Medics battle COVID-19 in the countryside

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."