By Sandra Rao, December 15, 2022
As widespread protests broke out across China in response to the deadly fire in the Xinjiang capital of Urumqi that killed at least 10 people, a new light was shone on the individual sacrifices and suffering endured in pursuit of zero-COVID. I am a Chinese-Canadian physician with family in China and have treated many COVID patients over the last three years, but I have also been a patient and a family member.
In the early days of the pandemic, the zero-COVID movement had strong support among academics on social media who endorsed a sense of collectivism and solidarity. As the collateral damage for the most vulnerable became more difficult to ignore, we see now the strategy’s perceived early successes concealed a darker reality of policies lacking compassion in their implementation.
I immigrated to Canada from Shanghai when I was just seven years old. I had last gone back in 2018, fresh out of medical school. As I strolled through the streets of the Old French Concession, a trendy neighbourhood with European-influence, I remembered thinking to myself, “I could probably live here.” In many parts, Shanghai appears clean, modern and progressive.
Yet some things weren’t quite right. For example, I couldn’t check my own email without a VPN, but at the time it only felt like a slight inconvenience. I was reminded of why my parents chose to immigrate when my hometown went into lockdown following the spread of the Omicron variant in April earlier this year.
For much of the pandemic since the initial lockdown in Wuhan in 2020, Shanghai was relatively spared from the draconian policies of zero-COVID due to its cultural and economic significance. With the lockdown, footage of a deserted, unrecognizable Shanghai emerged on Twitter and WeChat. A YouTube video titled “Voices of April,” leaked from the grips of censorship, revealed the strict COVID containment measures for what they are: a pet Corgi beaten to death, patients receiving chemotherapy locked out of their homes, citizens crying out for food from their welded apartments. Other stories also came to light, like a man who jumped to his death because he could not tolerate his pain from pancreatitis. Their pleas in Shanghainese dialect hit uncomfortably close to home.
During this time, I watched from afar as my family in China struggled to cope. It has been often said that strict pandemic measures were the compassionate way to save the lives of the vulnerable. For my grandparents, there was little humanity in what they endured. My grandfather is blind and, due to several strokes, he is no longer able to speak, walk or even toilet independently. Unable to leave his small apartment in three years, he relies upon my 84-year-old grandmother as his primary caretaker.
In an ideal world, public health measures would serve to protect the most vulnerable like them, but the reality has been quite the opposite. During lockdown, their only food supply were unpredictable (and often inadequate) boxes of arbitrary supplies delivered by the local government. They had no access to medications. They were separated from all of their home care support, such as their personal support worker and my other relatives who were also in lockdown. My grandmother refused to seek medical attention for her own health issues out of fear of contracting COVID, which would have left my grandfather alone if she gets taken to a quarantine facility.
My grandparents, like everyone else in lockdown, were required to undergo PCR testing three times a week for their Health Pass, an app that limits or grants mobility, and local officials would come to their home to swab my bedridden grandfather who encountered no one else. Suffering from caregiver burnout, my grandmother has told me on multiple occasions that she has had enough and no longer wishes to live, while assuring me that she has no need to leave the home anyway.
In their golden years, my grandparents have been forced to live a life devoid of joy and hope, “for their protection” they are told. It is true that they haven’t died of COVID, but they haven’t been living either. I felt helpless across the ocean, not knowing if they would starve confined in their homes or if a medical emergency would be their last. For months this continued, even in near 40-degree weather, with many residents not having air conditioning or adequate refrigeration to store perishable food. Even when restrictions were loosened, they were never truly free because the threat of lockdown loomed at every corner.
Looking at the plight of Chinese protesters from the vantage point of a now-fully open Canada, it was easy to feel a disconnect between their reality and ours. But in some ways, my grandparents’ experiences in China brought back painful memories in Ontario, which saw closures of playgrounds, schools, businesses, and police enforcement of stay-at home orders. It feels like just yesterday when physicians were recommended to carry hospital ID in case we were pulled over by police.
In late 2020, when my dad was diagnosed with gastric cancer, he was turned away by hospital screeners while receiving chemotherapy because he admitted to having shortness of breath when asked the standard COVID screening questions. The week prior, he had presented to the hospital with an arrhythmia from chemotherapy; this caused his heart to pump ineffectively, developing fluid in his lungs.
Being an honest man, he only wanted to tell the truth about this, but his language barrier prevented him from explaining himself. Despite my best efforts to advocate for him, he was turned away from his bone marrow biopsy that day. Then months later, when he would go on to have his stomach surgery done, I was turned away from visiting him at the hospital postoperatively despite having just been vaccinated with the then-new mRNA vaccines.
Then in July of 2021 I became a patient myself when I suffered a retinal detachment that put me at risk of permanent vision loss. I was just on the cusp of finishing residency with my whole career in front of me. Yet I found myself crying alone in the waiting room of a hospital where I was a resident just several months earlier, because I was scared and not allowed to have my partner with me for support. Like countless other patients during this time, even as a physician, I was stripped of my agency and powerless against the rigid monolith of COVID policy.
These frustrations as a physician-patient allowed me to empathize with what patients had to endure everyday, especially those who could not advocate for themselves. In my role as an emergency physician, I encounter patients daily who were negatively affected by isolation and delays in health care access. It was a routine struggle negotiating which family member should be present at the bedside of a critically ill patient. These policies caused significant moral injury for all of us in health care.
At great risk to themselves, the protesters in China finally gave a voice to those most affected by pandemic policies globally, voices of the most marginalized that were otherwise silenced or not heard from by those of us in ivory towers. Thanks to the incredible bravery of the protesters, China is swiftly ending its war with COVID, with state media now calling Omicron a mild illness for most and ending their tracking app, amongst other changes.
It is during times of great uncertainty where compassion is required most by both patients and the public. Through it all, I have learned that life cannot be measured by epidemiological charts alone, and humanity must underlie all that we do in medicine and in public health.
I wish for all patients the same thing I wish for myself and my grandparents: a life with purpose, dignity, and autonomy. Our pursuit of health should never again be incompatible with the human spirit.
Sandra Rao is an emergency medicine physician in the Greater Toronto Area and in under-serviced rural communities in Ontario.