Villagers buy groceries at a self-help marketplace to avoid infection in Yuantoudi village, Jiazhai town, Liaocheng, Shandong province. (PHOTO PROVIDED TO CHINA DAILY)
Editor's note: Rural areas, where seniors and children often account for the majority of the population, face new challenges after China adopted an optimized pandemic control policy. Doctors from village clinics and township hospitals tell of their ongoing fight against COVID-19.
In the week to Saturday, a village clinic in Anhui province received about 70 patients a day with fever.
Most of the locals in Chenxiaozhai village, Linquan county, have moved to cities across the country for work, but 2,000 residents remain in the area.
As China optimizes and adjusts its epidemic prevention and control measures, Chen said the village cadres' work priorities had also shifted
Chen Ping, the village chief, estimated that more than 90 percent of the patients were infected with COVID-19, despite the clinic not having enough rapid antigen test kits.
Chen was a doctor at the clinic until 2015, when he was persuaded by the Lyuzhai township government, which administers Chenxiaozhai, to serve as a full-time village cadre.
Chen fell ill around Dec 14, and an antigen test showed he was infected with COVID-19. The other 13 village cadres and the seven medical workers at the clinic fell ill later.
"They could take a break from work for two or three days, but after that they needed to return to work, as there was so much to be done to keep the village running," Chen said, adding that he never took a single day off work.
As China optimizes and adjusts its epidemic prevention and control measures, Chen said the village cadres' work priorities had also shifted.
Last month, their hardest tasks were organizing mass testing and keeping the villagers to stay home.
"At that time, the villagers were eagerly waiting the arrival of agricultural produce traders, but the traders were not allowed in from outside the village," Chen said.
Green onions, which cost only 0.80 yuan per kilogram last month, now cost 2 yuan per kg.
"The optimized epidemic prevention and control measures have still been welcomed by the villagers despite the number of infections," Chen said.
With urban residents experiencing severe shortages of the anti-fever drug Ibuprofen, Chen said it could be a different story for those in rural areas.
"Urban residents typically go to drugstores for anti-fever drugs, and they often ask for Ibuprofen, as the pharmacists cannot give customers diagnosis and treatment," Chen said.
"In contrast, in rural areas, there are hardly any drugstores. Villagers who are sick have to go to clinics and hospitals for treatment, where doctors have more choices of anti-fever drugs."
At a news conference held by the Anhui provincial health authorities on Friday, experts said infections in rural areas would peak in a few days and a number of measures would be taken to handle a possibly tough situation
At a news conference held by the Anhui provincial health authorities on Friday, experts said infections in rural areas would peak in a few days and a number of measures would be taken to handle a possibly tough situation.
The measures include increasing reserves of medical supplies for the villagers.
On Saturday, Ibuprofen tablets arrived in Chenxiaozhai and were distributed to villagers.
"Each of the 432 villagers who is 60 or older received four pills in the hope they could deal with the fever themselves and ease the doctors' workload," Chen said, adding that these supplies are not available for younger villagers at present.
In Lujiang county, Hefei, the provincial capital, a team of 30 medical workers was formed to man a hotline to answer local residents' calls 24 hours a day.
The local health authority said callers are provided with professional suggestions based on the symptoms they describe.
Vulnerable groups
Before Jiang Daping had to rest at home on Thursday after developing COVID-19 symptoms that included high fever, fatigue and body aches, she had worked relentlessly for nearly three weeks
Jiang, 44, a doctor at the village clinic in Xiawa, Xihe township, Shulan city, Jilin province, tested positive for the virus the day before.
"I began to show some mild symptoms on Tuesday, but there are only three doctors at the clinic who are responsible for providing medical services for more than 900 villagers," she said. "Therefore, we can only take a break when our symptoms become serious."
Jiang said most of the villagers are seniors and children, with the others earning a living in urban areas.
"Early this month, when the government introduced the optimized COVID-19 control policy, we issued notices to the villagers, urging them to prepare fever and cough drugs," she said. "Asymptomatic cases and patients with mild symptoms are advised to recuperate at home, avoid going out, and limit contact with their families. Patients with more serious symptoms should call the emergency medical number, 120.
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"We also prepared drugs and antigen test kits at the clinic, but initially faced a shortage of supplies. We tried various ways to obtain drugs, including asking for help from the township hospital and clinics in other villages, as well as contacting drug suppliers.
"To date, about 20 percent of villagers have been infected. The number began to rise after college students returned from other regions."
Every day, doctors at the clinic receive some 15 villagers, giving them drugs or transfusions, according to their symptoms.
Doctors have also embraced online medical services to offer guidance to villagers via phones and WeChat groups.
Jiang said: "In March, we carried out thorough investigations of each villager, recording their health information, especially for key groups such as the elderly with chronic diseases, pregnant women and seniors living alone. With the health condition database we established, we can easily give treatment once they become infected."
"As 2023 and Spring Festival are coming, more villagers will return from outside areas, which may increase the risk of the virus spreading.
"We will focus on recording people's information, and remind them to monitor their health, wear face masks, and reduce contact with elderly family members, especially those with underlying conditions.
"Even though both occasions are very important for Chinese, we hope villagers can avoid unnecessary gatherings during this period. With the experience of fighting the pandemic over the past three years, we are confident of winning the fight."
Fever cases rising
Liu Daoguang, director of a township hospital in Shaoyang, Hunan province, is racking his brains about buying anti-fever drugs.
"We ran out of Ibuprofen yesterday. Supplies of alternative drugs are also running low," Liu said on Thursday. "We contacted seven pharmaceutical companies, but failed to replenish our stocks."
There are more than 40 workers at the central hospital in Xiaoshajiang township, Longhui county, Hunan, including a dozen doctors. They serve the entire township, which boasts 14 villages with a total population of 26,000.
Liu said the health workers see more than 20 fever patients every day, and the number is continuing to rise.
The patients are now treated with other remedies for colds, physical cooling, and traditional Chinese medicine, as well as being given emergency intramuscular antipyretic drugs.
Liu said: "We have a limited number of medical staff. Many doctors have not had a break for a month or two. Even though more than 10 workers tested positive for COVID-19, some of them, including the deputy director, continue to work instead of taking a rest."
The condition of patients is seldom so severe that they need to be hospitalized, and Liu said the inpatient unit is now free from infections.
The hospital is about 1,350 meters above sea level, and the temperature is about 6 or 7 degrees Celsius lower than that in the county town, which is about 90 kilometers away.
"For critically ill patients, their condition might be more severe than for those living in low-altitude areas," Liu said, adding that more attention is being paid to prevent such cases emerging after infection, especially among those with underlying medical conditions, the elderly and infants.
Liu said there is a medical team for each village. For many years, these workers have made regular home visits to patients — mainly those with conditions such as diabetes, tuberculosis, psychosis and hypertension.
These teams now also provide health monitoring and consultation services based on patients' needs, deliver medicine to them, and provide guidance.
"These patients will be hospitalized if we find their condition is severe. In addition, we will prepare for them to be transferred immediately to hospitals in the county town, where there are better medical conditions," Liu said.
In the past two weeks, five patients have been transferred to hospitals in the county town.
Liu expects the biggest near-term pressure to come during Spring Festival next month, when people working outside the area return home for family reunions.
Many residents from Longhui county are migrant workers in factories in the Pearl River Delta, including most of the young people from Xiaoshajiang township, who account for about one-third of the town's population.
"With such a large number of people returning home, we're preparing for a spike in infections," Liu said.
Health monitoring guidance for families with vulnerable members is being stepped up to reduce the number of critically ill patients.
"In particular, we need to prevent medical staff members from being unable to work if they become infected at the same time, and reserve more staff," Liu said.
Higher risk
In Hainan province, where rural areas face an increasing risk of COVID-19 spreading, local governments and medical institutions are stepping up improvements to epidemic prevention and response work.
The number of people infected with COVID-19 each day in Hainan is surging.
Li Wenxiu, deputy director of the Hainan Provincial Health Commission, said at a news conference on Friday that rural areas of the province face a higher risk of a rapid growth in COVID-19 infections. This is due to the imminent arrival of 2023, Spring Festival, schools' winter vacation, and the return of urban migrant workers.
The province has established a five-level emergency response mechanism for fever clinics. As of Friday, there were 432 such clinics at medical institutions in Hainan. Each city and county in the province is required to build at least one mobile cabin hospital.
A special population diagnosis and treatment team has also been formed in Hainan. The team is responsible for ensuring prompt medical treatment for children, the elderly, expectant mothers and patients with severe diseases. The province has set up online treatment platforms for critical illness during childbirth and severe illness among children, with medical experts taking turns to man the platforms.
In rural areas, local governments are preparing to protect vulnerable populations as COVID-19 cases surge. The residential committee in Licai village, Sanya, has distributed 30 face masks per person to 87 vulnerable people, including low-income households and children with medical problems.
Local governments and medical institutions are also taking measures to ensure the supply of medication.
Li Shihua, director of Sandao Town Medical Center in Baoting Li and Miao autonomous county, said: "We have enough antipyretic, analgesic and antiviral drugs in stock for seven to 10 days. The Baoting government is stepping up drug procurement through various channels to ensure that medicines are constantly replenished."
Fu Yongfeng, director of Wenchang Huiwen Town Core Medical Center, said the facility prepared medicines three times based on the quantity of flu medication used from April to June.
Lin Shengwei, a doctor at the center responsible for fever diagnosis and treatment, said, "Medication urgently needed at fever clinics is not only in stock, but is also arriving promptly, allowing us to cope with the current situation."
In many towns and villages across Hainan, including Haikou, Sanya, Wenchang and Ding'an, residents with mobility issues can request vaccination at home.
An in-home vaccination team comprises at least three people — a village cadre or community worker, a doctor and a nurse. They have the ability to deal with adverse reactions on the spot.
Zhan Chunlian, a doctor at the core medical center in Huiwen town, Wenchang, said that after several campaigns to raise awareness of vaccination against COVID-19, only a small number of seniors in the area have still to be vaccinated.
For the elderly with diseases and concerns about vaccination, medical staff members in Huiwen use professional knowledge to help them understand vaccine safety, and also comfort patients by talking to them to help them relax, Zhan added.
Seniors with diseases who cannot clearly describe their symptoms usually bring their medical record and medication to doctors, who refer to the guidelines for vaccinating those who are 60 or older in Hainan. The guidelines explain whether those with certain diseases can be vaccinated. If there is no such explanation, doctors report the patient's medical record to the group of experts in Wenchang, and request a vaccination evaluation.
"Many seniors who were worried about being vaccinated felt fine afterward, and they thanked the doctors and asked when they could have their next shot," Zhan said.
Certain towns and villages in Hainan are short of medical workers due to a recent rise in demand for nucleic acid tests and medical diagnoses and treatment.
Some health workers have been infected, but they return to work as soon as they recover.
Lin said: "Medical staff members in China are really hardworking and responsible. The COVID-19 response is our battlefield and we'll fight on the front line."
Zhang Xiaomin and Zhou Huiying contributed to this story.
Contact the writers at zhulixin@chinadaily.com.cn
