China’s Covid-19 surge threatens villages as Chinese New Year approaches

China is bracing for an onslaught of infections in its fragile countryside. PHOTO: AFP

GUIZHOU - The Covid-19 infections in Dadi village, a corn farming community tucked between verdant hills in China’s remote south-west, started in early December when a handful of young people returned from jobs in big cities.

The nearest hospital was an hour’s drive away, and few could afford the US$7 (S$9) bus fare there.

The village clinic is not equipped with oxygen tanks or even an oximeter to detect if someone’s blood is dangerously deprived of oxygen. It quickly ran out of its stockpile of five boxes of fever medicine, so officials told sick residents to stay home and drink lots of water.

For three years, the villagers had avoided the worst of the coronavirus pandemic.

But in late 2022, Covid-19 infections surged across China, forcing the government to abandon its stringent, yet ultimately futile, policy of mass lockdowns.

It was only a matter of time before the virus wound its way out of the cities and arrived in poorer rural areas such as Dadi, in Guizhou province, with the barest of medical care.

China is bracing itself for an onslaught of infections in its fragile countryside as millions of migrant workers crowd onto trains and buses to leave factory towns, construction sites and cities to return to their rural homes for the Chinese New Year holiday.

The travel period, which began on Saturday and lasts 40 days, is expected to overwhelm the rural healthcare system only weeks after hospitals in wealthy cities such as Beijing and Shanghai were buckled 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,” Ms Jiao Yahui, an official with China’s National Health Commission, told state media.

With the populous countryside’s limited medical resources, she said, “how to deal with the peak of infection in vast rural areas has become a huge challenge”.

In Dadi, the local clinic is little more than a converted cottage with four rooms and a closet.

At best, it can offer intravenous drips, but for no more than five or six people at a time.

No one from the county government told the village to prepare for an outbreak, Mr Gao Hong, a village official, said by phone.

Because cases in Dadi have so far been mild, Mr Gao said, villagers were most in need of fever-reducing and cough medicine, but even those have been hard to come by.

“We are too remote to get any medicine purchased online delivered,” he said.

Despite the lack of reliable government data, there are signs that Covid-19 is already being transmitted freely in the countryside, particularly in places with large numbers of returning migrants, like central Henan province.

Long lines of people have been forming outside village clinics there, according to state media.

Such clinics and local community health centres are meant to serve as the first line of defence in a triage system and prevent overcrowding at county hospitals, which are often the closest places rural residents can be treated for serious medical conditions.

One such county hospital in Henan was so inundated with patients from the surrounding countryside that it had to ration fever-reducing medicine to patients registering a body temperature of 38.5 deg C or higher.

Officials at another county hospital in central Anhui province said they had received so many patients that the facility would soon run out of critical care beds and ventilators.

China’s countryside is less densely populated than its cities, which could mean the virus will spread less quickly.

But Omicron variants have proven so infectious that population density may not make a difference, especially as friends and families gather to celebrate Chinese New Year.

Rural areas are also home to a disproportionate number of older adults, because so many younger people have left for the cities to seek better job opportunities.

The rate of vaccination in the rural areas is unclear.

Nationwide, older adults have lower booster rates in general.

The government tried in 2021 to ramp up inoculations but encountered resistance among residents sceptical of the safety of the vaccines, state media reported.

“When people move around, we are very likely going to see a surge of cases in the countryside, but the healthcare system does not have the capacity to withstand the rapid increase of demand,” said Mr Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.

Other countries such as India have already experienced the devastating consequences of a runaway outbreak in rural areas with underdeveloped healthcare.

What later became known as the Delta variant tore through the Indian countryside in early 2021, leaving bodies floating in the Ganges and villagers clamouring for what little supplies of oxygen were available.

In China, few things highlight the inequities between urban and rural life as starkly as medical care.

Despite ongoing health reforms, access to everything from ventilators to fever medicine remains scant for the 500 million people who live in the countryside.

Staffing in rural health facilities is also woefully low. There are 1.3 million physicians and 1.8 million nurses in rural China – roughly less than half as many per 1,000 people as there are in the cities, government statistics show.

Rural communities are largely served by grassroots health workers who have only minimal medical training – less than 1 per cent hold university degrees, and just over half have graduated from vocational high schools.

They are often called upon only when needed.

“Village doctor is only a side job. The doctors need to farm as well,” said Mr Hunter Ge, a migrant worker describing the level of care in Maxiaoji, his village of about 700 people in Henan that has been hit with a massive virus outbreak.

Mr Ge said village doctors could not be relied upon for treating major illnesses but were often the only local source of medicine.

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

A patient receives IV drip treatment at a clinic in a village of Lezhi county in Ziyang, Sichuan province, China, on Dec 29, 2022. PHOTO: REUTERS

Village health workers can provide basic services such as vaccinating babies and treating minor ailments.

But experts say it is unrealistic to expect them to know how to effectively treat Covid-19.

Their lack of training makes them risk-averse, increasing the odds they will send people to a hospital and exacerbate overcrowding.

“What you ideally want is for people with less severe conditions to stay away from the higher-tier hospitals,” said Dr Sean Sylvia, an assistant professor of health policy at the University of North Carolina who has studied rural China.

“And if you’re relying on village doctors to appropriately triage patients, there’s a big question as to whether they can do that.”

The government is scrambling to address the looming crisis with social distancing restrictions, vaccination campaigns and pledges to improve the supply of drugs.

In south-western Sichuan province, officials recently ordered villages to restrict gatherings at weddings, banquets and mahjong parlours. And southern Yunnan province is urging returning migrants to stay away from crowds and older people.

As recently as last month, the National Health Commission called on health workers in the countryside to expedite efforts to fully vaccinate rural residents, particularly older adults. In the southern island of Hainan, teams of Communist Party cadres, doctors and nurses are going door to door to vaccinate villagers.

The shortage of cough and fever medicine has been widespread, a result of the explosion of infections and stockpiling by residents.

But those drugs only relieve symptoms. Antiviral treatments such as Pfizer’s Paxlovid, which can reduce the risk of hospitalisation and death, are far more expensive and scarcer, even in cities where healthcare services are better, let alone the countryside.

The State Council, China’s Cabinet, issued a directive last week calling on local authorities and Communist Party cadres to marshal resources to blunt the outbreak by, among other things, ensuring medical supplies, bolstering critical care and prioritising older adults.

The Cabinet called for grassroots health workers to distribute health kits packed with fever and cough medicine, rapid antigen tests and masks to vulnerable groups.

Public health experts say the last-minute efforts underscore how ill prepared the country was for the U-turn in Covid-19 strategy.

“The bottom line is that these measures should have been rolled out prior to the policy pivot,” Mr Huang of the Council on Foreign Relations said of the State Council’s directive.

“Many of the problems we are seeing in rural China are fundamentally problems in China’s healthcare reform, and you cannot expect to fix them in such a short period of time,” he said. “In short, they won’t be effective in significantly mitigating the harmful effects of the unbridled spread of Covid-19 in the countryside.” NYTIMES

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