Cun Cun on Frontline Health Care Personnel

Cun Cun, “Two Years in the Lives of Front Line Health-Care Workers Fighting the Pandemic:  Between ‘Heroes’ and ‘Deserters’”[1]
 
Introduction and Translation by David Ownby
 
Introduction
 
The text translated here comes from the WeChat feed of an online community of Chinese doctors and healthcare workers called Dingxiangyuan/丁香园 (Lily Garden).  Dingxiangyuan was set up in 2000 and has at least 3.2 million members who exchange various types of information and services via the platform.  Among these services is something approaching journalism, as this text suggests.
 
I don’t remember why I subscribed to Dingxingyuan.  The community posts a great deal, but I almost never read it, because it is about medical issues and is in Chinese.  I noticed it this time because I had just discovered that sociologist Sun Liping’s posts about living with the coronavirus had been taken down by Chinese authorities, and the title of the Dingxingyuan piece suggested that the piece might strike similar themes, so I took a look.
 
Cun Cun’s text does not in fact talk about living with covid, but it does probe—gently if directly—the theme of the immense fatigue and frustration experienced by China’s frontline health care workers.  It is in no way surprising that their sacrifices have worn them out; China’s policy of zero-tolerance requires vast amounts of labor, and these are some of the people performing that labor.  What caught my eye was that while in most media reports these workers are generally praised in near hagiographic terms for their heroism and service, in this piece they let their guard down and ask for more help, admitting that they are near the end of their rope.  I have no idea how new this is in the Chinese media context, but found it interesting that it was possible to talk about covid in such a way, even in a relatively obscure corner of the Chinese media.
 
On the unlikely occasion that someone might wish to use this translation to talk about how China’s zero-tolerance policy works on the ground, beware that I know little about such things.  I made a good faith effort to get the translation right, but don’t know enough about epidemiological practices to be able to tell where Google Translate might have let me astray on technical issues.  My concern was to convey the fatigue and frustration experienced by those working in China to control the pandemic, and not to provide a scientifically accurate description of the measures they employ.
 
Translation
 
"We are like a loud speaker at the entrance of the village." This is how Li Haoran describes the experience of doing full-scale nucleic acid sampling in a village in Eastern China.
 
With limited knowledge of how protection works, villagers at the sampling site would often take off their masks so they could gossip and discuss face-to-face, or sometimes even to spit. In order to persuade villagers to comply with prevention norms, Li Haoran spent the whole day repeating the same sentence: "Wear a mask and keep one meter apart."  He notes “I was hoarse by the end of the day.”
 
These days, full-scale nucleic acid screening is a common tool for pandemic control and prevention in many places, and "loud speakers" like Li Haoran are found all over the country.
 
The "Loud Speaker" at the Village Gate
 
Two years ago, Li Haoran was among the first groups of medical personnel to come to the aide of Wuhan.  "In Wuhan, our group was in an intensive care unit, and in terms of the management of the unit and providing for third-level protection, we were perfect."
 
Compared with the front-line strict prevention and control he had experienced in Wuhan, Li Haoran felt more uncertainty during his work at the grassroots level.  The problem was the material conditions and the control and prevention measures in the local areas.  He noted that "the local areas were not fully prepared, which meant that we had to take the initiative to coordinate things on our own.”
 
The first thing the team did on arrival was to communicate with the local village committee to confirm the extent to which control and prevention measures had been implemented. "The sampling sites were not fully equipped with supplies, the village was limited in what it could provide for control and prevention, and were unable to set up distinct contaminated zones, possibly contaminated zones, and clean zones, as well as clean and contaminated pathways.” The medical team had to make temporary site improvements to separate the sampling site medical staff access, residents’ access, and patients' access as much as possible. 
 
"Although there are lots of documents meant to guide you, and we have been drilled many times, the documents still only point you in the general direction, and on-site prevention and control work is different in each place. If a true emergency occurs, then there is always the danger that local leaders will take over and tell everyone what to do.  When this happens, there is no fixed mechanism allowing us to work, which destroys our rhythm and everything turns to chaos."
 
Li Haoran and the members of the medical team are trying to do "support" and "training" at the same time.
 
Originally, the medical team was only responsible for nucleic acid sampling, and the local government was responsible for confirming the diagnosis and quarantine management of the confirmed cases and close contacts. However, when it came to door-to-door nucleic acid testing, Li Haoran would take the initiative to communicate with the local community and confirm the level of protection and the protection process, "such how to handle the testing zone if there is a positive result during sampling.” He repeated himself over and over, trying to promote the standardization of operations and strengthen the awareness of epidemic prevention among local staff and volunteers.
 
Behind Big Data are the People who Handle the Data 
 
Behind the precision and control afforded by big data, we find people like Li Runze, a cadre stationed in the village, Huang Renjie, a disease control officer, and Dr. Zhou Yuzhe, a doctor at the isolation site. 
 
As digitalized procedures have spread, this has also increased what Dr. Zhou Yuzhe sees as "more menial work.”
 
For example, in the nucleic acid sampling process, each person's information corresponds to a barcode, which Zhou Yuzhe used to put directly on the sampling tube, but now he has to use his cell phone to log into an app and enter the person's information manually. When he takes people’s temperatures twice a day, in addition to taking and registering the temperature, he also needs to enter the data into another program. When entering the data, Zhou Yuzhe still has to wear protective clothing, and two layers of gloves.  There is also a germ-proof bag over his phone.
 
Epidemiological investigation is an extremely important part of epidemic prevention and control, and in order to do a good job, Li Runze needs to obtain villagers’ personal information, the history of where they live and where they have visited in the affected area, their contact history and itinerary.   Each bit of information is an important data point, but often all Li Runze can find out is their cell number and whether their daily route takes them into a danger zone. 
 
In order to make a complete epidemiological chain out of these two thin data points, Li needs to be constantly making phone calls and filling out reports, including information from the quarantine hotels, charts of dynamic data, and other charts with information on the personnel doing the testing.  Similarly, the data that comes down to the village from above has to be sorted and appropriately delivered to four different types of workers: those dealing with centralized quarantine, those dealing with home quarantine, those doing nucleic acid tests, and those providing nucleic acid reports.

The hardest part is asking for names, "I ask the person's name and they angrily yell me back 'Why are you calling me if you don't even know my name?’” 
 
Finding people is harder than finding data 
 
In order to identify all the contacts of a “downstream” exposure, Huang Renjie watched every surveillance video of the twelve buses the person took over the course of five days, "and I finally found more than 280 people.” 
 
One night at 10 p.m., Li Runze received data regarding a person in the at risk zone. After contacting the other party by phone, Li Runze went to the address provided, but found that the information was fake, and when he called back, no one answered. "The hardest thing is to convince people to cooperate with the control after the initial investigation and tracing are completed.”
 
When all else failed, Li contacted the wife of the person through public security, then spent a half an hour at their house trying to persuade the person to cooperate. "We told them that conditions are very good at the isolation site, that food and accommodation are free, and that they would not be quarantined for very long.” But by the time he finally sent to the person was sent to the isolation site it was already 5:00 am.
 
So now, they all have their own ideas about the best way to communicate with people.
 
Li Runze said, "If I am dealing with someone who is not from the village, then I have the landlord negotiate with them, because if the landlord threatens to throw them out then they will be in a tough spot; if it is someone local, then I let the village cadres handle it, because they have a bit more authority in the village. The most difficult are the cases with no fixed living situation, because they worry they will never get out of quarantine, so they find any reason they can to avoid you.”
 
Huang Renjie's solution is even a little harsher: "If two people were at a place where an infection occurred at the same moment, but only one person is identified as a contact, that person will be hard to convince.  We can either let them yell at us for a bit, or send them directly to file a complaint."
 
Between “Heroes” and “Deserters”

Two years of the pandemic has changed the course of everyone's life.
 
Zhou Yuzhe's wife, who is also a doctor at a public hospital in Wuhan, was on holiday at the beginning of the epidemic when she received an urgent notice from the hospital telling her to get back to work. Their child was less than five months old, and her mother, who was living with them, has sensorineural deafness. The couple brought the situation to the attention of the hospital leadership but received no response, and their request for a cross-city vehicle permit was politely denied.
 
In the process of negotiating family matters, Zhou Yuzhe's wife arrived at work one day after receiving the notice, and because of this one-day lapse, the leadership called her a "deserter."
 
At the same time, front-line health care workers are always praised as “heroes” for the difficulties and pressures they face.

Huang Renjie does not agree with this, because the impression this ultimately creates is that "if you don't suffer, then you didn’t contribute, so you’re in the wrong," and over time their work will be identified with suffering. Li Haoran has a similar view, and prefers that he and people like him receive "substantive benefits." Instead of looking like “fake heroes” on someone’s screen, it is more important for them to have help in the form of more personnel, more time to rest, and fewer salary deductions.
 
Caught between being "heroes" and "deserters," front line health care workers find themselves squeezed into a very small space.
 
Zhou Yuzhe's original plan to study abroad for his doctorate has been put on hold indefinitely, and he has not left his province since the beginning of the pandemic. "When the pandemic hit I had to do the nucleic acid tests, and once things calmed down it was the vaccinations.” Now, he starts work every morning at a little after 6 a.m. Everyone in the isolation site has the doctor’s phone number, and Zhou’s phone rings at all hours day and night.  "Someone is not feeling well, or has a question. Sometimes they ask us to help send them a package.”
 
The work at the isolation site requires Zhou Yuzhe to be on call 24 hours a day. "If someone working at isolation site gets sick, we will be punished.  If the test is negative the first time, but later tests are positive, this is also our responsibility.” Over the past two years, Zhou Yuzhe has lost over thirty pounds.
 
Since the beginning of the pandemic, Huang Renjie has never turned off his cell phone. Recently, due to the emergence of local cases, Huang Renjie and his colleagues have been able to only sleep two to three hours a day for almost two weeks, and their on-site office is full of cots and toiletries. "Some people worry that we need to be here in case something happens, which means they don’t know when they will be able to go home.”
 
A colleague of Zhang Miao, a resident in training, took a leave of absence to get married, but there was an epidemic in the area, so not only did the wedding not take place, but he also lost his wedding leave. Zhang Miao has not been home for three years, but she does not dare to ask for leave. "I worry that I’ll wind up in quarantine, in which case I might not be allowed to return for several months, and I would never make up the training I missed. We’re used to working 24 hours a day, seven days a week.”
 
Zhang Miao's concerns also extend to her colleagues in the hospital. Nurse Lou Ying, who is nearing retirement, said that she had been affected because her colleagues in the department went out to do testing and ran into an outbreak. Over the next ten days, she "took the place of 11 people all by herself.”
 
Complaints, Wear and Tear, and Hope
 
There were also some changes that the resident Zhang Miao did not anticipate.
 
The hospital where Zhang Miao works has a set of detailed hospital infection prevention and control procedures and emergency training guidelines. The Hospital Infection Office and the Health Bureau will from time to time check on the staff’s command of these procedures and guidelines by asking them to recite them.   "The medium and high risk areas are updated daily, we all have to memorize the updates, and if we don’t our department is fined.”
 
In addition, once they had set everything up on the ground, "the hospital even received more complaints than before.”
 
Beginning from when they enter the front gate of the hospital, those who are infected are required to provide detailed epidemiological information: their address, their identity papers, when they were vaccinated…Any question can trigger an emotional outburst. A patient once slapped the table and shouted at Zhang Miao “Are you treating me for covid or taking my general medical history”?   All she could do was explain and try to calm the patient down, or ask security to handle it.

In addition to complaints about intake information, there are also complaints about the food in the cafeteria, "because we don't allow people to come in with them and we don’t allow food delivery.  At the outset we didn’t think about people who were diabetic and prepared everything the same way.  Later, we got better.” 
 
Li Haoran constantly reminded patients to wear masks and have their health codes available, which also irritated them. "They think I’m intrusive." 
 
As Huang Renjie sees it, the value of their work is being eaten away by petty formalities.
 
In epidemiology, an initial investigation report guides the implementation of prevention and control measures, but in reality, Huang Renjie's reports are inevitably modified due to his leaders’ preferences, and he laughs helplessly, joking that "Someone blows the bugle urging us to charge, but no one blows the bugle telling us to stand down." 
 
"As an ordinary health-care worker, I really didn't expect the pandemic to be so hard.  There are plenty of people who pull two all-nighters in three days, so it is not that our situation is the worst…So people have to forgive me for losing my temper sometimes, or maybe they won’t forgive me.  Sorry.  I’m really too tired and this is just too much.”  A message in the comment section of the Shanghai Center for Disease Control WeChat public account touched the hearts of Huang Renjie, Li Haoran, Li Runze,
Zhang Miao and Zhou Yuzhe. “In all the work they do, it is like gears meshing together in constant motion.”
 
Huang Renjie now resents it when his phone rings, and is annoyed with the constant emergency notifications, which mean he "has to put down whatever he is doing." In his opinion, his current work is lagging behind the cases popping up, and it will take a lot of human and financial resources to plug the gap.  He also feels that "we need better medicines to defeat the coronavirus.”
 
All of those we talked to mentioned invariably mentioned needing effective medicines to deal with the coronavirus when talking about the future. In a high-pressure job with no end in sight, they pin their best hopes on improving the status quo.
 
Notes

[1]寸寸, “一线防疫人员的 2 年：我被夹在「英雄」和「逃兵」之间,” published on the WeChat feed of 丁香园/Lilac Garden on January 20, 2022.