Strengthening the Life-Science Industry in the PRC

Elderly Care System Development in Yichang, PRC

This video introduced ADB’s comprehensive support in elderly-case system development of Yichang City, PRC, with well-integrated technical assistance, loan projects and knowledge work.

Related event: Elderly Care System Development Forum

Regional Solutions for COVID-19 Response and Vaccine Delivery in Selected Developing Member Countries


0:00 / 0:00

ADB health expert Najib Habib headed a project on Regional Solutions for COVID-19 Response and Vaccine Delivery in Selected Developing Member Countries. The research and first-person accounts are on the RKSI microsite. He introduces some public health insights in the following episodes and his discussions with ADB economist Marzia Mongiorgi-Lorenzo, who tells of her personal experiences in Beijing at the height of the pandemic.

Najib: Hello everybody, this is Najib Habib, health expert at the East Asia Department of the Asian Development Bank. Welcome to the RKSI Health podcast. We are here with Ms. Marzia Mongiorgi, a principal economist at the East Asia Department, Asian Development Bank in Manila. And we are here to talk about some experiences and lessons learned related to the COVID-19 pandemic in People’s Republic of China (the PRC), but also related to our other developing member countries. We consider that the COVID-19 pandemic was a great learning experience. Not only did COVID-19 provide very valuable experiences and lessons learned to healthcare workers, but also policy makers in all ADB developing member countries and beyond on very key issues such as managing a massive public health crisis, but also even major crises that could be related to, for example, climate change or disasters.

Now we try to highlight some lessons learned focusing on experiences of healthcare frontliners in [the PRC] and maybe how these can be applied to other countries in our region.

Ep 1. The Shock of the New: An Expat’s Life Is Upended by a Yet-Unknown Flu

0:00 / 0:00
Ep 1

When the world started shutting down in early 2020, Marzia had only a vague idea what she and her family were facing. Her life in Beijing was about to change drastically.

Marzia: The hotel told us to pack up our bags and go back to Beijing. Once we arrived in Beijing, we found a very different city from what we left a few days before. We realized quickly. There was something serious happening.

Najib: We are talking to Ms. Marzia Mongiorgi, principal economist at the Asian Development Bank, who lived in Beijing during the beginning of the outbreak of COVID-19 in [the PRC].

Marzia: So in January 2020, I was living in Beijing with my family. I have two children and we were getting ready for the Chinese New Year vacation. We usually go to Chongli to ski. Chongli is where the 2022 Winter Olympics were held and we were looking forward to it, to see a lot of people. We don’t speak Chinese. So we were a bit detached from what was happening and we have heard about this strange flu. We didn’t anything too seriously.

To our surprise, the hotel was empty. The slopes were empty and we stayed there for 4 days. Totally ignoring what was happening in the rest of [the PRC]. But at one point, we were on the slopes and we were trying to go up again on the chair lift, when we realized that the mountain was closing down. And at that point we realized that there was probably something serious happening and that the flu or this strange flu, this virus was getting worse. And the cases were increasing in other parts of [the PRC] and that also there was a case in Chongli. A girl, I remember. The hotel told us to pack up our bags and go back to Beijing.

Once we arrived in Beijing, we found a very different city from what we left a few days before. People checking entry of people into the building. I remember very clearly the deliveries, which are a big, big business in [the PRC] were not reaching the lobby nor the apartment door, but they were left at the gate of buildings. And that was something that in years we have never seen. So we realized quickly that there was something serious happening. The office informed us that the virus was spreading that there was not enough knowledge of the virus to warn us on what to do. From outside [the PRC], families were calling us. What’s happening? This is serious. You might need to leave. What if it spreads into all [the PRC] and you are stuck there? So we had a lot of pressure from the families outside [the PRC] to leave [the PRC].

But I think that was fear talking. We tried to live our normal life. There was online work and online school for the kids and we had to get used to things we did not have anymore.

We did have a lot of support from the community, people in the building and I remember they were helping us carrying the drinking water, the big bottles. They were very nice to help us, because not speaking Chinese, we needed extra attention and extra help.

Najib: How did you get a sense of the scale of the outbreak then in Beijing? Did you feel that the outbreak was kind of like other seasonal flus or other diseases like dengue? Or did you get the feeling that this was something bigger?

Marzia: The feeling that it was something different and bigger came very quickly from calls from outside [the PRC]. Family friends. The fact that a lot of flights were cancelled. We were looking into ways to leave [the PRC]. There was absolutely no understanding or no knowledge of what was happening. Flights were either cancelled or full, so we finally did manage to get the flight.

We flew to Hong Kong, [China]. To go to Manila because my husband is from the Philippines. And also the headquarters of the Asian Development Bank is in the Philippines. The flight from Beijing to Hong Kong, [China] was full. Once we landed in Hong Kong, [China], the Philippines had just closed their borders to non-Filipinos. I was not allowed to fly on to the Philippines. And so we had to go back to Beijing. We got stuck two days in in Hong Kong, [China]. There was complete chaos in the airport. We couldn’t get our luggage for a day and but finally we managed to go back to Beijing.

Najib: Thanks a lot, Marzia. This shows the unprecedented nature of a global pandemic.

Ep 2. Anxiety on the Frontlines: Health Workers and Others Face Fear and Uncertainty

0:00 / 0:00
Ep 2

Najib describes health workers’ psychological hardship and Marzia relates how she and her family coped during the pandemic.

Najib: Among the healthcare workers in [the PRC] what we found was one of the biggest challenges was psychological.

Healthcare workers were working almost 24 hours a day to deal with this unprecedented unknown flu, eventually called COVID-19. Healthcare workers were responsible for testing, treating, and tracking suspected cases, especially difficult when people are traveling either within the city, across the province, or even across borders. When people returned from areas that are considered higher risk, they were quarantined in a hotel for 14 days and then 7 days at home, they underwent repeated nucleic acid tests.

Healthcare workers monitored the returning people’s close contacts and those who have been deemed exposed to COVID-19, including possible COVID-19 contaminated food such as fruits and vegetables. The health centers in [the PRC] regularly collected samples from workers who delivered these food packages. Healthcare workers assisted the whole population in cities and provinces to deal with the mass testing. Healthcare workers worked closely with neighborhood communities, health professionals, collecting samples every day, and collected samples from those who are bedridden or sick with the disease, and also those who are quarantined. Healthcare workers were so busy they could not go for lunch, restaurants were closed and the township health centers and others had to give them instant noodles and self-heating rice just so they could take turns eating and also sleeping so the testing and vaccination of the large population shouldn’t stop.

Many of them would go home very late at night, have a few hours’ sleep and do the whole thing all over again. Sometimes it would be difficult to agree to the quarantine measures. For example, some gaps in procedures, incomplete information, or ability to correctly follow the protocols would give rise to confusion and complaints and anger in the early days of the pandemic. Sometimes coordination mechanisms and networks did not function adequately to many health workers. People who took responsibility for rolling out these essential public health measures sometimes felt wrongly blamed for a process that was unprecedented and sometimes, of course, confusing and overwhelming. How did you cope with this stress and anxiety when you were there with your family?

Marzia: We tried to have a normal routine. We had clear times for studying or working, for lunch together, for cooking. We also would set a time for some exercise together. We could still go down and go to the park. But again, the stress of not knowing how the spreading was and how you could get it. There was really complete ignorance at the time.

Najib: Transparent and consistent communication is the most important thing to do when preventing and responding to an infectious disease. Communication through trusted sources that are consistent and regular reduce anxiety and also assist the people in making correct decisions that reduce their risk.

Among the healthcare workers in [the PRC], what we found was one of the biggest challenges was psychological. Though health workers may have mastered the procedures and the skills of how to test, treat and track the disease, still, many health workers experience difficulties in communication, difficulties on how to collaborate effectively with large teams, and even psychological difficulties. Technical issues can be resolved and overcome with skills, effort, study, and practice, but anxiety is invisible. Anxiety is something that needs to be resolved and addressed almost on a personal basis, and we need to empower people to try to address this very, very important issue when dealing with large-scale pandemics such as COVID-19. Consistent and reliable communication was seen as one of the best ways to deal with this issue.

Sometimes healthcare workers felt that communities were not being helpful because they did not understand. And this method of communication, again, often with incomplete information, but to the best of expert knowledge helped a lot in trying to reduce risk of everybody.

Marzia: I completely agree that communication is critical, especially at the beginning of the pandemic, of which there is very little knowledge. And that probably was the good thing and the bad things for us. The good thing was that not understanding Chinese, I was not fully aware of what was happening. But when information came in and I understood the scale of what was happening, we didn’t really have a sense of what’s happening.

Najib: What did you do to take care of your mental health in the pandemic, and what did you do to maybe even as a mother and as a spouse?

Marzia: We were running around the apartment, we were jumping, we were using our Xbox for We Dance, being active and making it fun for the kids. There are a lot of testimonies around the world that this work from home and this living indoors and not being able to go to work and the kids to school was heavier on women, because when kids don’t feel well or they are scared or they need help with the homework, they tend to be to go to the mother.

Maybe I was in a meeting with management and I had my son asking me how to solve the problem of math and then I would have to tell him to wait. But we had clear roles for all four of us—who cooks, who does a bit of cleaning, who helps with the homework. We were working as a team.

Najib: It shows to me that in times of stress and even disaster, you really rely on your family and your community, not just for food, shelter, protection, but also for mental health resilience and just coping with the pandemic. I really admire you and what you did.

Marzia: It was not always easy. We really had to alternate being strong for our kids.

Ep 3. A Lockdown Story: A Birthday Party Has an Unexpected Sequel

0:00 / 0:00
Ep 3

Marzia: Suddenly I hear crying and shouting in the living room. It was my daughter. She was having a hysterical breakdown because they went down to meet the mother of her friend. They realized we were in a full lockdown. So the building was sealed off and nobody could get out of the building.

Najib: I heard you hosted a birthday party and something unexpected happened.

Marzia: In June, it was my daughter’s 11th birthday, we decided to have a small dinner party with her good friends. At the time, some cases were popping up in Beijing but life was almost normal. The kids were having fun and it was time for the first friend to go home. So my daughter brought her down to the lobby to meet her mother and suddenly I hear crying and shouting in the living room. It was my daughter. She was having a hysterical breakdown because they went down to meet the mother of her friend, they realized we were in a full lockdown. So the building was sealed off and nobody could get out of the building because there was a potential close contact in our building.

So we realized quickly that we had 10 11-year-old kids in our apartment. And thank goodness it was a potential close contact, so it was only 5 days of lockdown. If it was a positive case, we would have been locked for 10 days with the kids. Now I can smile about it and even laugh about it. But at the time it was a big shock. Imagine the other parents, they couldn’t get their kids. The other parents were more anxious than us. We had to handle the situation. We had a camp in our in our living room. We arranged all the beds. Kids at that age, some are more independent than others. Some kids were not used to sleepovers. Some kids had the best time of their life. We had to arrange for food, have games because we didn’t want them to spend the whole day on the TV or phones. Monday came the school organized online classes and online games. They even arranged psychologists to talk to the kids individually. For us it was a bit of a shock in terms of logistics and spending so many days with kids. But for such young kids, we don’t know what’s the implication on mental health.

Then they became famous in school. They were called the Famous 10. It was not always easy. But we had support from everybody. The parents got organized very quickly. Each parent got a lunch or a dinner to support us. And they were sending comfort food for their own kids.

We ended up having boxes of deliveries that we had to return once the 5 days were over. My daughter was having a blast. But at one point I also asked her to put some rules, say, cleaning their beds, cleaning the garbage. She put down a list of tasks for everyone, we really had at the end a good time.

The kids made us a drawing to thank us at the end. I have to admit I was glad when it was over. Now this is an incredible, memorable experience that will stay with us forever. The most difficult thing, though, is my son was locked out with somebody else. My son was having himself a birthday party with his friends when we got locked down. Things could come in, but nothing could get out. So we told him that you can stay with your friends. Thanks to the mom of his friends. So he also had a fantastic 5-day party with his own friends.

Najib: Thank you very much, Marzia. What an incredible story.

Ep 4. Heroes: Health Workers Battle Stress and Exhaustion

0:00 / 0:00
Ep 4

Many frontline workers were traumatized by the physical toll their work took on their well-being. Najib quotes some of them.

Najib: Some healthcare workers were saying “I had to wear diapers, and so I don’t need to go to the toilet. And even to go to the toilet or take a shower, we had to stand in line because there were just so many people in different shifts.”

Healthcare workers had to go through incredible amounts of stress in dealing with the pandemic, not just in [the PRC], but in all of our developing member countries. Healthcare workers said, “I didn’t drink anything at the hospital. We couldn’t eat anything because there was a lack of food for the workers because they were so busy and there were so many cases. The hospital provided lunchboxes as much as they could.”

However, because of the surge of cases, many healthcare workers themselves got ill and had to be treated in hospital, either because they got COVID or they had other issues related to stress. One healthcare worker was mentioning “Even after work, when I should have been resting, I had to communicate with patient’s families from the hospital or other people in my community to address their concerns and try to address their issues related to COVID-19.” They had to use their own phones, their own homes, their own methods of communication, because people knew they were healthcare workers, not just doctors and nurses, but healthcare workers. Many people did not have COVID but had diabetes, had heart disease or were suffering from strokes were not able to access healthcare services. These are the kind of issues that many people in our developing member countries faced.

Some healthcare workers were saying “I had to wear diapers, and so I don’t need to go to the toilet. And even to go to the toilet or take a shower, we had to stand in line because there were just so many people in different shifts.”

We’d like to express our appreciation and our recognition that healthcare workers in [the PRC] and in all developing member countries and certainly across the world really had a difficult time. We really appreciate their hard work during this time of COVID-19.

Ep 5. COVID-19 Prevention: Communication Is Key

0:00 / 0:00
Ep 5

Najib explains the urban grid system and Marzia shows how it worked in her community.

Marzia, we have heard that in [the PRC] one element that was very effective was community engagement, especially at all levels, not just in townships and cities, but even province wide.

What was your experience of the community helping you as a resident, as an expat living in Beijing in these early days of the COVID-19 spread? And how do you think that was effective or useful?

Marzia: As soon as the emergency was declared, the community got immediately organized for two purposes. One is to support the people in the neighborhood, and two is to try to contain the spread or to understand the movements of the people in the neighborhood. There were people from the community committee that were helping with the basic supplies like water or telling us where to buy food. Then there were people that were supposed to help with the communication and information on the virus. We could indeed get a lot of support, especially on practical issues. It was very well organized from the start.

Najib: Communities are critical battlegrounds for preventing and controlling COVID-19 early detection, reporting, and reducing transmission risk are the preventive tools that can be employed at the community level are most effective. An example of community-level approaches is the community grid. The local government made use of the urban grid system extensively, in terms of testing, treating, and tracking COVID-19. The system organizes neighborhoods into several grids, each managed by a grid team. These team members collect information on the needs of residents. They conduct health education on how to prevent COVID-19. They monitor residents’ body temperature daily, which many of our developing member countries did to test for fever for a risk of COVID-19, so you can eventually do testing. Grid teams disinfected the surroundings. They helped conduct surveys which are really, really important in terms of tracking people who are deemed at high risk and who have been ill, and also mass testing whenever someone may have tested positive for COVID-19. Grid teams are also responsible for buying and delivering supplies and necessities in communities, including medicines, especially for quarantined households. Grid teams in [the PRC] use electronic information to accurately and quickly locate areas of high risk and enable orderly distribution of prevention and control materials in order to reduce the impact or spread of a crisis.

Misinformation about infectious diseases is probably one of the most dangerous aspects of disease prevention and control in a pandemic. That’s why public health education is so important.

Public health education and health promotion in communities are usually done through information and education drives. Many of these can include something as simple as mobile loudspeakers making the rounds to just remind people to wear face masks, wash their hands, practice social distancing, ensure ventilation, make sure that you don’t cough in public and observe etiquette. And also, just the simple things as providing posters in neighborhoods, especially those at high risk. Representatives in communities are also very important because they compile the concerns of the community and provide a feedback mechanism for public opinion. Public opinion messages help shape key messaging in pandemics. One way to quickly and easily gather opinions and key messages and areas of concern are social media and different types of mobile apps. 

We must show that when everybody follows the rules, the whole community can better protect themselves and their loved ones. We are only as strong as our weakest link.

Marzia, you were living in the midst of the COVID-19 pandemic in Beijing. What was your experience of the communication and education on COVID-19 happening through social media and mobile applications in [the PRC]?

Marzia: We all know for this type of pandemic, tracing is one of the critical aspects for public health and we used the WeChat application. We had to have a QR code that was either green, amber, or red and that would determine where you could go. Now this QR code was based on your personal data and on the results of the PCR tests. The number of PCR tests needed depended on the level of risk where you lived. So when my neighbor became medium risk, we were asked to take a PCR every day. It was extremely well organized. On every corner there was a white tent for people to go and take the test. It was very convenient. Mostly everybody had a tent under their building, so it became part of the normal life. The testing facilities were open from early morning to late evenings.

And then once you took the test, that result within few hours would go into the WeChat app and that would either confirm your green status or raise an issue or, say, that if you are positive then you become red code and then you go into the into quarantine.

But one small issue was the WeChat app was in Chinese and the health workers have difficulty sometimes in spelling foreign names. And imagine my name is not easy for Italians to pronounce. So “Mongiorgi” was kind of complicated for them. So sometimes they would give us their device and we would type in our own name and this was done for many of the foreigners. But the tracing app was good, was very well organized. Sometimes there were some glitches. So you become amber without reason, but then it would be sorted out quickly within a few hours. My experience in terms of the app was very good and made me feel safe because I knew that they knew where the cases were.

Najib: Were the testing and treatment free? Was it easy to access? Were the apps easy to use? And in your experience, is that a very important issue when dealing with pandemic on a day-to-day basis?

Marzia: The testing facilities were everywhere. They made it easy because we had to do it every day in some periods. But there were enough places in the city where you could go. We had one near our apartment and then one near the office. And then sometimes I missed the working hours of the one near my place. And so we went to the one near the park. We didn’t have to pay. We just walked in. And if you choose the timing well, you didn’t even have to queue. There were also some testing facilities where you had to pay very little. The QR code app for tracing of COVID-19 was really easy to use. It was demanding in the sense that everywhere you went you had to scan. And then you have to show the person at the entrance of the building or a shop that you were green and that had two purposes. One is to know where you were going and then two is to show the person of the building that you were allowed to go in. I didn’t find any difficulty in using it. And was very simple, very effective. And it became part of my daily routine.

Ep 6. Pandemic Preparedness: Standardizing Training for Future Crises

0:00 / 0:00
Ep 6

Najib underlines how important it is for countries to have surge capacity and for health workers to hone their skills, since this pandemic won’t be the last one.

Distribution and use of standardized applications, information, diagnosis, treatment are really, really important to try to deal with future pandemics and also other kinds of issues.

Najib: Overall, when dealing with pandemics and trying to gather as much standardized and accurate information as possible, it’s really important to follow standardized and centralized procedures. In this way, information can be quickly analyzed and quickly reported, and it’s also important to have standardized methods of diagnosis and treatment, because you know what you’re dealing with. So, this distribution and use of standardized applications, information, diagnosis, treatment are really, really important to try to deal with future pandemics and also other kinds of issues.

But that said, it’s also important to break it down into small pieces and ensure that the communities and those in the frontline can use them properly. Information can be centralized, but then that information needs to be brought down to a community level to make sure the supplies and resources that are limited anyway because of a pandemic can be put to good use.

Training of healthcare workers has been mentioned as one of the key ways to make sure high-quality services are delivered.  Many doctors and nurses who just finished medical school or nursing school or were still studying, were asked to participate in COVID-19 response. A lot of the basic skills such as sample collection of PCRs, taking temperatures and different kinds of procedures, including surveys, can be done quite easily with very basic public health training. Though what’s important and has been mentioned several times in [the PRC] and in many other developing countries, in these kind of extraordinary circumstances, it’s very important to have surge capacity, meaning the buffer of resources you have and also to make sure that some healthcare workers are ready to learn while doing or getting their training while doing, which is one of the best ways to get your training. This was seen as a good opportunity for many healthcare workers to learn and provide their skills when they’re needed most.

© 2024 Regional Knowledge Sharing Initiative. The views expressed on this website are those of the authors and presenters and do not necessarily reflect the views and policies of the Asian Development Bank (ADB), its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data in any documents and materials posted on this website and accepts no responsibility for any consequence of their use. By making any designation of or reference to a particular territory or geographic area, or by using the term “country” in any documents posted on this website, ADB does not intend to make any judgments as to the legal or other status of any territory or area.