COVID is spreading in rural China and doctors can do little to stop it

Villagers from Luyi County in the heart of China usually start preparing for the Lunar New Year celebration weeks in advance.

Residents of the hundreds of villages that make up the county of 1 million people in Henan province extract oil from home-grown peanuts, an important local crop, and slaughter pigs, geese and chicken in anticipation of the annual holiday. The spring festival couplets, the red scrolls that express good wishes for the coming year, will decorate their doors for the event starting January 22.

This year, there is only the eerie silence That’s with the Covid waves around the world. Residents walking through a wheat field in a village all headed in the same direction: Wang Jian’s clinic, the only place to get basic care. Everyone is in bed fighting the virus that is spreading like wildfire, or staying at home in hopes of avoiding it.

“I’ve never seen so many patients,” said Wang, whose family has operated the clinic in the village of about 1,000 residents for more than 50 years, who Bloomberg did not name out of concern. “Last week, almost every family in the village had someone who was getting medical treatment.”

He fears that the situation will worsen as the younger members work in factory or office jobs back on holiday, probably carrying many viruses with them. Across the country, this journey home – known as the Great Migration – sees millions criss-cross China’s vast territory, deepening and complicating transmission chains.

Quiet and intense

Omicron breaks into China big cities including Beijing, Shanghai and Guangzhou, many hospitals and causes of widely reported, if not officially recorded, death. Small towns and rural areas where serious illness and death tend to be more prevalent due to lack of robust medical resources and advanced age are now being overtaken. Many provinces, including Zhejiang, Shandong and Hubei, are expecting the outbreak maximal later this month.

“There’s a lot of attention focused on how Beijing and Shanghai are struggling – as if they’ve seen the worst – but that’s really drowning out what’s going on in the lower-tier parts of the country,” said Chen Xi, is an associate professor specializing in aging and public health at Yale University.

“The peak of infection and severe disease has not yet hit rural areas, and a big problem is waiting on the road,” Chen said, referring to the effect of the Lunar New Year travel on hearts.

Those regional hospitals and local clinics have little experience with Covid and don’t have much support. Medical supplies and emergency treatment facilities are scarce. By the end of 2020, there will be only 1.62 health care workers for every thousand people in rural China, compared to 2.9 doctors and 3.3 nurses in the country, strong evidence of the huge resource gap.

In Luyi, Wang finds it difficult to treat even patients with mild symptoms, like doctors in other villages. Among the whole country drug shortage, he cannot buy many common medications, including ibuprofen, antibiotics and antiviral pills. The local government did not help, Wang said, offering Chinese medicines such as isatis root and forsythia to ease symptoms such as sore throat and fever.

The situation is worse for those with severe symptoms. The only option for people with shortness of breath is to go to one of the few large hospitals in the county with ventilators, and hope that one is available. There is no ambulance in the village, so family members have to figure out how to make the 40-minute drive to the nearest facility with a seriously ill person.

“It’s sad to tell them to go to county hospitals — they’re full now — but that’s the only hope,” Wang said. “There are no clinical facilities to save them.”

The National Health Commission ordered local governments last week to provide Covid antivirals, ventilators, oxygen and other supplies to medical facilities in a timely manner, but doctors like Wang say there is not yet they will receive.

The government also encouraged migrant worker and students to delay flights home if they are infected, while asking major hospitals to help rural clinics and facilitate the transfer of critically ill patients to higher-level medical institutions.

Not alone

The same scenario is playing out across China.

In the far west, in Ximeng County in Yunnan Province near Myanmar, Ding Min’s 81-year-old grandfather contracted Covid in late December. The family drove him 90 minutes to the town of Puer to find a bed in the intensive care hospital, because there was no medicine or treatment in the clinic in his village, but nothing was available. He died three days later.

The family is still waiting for the funeral home to collect his body. They haven’t been told how long.

Pressure builds on regional facilities, which are not as well resourced as those in large urban centres. Daily oxygen demand has tripled at a large hospital in a tier-three city in Guangdong Province in recent weeks and is nearing full capacity, according to an executive who asked not to be named. which deals with sensitive subject. The hospital doubled its intensive care beds in December but still expects it will not be able to meet demand if the outbreak peaks later this month in nearby counties and villages.

The collapse of resources extends to the level of provincial governments. The northern province of Shanxi, a largely rural area with a population of about 35 million, is offering free fever-reducing medicine, officials announced on WeChat, but per person is limited to just six ibuprofen or paracetamol tablets at their local clinics.

Roots efforts are also increasing. The Campaign to Bring Fever in Villages, an online initiative to collect donated ibuprofen, sent medicines to the 13,000 elderly residents of 110 villages on December 29 after family members signed them through a Post on Weibo.

Never knew

The full extent of the situation in rural China, where basic data collection and surveillance is often more porous than in cities, may not be known. The country abruptly shut down its once ubiquitous network of PCR testing booths in early December and stopped publishing daily Covid data later in the month.

The official death toll since the country suddenly moved from Covid Zero in early December remains less than 40, despite reports of overcrowded crematoriums and nursing homes with many daily deaths.

In Wang’s village, there is no trace of the virus, as all efforts continue to try to survive it. The doctor continues to work through his own infection, while dozens of patients line up from sunup to sundown to be treated each day. So many need intravenous fluids that Wang treats elderly patients in his house next door, because the only other option is outside where the temperature drops.

“Most of the villagers don’t even call it Covid,” he said. “That’s a new word. They just said it was very cold.”

A sense of resignation permeated the village. Many families have no plans to take their elderly or seriously ill relatives to regional hospitals for emergency treatment, which they say is expensive and useless. Instead, they will stay at home for the last period of their lives.

It is unlikely that their names will appear on any official list of Covid deaths.

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