Friday, 28 February 2020


In China’s War on the Coronavirus, a Community Is Besieged

The people of Zuoling, a suburb of Wuhan, have gone through a gamut of emotions as the epidemic raged: from complacency, to alarm, and finally, to anger.

Credit...Chinatopix, via Associated Press

WUHAN, China — When the coronavirus emerged in Wuhan, residents in a rising suburb on the city’s rural edge thought they were safe. Zuoling New Town, a bustling community of retired farmers, factory workers and young, white-collar professionals, was 22 miles from the market where the outbreak appeared to have arisen. The apartments had sprung from former farm fields, far beyond the alleys of old Wuhan.
But as the virus spread, Zuoling emerged as a stubborn hot spot of infections in Wuhan, and a somber lesson in how the state’s vast effort to contain the virus left some communities acutely vulnerable. The leadership’s top-down campaign relied on grass-roots mobilization, and the very newness and isolation of Zuoling proved to be a weakness, depriving residents of food supplies, medical care and labor during crucial weeks.
Residents crammed into the only large supermarket to stock up. Those worried about fevers crowded the local, government-run clinic, and many were sent back to their high-rise homes, sometimes spreading the virus. The nearest major public hospital assigned to take patients was 10 miles away, making it more difficult to get treatment, especially without a car.
“I never imagined that this would hit our home,” said Zhang Jin, a 47-year-old resident of Zuoling. His mother, Yan Yinzhen, who was living with him, contracted what doctors believed was the coronavirus, possibly from a neighbor. Mr. Zhang, his wife and father all later fell ill.
“We’ve lost confidence,” said Mr. Zhang, a school bus driver. “Nobody in the neighborhood took charge.”
Credit...Agence France-Presse — Getty Images
The coronavirus has formed an insidious threat that medical authorities worldwide have struggled to tame. Italy, Japan, South Korea, the United States and other wealthy societies have stumbled in their responses.
For China, the long-term repercussions may be greater, given the size of its outbreak and the bleak contrast with assurances from the national leader, Xi Jinping, that the Communist Party was a robust shield providing “holistic security.” Officially, the virus has infected almost 80,000 people and killed about 2,700 across China, mostly in Hubei Province and its provincial capital, Wuhan.
While China’s efforts appear to have slowed infections, a reconstruction of the epidemic in Zuoling — based on over a dozen interviews as well as hundreds of pages of government documents, reports and online accounts — shows how the containment campaign suffered from confusion and discord at the local level, turning unlucky and ill-prepared communities into trouble zones.
There were not enough masks, disinfectant or sanitation workers. Patients suspected of having the virus were confined to their homes, allowing the pathogen to spread. When people were eventually moved to isolation sites, residents initially found that promised care was missing.
On the first day of February, Zuoling New Town had 11 cases, according to community records. A week later there were 79. By Feb. 11, the number of confirmed infections was 116, including four deaths.
At that point, officials stopped sharing the information, to the fury of many residents. Some have claimed online that Zuoling has hundreds of infections.
“Currently nobody is in charge,” a Zuoling resident railed in an online complaint submitted on a party website this month. “The inaction of the government agencies to prevent and control this has led to more and more people contracting this pneumonia.”

The Coronavirus Outbreak

  • Answers to your most common questions:

    Updated Feb. 26, 2020
    • What is a coronavirus?
      It is a novel virus named for the crownlike spikes that protrude from its surface. The coronavirus can infect both animals and people and can cause a range of respiratory illnesses from the common cold to more dangerous conditions like Severe Acute Respiratory Syndrome, or SARS.
    • How do I keep myself and others safe?
      Washing your hands frequently is the most important thing you can do, along with staying at home when you’re sick.
    • What if I’m traveling?
      The C.D.C. has warned older and at-risk travelers to avoid Japan, Italy and Iran. The agency also has advised against all nonessential travel to South Korea and China.
    • Where has the virus spread?
      The virus, which originated in Wuhan, China, has sickened more than 80,000 people in at least 33 countries, including Italy, Iran and South Korea.
    • How contagious is the virus?
      According to preliminary research, it seems moderately infectious, similar to SARS, and is probably transmitted through sneezes, coughs and contaminated surfaces. Scientists have estimated that each infected person could spread it to somewhere between 1.5 and 3.5 people without effective containment measures.
    • Who is working to contain the virus?
      World Health Organization officials have been working with officials in China, where growth has slowed. But this week, as confirmed cases spiked on two continents, experts warned that the world was not ready for a major outbreak.

Zuo Jinjin learned that the virus had reached Zuoling on Jan. 19, when he and other community workers were ordered to guard the home of a woman suspected of being infected. The 69-year-old woman had been taken to a hospital, while her husband waited in quarantine in the apartment.
A Communist Party official in charge of the area gave the team another mandate: Don’t tell residents much about the case for fear of sowing panic ahead of the Lunar New Year; a general warning would suffice.
“There was discussion about what if this was publicized everywhere, when the New Year was arriving,” said Mr. Zuo, a 31-year-old employee of the Zuoling community office, the government’s grass-roots administration. “There was publicity asking residents to wear masks, but many people didn’t take notice of that.”
Mr. Zuo said his wife, a nurse, told him as early as December about a mysterious virus striking people in Wuhan. But city leaders had encouraged confidence that the virus was not highly contagious and that the outbreak was likely to peter out. In Zuoling, officials did little to initially warn residents.
“Back then, there weren’t enough reports about it, and it hadn’t grabbed the attention of all Wuhan residents,” Mr. Zuo said. “We believed, me included, that it was a little flu and would be OK — until people were dying.”
Credit...Hector Retamal/Agence France-Presse — Getty Images
The alarm level jumped on Jan. 20, when officials disclosed a burst of 136 infections across Wuhan in two previous days. News reports noted that many victims were linked to the market.
“At that time, we heard that it came from eating wild game, and we didn’t eat that,” said Li Wangjiao, a resident of Zuoling who is also a housing manager there. “I never expected it would come to the edge of Wuhan.”
Three days later, Ms. Li’s daughter developed a fever. On that same day, Wuhan barred people from leaving in a bid to stifle the outbreak.
Looking back, residents of Zuoling pointed to lapses that they said let the virus quietly spread.
Ms. Li said she believed that her daughter had become infected in the local branch of the Zhongbai supermarket chain, the only major food store in the neighborhood, which was crowded before the holiday. The supermarket remained crowded after the government lockdown, extending the risks, residents said.
There was also the recently opened subway station where thousands of commuters crowded every day.
Even as official warnings grew louder, older people in Zuoling walked around and socialized without masks, because they did not grasp the need or could not buy them, some residents said.
“There were no protective measures,” said Lu Ying’ge, a Zuoling resident who was later diagnosed with the coronavirus. “Nobody wore masks, nobody cared.”
As infections multiplied, Mr. Xi mobilized the party to lead a “people’s war” against the epidemic. In Zuoling and many other areas, a front-line force was the party’s neighborhood offices.
These local bodies in China are much more powerful than voluntary neighborhood associations in many Western countries — and in the crisis, they took on more authority. They were assigned to monitor residents for signs of illness, screen them for treatment and quarantine, and bolster residential checkpoints to guard against outsiders who might bring in the virus.
Zuoling seemed ill prepared. Often, new suburban areas have not accumulated the same labor force, experience and resources from the state as older neighborhoods, said Benjamin Read, a professor at the University of California, Santa Cruz who studies local politics in China.
“With a mission like maintaining quarantine, they are dealing with a complicated set of ongoing tasks,” he said. “Any lapse at any time could undermine the containment of the epidemic.”
Credit...China Daily/Reuters
Many maintenance workers and guards for housing management companies in Zuoling quit as worry about the virus grew, leaving them short of employees to disinfect and clean, said residents and security guards. These poorly paid employees typically received little protection or training for the risky work.
“Some property management quit as it’s too dangerous. It was just a few people without any protection to go around the compound,” said Yan Yanbin, an apartment guard in Zuoling who developed a fever and other signs of coronavirus infection. “Checking temperatures became a charade; the thermometers didn’t work.”
Clusters of infections mushroomed across Wuhan. Hankou Gardens, an apartment complex a mile from the market, recorded over 50 infections by mid-February. Gangdu Gardens, a sprawling housing complex attached to a steel mill, recorded nearly 400 infections over that same time, according to records shared online by residents and property managers.
“Anytime you have a high number of people in a shared space, there’s always an increased risk of transmission, especially if you don’t have good hygienic practices,” said Melissa Nolanan assistant professor in epidemiology at the University of South Carolina’s Arnold School of Public Health.
As hospitals across Wuhan were swamped by patients, the government said on Jan. 23 that neighborhood health centers would be the first defense against the coronavirus.
Community health workers are usually not well paid and have fewer qualifications than hospital doctors. Now they stepped forward as triage workers, screening people for fevers, and dispatching patients who might have coronavirus to the bigger hospitals.
The Zuoling community medical center, opened in 2017, was clean, modern and had 99 beds — enough for normal times but too little for the surge of hundreds of patients every day.
“Beds were extremely tight, and the community tried to do what it could to find spots,” said Mr. Zuo, a worker for the Zuoling neighborhood administration. “We did everything we possibly could, but because there just weren’t the beds, they just had to go home.”
Credit...Agence France-Presse — Getty Images
After the daughter of Ms. Li, the housing manager, fell ill with fever, her family drove to a larger hospital in the district, hoping for a clear diagnosis and better treatment. More than 100 people stood in line to see a doctor; several patients slumped on the floor, Ms. Li said.
“There were not enough doctors and so many patients,” she added. “I felt this indescribable horror.”
Inundated public hospitals sent many feverish patients home, telling them to lock themselves in their apartment. But residents said the practice allowed the virus to spread, ensnaring entire families, from grandparents to the children, and jumping from neighbor to neighbor.
Ms. Li took her daughter home from the hospital, and she also developed lung damage that pointed to possible coronavirus infection. Officials ordered Ms. Li, her husband and son to stay in their apartment.
“Later, the community office called and told us to go and quarantine in a hotel,” she said.
New orders had gone out across Wuhan: Patients who were sick or suspected of having the virus would be moved from their homes to makeshift quarantine sites opened in hotels, dormitories and even a convention center.
Many residents of the city, like Yuan Jiaxiang, a 41-year old engineer suffering from a high fever, felt relief that they could end waiting in their homes. But many of the requisitioned hotels strained initially to care for the masses of weak, feverish patients.
“There was no treatment at all, simply locking down the patients,” Mr. Yuan said of the hotel where he spent five days. “I felt kind of disappointed at that point, and this constant fever didn’t get proper treatment.”
Officials had seen early on that sending patients home, or holding them in crowded local fever clinics, increased the risks of the coronavirus lingering in communities. In early February, the government had created a plan to take potentially infected people from their homes, but the policy faltered for lack of spaces for patients.
After a renewed push from the following week, growing numbers of mild cases were sent to cavernous sports and convention centers crammed with rows of beds. Patients who had not been tested but showed symptoms were sent to dormitories or hotels turned into makeshift wards.
Credit...China Daily/Reuters
The transfers happened with such urgency that safety was sometimes ignored. Patients who had waited many days at home for a hospital bed were rounded up at night by community workers and put aboard buses.
“The organization was chaotic,” a report from Xinhua, the official news agency, said of one transfer. “The outcome was patients losing control of their emotions after being kept waiting for a long time.”
Patients sent to hotels sometimes found that their families could not send them medicine or food. And hotel workers, often scarce and scared during the crisis, could not keep their rooms clean. “The beds were clearly not enough, and disinfection of the isolation sites was not timely,” said a report by Wuhan city inspectors who visited Zuoling.
Conditions have improved as more aid has poured into Wuhan and the number of infections has fallen. Despite concerns about the risk of infection in quarantine sites, many patients said they felt safer there.
“It’s not as depressing here,” said Mr. Yuan, the engineer, who was moved from the hotel to a large quarantine site — a commandeered exhibition center — after he was diagnosed with the coronavirus. “There are people to talk to, so I think it’ll be easier to pass the time.”
Mr. Zhang, the driver, is also recovering after time in quarantine, but the improvements came too late for his mother. She was moved from the community health center to a hospital, but died 11 days later.
Mr. Zhang begged doctors to briefly leave the sports center where he was quarantined to make a final farewell to his mother. Protective suits and medical workers were too scarce for that, the doctors said.
“I don’t know what happened to her body,” he said. “Nobody told me.”
Amy Qin reported from Wuhan, and Sui-Lee Wee from Singapore. Amber Wang and Zoe Mou contributed research.


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