Quanbao Jiang and Yu Guo
Ever since the first case of COVID-19 was identified in December 2019 in Wuhan, China, this Coronavirus disease is spreading around the world. Up to April 23rd, 2020, a total of more than 2.63 million has been infected, with more than 184 thousand deaths. The death rate is the highest among people aged 60 and over, especially among older people with chronic disease, reaching 9.4%. With the outbreak of this pandemic, the Chinese government decided to lock down Wuhan on January 23rd, and other provinces launched the highest level of public health emergency response to contain this virus in the next two days. Now, China has largely curtailed the spread of this infectious disease, with sporadic cases from abroad.
Rural China faces more challenges in terms of virus prevention and control. Firstly, the Chinese Spring Festival was January 25th this year. As the most celebratory time in China, rural-to-urban migrant worker, which accounted for 60 percent of rural population, would return to the countryside for family union. Before the emergency lockdown in Wuhan, some factories have started the festival holiday 1-2 weeks in advance. Especially after the news of travel ban, many people left overnight and over 5 million people left Wuhan totally, which increased the risk of virus transmission. One case is, a migrant worker Zhang Fang returned to his hometown from Wuhan and participated in a clan banquet with more than 3,000 attendees held on January 22nd in the village. Zhang tested positive for COVID-19 on February 1st, and subsequently led to 10 confirmed cases, 91 people were put under home quarantine, 3557 under health monitoring. Secondly, due to low education level and public health awareness, even though the government strongly required staying at home and wearing masks, some villagers still regarded that “it looks normal”, “completely in festive atmosphere and not aware of the need to quarantine”. Thirdly, there are a large number of older people, many of whom have more than one chronic disease and are vulnerable to this infection. Finally, the accessibility of medical resources is relatively disadvantaged in rural China, which limits the access to timely medical treatment.
Despite those unfavorable factors, effective epidemic control measures have been taken in rural China. On April 8th, 76-day lockdown in Wuhan was lifted; high school and junior high school students in many provinces have already resumed classes; restaurants, hotels and other public places were reopened, and factories resumed operation. This should be attributed to Chinese government’s strong mobilization and support, as well as the grass-roots government’s active response and rapid implementation and the nationwide efforts amid epidemic outbreak.
Firstly, the Chinese government mobilized quickly to guide and support for epidemic control. Though being delayed on the outset, the Chinese government had the marked mobilization power and rich campaign experience. When realizing the seriousness of the infection situation, the Chinese government established leading groups immediately at all levels; arranged specific measures; issued various documents for the administrative system from top to grass-roots government to implement; dispatched and distributed resources nationwide to provide a strong support to contain the virus spread. It also vowed strong accountability for those who concealed, underreported or delayed the reporting of infection cases.
Secondly, all the medical expenses of COVID-19 patients would be covered by the medical insurance, which is especially helpful to those who could not afford the cost of test and treatment in rural areas, containing the outbreak of virus in poor rural areas.
Thirdly, areas were categorized and countermeasures were localized based on local infection risk. The government also rolled out specific approaches for vulnerable groups. For example, Yunnan province divided 129 counties into 5 categories, each category took specific prevention and control measures based on its epidemic situation. Henan province Health Commission published prevention tips for children and maternal/perinatal women to counties and these tips were applicable as guidance during the test and treatment.
Local response includes the response of grass-roots government, namely county and township government, and that of village.
Firstly, under the strong administrative system, the grass-roots government attached great importance to the prevention and control of this pandemic in response to top government. Take Fengxiang government, a county of Shaanxi province as an example, since January 23rd, it has conveyed from the top government, or drafted for local regulation, more than 240 documents, conference summaries and news reports in the column of prevention and control of COVID-19. These documents, as guidelines or specific measures, required to close scenic spots and museums, suspend long-distance public transportation, delay the resumption of factories and schools; appealed to stay at home, cancel large-scale banquets or gathering; strengthened market supervision and stabilized the prices of medical devices and drugs amid the epidemic outbreak.
Secondly, emergency publicity was strengthened. Besides all modern social media via internet and TV, village trumpets, which were widely used during the planned economy and occasionally used now for village announcements, were sounded in rural areas, using “village language” to deliver the latest information, popularize epidemic prevention tips and put forward action proposals.
Thirdly, as always, grass-roots cadres took the lead in epidemic prevention especially township cadres, they were asked to be on duty during the Spring Festival Holiday, visited villages regularly besides the routine work. In villages, village cadres, village doctors and villagers jointly carried out strict surveillance. Village cadres implemented a subcontracting responsibility system, leading teams to guard important check-points, entrance and exit to the village, around the clock. Those who were derelict of duty and failed to implement the tasks would be held accountable.
In addition, the village doctor system played a huge role. China established a sound medical system even at the level of villages. In principal, every village was equipped with a clinic and one village doctor, partly supported by China’s financial system. During this pandemic, village doctors were expected to detect COVID-19 patients, transfer them to hospital to avoid cross infection at the early stage. Village doctors cooperated village cadres to take temperature for villagers, checked health conditions and promoted health knowledge door to door. He Jin’an, one of village doctors in Yucheng county of Henan Province, started investigating migrant workers returning home for the Festival, he distributed publicity materials and shared epidemic prevention knowledge with villagers.
Finally, villages took strict measures to quarantine. In order to prevent importation of virus, most regions stipulated that people and vehicles from the epicenters of the virus outbreak would not be allowed to enter; others are allowed to enter within 14 days of self-quarantine at home. Village cadres patrolled and checked around the clock to discourage mass gatherings in the village. In order to dissuade visiting relatives and friends during the Spring Festival, some rural areas in Henan blocked or even dug up the roads to isolate the village. Each household was limited 1 person out 1 day for purchasing daily necessities. Village cadres strictly inspected on check-points when villagers entered and left, confirming identities, taking temperatures and checking their “health QR Code”.
Even though the pandemic in China has been roughly under control, it comes with huge social and economic costs. For example, the huge national expenditure on epidemic prevention reached 137.2 billion RMB, resulting in a decline in public service, national defense, education and other fiscal expenditures. Due to business ban, many service enterprises and factories went bankrupt, which directly led the unemployment rate rose by 0.7%, GDP decreased by 6.8% compared with the same period of 2019. Besides, the overreaction and regional discrimination in some areas not only caused panic, also harmed social harmony. Now, China is reopening businesses and schools gradually and cautiously, try to achieve an optimal balance between health and economic protection.
China’s success of fighting COVID-19 in rural areas can be attributed to three main aspects. Firstly, China has a strong administrative system, which ensures directives can be quickly responded to and uniformly executed at all levels of government. Secondly, villages in rural China are still granted great autonomy, and applauded to take actions based on its own local characteristics. Lastly, as the second-largest economy in the world, China has sufficient financial and medical resources to respond to emergency public health events and cover all medical expenditures. However, whether the Chinese experience in combating COVID-19 and containing the disastrous spread of this pandemic in rural areaa is applicable to other countries remains to be seen.