Hospital visits spiked, roads were closed and flights cancelled Monday as China choked under a vast cloud of toxic smog, with forecasters warning worse was yet to come.

At least 23 cities in the world’s most populous nation have issued red alerts for air pollution since Friday, according to the official Xinhua news agency.

A host of emergency measures have been implemented to protect the public’s health from the smog, which is smothering almost a ninth of the entire country.

On Monday evening — the fourth day of the alert which is scheduled to end on Wednesday — Beijing’s air quality was better than feared, with PM 2.5 levels hovering around 200, according to data maintained by the US embassy.

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