Attached to a breathing tube under a pile of blankets, an old man racked with Covid-19 lay groaning on a stretcher in the emergency department of a hospital in central China Thursday.

In Chongqing, and across the country, the virus is surging. Authorities say the number of cases is impossible to track after the abrupt abandonment of years of mass testing, lockdowns and travel restrictions.

A paramedic at Chongqing Medical University First Affiliated Hospital who confirmed the old man was a Covid patient said he had picked up over 10 people a day, 80 to 90 percent of whom were infected with coronavirus.

"Most of them are elderly people," he said.

"A lot of hospital staff are positive as well, but we have no choice but to carry on working."

The old man waited half an hour to be treated, while in a nearby room AFP saw six other people in sick beds, surrounded by harried doctors and relatives.

They too were mostly elderly, and when asked if they were all Covid patients, a doctor said: "Basically."

Five were strapped to respirators and had obvious breathing difficulties.

Millions of elderly people across China are still not fully vaccinated, raising concerns that the virus may kill the most vulnerable citizens in huge numbers.

But under new government guidelines, many of those deaths would not be blamed on Covid.

Previously, people who died of an illness while infected with the virus were counted as a Covid death, but now only those who directly die of respiratory failure caused by the virus will be tallied.

"Old people have other underlying conditions, only a very small number die directly of respiratory failure caused by infection with Covid," an official said this week.

At the Chongqing hospital, staff had their hands full, ferrying elderly patients to different floors as families and other visitors hovered anxiously.

A passing inpatient ward doctor confirmed the hospital had been very busy with Covid patients, but declined to elaborate.

AFP was not permitted to access the critical respiratory illness ward.

'Constantly busy'

At a large crematorium on the rural outskirts of the city, a long line of cars waited for parking spaces inside the compound Thursday afternoon.

Dozens of bereaved relatives milled around in groups, some carrying wooden urns, as funeral gongs sounded and mourners burned incense.

In a waiting room adjoining a large furnace, grieving relatives watched as their loved ones' remains were incinerated and carefully swept into a metal box by workers.

Four families told AFP their relative did not die of Covid but other conditions including heart attacks, but one middle-aged man carrying an urn said an elderly relative died after testing positive for the virus.

"It's been constantly busy lately," said one crematorium driver sat smoking in his car.

"We work more than 10 hours a day with few breaks."

He added he did not keep count of how many bodies he transported per day, nor did he know if they were Covid patients.

At another vast crematorium in urban Chongqing, AFP saw about two dozen mourners waiting in its sleek service hall.

"Recently the daily number of cremations has been very high," said one staffer wearing an overcoat and face shield.

"It's not possible to put bodies in cold storage, they must be cremated on the same day."

'Covid no big deal'

Away from the Covid wards and crematoriums, the streets of Chongqing were returning to a semblance of normal, with pedestrians and traffic beginning to clog up some roads.

A taxi driver surnamed Yang said a lot of people had been infected in the city already — including himself, his entire family, and most of his friends.

"We had no choice but to treat ourselves at home," he told AFP.

But Yang said he thought it was worth it.

"We should have reopened a long time ago," he said.

"Covid isn't a big deal. For most people, they just get it and move on."