Villagers from Luyi County in the heart of China would normally start preparing for the Lunar New Year celebrations last week.
Residents of the hundreds of villages that make up the 1 million-person county in Henan province will extract oil from home-grown peanuts, the main local crop, and pork, goose and chicken in anticipation of the annual holiday. Spring festival couplets, red scrolls proclaiming good wishes for the coming year, will decorate the entrance to the event from January 22.
This year, there is only an unpleasant silence that accompanies the Covid wave around the world. Residents walking through the wheat fields of one village all headed in the same direction: Wang Jian’s clinic, the only place for basic care. Others are in bed fighting the virus that is spreading like wildfire, or staying at home hoping to avoid it.
“I’ve never seen so many patients,” said Wang, whose family has operated a clinic in the village of about 1,000 residents for more than 50 years, which Bloomberg did not name out of concern for its safety. “In the past week, almost every family in the village has come for treatment.”
They fear the situation will worsen as younger members who work in factories or offices return for the holidays, possibly bringing more viruses with them. Across the country, this home front track – known as the Great Migration – will see millions of Chinese regions cross, deep and complex transmission chains.
silent and heavy
Omicron has swept through major Chinese cities including Beijing, Shanghai and Guangzhou, overwhelming hospitals and causing many reported, if not officially recorded, fatalities. Currently ravaging small towns and rural areas serious illness and death will be more widespread due to a lack of strong medical resources and an aging population. Many provinces, including Zhejiang, Shandong and Hubei, expect the outbreak to peak this month.
“There’s a lot of attention focused on how Beijing and Shanghai are struggling – as if they’re seeing the worst – but it’s really devastating what’s happening in the lower parts of the country,” said Chen Xi, an associate professor specializing in aging and public health at Yale University.
“The peak of infection and severe disease is not yet in rural areas, and there are big problems waiting on the road,” Chen said, pointing to the impact of Chinese New Year travel to the heart.
Regional hospitals and local clinics have no experience with Covid and have no support. Medical supplies and emergency care facilities are scarce. By the end of 2020, there were only 1.62 health care workers for every thousand people in rural China, compared to 2.9 doctors and 3.3 nurses nationally, a clear evidence of the huge resource gap.
In Luyi, Wang struggled to treat patients with mild symptoms, just like doctors in other villages. Amid a nationwide drug shortage, they are unable to obtain many common medicines, including ibuprofen, antibiotics and antiviral pills. The local government is not helping, said Wang, who offers Chinese medicines such as isatis root and forsythia to ease symptoms like sore throat and fever.
The situation is worse for people with severe symptoms. The only option for someone with shortness of breath is to go to one of the larger hospitals in the county with a ventilator, and hope it’s available. There were no ambulances in the village, so family members had to figure out how to make the 40-minute drive to the nearest facility for the critically ill.
“It’s very sad that he went to the district hospital – it’s very full now – but it’s the only hope,” Wang said. “There are no facilities in the clinic that can save you.”
The National Health Commission instructed local governments last week to provide antivirals, ventilators, oxygen and other supplies to medical facilities on time, but doctors like Wang say they have not yet received them.
The government also urged migrant workers and students to delay returning home if infected, while asking for larger hospitals to assist rural clinics and facilitate the transfer of seriously ill patients to higher medical institutions.
Not alone
A similar scenario is playing out across China.
In the west, in Ximeng County in Yunnan Province near Myanmar, 81-year-old grandfather Ding Min contracted Covid at the end of December. The family drove him 90 minutes to the town of Puer in search of an intensive care hospital bed, as there was no medicine or treatment in their village clinic, but could not find any available. He died three days later.
His family is still waiting for the funeral to retrieve the body. They haven’t been told how long it took.
Pressure is mounting on regional facilities, which do not have the same resources as those in major urban centers. Daily demand for oxygen has tripled at one large hospital in a tier-three city in Guangdong Province in recent weeks and is nearing full capacity, according to executives who asked not to be named to discuss the sensitive topic. The hospital doubled its intensive care beds in December but still expects to be unable to meet demand at the peak of the outbreak this month in nearby districts and villages.
The loss of resources extends beyond provincial-level governments. The northern province of Shanxi, a largely rural region with a population of about 35 million, is offering free fever-reducing medicine, officials announced on WeChat, but each person is limited to six tablets of ibuprofen or paracetamol at local clinics.
Grassroots efforts are also taking off. The Campaign to Eliminate Fever in Villages, an online initiative to collect donated ibuprofen, has delivered the medicine to about 13,000 elderly residents in 110 villages since Dec. 29 after family members signed up through a Weibo post.
Never knew
The full extent of the situation in rural China, where basic data collection and surveillance has always been more porous than in cities, may not be known. The country abruptly shut down its ubiquitous PCR testing network in early December and stopped publishing daily Covid data that month.
The official death toll since the country suddenly moved from Covid Zero in early December remains below 40, despite reports of crematoriums and nursing homes where more people are dying each day.
In Wang’s village, no one can trace the virus, because all efforts will be saved. The doctor continues to work on his own infections, as dozens of patients queue up from sun up to sun down to get treatment every day. With so many needing intravenous fluids, Wang is treating elderly patients in his house next door, because the only other option is to be outside when the temperature rises.
“Most villagers don’t even call it Covid,” he said. “It’s a new word. They just said it was a cold.”
A sense of surrender prevailed in the village. Many families do not plan to take their elderly or critically ill relatives to regional hospitals for emergency treatment, which they say would be expensive and pointless. However, he will remain at home until the final stages of his life.
It is unlikely that his name will appear on the official list of Covid deaths.