Elderly In Rural China The Most Vulnerable Group In Recent COVID-19 Outbreaks – Analysis


By Xia Ri*

As China continues to tweak and relax its COVID-19 policy, there have been mass outbreaks throughout the country. Judging from the global experience of the pandemic, this wave of infections in China can be regarded as a sort of “remedial lesson”. In the early stages of the pandemic, during the stage when the strains were deadlier, China adopted strict prevention measures to avoid the death of a large number of people. This is an achievement that should be acknowledged.

Researchers at ANBOUND have been tracking the COVID-19 pandemic for the past three years. We have repeatedly proposed that China needs to focus on the protection of the elderly, especially those with comorbidities. Unfortunately, in the new stage of the battle against the novel coronavirus, the elderly are affected the most. As the outbreaks spread from urban to rural areas, it has become difficult for the elderly with underlying diseases in less developed places to receive effective treatment, and they have become the most vulnerable group in the country.

According to a local survey conducted by ANBOUND’s researchers in some rural areas, in this round of outbreaks, the death rate of rural elderly with comorbidities is higher than that of the same period in previous years. If the relevant departments expand the scope of statistics, they may find that the mortality rate of the elderly in rural areas has increased significantly in recent years compared with the past. This shows that in the current stage, these elderly populations have been significantly impacted by COVID-19.

First of all, there are a large number of elderly people with comorbidities in rural areas. The 2020 Chinese census data shows that by the end of 2021, the national population would reach 1.41 billion, with the rural population being 510 million. Among them, the proportions of rural people aged 60, 65, and over were 23.81% (120 million people) and 17.72% (90 million people), which were 7.99 and 6.61 percentage points higher than those in urban areas. According to relevant statistics, about 190 million elderly people in China suffered from chronic diseases in 2021, such as cardiovascular and cerebrovascular diseases, diabetes, chronic respiratory diseases, and others. About 75% of the elderly aged 60 and above suffered from one or more chronic diseases, and 43% of them had multiple diseases. Calculating proportionally from the above data, the number of various types of sick elderly groups in rural areas is considerable. Due to their long-term medical and health conditions, as well as the poorer environment, it is more common for the elderly in rural areas to have chronic diseases.

Secondly, medical awareness of the rural populations is still wanting. With the relaxation of China’s COVID-19 policies, control measures too were also withdrawn in rural areas, and with it the increase in infection cases in those areas. According to our researchers’ surveys in multiple places, before the pandemic spread in rural areas, most people there did not consider about buying related medicines in advance to prepare for possible outbreaks. When the novel coronavirus spread in the countryside, the general mentality of the people is that they will be infected anyway, hence it did not matter much to them. Regardless of whether they are infected or not, many of the rural dwellers do not wear masks and do not isolate themselves at home. Under such circumstances, there are waves of infections quickly rolling up in rural China.

However, the real impact of the mass death of the elderly in a short period is gradually changing the rural populations’ awareness. In one village, when one or two old people died in the village, the villagers did not think this was out of the ordinary. They gradually began to pay attention to the protection of the elderly at home when more deaths occurred. That being said, there are limited means of protection for the elderly, mainly basic measures such as reducing the contact between the elderly and the outside world.

Finally, there is a serious shortage of medical resources at the county and township levels. As the end of the tertiary medical service system, the village clinic can basically meet the basic medical needs of a village in normal times. Once many villagers are infected at the same time, such small medical institutions will definitely be overwhelmed. To cite an example, in a village in northern China, there are only two village doctors to more than 1,300 people. In another village in the central region, there are more than 2,000 people, yet the village clinic is only 80 square meters, with only one single doctor. Faced with a large number of infected patients, the village doctors are overwhelmed. Some live in clinics and provide treatment 24 hours a day, even when the doctors themselves are sick.

If there is an elderly person who is seriously ill, he or she would often just take some medicine or drip treatment at most. The villagers are unable to change the status quo of medical care, and there is no better option for them. County and township hospitals in the country are also overcrowded, medical resources are tight. There is a lack of ICU beds and ventilators and other severe treatment measures. In the central region, in a township with 13,000 people, there are only 4 doctors and 4 nurses in the health center. In a county hospital in the central region, 10 ICU beds are operating at full capacity. One medical staff at the county level revealed that the hospitals are currently understaffed, and even various children’s and gynecological hospitals have been transformed into treatment centers for the elderly. Doctors from other departments too, have to assist in the treatment of severely ill elderly people.

Final analysis conclusion:

With a large number of elderly people with comorbidities in rural China, as well as the villagers’ lower level of health awareness, in addition to that medical resources at the county and township levels are seriously insufficient, the COVID-19 mortality rate of elderly people has been relatively high recently compared with the same period in previous years. This makes these elderly people one of the most vulnerable groups in the current development of outbreaks in the country. As it stands, such an outcome is truly due to the aging crisis of the country.

Xia Ri is a researcher at ANBOUND


Anbound Consulting (Anbound) is an independent Think Tank with the headquarter based in Beijing. Established in 1993, Anbound specializes in public policy research, and enjoys a professional reputation in the areas of strategic forecasting, policy solutions and risk analysis. Anbound's research findings are widely recognized and create a deep interest within public media, academics and experts who are also providing consulting service to the State Council of China.

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