The Silent Storm: Omicron Comes to the Northern Villages

On December 6th, 2022, China unveiled the so-called "Ten New Measures" to optimize the prevention and control of Covid-19. From that moment on, the "dynamic zero-Covid policy," which had been in place for nearly three years, ended abruptly. The shift in policy was quick and dramatic: the day before, the PCR tests were still strictly reinforced, and there were spot checks on local clinics that illegally carried cold medicines and such; the next day, it was the sudden reopening.

China plunged into a new wave of Covid infections. Even in first-tier cities such as Beijing and Shanghai, which had the best resources, the healthcare system and families strained to cope with it, due to inadequate preparation. Hospitals were overcrowded, and pharmacies ran out of medicines. The situation was even worse in the countryside than in the cities.

One week after the introduction of the Ten New Measures, the author of this article chose to study the new wave of infections in rural areas, where healthcare resources were even more scarce. Henan Province, a populous province in central China, was chosen for the purpose. The author interviewed more than a dozen rural clinics in two towns in a prefectural-level city of the province and also carried out undercover visits. Another neighboring town in Anhui Province was used as a control sample for the investigation.

Rural residents were poorly informed about Covid-19, and most assumed they simply had a bad cold. Many of the elderly died in the wave of infections, but this went unnoticed. Rural areas had limited medical resources and saw the death of elderly people in winter as "normal." Rural residents were far more realistic and aloof about death than their urban counterparts. During the interviews, we also witnessed a village doctor falsifying the number of new infections to be reported, which has been documented in this article.

In addition, this article also tells more generally the story of how village doctors and villagers lived under the "dynamic zero-Covid policy" during the three-year period of the epidemic prevention and control. Village doctors had to face the pressure of being spot-checked whether they were in “illegal” possession of cold and flu medicines and they had to take on the task of PCR testing. Some village doctors reported during the interviews that they hadn’t received any money for their work.

Beyond the epidemic prevention and control as well as the reopening, the author also uncovered and exposed the decades-long plight of village clinics: village doctors earned so little that they must also labor in the fields to support their families; the standard of healthcare in village clinics was poor, the doctors’ abilities were uneven, and urban medical resources hadn’t been providing any relief to rural villages for decades; and rural residents with household registrations received even less reliable treatment but at a higher cost than their urban counterparts. The issues exposed by the outbreak of the new wave of Covid infections were only a brief unfolding of what had long been a systemic problem. More complicated issues have yet to be solved.

This article was first published on December 30th, 2023, on LatePost, a studio of Caijing Magazine, and was read more than 210,000 times on WeChat in less than 12 hours. The article was quickly deleted from the website the day after it was published due to its rapid dissemination, high impact, and direct exposure.

Many cities were experiencing peaks of new Covid infections as well as difficulties in purchasing medications and accessing medical care. We visited several rural clinics in three villages in Henan and Anhui provinces to see how the primary healthcare system in rural areas coped with this onslaught of new infections. 

 

Seeing is believing. In these villages, the peak of infections came and went earlier than expected. Like in the cities, there was a great shortage of healthcare professionals and medical supplies in rural areas. Unlike in the cities, there was a severe lack of information in the countryside, and villagers were at a loss for terms like "antigen" and "Omicron"; they took whatever the village doctors prescribed. Village doctors responded with limited knowledge, resources, and experience. No one grabbed the antigen tests, and the vast majority had no idea about them. Village doctors had no way of knowing who was infected and who was not.

 

In the villages, everyone "caught a cold," and villagers flocked to the village clinics, where they were given injections and medicines until "every household went through fever," and things became quiet again.

 

A week or two after the wave of infections, these villages did not see many critical cases and deaths that some had imagined. But the status quo had more serious issues than expected. It's not entirely related to Covid, but rather the manifestation of decades-long problems in the primary care system.

 

##"Every household went through fever."

 

It was as if Omicron had never been to these villages, but everyone had "caught a cold."

 

Every villager could recall exactly how they got the "cold":

 

"It was a little too warm when I was working, and I unbuttoned my shirt."

"I got up in the middle of the night to use the bathroom and got the cold."

"I fell asleep and suddenly felt a shiver, then I got sick."

 

Those villagers who wanted to be treated for their “cold” gathered in front of the village clinic early in the morning. At round 7:30 a.m. on December 22nd, when business hours began, the clinic was still not open. “They are exhausted,” said someone sympathetically. Two elderly who could not bear waiting went up and tapped on the rolling door; another went to his electric motorcycle and honked the horn. “There’s a number on the door, let’s call him,” a neighbor kindly suggested. 

 

“I cannot wait anymore, please open the door!” A villager shouted as soon as the call went through. 

 

The doctor lifted the side of the curtain and peered down through the second-floor window. “I’m coming, I’m coming.” He said. 

 

A busy day at the clinic began. The patients poured through the door and automatically split into two lines, one to the right that quickly took up three of the four beds, the other to the front that lined up as far ahead as possible in front of the pharmacy window. 

 

Dressed in a thick coral-fleece pajama set and wearing two surgical masks, the doctor stood in front of the large table in the clinic pharmacy. A variety of white bottles took up half of the space on the table. He tore off a few pieces of square-shaped wrapping paper and arranged them neatly. Then, he ran his fingers through the big and small bottles, picked up a few, and shook out a few tablets: big white ones, small white ones, round red ones, round green ones, small brown ones…Each piece of paper wrapped a day’s worth of medications for a patient. Some patients took four packets, others took six or ten. 

 

Waiting was the first step for patients at the clinic to see a doctor. Generally speaking, there was only one doctor in a village clinic, who took care of about 1,000 villagers. If a village doctor like Xia Xiaojun (a pseudonym) happened to be married to a woman who had been to a nursing school, this meant that the village had a nurse. If a village doctor retired, and there was not a young person who was willing to take over, this meant the village had no doctor. 

 

It was a lot of work for a doctor to see 10 patients in an hour. If he was in a hurry to write a prescription for a patient in line, another patient who was put on an IV had to wait. If he was in a hurry to prepare a patient for an IV, another patient had to wait for the prescription. A young mother with unbound hair in a thick coral-fleece pajama set brought her baby daughter to get a prescription. After waiting for more than 20 minutes, she took away a whole plastic bag of medicine packets. An old man who was lying on the hospital bed the minute he entered tilted his head back and snored like thunder, perhaps he had been waiting for too long. 

 

The patients passed the time by talking to each other about their conditions: I cough; I retch (from nausea); my throat hurts; I have no appetite and cannot eat anything; what a headache! I need to find folks to blow off some steam. 

 

It had been two weeks since the announcement of Ten New Measures on December 8th, and every day, fewer patients came to the clinic to treat their fever than the day before. Without exception, every household had gone through their fever, and no one in the family was left behind. Nevertheless, patients kept coming to the clinic during business hours. 

 

The common cold was the most common disease in winter for local villagers. Most village houses faced the road with vast farmlands behind them. Gusts of wind swept across the farmlands and poured through the backdoors and the window slits. There was no heat system in the villages. All the folks mostly relied on thick coral-fleece pajamas and hand-sewn high-cut cotton-padded felt shoes to protect themselves from the cold.  

 

Just like in previous winters, the villagers believed that the cold weather made it easy for them to catch a cold, and once you caught a cold, you should go to the clinic, get a prescription or a shot or an IV, and then go home. However, they noticed that there were more people in the clinic this year, the lines longer, the medicines more expensive. Only very few villagers thought they had indeed contracted Covid. One said, “It’s not normal for the virus to spread so quickly.” Another said, “If it wasn’t for the virus, how come my body feels so sluggish?” 

 

In the villages, very few people knew about “Omicron,” and no one ever mentioned “Covid-19.” After inflecting most of the villagers for the past two weeks, it gradually disappeared from their daily conservations. 

 

Every morning after 9 o’clock, the sun drew people out of their houses, who gathered at the village’s T-junction to discuss matters big and small, such as the price of the sheep. The price of a small and a large sheep was 1,700 yuan last year but dropped to 1,300 yuan this year. 

 

##"How come you run out of medicines?"

 

Doctors usually had some inkling before changes took place. For instance, on that day in early December, when the township healthcare center held a routine video conference, the director said something vague to the dozens of village doctors: “Please hang in there for a couple more days.” By that time, the village doctors had already done more than 100 rounds of PCR tests for the villagers.

 

From these vague words, the village doctor Xia Xiaojun got what the director was hitting at: to hang in there for “a couple more days” meant “just a couple more days left.”

 

The village doctor Zheng Shengshan (a pseudonym) sensed the relaxation of the prevention and control policy in his daily work. During the last few days in November, after he finished the PCR tests for the villagers and sent in the “tubes,” the tested villagers did not get the results even two days later. He thought this was very unusual. It was difficult for him to trace exactly how the news of the “reopening” reached his clinic, perhaps from TikTok, perhaps from whoever brought the news from the town down to the village, perhaps because the supermarket that had been in lockdown suddenly opened its doors. 

 

The village doctor Luo Rui’an (a pseudonym) had a more specific proof. On the evening of December 7th, the township healthcare center WeChat group sent out a notice: no more PCR tests tomorrow. “Those who have tested positive don’t have to quarantine the following day. Doesn’t that mean reopening!” On the early morning of December 8th, he took out the cold medicines that had been locked up and put them back in the clinic pharmacy. 

 

More concretely for the village doctors, the main change was this: they were allowed to treat patients with fever.

 

Luo Rui’an found 5 or 6 kinds of oral solutions for the cold. Zheng Shengshan found 12 packets of ibuprofen for children and around a hundred tablets of paracetamol. Xia Xiaojun had nothing in stock, not even a capsule of ibuprofen.

 

Earlier on, the village doctors were not permitted to treat patients with fever. There were spot checks every other day. The inspectors checked whether there were any patients who had fever. They looked at all the prescriptions. They checked whether the pharmacies had any cold medicines on display or hidden in another room.

 

Because “it’s not a good idea” and “we lose money if the medicines go expired,” doctors hadn’t been stocking cold medicines for a long time.

 

At first, they didn’t think they would run out of medicines later. They all knew a lot of pharmaceutical sales representatives, both local and from out of town. These representatives were all very enthusiastic and gave the doctors a call every other day. They drove themselves to the clinics to bring the orders or shipped them via courier services. 

 

A few days later, when Zheng Shengshan’s one hundred tablets of paracetamol slowly ran out, he called the largest pharmaceutical agency in town. 

 

“Everything’s been snatched up.” A representative said. 

 

Zheng Shengshan had absolutely no idea about the situation in many cities where ibuprofen and Tylenol were hard to come by, so for a moment, he didn’t get what the representative was saying. 

 

“What has been snatched up? How come you run out medicines?” He asked. 

 

 

 

By the time he arrived in town by car, there were one to two hundred doctors who were already waiting to get medicines in front of the pharmaceutical sales company.

 

After December 10th, more and more patients with fever came to the clinic. Every day after dinner, Xia Xiaojun drove out to look for medicines. On the afternoon of December 20th, he anxiously got into his car, after seeing that he was about to run out of medicines. From 6:30 p.m. to 10 p.m., he visited 6 pharmacies and then went all the way to the town that was 30 kilometers away. 

 

Being a village doctor for more than twenty years, he had made a few good friends and hoped to “get some medicines.” But he could only get one-to-two-thousand-yuan worth of medicines. “Just a small bag,” he said, pointing to the thin plastic bags on the wall, where medications were filled. He gave up hope for ibuprofen first and then for oral solution. His bottom line was to get a few injections for fever. “As long as you can give someone a shot, their fever will go.”

 

The 68-year-old Luo Rui’an rode a tricycle into town and stood in line for nearly two hours at the pharmaceutical agency to get the medicines. Before leaving the clinic, he had 20 medicines on his list, but he was only able to bring back half of that. 

 

The price of the medicines rose day by day: a box of aminopyrine injections that reduced fever cost 7 yuan, then 27 yuan, and now 44 yuan; Vitamin C Yinqiao tablets were 25 yuan the day before and then 55 yuan the day after; a bottle of 1,000 tablets of paracetamol (acetaminophen) originally cost 40 yuan and most recently 280 yuan. 

 

Zheng Shengshan, who knew how much money the villagers would like to spend on the common cold, asked for 60 small boxes of medicines. Worried that he had bought too much, he came back to the clinic. Within two days, everything was sold out. 

 

On those days when he had the most patients, Luo Rui’an was woken up at 5 a.m. to see patients and had no time to wash his face or brush his teeth until 10 p.m. He had breakfast at 2 p.m., lunch at 10 p.m. He was so busy that his legs gave out. 

 

Patients came one after another. First, the two beds and four sofa seats in the IV room were taken, then, the five sofa seats in the foyer. The villagers who came for the IV roamed into the small clinic courtyard and sat on the benches to take their IVs. He was so overwhelmed that he had to call out his wife, who had never studied medicine but had been giving him a hand in the clinic. “I was so panicked that I couldn’t even walk.” The wife recalled those days when she had to change IV bottles and “remove the catheter” (pull the needle out).

 

Despite Xia Xiaojun’s efforts to avoid “crowded” conditions at the clinic by speeding up with the patients, his neighbors still saw their homes blocked by the patients’ vehicles and could do nothing. 

 

## “The virus floats around our town, and you can get a cold as soon as you leave your house.” 

 

How many people in the village tested “positive” was a question that simply could not be answered. Very few people had antigen tests at home. Some had simply never heard about them, let alone how to use them. The villagers were at a loss when it came to “antigen” and “Omicron.” 

 

In terms of “PCR tests,” there were more positive responses. “Done it!” An old man with gray hair exclaimed immediately. 

 

Several village doctors that were interviewed did not actively procure antigen test kits. They had no way of distinguishing whether the patients who came to the clinic had Covid, or the flu, or a cold but saw no point in making the distinction at the time——“We’ll treat them as if they all had a cold.”

 

Prior to December 8th, everyone panicked at the slightest movement and the slightest sound. Checkpoints and fences were set up. Every household kept quiet. “As soon as I hear that someone tested positive or was in close contact, I am just too scared to go near them,” said a driver from Bozhou, “You’re scare of me, and I’m scared of you.”

 

After December 8th, the fear of Covid still lingered.

 

A mother in the village couldn’t sleep the whole night after hearing that her son, who was working in Beijing, had been infected. A middle-aged woman who lived in the town told her family members from out of town, “The virus floats around our town, and you can get a cold as soon as you leave your house.”

 

The driver Zhang Jiadong (a pseudonym) from Henan Province said he had a good friend who had always been nervous about Covid. This friend carried an alcohol spray bottle with him and sprayed himself before meeting anyone and sprayed the seats after he got on the bus. The reopening turned him more nervous. “Hey, that’s the way it’s going to be from now on. If you have a fever, then so be it. If you want to take some medication, so be it.”

 

A village doctor’s wife confessed that the reopening made her feel apprehensive, “It was said to be horrible, but I don’t know how terrible it will turn out.”

 

Xia Xiaojun was most afraid of his family members getting infected. After preparing himself psychologically, he moved the table that was used to scan health codes from the entrance back to the clinic, “Even with control, infections cannot be avoided.”

 

Then the wave of infections started. First, it was those who worked in government organizations in the township. Then, it was the healthcare professionals in township hospitals and village clinics. After that, it was the households in the village. Luo Rui’an had been a village doctor for 50 years and was familiar with the situation in previous years, “It spreads so quickly. Everyone must be positive.”

 

But none of the villagers thought they were positive, not just out of fear that might lead to superstition, but they just couldn’t figure out what they got was something other than a cold. 

 

The villagers actively sought vaccinations and cooperated with the lockdown. They believed that as long as they didn’t run around, they wouldn’t be positive. An old woman sunbathing in front of her house said, “I just walk from the front door to the backdoor, who can infect me?” Meanwhile, her daughter-in-law had not yet recovered from the “cold” as she had. 

 

A villager doing wall repairs thought the same thing. He had a needle in his arm and was taking an IV, even though he “ran to work,” masked every day and self-isolated. 

 

“Then how come you caught it?” The wife of the doctor who was treating him asked. 

 

“How I got it? It was from my younger daughter, who was a little over two years old. She went out to play. The two of us slept together, and she gave it to me.” He said. 

 

##"With one shot, you're good to go."

 

To protect his family, Xia Xiaojun wore the blue hazmat suit with a round neck that he had saved from PCR testing for the days when he had the most patients. He wore it backwards like at a hair salon. He wore no protective mask nor gloves because he had none. He wore two surgical masks. Before going to bed, he sprayed the hazmat suit with alcohol before throwing it away. He also sprayed himself with alcohol before entering the bedroom. But as a nurse, Xia Xiaojun’s wife got infected first, as she had even fewer protective materials. 

 

The villagers with symptoms went straight to the clinic. Once inside, they felt at home and quickly found the two thermometers, which they passed around among themselves. Without waiting for the doctor to speak, the patients made an immediate request——“A shot, please.”

 

“A shot would do.” “An IV is even faster.” The patients said. If the doctor found it unnecessary for the patient to take a shot, the patient would be upset: “Why don’t you give me a shot?”

 

It was not until the doctors’ needles were in their muscles could the patients’ fear and anxiety be pacified temporarily.

 

In the eyes of the villagers, injections and IVs were the most effective medicines. The driver from Bozhou was not able to get his wife and children an IV and felt helpless. There were too many people lined up at the clinic. His belief in the IV came from his suspicion: “If you take cold medicines, it’ll take ten days or half a month for you to get well again. With an IV, it just takes two or three days.” “The medicines in the IV are more concentrated, and it usually takes four bottles.”

 

Be it fever, headache, nausea, cough, bad appetite, the villagers always asked for “a shot.” The price for three IV bottles rose from a little over 40 yuan to more than 50 yuan. Gritting their teeth, they still wanted the IV. Even when they were back in shape, they would come back for another day of IV to “consolidate.” 

 

The fever of the villager who repaired the wall was long gone, but he went straight to the clinic after work and had three “nutritional injections.” These injections consisted of Chinese patent medicine Shuanghuanglian or Qingkailing with sodium chloride and glucose solution as the base. “To clear excess heat and toxins.” The village doctors explained. After taking these “nutritional injections,” the villager had the strength to work the next day. 

 

In the clinic, a woman who was over 70 years old and whose fever was gone shared her own experiences. She had a heart disease. During the days when she had fever, she found a box of cold medicine for children. She was able to tell that was for children, so she took two packets of the granules after each meal until her fever was gone. 

 

These days, many villagers were making a hot medicinal drink of ginger, green onions, and brown sugar at home. Some got the recipe from TikTok. One had to keep the ends of the green onions for the drink. Some doctors also instructed patients who almost recovered to go home and drink some “brown sugar ginger tea.” Other doctors believed in the power of the garlic, “After all, it contains antibiotics.”

 

One day, a patient from the neighboring village came to Xia Xiaojun. After taking the cold medicine, the patient kept retching. Xia Xiaojun asked him whether he had an overdose of paracetamol. The patient was not sure: it was no small amount. He took two white tablets.

 

Xia Xiaojun said, “Right, it should be two white tablets, but are they the same? One should be paracetamol and the other metamizole sodium.” The patient had taken both.  

 

Xia Xiaojun had always advocated medicines over injections. During the past two weeks, he had not used any anti-inflammatory medications on patients, “because it (Covid) is viral, no?”

 

Twenty years ago, Xia Xiaojun graduated from a college medical program and obtained a physician’s license. Of the nearly 60 village doctors in the township, only 10 or so had similar qualifications. 

 

However, most doctors spent the past two weeks treating Covid in the exact same way of treating the common cold. They used both anti-inflammatory and antiviral medicines. Shuanghuanglian and Qingkailin were often used. 

 

A few days ago, a doctor treated a young man in the village for "tonsillitis" (sore throat after Covid infections), he added both antiviral and antibacterial medications to the same sodium chloride solution. More than halfway through the bottle, the patient had an allergic reaction, with protruding blood vessels and a line of red rash on his arm. The doctor hurriedly stopped the IV and gave him anti-allergic medications dexamethasone and chlorpheniramine. When the rash was gone, the doctor asked, “There’s still something left in the IV bottle, do you want to finish it?” “Sure,” said the patient. 

 

A few hours later, the patient was assisted back to the clinic. He had vertigo and felt like "being electrified” and could barely walk. The doctor took the patient's blood pressure, SBP 162, and told the patient to drink a few glasses of hot water. 

 

The doctor called his best friend right away, who was a liver doctor in the township. He described to his friend every step of his treatment in detail. In the end, he turned to the patient: “Was one of the bottles yellow?”

 

“Yes,” said the patient.

 

He could not remember whether it was Shuanghuanglian or Qingkailing, which were both yellowish when dissolved into sodium chloride. He gave the patient a glass of sugar water to drink. 

 

Chinese patent medicines like Shuanghuanglian and Qingkailing were no longer used in Grade 3A hospitals in first-tier cities but were still widely available in township hospitals and village clinics, and so were risky injections of uncertain efficacy. The main ingredient in the fever-reducing injection was aminopyralid, also in Analgin. In November 2021, Alnagin had its certificate of drug registration canceled by the State Bureau of Pharmaceutical Supervision. 

 

Rural clinics consumed a large number of IV bottles every year. China produced nearly 10 billion bottles per year. A study published by The Lancet Global Health in 2017 mentioned that about 70% of cold and flu outpatients in China received inappropriate antibiotic treatment, usually through the IV. China's drug regulatory authorities had escalated their "anti-antibiotic restriction" and "IV restriction" orders several times.

 

Within an hour, the allergic patient's blood pressure was taken three times. He drank a large amount of sugar water but still had vertigo and felt sluggish. Basically, he was not getting better. The doctor decided to give up on keeping the patient under observation and recommended sending him to the township hospital. In the end, the patient's father got on his electric bike with his son on the backseat. They drove off to the township hospital.

 

## A doctor, when seeing patients. A farmer, when not seeing patients.

 

While treating patients, the doctors, one by one, also became infected. Even during these difficult days, none of the village and township doctors stopped seeing patients. 

 

“It was really difficult to carry on, but I did hang on for a few days,” Xiao Xiaojun said, “and I truly felt a lot of stress during those days.” When his body temperature got higher, he opened two packets of Chaihu (bupleurum root) granules and dissolved them in water in a large bowl. After he drank it, a chill ran down his back. 

 

The peak period in the countryside only lasted a few days. Once all the households were inflected, the first wave of infection in the village had passed. Only during the visits could one see that most of the beds and benches were still occupied by the elderly on the IV. The six or seven empty bottles that the doctors did not have the time to take off from the poles revealed traces of Omicron’s visits to the villages. 

                             

During low season, the villages became quiet. In the morning, after the sun rose high in the sky, an old man who came to the clinic for an IV asked Luo Rui’an to move the IV pole and an old cushion-less couch to the courtyard, so that he could sunbathe while going through his three bottles. A young lady put the passenger seat in the front of her own car as flat as possible, so that she could half-lie down in her car with the IV pole against the door and the tube inserted into the back of her hand through one of the thin slits of the window.

 

Luo Rui’an could finally slow down a bit and tell the story of his 50-year career as a barefoot doctor. He was diligent and hardworking. After finishing high school, he went to a nursing school to further his education and then returned to become a village doctor. 

 

During the first few years, he carried a medicine cabinet on his back to visit patients. The salary was not high, but the job was reliable. In his old age, he fell in love with writing poems. When there was no patient in the clinic, he would take out his notebook and jot down a few lines. Drawing in classical and modern traditions, his poems were full of his longing for love, praise for the natural landscapes and younger generations, and dissatisfaction with his own life. 

 

After the reform and opening-up, Luo Rui’an, like most village doctors, opened his own clinic, which has been self-financing ever since. It was never an easy job.

 

Every day, he was under great pressure. He could not refuse any patient. “The one knocking on the door could be someone from an older or younger generation.” He tried to treat every patient the best he could, otherwise he would have bad business and a terrible reputation.

 

An old man who came to see the doctor at the clinic had vellum-thin and dark skin on the back of his hand. Luo Rui’an missed the vein the first time and asked the old man to try the other hand. The old man reluctantly held out his other hand and complained: “Never in my life do I have to do it twice.”

 

“Okay. Okay.” Luo Rui’an kept his head down and spoke softly.

 

More than ten years ago, the village doctors were given new tasks——managing the villagers’ health records, following up on patients with chronic diseases, documenting births, and deaths, writing monthly, quarterly, and annual reports for various programs to higher-level healthcare centers. The endless forms added more work to the already hard job.

 

Luo Rui’an opened a double-deck display cabinet in his bedroom that was filled with different forms. When he was around 50 years old, he learned to use the computer. The township health center issued him a printer. He used it to print forms. 

 

Once, when he went to the township to deliver forms, Luo Rui’an was so overwhelmed with emotions that he wrote a poem:

 

Difficult is it for the village doctors

Surrounded by computers all day long

This form and that, endless to write

If ever something goes wrong

All say that all bark and no bite

 

In the past year, most of the village doctors spent their time doing PCR tests for the villagers. They had to leave the house at 5 a.m. or 6 a.m. every day. Children waiting to go to school were the first in line, then adults. The doctors had to make house calls to those who were more advanced in age. Luo Rui’an rode his white tricycle from one testing station to the next. 

 

Sometimes, he didn’t even have time for breakfast. After swabbing throats for 4 or 5 hours, his legs gave out. The township had promised to give him an honorarium, but he hasn’t received it yet. Xia Xiaojun hasn’t received it either. Zheng Shengshan’s township was sympathetic to their situation and packed schedules and gave every doctor a “subsidy” of 600 yuan.

 

The village doctors were doctors when they were seeing patients. If not, they were farmers. Every one of them had a few acres of land. 

 

After doing more than 100 PCR tests, Luo Rui’an saved five hazmat suits and dozens of throat swabs, which not only testified to his hard work, but were also precious goodies for him. He saved IV packaging and used these boxes to fill the medications for the patients. He used the instruction paper in the box as wrapping paper for the medications. “This paper is sterilized.” He cut and put away the paper. 

 

With a pension of only 300 yuan, he couldn’t make ends meet, so he had to keep the clinic running at the age of 68. He should have become a teacher. “I’ve made the wrong choice in my life.”

 

##"What's the use of being afraid now that the country has lifted the lockdown? We're not afraid anymore."

 

Luo Rui'an has spent his whole life accepting his destiny and obeying orders, and this time was no exception. "What's the use of being afraid now that the country has lifted the lockdown? We're not afraid anymore."

An old man who worked in the flour factory didn’t have such a good temper. At around 7 p.m., he hurried into the clinic, with flour on his shoes, jacket, face, and hands. He couldn’t help complaining during the half-hour wait. “The lockdown was good. Why reopen now?!”

The flour factory originally had a dozen workers loading trucks, but only four could come to work during the last few days, because the rest had fever. The old man ran upstairs and downstairs in the clinic despite his body temperature of 38 degrees Celsius. “The lockdown should last another year!” After getting his fever-reducing shot and some medications to take home, he rushed off again.

 

None of the village doctors has ever heard of any critical cases. If there were, their families would have sent them directly to the hospital in town, as the village clinics were not equipped to take on such cases. 

 

The low rate of severe cases could be due to the vaccinations. Several villages in Henan Province had a high vaccination rate. Some people got fully vaccinated last year, others until September this year. The vaccination was mandatory. “If you don’t get vaccinated, they’d call you a few times every day.” A villager recalled. The villagers didn’t have a lot of concerns. “The vaccination is free, then why not get it?” Another villager added. He hadn’t heard of anyone who hadn’t been vaccinated. 

 

Another reason may have to do with the rural mentality toward medical treatment and the level of medical care in villages. 

 

In terms of health, the villagers always said, “I know my own body.” Luo Rui’an has heard and witnessed over the years that many people in the village have been diagnosed with cancer, but usually in the middle or late stages. 

 

In terms of major diseases and cancer treatment, rural and urban differences were significant. Researchers from the Affiliated Cancer Hospital of Zhengzhou University analyzed 26,000 liver cancer deaths in Henan Province in 2015, and the cancer mortality rate in the 50-70 age range in rural areas significantly exceeded that in cities. Rural areas were also unable to quickly dispatch ambulances to allow patients with sudden heart and brain infarcts the "golden hour" of emergency care.

 

The National Bureau of Statistics and China's National Health Commission had released "The Average Life Expectancy Ranking of Provinces in China" in 2017. The life expectancy per capita in big cities represented by Beijing, Shanghai, and Tianjin exceeded 80 years, which was already the level of the most developed countries. However, in provinces with a high proportion of rural population, life expectancy was less than 70 years in some cases. The Health and Welfare Commission had included people over 80 years of age in the Covid high-risk groups. According to the statistics of the Hong Kong SAR government, 86% of the 11,296 infected people who died during the local Omicron period were over 70 years old.

 

Behind these figures may be the fact that many elderly people in rural areas did not live beyond the age when they were vulnerable to Covid-related deaths. During the visits, none of the village doctors said that an elderly person had recently died of Covid, although one or two elderly people did die. 

 

A retired village doctor in rural Jilin Province heard people in the village playing "double cracks" in the middle of the night for four or five days in a row, which turned out to be a local custom to send off the elderly on their last journey with a burst of firecrackers. In the cold season, one would hear more “double cracks,” and it was “a common thing.”

 

On the evening of December 22nd, an old man whose temperature had dropped to 36.8 degrees Celsius came to the clinic in a yellow overall worn backward to get an IV. He wanted to “consolidate.” As he daydreamed and dozed off, the sun set, and the sky became dotted with stars. He was the only patient left in the clinic. The lamp, just a little thicker than a finger, glowed with a dull white light, and nothing could be heard outside.

 

On that day, Luo Rui'an agonized over the number of Covid infections on the statistics form that he needed to submit to the township. First, he handwrote the header of the form on a piece of white paper. Then, he opened the 118-person WeChat group and looked through all the forms submitted by doctors from other villages. Some of them put 6 down, some 3, others 5.

 

"What’s better?" he asked himself and then came to a decision. In the section of “confirmed cases,” he wrote “4” and submitted the form. 

 

(In order to protect the privacy of the interviewees, all the names in the article are pseudonyms.)