‘In these two streets alone, 20 people died from Covid last month’
Dong Chunhong sighs with relief. After weeks toiling away in his clinic, treating up to 50 Covid patients a day, the 45-year-old doctor finally has time for dinner with his family.
“People came knocking on my door until midnight,” Dong says from his home in Gongjiahe, a tiny village out in the distant hills and valleys of China’s Shaanxi province, in the north of the country. “I was exhausted. My whole family had a fever, I wasn’t feeling well but I still had to serve my people.”
Unlike the doctors and medics in China’s sprawling cities, Dong was limited in what he could offer the sick – largely a result of the government’s sudden abandonment of its zero-Covid policy, which left the country’s rural health services desperately unprepared for the colossal wave of infections that followed.
“This is coughing medicine, this is for phlegm, and this is for a headache,” Dong says, pointing at the shelves of his clinic’s pharmacy. The most desired medicine was ibuprofen, which would bring down the fever. Yet there was no stockpile to rely on. “I couldn’t order more. There was a shortage.”
As for effective antiviral medicine like Paxlovid, which is widely available throughout the West, Dong says he has never heard of it. He does, however, have two oximeters for testing patients’ blood oxygen levels, which he proudly shows off.
Of the 1,136 people who live in Gongjiahe, half had the virus and 90 per cent survived, Dong estimates. It is not unimaginable that many died in their homes without him knowing, he adds. But it could have been a different story if the village was better resourced.
People ‘don’t trust’ health centres
Over the years, there has been “no effort to fix the root causes” of poor healthcare access and provision in China’s countryside, says Professor Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.
Healthcare spending has gradually increased, rising from four per cent in 1990 to more than seven per cent in 2020, while all Chinese citizens now have their basic medical needs covered by insurance.
But the quality of this care remains inadequate in parts of the country and, out in rural China, the number of village clinics offering health services has reduced by almost 20 per cent over the past 30 years, according to official government data.
“People don’t trust the [rural] health centres,” Prof Huang says. “They prefer to go to county level hospitals. But then often either they themselves or their children don’t want them to go. They find it too costly or feel like it’s not needed anymore after a certain age.”
As far as the government is concerned, the worst of the pandemic is now behind China. Fever clinic visit rates have dropped over 90 per cent through January and hospitalisation rates are down more than 85 per cent, authorities say.
Deaths are said to be falling too, after officials reported almost 60,000 fatalities last month.
However, this number is limited to those who died in a hospital bed, while questions persist over the government’s decision to narrow the definition of a Covid death, which has forced hospitals to put other causes of mortality on the certificates of the deceased.
Mr Chen’s wife is one of the hundreds of thousands of people who are unlikely to ever appear in the government’s official Covid statistics. His whole family came down with a cough last month, but only his wife, Ms Luo, developed a fever.
Due to a lack of adequate health services in the local area, he drove an hour from Heishan, a village in the south of Shaanxi province, to take his wife to Shangluo city hospital.
“At first they wouldn’t take her in because she had the virus,” he says, leaning over his tricycle at Heishan market, where he sells socks. “I don’t know how they knew that because she wasn’t tested. They finally took her. But the next day she was dead.”
Her death certificate said that she died of heart disease, but Mr Chen believes it was Covid that killed her. “I didn’t know she had such a disease,” he says.
Rather than take her body to the crematorium in Shangluo, which burned incessantly over the past month, Chen decided to bury his wife deep in the hills surrounding Heishan, as is common among China’s rural population “We chose a nice spot for her in our field.”
In a nearby market stall, Yun You Ping is selling stacks of fake money ritually burned at funerals. “This is only a side business. But last month I sold a lot because so many people died due to the epidemic or to the cold.”
He explains that normally in Heishan, a village of 3,000 people, only a handful of people die each year. “Now, in the month before New Year, about a hundred of them died at once.”
The scale of transmission across China has been staggering. A recent report by Peking University shows that 91 per cent of the population of the very sparsely populated central province of Gansu had already been infected as of 11 January, followed by remote provinces Yunnan (84 per cent) and Qinghai (80 per cent).
Given the rurality of these regions, it's “likely that the virus was already spreading” throughout the country before the government lifted all restrictions at the end of last year, says Prof Huang.
But the ending of zero-Covid will have no doubt accelerated the rate of transmission, as will the Chinese New Year and mass movement of billions of people across the nation.
Although the peak of the current wave has passed, scientists expect it will still take two months or so for infections in China to settle. According to the data analytics firm Airfinity, the average Covid outbreak lasts 65 to 138 days.
“If the [China] wave started early December, it is in line with the lower lengths of other countries,” says Airfinity analyst Louise Blair. “It is also possible there was more spread in the community prior to December, and therefore we would expect to see a smaller number of cases [in the weeks ahead].”
But determining the true scale of loss and suffering among China’s rural population is likely to remain an impossible task – especially in a country where many are reluctant to speak out.
In Heishan, the owner of a large market stall that sells burial decorations says his business was busier than usual throughout January.
“In these two streets alone, 20 people died last month,” he says. Suddenly, the sight of two local officials who conspicuously start lingering nearby make the man change his tune. It was twenty people in a year, he clarifies. “No, less than twenty actually.”
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