Turning rural villages into the home front for social stability—Examination of coronavirus disease 2019 control experiences in rural areas in China

Summary

Since the outbreak of COVID‐19, the disease has continued to spread and countries around the world have been plagued by its causal agent, the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). In the comprehensive fight against the SARS‐CoV‐2, China has taken a series of important measures, achieved major victories in safeguarding people's lives and health, and accumulated important experience. Rural epidemic prevention and control is a basic part of the entire prevention and control system, with certain particularities. This study summarizes China's experience in preventing and controlling COVID‐19 and the local measures taken to effectively prevent the spread of the disease in rural areas. All countries worldwide can learn from China's experience and take measures according to their own national and local conditions to effectively achieve the rural prevention and control of COVID‐19. Meanwhile, the crisis itself can be viewed as a new opportunity for rural development.

Coronavirus disease 2019 (COVID‐19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), is a new infectious disease that was discovered toward the end of 2019. SARS‐CoV‐2 is highly infectious and has a fast transmission rate and long incubation period. Importantly, there is no specific COVID‐19 treatment or SARS‐CoV‐2 vaccine at present, which poses a great threat to the lives and health of people worldwide. In China, the healthcare and hygiene conditions of rural areas are poorer than those of the urban areas, with rural residents possessing poor knowledge about protection from diseases. ¹ Furthermore, this epidemic occurred during the Chinese New Year, a time when large numbers of rural residents return to their hometowns, thus leading to an increased risk of an epidemic. Notably, disease control in rural regions is one of the major areas in the prevention and control of an epidemic. Therefore, the Government of the People's Republic of China swiftly employed forceful, orderly, scientific, and thorough measures to effectively prevent the spread of the disease in rural areas. This ensured the health and safety of the public as a whole, healthy economic development, social stability in the rural communities, and enabled rural areas to become the home front for national stability.

There were five major areas in the COVID‐19 prevention and control experience of China's rural areas, all of which involved different components and focus areas.

First, an organization—along with an effective operation mechanism—was established to lead and clearly define the responsibilities of COVID‐19 prevention and control and to carry out the tasks involved. On the basis of existing regulations on the response to public health emergencies, the governments of the various provinces, autonomous regions, and municipalities directly under the central government set up local epidemic emergency response headquarters after the COVID‐19 outbreak. The relevant departments of the local governments at or above the county level were responsible for handling the emergency response to the outbreak within the scope of their respective functions and duties. Once COVID‐19 had become an epidemic, committees in villages and towns immediately organized forces to unite and cooperate on mass disease prevention and treatment measures, assisting the health administrative department and other relevant departments as well as medical and health institutions in the collection and reporting of information, the dispersion and isolation of personnel, the implementation of public health measures, and the conveyance of infectious disease prevention and control knowledge to the villagers. During the epidemic period, the state council issued a notice on further improving the prevention and control of the pneumonia epidemic caused by the novel coronavirus in rural areas. Under the leading group for epidemic response and following the working mechanism for joint prevention and control, local party committees and governments set up special classes on epidemic prevention and control in rural areas to strengthen the unified command and dispatch measures, to adhere to the integrated deployment and promotion of prevention and control in rural and urban areas, and to effectively guarantee the needs of materials, funds, and personnel for epidemic prevention and control in rural areas. For example, in the Fuyang District of Hangzhou City (Zhejiang Province), the whole region implemented a four‐level linkage mechanism of “organizing groups and joining villages” to carry out the epidemic prevention and control work. According to the overall planning requirements of the main leaders, which included all township cadres and village (Party member) representatives, a total of 276 epidemic prevention teams were set up in 276 administrative villages in 24 townships (subdistricts) of the region. More than 1600 township cadres were assigned to the teams to carry out COVID‐19 epidemic prevention and control, thus achieving full coverage of the region. During the period of group association, members of the town and street leading group were responsible for contacting the villagers, grasping the whereabouts of the mobile personnel in the village, paying attention to the personnel trends, and regularly reporting to the main leaders of the town and street leading group. In the event of any special situation, the town and street leading group would contact the emergency response team immediately and report to the district leading group. Township cadres clarified specific responsibility blocks through zoning; regularly collected and summarized changes in the epidemic situation in the area; and organized the promotion of epidemic prevention knowledge, the control of personnel entry and exit, and other investigations. The village representatives (Party members) were divided according to their place of residence and were in close contact with the households, being responsible for understanding the situation of each household in real time (via telephone, WeChat, etc.), collecting information on the actual difficulties faced by each household, and reporting any emergencies. All the villages in the district had established a village‐level defense network, with the town and village cadres and village (Party members) representatives acting as the main body, and the anti‐epidemic work was thus carried out in an orderly manner.

At the same time, Article 9 of the “Law of the People's Republic of China on the Prevention and Control of Infectious Diseases” clearly stipulates that the State supports and encourages the participation of units and individuals in the prevention and treatment of infectious diseases. All levels of the People's governments have formulated clear and specific measures for epidemic prevention and control and have fully mobilized organizations and individuals to publicize and educate the public about infectious disease prevention and control, epidemic situation reports, voluntary services, and donation activities. The village committee encourages villagers to participate in the prevention and control of infectious diseases in rural areas. During this current epidemic, the county and township party committees and governments gave full roles to grassroots party organizations and villagers' self‐governance organizations and mobilized the masses of farmers to actively participate in disease prevention and control, forming a joint force for prevention and control. For example, as a proponent of national village governance townships, the Party Committee of Huangxi Town (Yujiang District, Yingtan City, Jiangxi Province) has always insisted on mobilizing, organizing, and cohering the masses so as to draw strength from their practices to win the war on the epidemic. The committee played on the villagers' strength, encouraging them to expediently find people returning from Hubei province and other places and to promptly report crowds that had gathered for nonessential reasons, such as gambling. At the same time, they organized the villagers to set up a guard at the entrance of the village to build a tight defense line to prevent and control the masses. They mobilized social volunteers to form veteran persuasion teams, square dance association publicity teams, female volunteer service teams, and youth volunteer service teams. Three to five teams of volunteers in groups of two passed out leaflets, registered vehicles that were moving to and fro, and persuaded pedestrians to wear masks. They pooled the strength of the “Xiangxian Enterprise” and used WeChat Groups and the Charity Association platform to call on the majority of the township sages, enterprises, and caring people to fight the disease. Some township members rushed to purchase personal protective equipment and generously donated a total of 1.51 million yuan in money and materials.

Second, the important roles of rural medical institutions and rural physicians were fully utilized. China has 1.44 million village clinics, and most villages have rural physicians. For those villages that do not have rural physicians, staff members from township hospitals periodically provide services for the villagers; as such, the services of rural physicians generally cover the entire rural area. ² Rural grassroots medical institutions are the foundation of the rural healthcare service system and play an important role in COVID‐19 epidemic prevention and control in the rural areas. As an important component of the rural grassroots healthcare service system in China, rural medical teams play an irreplaceable role in rural healthcare as they are the “gatekeepers” of the health of rural residents. Various rural grassroots medical institutions have actively participated in epidemic prevention and control work according to the overall deployment and requirements by the National Health Commission of China. Various township hospitals and village clinics are COVID‐19 epidemic monitoring and reporting sites and have increased the screening efficiency of suspected patients, aided in the control of infection sources, and protected susceptible populations from infection. At the same time, rural grassroots medical institutions complied with scientific requirements to effectively screen, test, examine, and refer patients, while setting up prescreening and triage areas, isolation and observation rooms, and fever consultation rooms. ³ The state had also increased training for medical and health personnel in counties and villages to improve their expertise in disease identification, initial treatment, and infection control and protection. Support and support personnel were expediently arranged for the health centers and clinics that had insufficient manpower to ensure the implementation of work tasks. Each day, rural physicians would visit villagers household by household and actively carry out temperature measurements as well as note medical observations among quarantined villagers and deploy key personnel.

In addition, the laws of the People's Republic of China clearly point out the promotion of basic medical care and health and the opinions of the state council on supporting and promoting the development of traditional Chinese medicine (TCM). The state shall vigorously develop the cause of TCM, vigorously strengthen the construction of TCM departments in town and township clinics, and actively develop TCM services in village clinics. Township health centers have set up TCM departments and pharmacies that are equipped with TCM professionals and technicians, basic TCM diagnostic and treatment equipment, and essential TCMs, basically realizing that every village clinic can provide TCM services. The state has made great efforts in developing TCM, attaching equal importance to both traditional and western medicine and combining inherited knowledge and innovation so as to enable the unique role of TCM in medical and healthcare. The state shall strengthen the protection and development of TCM, fully embody its characteristics and advantages, and enable its role in disease prevention, healthcare, medical treatment, and rehabilitation. In this current outbreak, the National Health Commission clearly proposed in its COVID‐19 Prevention and Control Plan (sixth edition) to encourage and support the unique advantages and role of TCM in epidemic prevention and treatment. Grassroots health institutions in rural areas around the country have fully promoted the application of high‐quality TCM resources and the role that TCM plays in curing diseases. Consequently, the prevention and treatment of the disease has moved forward, and patients have received timely treatment, thus reducing the rates of virus transfer and mortality from the disease. According to statistics, more than 90% of the patients with confirmed COVID‐19 used TCMs. Clinical observation has revealed that the total effective rate of TCM is over 90%. To facilitate the epidemic prevention and control work, health institutions at the grassroots level in rural areas publicized TCM prescriptions to the public, and some areas provided TCM decoctions free of charge to epidemic prevention and control workers and residents within their jurisdiction. For example, the Yimuxi Township Hospital of Yuanling County (Huaihua City, Hunan Province) dispatched medical staff, gathered materials, worked overtime and over a long period of time, and uniformly prepared more than 500 herbal TCM decoctions. The enforcement squad, the joint medical staff for the township home medical observers, the rural frontline epidemic prevention and control personnel, and the orphaned elderly in COSCO Xingyuan distributed three‐day doses of TCM decoctions for free. The Health Center of Huayu Town (Jinxiang County, Jining City, Shandong Province) prepared TCM decoctions in accordance with prescriptions in the “Prevention Program for Pneumonia in Traditional Chinese Medicine in Shandong Province in Winter and Spring 2020 and New Coronavirus Infection” document issued by the Provincial Health and Health Commission and distributed them to all employees and some people in need to effectively prevent the spread of new infectious diseases. At the same time, the hospital publicized the TCM program through the unit's public WeChat account as well as through the personal WeChat accounts of the unit's cadres and employees and their circle of friends.

Third, the monitoring of migrant staff, returning staff, and rural residents was strengthened, and autonomous epidemic control based on local conditions was carried out. Epidemic prevention and control is a battle that requires the participation of everyone, and rural residents must also be guided and mobilized to participate as a joint prevention and control effort. As many staff and students returned to the rural areas before the Chinese New Year, the pressure of prevention and control in the rural areas was increased. Therefore, Chinese villages viewed the quarantine and observation of returning staff as one of the important measures for epidemic prevention and control. Various rural areas used villager groups as a unit for the detailed recording and dynamic and precise monitoring of returning staff. A system of daily reporting, zero reporting, and timely reporting of unique cases was implemented. A guarantee of responsibility system was carried out on quarantined individuals, where township hospitals and village clinics carried out temperature monitoring of home‐quarantined individuals twice a day. In addition, 14‐day home quarantine was carried out strictly, and quarantine labels were posted on the front doors of villagers who had returned home. Meanwhile, multi‐village linkages were employed for the rural areas, while at the same time, a strict 24‐hour monitoring of vehicles and people was implemented and road blocks were set up at village entrances for the registration of vehicles and the monitoring of people's temperature; subsequently, a resident or vehicle pass was required for entry/exit to prevent the import of the SARS‐CoV‐2. The adoption of these measures had its legal bases, being backed by the criminal law of the People's Republic of China, the public security administration punishment law of the People's Republic of China on the prevention and control of infectious diseases, the emergency response law of the People's Republic of China, and other relevant laws and regulations. Noncompliant individuals could be legally detained and punished for disturbing public order and conducting other illegal and criminal activities, such as the following: refusing to cooperate with epidemic prevention, quarantine, compulsory quarantine, and isolation treatment by deliberate escape, malicious obstruction, violent resistance, and other means; disturbing the medical order of a hospital, injuring medical staff, or preventing state functionaries from performing their official duties according to law; knowingly entering a public place or coming into contact with others while concealing his or her status of being possibly or definitely infected with the novel coronavirus; fabricating and spreading false information related to the epidemic situation, knowingly spreading false information on the information network or other media, spreading rumors, making false reports of dangerous situations or the epidemic situation, or deliberately disturbing public order by other means; disturbing the work of epidemic prevention and control groups and disrupting public order by bidding up prices or hoarding supplies for profit; and refusing to carry out the commands issued by the various levels of the People's governments during the period of epidemic prevention and control.

In addition, it is insufficient to rely solely on top‐down resource allocation and grassroots cadres for epidemic control. Therefore, the characteristics and situation of each village were used to actively mobilize the public. That is, existing rural administrative organizations and social organizations were utilized; and WeChat groups, public accounts, and mobilization books were all used to mobilize the masses to participate in grassroots epidemic prevention and control. Mobile investigation teams, village patrol teams, anti‐gathering persuasion teams, and volunteer teams for assisting vulnerable people were established. A medical system that complies with various epidemic control regulations was set up to maintain social order and focus on reconstruction and prevention. During the epidemic, many rural organizations, retired soldiers, high school students, and ordinary villagers in the rural areas were frontline staff who carried out tasks ranging from cleaning, to the disinfection of public places, and guard duty. These people used professional knowledge for psychological counseling, assisted in promotion work, donated funds and materials, assisted in the collection and distribution of materials, and aided in the organization of epidemic‐related data, updating, and verification work so as to truly achieve joint epidemic prevention and control based on society‐wide efforts.

Fourth, the promotion of guidance for the epidemic prevention and control work, along with the promotion of epidemic‐specific laws, was strengthened. Guidance promotion was strengthened via promotional banners, village broadcasting stations, mobile broadcasts, WeChat groups, household notifications, and the printing of brochures to promote COVID‐19 epidemic control knowledge to residents. Villagers were educated and guided on scientific understanding of the epidemic. They were advised not to move around, visit others, or gather in groups, and to cancel, simplify, or delay weddings, wakes, Chinese New Year celebrations, and temple festivals. Furthermore, the residents' cooperation and epidemic control awareness were improved to minimize transmission risk. At the same time, a combination of online and offline methods were employed in rural areas to promote the Law of the People's Republic of China on the Prevention and Treatment of Infectious Diseases, Emergency Response Law of the People's Republic of China, Wild Animal Conservation Law of the People's Republic of China, Regulation on the Urgent Handling of Public Health Emergencies, Criminal Law of the People's Republic of China, and Public Security Administration Punishment Law of the People's Republic of China, for strengthening the legal knowledge in villagers so that they will obey relevant laws and regulations on epidemic control.

Finally, the coordination of epidemic prevention with control promotion and rural economic development was carried out. Similar to many industries affected around the world, the spread of COVID‐19 has threatened agricultural development and the livelihood of farmers. Agricultural production is strongly seasonal, and the epidemic had a direct and huge impact on this industry. During this epidemic, some agricultural products in many rural areas showed slow sales and poor transportation. Moreover, agricultural labor was also impacted, and a shortage of labor for large‐scale cultivation was noted. In view of the difficulties in rural economic development caused by the epidemic, the Government of the People's Republic of China has adopted the following series of effective measures ⁴ :

1. Solving the slow sales of agricultural products: To improve the sale of agricultural products, rural organizations and companies in China have carried out activities to link agricultural product production and sales. In response to calls from rural areas, many electronic platforms have launched farmer assistance activities to assist farmers in selling their agricultural products. The Chinese Agricultural Produce Marketing Association has linked up with the agricultural and rural affairs authorities in various provinces to organize the purchase of products (via agricultural product wholesale markets) with slow sales in many areas.

2. Guaranteeing the flow of capital: To ensure that farmers had access to capital, credit guarantee‐related fees for the agricultural industry were reduced/waived, disaster relief funds for the agricultural industry were disbursed as soon as possible, Central Finance development funds for the agricultural industry were distributed to key epidemic regions, and the coordination of local fiscal funds was strengthened.

3. Optimizing administrative review and approval services: The Government of the People's Republic of China has requested various levels of agricultural departments to simplify review and approval procedures, shorten their duration and efficiency, and continuously innovate services through online work. All these measures will drive the resumption of work and production in the agricultural industry.

4. Driving the resumption of work by migrant workers: Migrant work concerns the livelihood of farmers. While resuming work and production in companies in China, epidemic prevention and control for the resumption of migrant work should be carried out to strengthen the effective linkage between import and export regions.

5. Ensuring the availability of the daily necessities for agricultural production: The guarantee that materials and tools are available for agricultural production necessitates smooth transportation to villages and the maintenance of access to exclusive roads. To completely restore normal agricultural production and vehicular access so that agricultural products are able to leave places of production and materials for agricultural production can in turn enter these places, the blockade of all disease transmission channels is a prerequisite.

Rural COVID‐19 prevention and control work is an important component of this epidemic's prevention and control. However, in rural areas, there is a shortage of medical resources and the diagnostic and treatment levels are poor. Therefore, COVID‐19 control work in rural areas should be adjusted according to local conditions, widespread promotion should be carried out to improve the disease control knowledge of the public, and the masses should be mobilized for participation in epidemic prevention and control work. In China, a strict COVID‐19 control network was set up and responsibilities were strictly defined to ensure its efficient operation. In addition, existing medical resources were fully utilized so that the COVID‐19 prevention and control work in rural areas could be carried out by rural grassroots medical institutions and rural physicians.

This COVID‐19 epidemic has brought many new crises to rural areas. However, crises are also opportunities to develop rural regions. At the grassroots level, rural grassroots governance will be optimized to guide the healthy development of rural organizations. With regard to rural environmental governance, the rural toilet revolution was launched, and village cleaning activities were strengthened to comprehensively drive domestic garbage governance and domestic wastewater processing in rural areas. With regard to economic development in the agricultural industry, the collective economic activity of rural areas was strengthened and a modern and intelligent agricultural industry was developed.

CONFLICT OF INTEREST

The authors have no competing interests.

AUTHOR CONTRIBUTIONS

Xiaoyan Zhang contributed to the conception of the study and helped perform the analysis with constructive discussions. Chen Xiang contributed significantly to analysis and manuscript preparation and performed the data analyses and wrote the manuscript.

ETHICS STATEMENT

This manuscript is a commentary and does not involve a research protocol requiring approval by the relevant institutional review board or ethics committee.

Zhang X, Xiang C. Turning rural villages into the home front for social stability—Examination of coronavirus disease 2019 control experiences in rural areas in China. Int J Health Plann Mgmt. 2020;35:1250–1256. 10.1002/hpm.3007