As China grapples with surging COVID-19 cases, emergency wards in small cities and towns southwest of the capital, Beijing, are overwhelmed. Intensive care units (ICUs) 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 a lack of beds.

The towns and small cities in Baoding and Langfang prefectures, in central Hebei province, were the epicentre of one of China’s first outbreaks after the state loosened coronavirus controls in November and December. For weeks, the region went quiet, as people fell ill and stayed home.

Many have now recovered. Today, markets are bustling, diners pack restaurants and cars are honking in snarling traffic, even as the virus is spreading in other parts of China. In recent days, headlines in state media said the area is “starting to resume normal life”.

But life in central Hebei’s emergency wards and crematoriums is anything but normal. Even as the young go back to work and lines at fever clinics shrink, many of Hebei’s elderly are falling into critical condition. As they overrun ICUs and funeral homes, it could be a harbinger of what is to come for the rest of China.

The Chinese government has reported only seven COVID-19 deaths since restrictions were loosened dramatically on December 7, bringing the country’s total toll to 5,241. On Tuesday, a health official said China counts deaths from pneumonia or respiratory failure only in its official COVID-19 death toll, a narrow definition that excludes many deaths that would be attributed to the disease in other places.

Experts have forecast between a million and 2 million deaths in China next year, and the World Health Organization warned that Beijing’s way of counting would “underestimate the true death toll”.

At Baoding No 2 Hospital, in Zhuozhou, patients on Wednesday thronged the hallway of the emergency ward. Others were breathing with the help of respirators. One woman wailed after doctors told her that a loved one had died.

At the Zhuozhou crematorium, furnaces are burning overtime as workers struggle to cope with a spike in deaths in the past week, according to one employee cited by The Associated Press news agency. 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.

At a crematorium in Gaobeidian, about 20km (12 miles) 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, Liang added, when she came down with coronavirus symptoms, and had spent her final days hooked to a respirator in a Beijing ICU.

The Baigou New Area Aerospace Hospital was quiet and orderly, with empty beds and short lines as nurses sprayed disinfectant. COVID-19 patients are separated from others, staff said, to prevent cross-infection. But they added that serious cases are being directed to hospitals in bigger cities, because of limited medical equipment.

The lack of ICU capacity in Baigou, which has about 60,000 residents, reflects a nationwide problem. Experts say medical resources in China’s villages and towns, home to about 500 million of China’s 1.4 billion people, lag far behind those of big cities such as Beijing and Shanghai. Some counties lack a single ICU bed.

As a result, patients in critical condition are forced to go to bigger cities for treatment.