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The first thing the orderly noticed when she arrived at the Shanghai nursing home was the rats.

"Many of the residents are paralyzed elderly folk, so we had to keep watch. If the rats bit our patients, they would not even be able to yell for help," she said.

But she and the approximately 40 other orderlies hired by the Shanghai Donghai Elderly Care Hospital had a bigger problem on their hands: a rampant but undisclosed COVID-19 outbreak that had decimated the previous care staff and left the hospital overwhelmed and under-resourced.

"We were tricked into working here," said another orderly on the care center staff. Both employees requested anonymity because they feared legal repercussions for speaking to foreign media. "The employment agency said they were looking for cleaners and would pay us extra. They told us we would not be working with COVID patients, just changing bedsheets for close contacts."

The nursing home outbreak – largely unreported in China's heavily-censored domestic press – is sign of the pressure Shanghai is under as it battles its largest-ever surge of COVID-19 cases.

The entire city of nearly 26 million residents is now entering a second week of lockdown as well as a second round of mass testing to contain the highly transmissible omicron variant of COVID-19. The city has logged more than 64,000 cases in the last week.

 2,000 army medics to Shanghai to keep order in the medical system and help with virus prevention efforts, while 38,000 medical personnel from other provinces have streamed in to assist with mass testing and contact tracing efforts.

China's approach to containing COVID relies on testing and quickly isolating all coronavirus cases faster than the virus can spread, often in densely-crowded cities like Shanghai, a method which requires huge reserves of manpower and physical space to house infectious patients.

But the sheer number of residents who must now be isolated have strained isolation wards. Public health authorities still insist that even asymptomatic cases must be sent to government quarantine wards rather than isolate at home. Municipal authorities have hastily erected temporary wards 

 of holding up to 15,000 people each, but the testing the scale of Shanghai's outbreak is testing the limits of one of China's wealthiest cities.

A setback for China's zero-tolerance approach

For much of the past two years, such costly lockdowns and mass testing campaigns have been successful at keeping infections and deaths in the single digits. Shanghai in particular had been relatively unscathed even as other Chinese cities went into lockdown, and the city enjoys one of the country's best-run public health systems.

But China's stand on parents and their young children has proven controversial. The policy has always been to quarantine parents and young children separately if one or both parties test positive for the coronavirus, but in Shanghai the scope of the policy has become horrifyingly clear as more people are quarantined.

"I asked if we could be in the same room, and the doctor said for an extra 2000RMB ($300 U.S. dollars) a day, I could see him. Then they said, if I did not pay on time, they would not let my child out of quarantine. Is that not a bribe?" said Suki Wang, a parent in Shanghai.

Wang traveled to Shanghai in late February, just as cases started to crop up. She tested positive and so did her 7-year-old son. Authorities quarantined them in separate hotels. After more than one month apart, Wang and her son were finally reunited in the last week of March. She says he is still traumatized, beset by daily nightmares about being abandoned again.

She's now in an online support group with more than 300 other parents who were separated or are currently separated from their infants and young children. One of her friends from the group says her 6-month-old baby was returned after two weeks with open sores on their legs, wearing the clothes of another child. The infant's parents shared pictures confirming the baby's physical condition.

Shanghai's government said Tuesday it would make "better preparations" and 

 families quarantine together if everyone tested positive.

The Shanghai Donghai Elderly Care Hospital remains sealed off. Family members desperately call the center each day, seeking updates on their loved ones inside.

"We are ordinary workers. We only watch state TV, and we support the Communist Party, but this time I have lost all hope," said the son of an elderly woman living in Donghai, who spoke to NPR on condition of anonymity. "No government office picks up our calls. All of us are extremely worried."

The son has learned that his mother is living in a room with two other elderly patients who have both tested positive. He and his sister have spent a week trying to have her moved to a private room. So far, she has been given a mask but remains in a shared room.

As for the orderlies, they say they are now terrified about getting sick themselves. Neither of the orderlies interviewed by NPR are trained nurses, but as staff resources grow scarce, they say they are being asked to treat bed sores and insert intravenous tubing.

And more and more elderly residents are falling ill, they say. Both orderlies say at least one elderly resident with COVID died. They only discovered her body six hours after her passing.

"The elderly care home put her body in a yellow body bag and wrote her name on it with a marker. That was it," she said.

Caixin, one of China's last-remaining independent media outlets, reported earlier this week that an 87-year-old woman had died in the Donghai nursing home. The article stayed online for only one hour before government censors took it down.

The orderlies say they are now trapped. They are not allowed to leave the infected nursing home lest they themselves might harbor the virus and are waiting to learn their fate: likely being sent to a hastily erected mass isolation facility that can hold thousands of possibly infected people at a time.

Aowen Cao contributed research from Beijing. 

Health

COVID-19

Emily Feng

Author

China's lockdown and quarantine policy is testing the limits of the city of 26 million. Parents were separated from kids. And there's not enough staff for the elderly residents of care centers.

Voices from Shanghai: The trials of living through a massive COVID lockdown

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