The infection in Dadi Village, a corn-farming village nestled among rolling green hills in China’s remote southwest, began in early December, when a handful of young people returned from jobs in big cities.

The nearest hospital was an hour away, and few people could afford the $7 bus fare there. The village clinic doesn’t have an oxygen tank or even an oximeter to check if someone’s blood is dangerously low on oxygen. It quickly ran out of a stockpile of five boxes of fever medicine, so officials told sick residents to stay home and drink plenty of water.

For three years, the villagers had avoided the worst of the coronavirus pandemic. But late last year, Covid infections surged across China, forcing the government to abandon its draconian, yet ultimately futile, policy of mass lockdowns. It was only a matter of time before the virus moved out of the cities and reached poor rural areas with little medical care, such as Dadi in Guizhou province.

China is bracing for an onslaught of infections in its fragile countryside as millions of migrant workers crowd trains and buses to leave factory towns, construction sites and cities to return to their rural homes for the Lunar New Year holiday . The travel period, which begins Saturday and lasts 40 days, is expected to overwhelm the rural health care system just weeks after outbreaks in hospitals in wealthier cities such as Beijing and Shanghai.

“What worries us most is that after three years everyone … can go home to visit their relatives in the new year,” said Jiao Yahui, an official with China’s National Health Commission. told state media, With the limited medical resources of populated rural areas, she said, “how to deal with the peak of infections in vast rural areas poses a major challenge.”

In Grandma’s, the local clinic is little more than a converted cottage with four rooms and a closet. At best, it can offer intravenous drips, but not for more than five or six people at a time. Gao Hong, a village official, said by phone that no one from the county government told the village to prepare for an outbreak.

Because cases in Dadi have been mild so far, Gao said, villagers were most in need of fever-reducing and cough medicines, but even those are hard to come by. “We are too far away to deliver any medicine online,” he said.

Despite the lack of reliable government data, there are signs that COVID is already circulating freely in rural areas, especially those with large numbers of returning migrants, such as in central Henan province.

Long queues of people form outside the village clinic state media, Such clinics and local community health centers are meant to serve as the first line of defense in a triage system and prevent overcrowding at county hospitals, which are often the closest places where rural residents are treated for serious medical conditions. can go.

One such county hospital in Henan was so overwhelmed with patients from the surrounding countryside that it had to give fever-reducing drugs to patients with body temperatures of 101.3 degrees or higher. Officials at another county hospital in central Anhui province said they have received so many patients that the hospital will soon run out of critical care beds and ventilators.

China’s rural areas are less densely populated than its cities, which may mean the virus will spread less quickly. But the Omicron variants have proven to be so contagious that population density may make no difference, especially when friends and family gather to celebrate the Lunar New Year. Rural areas are also home to a disproportionate number of older adults, as so many young people have moved to cities in search of better job opportunities.

Vaccination rates in rural areas are unclear. Nationwide, older adults generally have lower booster rates. The government tried to increase vaccinations in 2021, but faced resistance among residents who were skeptical about the safety of the vaccines. state media reported,

“We’re going to see an increase in cases in rural areas as people move around, but the health care system doesn’t have the capacity to cope with the rapid increase in demand,” said Yanzhong Huang, a senior fellow at Global Health ” In Council on Foreign Relations.

Other countries, such as India, have already experienced the devastating consequences of outbreaks in rural areas with underdeveloped health care. What later came to be known as the delta variant hit the Indian countryside in early 2021, leaving bodies floating in the Ganges and villagers struggling for a low supply of oxygen.

In China, few things highlight the disparities between urban and rural life as clearly as medical care. Despite ongoing health reforms, the 500 million people living in rural areas have little access to everything from ventilators to fever medicine. There is also a shortage of staff in rural health facilities. There are 1.3 million doctors and 1.8 million nurses in rural China – nearly half as many per 1,000 people in cities as government data shows.

Rural communities are largely served by grassroots health workers who have only minimal medical training – less than 1 percent have university degrees, and more than half have graduated from vocational high schools. They are often called only when needed.

“The village doctor is only a side job. Doctors also need to cultivate,” said Hunter Ge, a migrant worker describing the level of care in Maxiaojie, his village of about 700 people in Henan, which has been largely hit by the virus outbreak.

Mr. G said that village doctors cannot be trusted to treat major ailments, but they are often the only local source of medicine.

“They are quite nice,” said Mr. Ji, who works in a factory. “If necessary, you can call the village doctor at midnight.”

Village health workers can provide basic services such as immunizing infants and treating minor ailments. But experts say it is unrealistic to expect them to know how to treat Covid effectively. Their lack of training makes them risk-averse, increasing the likelihood that they will send people to the hospital and exacerbate overcrowding.

“Ideally you want people with less severe conditions to stay away from higher-tier hospitals,” said Shawn 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, it’s a big question whether they can do that.”

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

In southwestern Sichuan province, officials recently ordered Gathering of people in villages, weddings, feasts and Mahjong parlors will be banned. And southern Yunnan province is urging returning expatriates to stay away from crowds and older people.

As recently as last month, the National Health Commission called on Health workers in rural areas to accelerate efforts to fully vaccinate rural residents, especially older adults. Teams of Communist Party workers, doctors and nurses are on the southern island of Hainan going door to door Vaccination of villagers.

Shortages of cough and fever medicines have become widespread as a result of the explosion of infections and hoarding by residents. But those drugs only relieve symptoms. Antiviral treatments such as Pfizer Paxlovid, which can reduce the risk of hospitalization and death, are far more expensive and scarce, even in cities where health care services are better, let alone in rural areas.

State Council, Cabinet of China issued an instruction Last week called on local officials and Communist Party cadres to marshal resources to ensure medical supplies, strengthen critical care and prioritize older adults, among other things. The cabinet called upon grassroots health workers to distribute health kits containing fever and cough medicine, rapid antigen tests and masks to vulnerable groups.

Public health experts say the last-minute effort underscores how unprepared the country was to make a U-turn in its Covid strategy.

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

“Many of the problems we’re seeing in rural China are basically problems with China’s health care reform, and you can’t expect to fix them in such a short period of time,” he said. “In short, they will not be effective in mitigating the harmful effects of the unbridled spread of COVID-19 in rural areas.”

Daadi official Mr. Gao said that donors and non-governmental groups recently delivered medicine to his village, bringing relief to the community’s 760 residents. He estimates that 300 migrants will return to Grandma’s in the coming weeks and fuel infections, which are more than 150 at present.

“It’s not a rich village, it’s actually quite poor,” Mr. Gao said. “It is not realistic for the villagers to spend 50 yuan to take a bus to the county and buy medicine. Even if they take the bus, there is no guarantee that they will get the medicine due to extreme shortages.”

Chris Buckley And Zixu Wang Contributed to reporting and research.

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