed China’s economy, the abandonment ahead of a winter surge is fueling uncertainty around Asia’s powerhouse.