China’s Covid Surge Threatens Villages as Lunar New Year Approaches

Cases in Dadi village, a corn-growing community nested among the verdant hills in China’s far southwest, began in early December when a small number of young people returned from work in the cities. big street.

The nearest hospital is an hour away and few people can afford a $7 bus ticket there. The village health station is not equipped with oxygen tanks or even an oximeter to detect if someone’s blood is dangerously starved of oxygen. It quickly depleted its stockpile of five boxes of fever-reducing medicine, so officials asked sick residents to stay home and drink plenty of water.

For three years, the villagers have avoided the worst of the coronavirus pandemic. But by the end of last year, Covid cases had increased across China, forcing the government to abandon its strict but ultimately futile policy of mass lockdown. It was only a matter of time before the virus spread beyond the cities and into poorer rural areas like Dadi, Guizhou province, with the most meager medical care.

China is bracing for an onslaught of infections in its fragile countryside as millions of migrant workers crammed onto trains and buses leaving towns with factories, construction school and city to return home to the countryside during the Lunar New Year holiday. The travel time, which begins Saturday and lasts 40 days, is expected to overwhelm the rural healthcare system just weeks after hospitals in wealthy cities like North Kinh and Shanghai shut down. buckling by the outbreak.

“What we are most worried about is that after three years, everyone… can finally go home for the New Year to visit relatives,” said Jiao Yahui, an official with China’s National Health Commission. told state media. Given the limited health resources of densely populated rural areas, “how to deal with the peak of infection in large rural areas has become a major challenge,” she said.

In Dadi, the local clinic is just a converted small house with four rooms and a wardrobe. At best, it can give intravenous fluids, but no more than five or six people at a time. Gao Hong, a village official, said by phone that no one from the county government had told the village to prepare for an outbreak.

Mr. Gao said that since the cases in Dadi so far have been mild, villagers desperately need fever-reducing and cough medicine, but even those are hard to come by. “We are too far away to be able to deliver any drugs purchased online,” he said.

In spite of lack of reliable government dataThere are signs that Covid has spread freely in rural areas, especially in places with large numbers of return migrants such as Ha Nam province in the central region.

Long lines of people had formed outside the village clinics there, according to state media. Such local community health clinics and centers are intended to serve as the first line of defense in the triage system and prevent overcrowding at county hospitals, which are often the closest to residents. rural areas can be treated for serious medical conditions.

A district hospital in Henan was so overwhelmed with patients from the surrounding countryside that it had to dispense fever-reducing medication to patients with a body temperature of 101.3 degrees or higher. Officials at another county hospital in central Anhui province said they were taking in so many patients that the facility would soon run out of intensive care beds and ventilators.

China’s rural areas are more sparsely populated than cities, which means the virus will spread more slowly. But variants of Omicron have been shown to be so infectious that population density may not make a difference, especially when friends and family gather to celebrate the Lunar New Year. Rural areas are also home to a disproportionately large number of older people, because so many young people have left the cities in search of better employment opportunities.

Vaccination rates in rural areas are unclear. Nationally, older adults generally have lower rates of booster shots. The government has tried to increase vaccinations by 2021 but has faced resistance from people who are skeptical about the safety of the vaccine. state media reported.

Yanzhong Huang, a senior fellow for global health, said: “As people move around, we will most likely see an increase in cases in rural areas, but the health care system is incapable of responding to rapidly increasing demand.” at the Council on Foreign Relations.

Other countries such as India have experienced the devastating consequences of the outbreak, which broke out in rural areas with underdeveloped healthcare. What later became known as the Delta variant ripping the Indian countryside in early 2021, leaving bodies floating in the Ganges and villagers calling for the meager supply of oxygen available.

In China, few things highlight the inequality between urban and rural life as clearly as medical care. Despite ongoing health reforms, access to everything from ventilators to fever-reducing medicine remains scant for the 500 million people living in rural areas. Staffing in rural health facilities is also unfortunately low. Government statistics show that there are 1.3 million doctors and 1.8 million nurses in rural China – almost half the number of people per 1,000 people in the city.

Rural communities are largely served by junior health workers, who have only minimal medical training – less than 1% have a university degree and just over half have graduated from schools. vocational high school. They are usually summoned only when necessary.

“The village doctor is just a side job. Doctors also need to farm,” said Hunter Ge, a migrant worker, describing the level of care in Maxiaoji, his village of about 700 people in Henan, which suffered a massive virus outbreak.

Mr. Ge said that village doctors cannot be relied on to treat serious illnesses, which are often the only local source of medicine.

Mr. Ge, who works at a factory, said: “They are quite beautiful. “You can call the village doctor at midnight, if needed.”

Village health workers can provide basic services such as vaccinations for infants and treatment for minor illnesses. But experts say it’s unrealistic to expect them to know how to treat Covid effectively. The lack of training makes them risk-averse, increases the likelihood they will send people to the hospital and exacerbates overcrowding.

“The ideal thing you want is people with less serious medical conditions,” said Sean Sylvia, an assistant professor of health policy at the University of North Carolina who has studied rural China. will stay away from higher level hospitals. “And if you’re relying on village doctors to properly triage patients, there’s a big question whether they can do that.”

The government is trying to tackle the impending crisis with restrictions on social distancing, vaccination campaigns and a commitment to improve drug delivery.

In southwestern Sichuan province, officials recently command Villages limit gatherings at weddings, receptions, and mahjong games. And the southern province of Yunnan is urging returning migrants to stay away from crowds and the elderly.

As recently as last month, the National Health Commission call health workers in rural areas to accelerate efforts to fully immunize rural residents, especially the elderly. In the southern part of Hainan Island, groups of Communist Party cadres, doctors and nurses are go from house to house to vaccinate the villagers.

Shortage of cough and fever medicine popular, as a result of an explosion of infection and hoarding by residents. But those drugs only relieve the symptoms. Antiretroviral treatments like Pfizer’s Paxlovid, which can reduce the risk of hospitalization and death, are much more expensive and scarce, even in cities where health care is good. let alone the countryside.

The State Council, China’s cabinet, issued an instruction last week called on local governments and Communist Party cadres to align resources to contain the outbreak by securing medical supplies, increasing critical care and prioritizing the elderly. The cabinet urged grassroots health workers to distribute medical kits containing fever and cough medicines, rapid antigen tests and masks to vulnerable groups.

Public health experts say the last-minute efforts show how poorly the country is prepared for its Covid turn-back strategy.

Mr. Huang of the Council on Foreign Relations said of the State Council directive: “The bottom line is that these measures should have been implemented before the policy pivot.

“Many of the problems we’re seeing in rural China are essentially problems in China’s healthcare reform, and you can’t expect to solve them in such a short amount of time,” he said. so. “In short, they will not be effective in significantly mitigating the harmful effects of the uncontrolled spread of Covid-19 in rural areas.”

Mr. Gao, an official in Dadi, said donors and NGOs had recently delivered medicine to his village, providing relief to the community’s 760 residents. He estimates that 300 migrants will return to Dadi in the coming weeks and the number of fuel contamination now stands at more than 150. Even when the medication runs out, most will try to overcome the illness at home.

“This is not a rich village, it is actually quite poor,” Mr. Gao said. “It is unrealistic for villagers to spend 50 yuan to take the bus and buy medicine in the district. Even if they take the bus, there is no guarantee they will have medicine because of the extreme scarcity.”

Chris Buckley and King of Death contribute reports and research.