Xiaoling Chen. Eurasian Geography and Economics. April 2020.
Introduction
During the month around China’s Spring Festival, tracking the development of COVID-19 through Chinese social media became a routine of my daily life in the United States (U.S.). Posts and shares were almost exclusively about this novel coronavirus first found in Wuhan city located in central China’s Hubei Province. Very soon, COVID-19 occupied most media headlines as it spread from China to 184 countries/regions across the globe. As of April 20th, 2020, COVID-19 had infected more than 2,472,000 individuals globally with over 83,800 cases in China. At the time of writing, both numbers continue to increase (CSSE n. d.). As governments scramble to respond to the pandemic, the Chinese government’s efforts to contain the virus were lauded by the World Health Organization (WHO) (WHO 2020). The WHO’s stance has been heavily criticized by right-wing groups in the U.S., turning the health crisis into a political event (Huang 2020b; Ordoñez 2020; Edmondson 2020).
While governmental handling of the COVID-19 pandemic was quickly highjacked for geopolitical agendas by the White House and China’s Communist Party alike, public engagement within China has not been adequately addressed in either public media or the scholarly world. In contrast to popular media depictions of panicked citizens overcrowding health institutions and stockpiling health and daily supplies, the landscape of public response to COVID-19 is rather complex. Conventional views of Chinese social media (i.e. in the Western press) focus on self-censorship and surveillance, making it difficult to see how civic engagement is occurring in complicated and nuanced ways. The COVID-19 crisis offers an opportunity to explore some of this nuance. I argue that in the time of the coronavirus outbreak, social media have become a space of active public engagement, in which Chinese citizens expressed care and solidarity, engaged in claim-making and resistance, and negotiated with authorities.
With more than 430 million active monthly users on Sina Weibo and over one billion on WeChat (New York Times 2018), Chinese social media play a crucial role in social interaction and political intervention. Social media is often associated with false information (UN News 2020) and is known for mass surveillance and censorship by Chinese authorities, and thus not considered as ideal and effective for public response to disasters like the COVID-19 outbreak. However, some evidence has begun to acknowledge the significance of virtual spaces as effective sites for health intervention (Fung et al. 2013; Song and Walline 2020) and as complex landscapes for civic engagement (Chen 2014). Through textual analysis based on a wide range of sources including government announcements, posts and articles, and national and international news published primarily since mid-January, two themes emerge as salient in the public response to the outbreak through social media. These themes can be conceived as two different kinds of spaces produced through Chinese social media: spaces of care and solidarity, and spaces of claim-making, resistance, and negotiation.
Spaces of Care and Solidarity
When fallen upon an individual, the dust of an era weighs like a mountain.
~ Fang Fang, a Wuhan-based writer.
The coronavirus crisis has seen Chinese citizens at home and abroad turning social media into sites of care and solidarity with textual, visual and video aids. Similarly to the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic, this outbreak coincided with China’s Spring Festival travel season that began on January 10th, 2020. Even before the governmental effort to disseminate information and contain the outbreak, Chinese citizens had begun to actively engage in self-help, disseminate information, and dismiss rumors, based on the scarce information they received through social media in the form of articles, posts and discussion from WeChat friends and groups. Despite government censorship and inadequate understanding of the outbreak, knowledge about the crisis proliferated and was disseminated through some renowned health-related platforms. One of the most followed and credible official accounts is Ding Xiang Yuan (literally “Lilac Garden” or “DXY”), an online community for physicians, health-care professionals, pharmacies and facilities. Most of its articles on COVID-19 were viewed more than 100,000 times and widely shared, and some were cited by Xinwen Lianbo, the official WeChat account of China Central Television (CCTV).
Through these social media outlets, many Chinese sought to keep themselves, their friends, and their family informed of case numbers, prevention and treatment, and governmental efforts. Most prominent was the initiative to educate parents on how to minimize the risk of contracting the virus by washing hands, wearing a mask, and limiting gathering for Spring Festival. Online users shared experiences via social media and video blogging on how to persuade their parents. Many domestic migrants canceled their plans to return home for Spring Festival in the hopes of minimizing their chances of spreading the virus. Meanwhile, discriminatory narratives and practices against Wuhan and Hubei citizens were quickly subject to criticism from conscientious social media users. Some Wuhan tourists, who were discriminated against when identified in places outside Hubei, were welcomed by local governments and businesses who offered them free hotel rooms and food using official social media accounts and individual posts. One of the most hospitable places was my dissertation field site, Guangdong province and its local businesses. An early post I shared on my WeChat account involved two hotels in Xuwen County, which requested Guangdong residents to guide “Wuhan friends” to the location of free accommodation and urged the relevant governmental departments to disseminate this information about hosts across Zhanjiang City. The post further noted: “… the temperature is dropping tonight as the rain continues, please provide our Wuhan fellows with warmth and food, [so that together we can] combat the epidemic.” Accommodating suspected cases and close contacts later become a universal practice to contain the virus across China.
Grassroot efforts to fight the epidemic were unprecedented during this crisis. Chinese citizens at home and abroad have provided financial and material support to the health-care workers and health institutions in China, showing solidarity. As soon as panicked citizens stockpiled masks and flocked to hospitals to seek health care, an increasing number of health institutions began to experience significant shortages of health supplies such as N95 and surgical masks, gloves, and numerous coveralls, face shields, and shoe covers, and sent out letters via social media asking for help and donations. This information was compiled and disseminated by official accounts, WeChat groups, and individual online users. For example, on January 26th, 2020, 3 days after Wuhan city was locked down, DXY gathered request letters from 44 hospitals in Hubei Province alone. WeChat groups were established by Chinese citizens abroad for fundraising, collecting donations, and coordinating the shipment and disbursement of health supplies. When the Red Cross in Wuhan city was assigned by the authorities to distribute donated health supplies, individual volunteers diligently itemized the distribution, making the authorities more accountable for their actions. Even when health institutes across China experienced shortages of supplies and personnel, there was a common agreement that the needs of Wuhan city and Hubei Province should be prioritized.
For example, a website called Shimo Document was compiled by many volunteers with various backgrounds (i.e. health, social workers, psychology) working around the clock to address gaps in information. They collected and verified about 400 health-seeking posts, created a directory of health institutes in Wuhan including contact information, bed capacity, and nucleic acid testing capacity among others, provided information to those seeking treatment, and coordinated resources. Confronting neglect, hopelessness and death on a daily basis, these volunteers have constantly grappled with physical, mental and moral challenges, and reflected on the crisis. The grassroot activities supplemented public health efforts but gradually faded away as the authorities took over since the end of February. Nevertheless, the care and solidarity they provided to those seeking help were felt in a material manner in the time of governmental inaction. Meanwhile, the rationality and reflection behind these activities shed light on our understanding of Chinese citizens’ attitude toward government roles and responsibility in addressing health crisis. As one volunteer testified in her article:
In this disaster, it is the sacrifice of medical workers and mutual aid among regular people that prevents faith in our society from collapsing and us falling into darkness. However, these inspiring, warm and touching moments should not cease our contemplation on the problems. In front of tragic victims, any type of propaganda and praise constitute secondary harms. They [the victims] need reflection, accountability, justice and improvement. (Chen 2020)
Spaces of Claim-Making, Resistance, and Negotiation
Later a good friend asked me if I was a whistleblower. I said I was not a whistleblower. I was the one who disbursed the whistles.
~ Ai Fen, Director of Emergency Department, Central Hospital of Wuhan.
Ai Fen was the first to post information (on WeChat groups for health-care workers) on the SARS-like virus on December 30th, 2019, which was disseminated by the eight whistleblowers on December 31st, 2019 including the late Ophthalmologist Li Wenliang. Both were reprimanded by hospital supervisors. On March 10th, 2020 an interview with Ai Fen was published by the Chinese magazine People on its official WeChat account and quickly deleted on the same day (Huang 2020a). Like other articles and posts, such as Fang Fang’s Wuhan Diary and a timeline circulated on social media exposing the government cover-up (the “Timeline”), the interview was eventually deleted but was still disseminated by many social media accounts and online users. Later, part of the interview was translated into various real and fictitious languages and codes and circulated widely on WeChat and Weibo. What was the point of doing this? As Ai Fen contemplated in the interview:
No one under any circumstance apologizes to me. But I still think, this crisis has proven that each of us has to insist on our independent thoughts, because there need to be someone who stands out and tells the truth, has to be someone. This world must have different voices, right? (Gong 2020)
Indeed, as a tool of mass surveillance, social media in China have “no memory”. However, it provides a platform and channels for many online users to share and document critical information, make claims about their attitudes and positions, and express resistance. I argue that it is through the actions of posting, discussing, and sharing, that a space for negotiating with authorities emerges. On December 31st, 2019, China reported the disease to the World Health Organization (WHO) and on January 7th, 2020, the virus was identified. Compared to SARS, the time taken to identify the novel coronavirus was dramatically shorter (Wu and McGoogan 2020). However, between January 6th and 17th, no incidence was reported by the Wuhan health authority (WMHC n. d.), while both false and factual information about the SARS-like disease began circulating on social media. China missed the best window to contain the epidemic due to the failure of China’s warning system that was established after SARS to report disease outbreaks and alert the people, resulting in excessive fatalities (Lai et al. 2020; Yip 2020). Some analysis noted that this automatic reporting system, initially designed to avoid politics, was again undermined by politics while both Ai Fen and the eight whistleblowers managed to substitute the role of the reporting system through the viral circulation of information on social media (Guo 2020; Myers 2020). On January 20th, Hubei health authority reported as many as 136 new cases (WMHC n. d.), immediately eliciting public panic and distrust toward government on social media. Around the same time, both central and local governments began to release data on a daily basis while Chinese citizens demanded accurate surveillance data for the outbreak.
Social media like WeChat helped to make these data accessible to, and easily sharable among, many regular Chinese citizens, facilitating public participation. Organizations like Lilac Garden and the Institute of Public and Environmental Affairs (IPE—http://www.ipe.org.cn/) were able to provide more comprehensive data information and analysis, which has been viewed considerably more often than governmental announcements: more than 100,000+ vs. a couple of hundred views. This indicates that these online users, likely mobilized for advocacy efforts, display more trust in and loyalty to the former than the latter. The central government’s “draconian” measures, including lockdown and mandatory quarantine, have caused harm and trauma while achieving some level of success according to public health metrics such as incidence and mortality rate (Wong 2020). Governments at different scales initiated containment measures in the form of the “grid reaction”, which refers to a type of hierarchical administration of outbreak control that is characterized as “all-out, undifferentiated, war-like strategy” (Xiang 2020). However, according to social media writers and my chats with family and friends, the grid reaction, mediated by primary health-care resources, administrative capacities and awareness, public awareness and coordination among other factors, were highly heterogeneous and discrete (see for example, Fang 2020). In addition, central government developed the approach of creating spectacles through its WeChat accounts (i.e. CCTV official WeChat account) as its propaganda depicted the dispatching of military aid, the rapid construction of the Huoshenshan hospital, and the sacrifice and “beauty” of health workers. Undeniably, many Chinese citizens were pacified by this propaganda. However, others recognized how it obscures and diverts attention from suffering, death and injustice, especially among health-care workers.
According to the Timeline, the first medical workers contracted the disease as early as December 25th. Similar information was shared through social media within the health community which soon became the frontline of both the epidemics and politics. On social media, health workers’ motives, safety and welfare were—and continue to be—of major public concern at the time of writing. By mid-February, more than 32,000 health workers arrived in Hubei, and by mid-March, the nation had “dispatched” more than 346 medical assistance teams totaling 42,600 health-care workers (Health Health CCTV 2020). Competing narratives about the motives and medical ethics of health workers in staying on the frontline as well as aiding Hubei created much tension on social media. On the one hand, central government propaganda elevated health workers onto the moral high ground under the banner of the Communist Party, glorifying them as “heroes” and “angels”, and dramatizing their determination and sacrifice. On the other hand, many health-care professionals refused to be politicized, and defended their bodies, motives and morality by posting pictures, telling their stories, and expressing fear and worries. “We are just human beings!” they claimed. During this process, the efforts and contribution to containment made by health-care workers are at risk of being subsumed by central government which tends to claim all of the credit to strengthen its rule.
Information on infections and deaths among health-care workers was strictly controlled by the authorities. The death of Li Wenliang on February 7th, 2020 elicited outrage toward and disapproval of Wuhan government’s mistreatment of the whistleblowers, and fueled public concern for physicians’ health status, urging the National Supervisory Commission of the People’s Republic of China (NSC) to establish a team to investigate the case. On March 19th, the NSC published the detailed results of the investigation regarding how Li disseminated information about COVID-19, how he was subsequently investigated and reprimanded by the Wuhan Public Security and hospital supervisor, how he was infected, tested and treated, and, lastly, how he would be compensated. The document exonerated Li and ascribed all responsibility to Wuhan Public Security and the local police station (CCTV 2020). Local and central authorities were criticized for using lower-ranking officials as scapegoats. I argue that this result was an implicit negotiated compromise by many parties including online users who have been advocating for Li and putting significant pressure on the authorities.
On February 14th, central government released the number of infected health workers for the first time on WeChat: as of 11 February 1,716 health professionals had been infected, 6 had died. Several days later, a paper published by Chinese Center for Disease Control and Prevention (CCDC) showing that 3,019 health workers contracted the virus in 422 health institutes providing healthcare to infected patients, with 5 deaths. The findings confronted the official accounts that ascribed infection of health workers to family transmission and their lack of awareness of using protection, as well as bringing attention to the shortage of health supplies since the beginning of outbreak (Caixin 2020; DXY 2020a). Testimonies from frontline doctors also pointed to the hospital leadership’s responsibility for silencing employees and forbidding them from wearing protective gear such as facemasks in the name of preventing panic among patients (China News Weekly 2020).
Meanwhile, many frontline workers developed health complications due to physical and mental exhaustion, cumbersome protective gear, and irregular diets among many other factors associated with their jobs. Since mid-March, dispatched health-care workers were returning to their health institutes with “zero infection, zero death”, according to the authorities, while online users were mourning Liang Xiaoxia’s death at the age of 28 (Fang 2020). A nurse from Guangxi, Liang arrived in Hubei on February 20th and was hospitalized reportedly due to exhaustion and cardiac arrest on February 28th. Fang Fang wrongly reported that Liang passed away on March 23rd but apologized for providing this false information the next day. On March 25th, an official account reported that Liang remained in emergency care. Despite Fang Fang’s immediate apology, and the subsequent official clarification, the public outcry surrounding Liang’s “death” persisted for several days. This public reaction signifies Chinese netizens’ mistrust of the government as well as their sympathy and concern for health-care workers.
Lately, compensation for health-care workers has attracted increasing attention. On January 25th, several central government departments announced a joint release to subsidize health workers participating in combating the epidemic. Workers who had direct contact with either suspected or confirmed cases (also called “frontline workers”) would be awarded 300 RMB (about 42 USD) per day; the rest would receive 200 RMB (US$28) per day. Many provincial and local governments followed suit to provide higher compensation. For example, Hubei would double the frontline workers’ salaries, while Guangdong would pay each infected health worker with a one-time compensation of 30,000 RMB (US$4236). However, an updated regulation stipulated that only frontline workers would be compensated, and they had to have both participated directly and had direct contact with either confirmed or suspected cases. According to DXY’s most recent survey with 1,900 participants, only 12% received compensation (DXY 2020b). After its release on March 13th, the article was viewed more than 130 million times and discussed widely. Some sources reported that the central subsidies were disbursed to the leadership of some hospitals, while some frontline health workers received very little or nothing. Some frontline workers had to return the compensation as local governments further narrowed the criteria for the “frontline” category (DXY 2020c; Youyou Luming 2020).
If I were to identify only one event that connects both spaces of care and solidarity and that of resistance and negotiation, it would be Fang Fang’s Wuhan Diary. On Weibo, the Diary had over 380 million views, 94,000 discussions, and 8,210 original posts (Davison 2020). Sixty nights during the stay-at-home period saw an average of 5 million Chinese readers staying up for Fang Fang’s updates. The obligation to read, save and circulate the diary as soon as it was published on social media, and before it was deleted, demonstrates the readers’ empathy and concern for their Wuhan fellows as well as their discursive confrontation with censorship and left-wing groups in China. Certainly, the unfolding controversy over the official publication of the Diary in English and German reveals the parallel spaces of bigotry, and social divide and rupture within China, as well as attempts by left-wing groups to appropriate the current geopolitical clash between China and United States to silence dissent at home. However, many scholars and conscientious individuals caution against downgrading the Diary as merely a geopolitical tool and urge the public to recognize its profound social, cultural and political significance (Fei Fei Ma 2020; Li 2020; Wang 2020), defending the shared spaces of care, solidarity and resistance.
Conclusion
In China, social media remains heavily censored while information about the coronavirus outbreak is still under the strict control of the authorities. These facts help us understand the significance of being vocal about the complex landscapes of the development and impacts of the COVID-19 outbreak and response. This paper is focused on the public response which, though continuously suppressed by the authorities and neglected by Western media, managed to create spaces of care, solidarity and political negotiation. Going beyond understanding public participation as “patriotic activities” with “Chinese characteristics” (Zeng and Liu 2020), this paper provided a picture of how public efforts and activist forces take shape in social media through interaction and negotiation with various authorities. Even under conditions of mass surveillance, social media have become a space for people to express care and solidarity, especially to those who were marginalized, neglected, and victimized. While this public participation and grassroot effort did not seem to have determining impacts on the containment of the epidemic per se, the material and emotional care for help-seekers were real and the public’s reflection on the suffering could be long-lasting and profound. Public participation and grassroot efforts also signify the formation of an alliance between the general public, health-care workers, activists and independent media. Over the last 2 months, this alliance has created spaces and channels on social media to share and disseminate information, in order to bring more and more attention to health workers’ safety, wellbeing and welfare. Meanwhile, the numerous discussions and increasing sharing of posts helped establish a space in which to negotiate with the authorities who were forced to address the issues raised and make concessions.
In its broader context, the progress of the outbreak and its draconian containment has revealed many deep-rooted institutional and political problems within China’s health-care system, and the political dynamics and processes of the health sectors. As has happened many times already, such as during SARS outbreak, political issues have easily undermined institutional and individual efforts within the health-care system to combat outbreaks like this crisis. This is evidenced by the failure of the warning system, the lack of data transparency, resource and personnel shortages, draconian measures, and the hopelessness and death of the needy. Meanwhile, this crisis has demonstrated the inadequacy of the health-care reforms that target both the public health and professional health-care delivery over the last ten years. Primary health-care capacities were insufficient and heterogeneous with underprepared local administrators and low public awareness of how to respond to disease outbreaks.
Health-care professionals, I argue, have been squeezed between top-down and bottom-up pressures during this outbreak as well as in their everyday practices. The top-down pressure comes from the health institutes’ profit-oriented goals and hierarchy, while the bottom-up pressure originates from increasing health demands and expectations. There are health-care workers’ multiple positionalities at play, not only as communist party members (which the majority of them are) and as employees of public institutes who need to show their loyalty, but also as medical and health professionals who have certain ethical standards to abide by and certain career goals to achieve, and as ordinary people who are aware of their community’s needs for health and “justice” in their own terms. The goals of these positions do not always align, resulting in conflicts and tensions that have been manifested as, for example, strained patient–doctor relations as well as activist efforts (such as DXY). The alliance between the general public, health-care workers, activists and independent media did not simply emerge out of this outbreak but can be traced back to a tragic event where Doctor Yang Wen died of an assault by a patient’s son on December 25th, 2019 (Zhang 2019), among many medical disputes and violence over the last 10 years. Most significantly, governmental intervention highlighting two recent regulations targeting violence toward health-care workers did not seem to address these structural problems, which have elicited heightened discontent toward the government among both the health community and many sympathetic Chinese.
This paper has highlighted some facets of the complexity and nuance of the outbreak response among Chinese citizens. It highlights the spaces of care and solidarity created by social media users who reached out to those experiencing helplessness, suffering, and trauma during the outbreak. Going beyond critiquing governmental censorship and lamenting self-surveillance, this paper calls attention to public and activist effort, through the aid of social media, in both responding to the epidemic and prompting the authorities to respond. It has traced the inadequate governmental response to the COVID-19 outbreak back to the persistent institutional and political problems, and brought attention to health-care workers’ precarious positions within China’s health-care system, shedding light on possible solutions for medical violence toward health-care professionals.