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ABC News
ABC News
By Iris Zhao

Fears for rural population in China as COVID-19 spreads in villages lacking health care

University student Daqing was in awe of how quiet her once-bustling rural village in eastern China had become.

"The streets were empty," Daqing said.

"I used to wake up to noise from the fruit and meat vendors, but it was gone this year.

"I only heard the sound of people coughing in the morning, and gusts of wind."

Daqing, who did not want her real name used out of fear of repercussions for speaking out, came home in her winter school break in December just as China abruptly loosened strict COVID-19 restrictions.

An outbreak quickly spread across the country, and after being criticised over a lack of public data on cases and fatalities, last week China unveiled a hospital COVID-19 death toll — almost 60,000 deaths between December 8 and January 12.

However, experts said COVID-related deaths in rural areas and villages, such as where Daqing's family live, are unlikely to have been included that figure.

They say the virus poses a real threat to people living outside major cities, where there are aging populations and limited medical resources.

Speaking publicly ahead of the Lunar New Year travel rush, even China's President Xi Jinping expressed his concern.

"I am most worried about the rural areas and farmers. Medical facilities are relatively weak in rural areas, thus prevention is difficult and the task is arduous," Mr Xi said on Wednesday.

Hundreds of coffins on order

In Daqing's village, there are only several hundred residents and the number of funerals this winter is increasing.

People suspect the deaths are because of COVID-19 but no-one is certain, Daqing says.

"It's impossible for every old person who passed away to get tested," she said.

Daqing attended a villager's funeral earlier this month, but said the cause of death was unclear.

Relatives also told her the village crematorium was full.

"I thought it was a rumour [that crematoriums were full] until they told me they really had to queue for days."

A funeral and burial service in Jiangsu, a province north of Shanghai, said its coffins had been in high demand since mid-December.

"We are able to make 200 to 300 coffins per day, but there are hundreds more orders," a worker said.

"The cost [of making a coffin] also climbed a lot as we have to hire more workers and it's holiday time," she said, speaking anonymously because COVID-19 deaths are a politically sensitive topic in China.

Limited medical services in villages 

Like tens of thousands of other villages in China, Daqing's home town only has one clinic and medical resources are limited.

"We have only one doctor and one nurse in our village. They both had to work after testing positive. That's how bad it was," she said. 

Latrobe University's Liu Chaojie, director of the university's China Health Program, said outbreaks in rural China would be the real test of the primary healthcare system.

"The gap in medical resources between urban and rural areas existed pre-COVID but it's [being] challenged now," Professor Liu said.

He said people in rural areas were less likely to seek medical treatment than urban residents for various reasons such as long travel distances and costs.

"Some people don't trust the village doctors. They might hesitate and delay their treatment," Professor Liu said.

"And even if they go to the village clinics, the resources are very limited. They may not be able to get diagnosed and treated properly."

Professor Liu said Chinese authorities made it clear that the hospital death toll of roughly 60,000 was only cases reported by hospitals, which would not fully capture deaths in rural villages in China.

"Outbreaks always start from populous cities. It's globally the same. The biggest concern is when it hits remote areas outside big cities like Beijing and Shanghai," Professor Liu said.

Medicines were also in short supply, he added. 

"In rural areas, the variety of medicines and medical services are both quite limited.

"As far as I know, China has provided rural clinics with fever drugs, intravenous drips, Chinese medicines and oximeters."

"But only hospitals at county levels are equipped with ventilators. It won't be possible to access that in villages." 

Huang Yanzhong, senior fellow for global health at the Council on Foreign Relations in New York, agreed limited medical resources left rural China vulnerable to COVID-19, but also pointed out another area of concern.

"There is a larger aging population in rural China," Professor Huang said. 

"If we count only people over 60 years old, it's over a quarter [of the population] in rural China."

He added that many village doctors stopped working in the medical field during the pandemic, and that would place further strain on rural healthcare systems.

"Under the previous zero-COVID policies, village doctors were not allowed to treat patients with fever. Those patients had to go to fever clinics in hospitals," he said.

"As a result, many village doctors actually ceased the operation and chose other jobs."

Travel rush prompts infection spread concern  

The final Lunar New Year travel rush starts on Friday.

China's Ministry of Transport estimates there will be 2.1 billion passenger trips between mid-January and mid-February as people travel to their home towns from their urban workplaces to celebrate the national holiday.

The huge movement of people is sparking concern about an increase in COVID-19 cases.

While the latest figures from Chinese authorities shows the number of infections peaked in most places at the end of December and early January, including in rural areas, experts remain concerned by the veracity of the data.

"[According to the government's statistics], there won't be big waves [of infections] during the travel rush days since most people have acquired the immunity naturally," Professor Huang said.

"The point is whether the local government's figures are trustworthy."

Professor Huang said he believed local governments in China had an incentive to report that the peaks had passed because it meant they were ready for economic rebound. 

To peak as fast as possible is actually unfair to the vulnerable people and might give rise to a sharp increase in COVID-19 deaths over a short period of time, he said.

Daqing, who has just recovered from COVID-19, said hardly anyone in her village had caught the virus during the COVID-zero period, and even wearing masks was mocked and considered weird not long ago.

But, like the millions of people celebrating Lunar New Year, she's determined not to let COVID-19 disrupt the holiday. 

"I'm not that concerned about infection rates right now," she said.

"My father is a migrant worker so I just can't wait any longer to have him coming back to celebrate the festival.

"It would be better if they (the government) had prepared the villagers with more [masks and sanitisers] so that people can stay calm without panic."

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