It was the middle of the night when the phone rang in Du Mingjun’s apartment in the city of Wuhan, China. When she answered the strained voice of a woman came down the line. The caller was quarantined, and afraid.
“My heart is filled with fear,” the voice told Du. The caller and her husband were suffering from chest pain and fever, which they believed were symptoms of coronavirus, and the woman couldn’t sleep, couldn’t breathe. In between apologies to Du, she detailed her anguish. “Ask the hospital to take us in,” she pleads. “Otherwise, it will really be the end of us.”
Du’s voice was hushed and measured in response: “Think: ‘What can I do for myself? What can I do for my body?’” She told the caller she would do what she could to help her find a hospital bed and urged the woman to get some rest: “Try to transform [your emotions] into a force that can support you to defeat the virus. You are not alone in this misery.”
The caller listened and then told Du that she felt a bit calmer. She promised to get some rest, but the conversation ended with a final plea for medical assistance. “Please, Ms Du…” she said, “we really can't afford to keep waiting.”
For the first two months of the covid-19 outbreak, news of the virus created a cocktail of anxiety for those trapped in Wuhan, the city in central China at the heart of the pandemic now spreading rapidly around the world. People were scared at the news of contagion, hearing about people getting ill and dying, as well as the prospect of their livelihoods being destroyed around them. As Hubei province was put under varying degrees of lockdown in the days following Wuhan’s quarantine on January 23rd, many of the city’s 11m residents then learned about what was happening from the confines of their homes, absorbing a barrage of information and misinformation – from fake cures to rumours about how the virus spreads – through social media in China.
It wasn’t just the disease that was contagious, but fear and anxiety about its spread. From within her living room, Du Mingjun was on the receiving end of this disquiet. Du is a counsellor at the Hubei Psychological Consultant Association – a provincial, non-governmental organisation which promotes mental-health awareness and offers in-house counselling. During the first days of the lockdown she had been asked by the association’s president to set up a hotline to provide emotional support to city residents – something also done around the country by universities, NGOs and volunteer counsellors. For the first few days, Du was the only person answering calls on the Wuhan crisis line as the city was gripped by an all-encompassing feeling of panic.
It’s hard to quantify the psychological toll that such an unusual form of duress took on the people of Wuhan. Under normal circumstances mental-health services in China are extremely limited and most people with mental disorders never receive treatment. Many people don’t admit to a problem even if they recognise it, and family members often seek to hide rather than help the suffering of their loved one. The woman who called Du that night admitted she was keeping the news from her family because she didn’t want them to worry. There’s also a shortage of clinically trained professionals – around two psychiatrists for every 100,000 people, according to the World Health Organisation, compared with around 20 for every person in Japan and 12 in America. After she started the hotline, Du put out a call through Chinese media for qualified volunteers to help run it. She chose 200 counsellors to answer the phones, including overseas Chinese from America and Canada.
During the peak of the outbreak in Wuhan frustration and helplessness took on a myriad of forms. People on social media described Kafkaesque attempts to secure hospital beds for their sick family members. Du received calls from people with physical health challenges who were trapped, confused and uncertain how to proceed: often these individuals had already failed in their efforts to find help from hospitals or local government. The hotline was a last resort.
Although social media was a source of information, it also spurred anxieties. It was common to see long posts on Weibo, a Chinese social-media platform similar to Twitter, outlining the condition of a family member along with appeals to volunteers and the media for help in spreading the message. In one post a man described how his father was taken to a quarantine centre after showing symptoms of the virus, then went into a coma. The post was accompanied by a photo of a man splayed face down, limply, on a bed. The man’s father later died.
The post (among many with a similar response) received 9,000 comments, many grieving for the man’s situation and fuming about the lack of response from the authorities. Other comments expressed frustration over the dissonance between official messages from the government and the scenes playing out on the ground. “We have seen way too many similar incidents in these few days,” one person wrote. “Tens of thousands of people were getting infected, while the news only reported on how quickly they built the hospital. How many more cases are there of people who need help, that don’t meet CCTV’s broadcasting standards? The top searches [online] are all goddamn positivity.”
Policies to contain the virus spurred panic across the whole of China, as people outside Wuhan were also required to stop all travel and then remain in their homes. In smaller towns and villages, a “closed management” strategy was used, with barriers – policed by local volunteers – used to stop anyone from the outside from coming in. Videos circulated of a woman at a roadblock in Hubei province pleading with officials to let her daughter with leukemia pass through for treatment; a family forcibly pulled from an apartment for quarantine in Jiangsu province; and news of a disabled child who died in his home in Hubei after being left alone for six days after his father and brother were put in quarantine. For those scrolling social media from their homes, these posts and videos added to a deep feeling of unease.
Du was stuck inside her own apartment too, as she listened to the public’s cry for help. In the first weeks of operating the hotline, she would take calls all day and stay up into the early hours replying to messages – sleeping when she could in between. Taking calls interfered with cooking and eating. “Sometimes I would keep the callers company through the night, so I would become an insomniac too,” she said.
The hotline has received over 2,000 calls since it started operating in late January, with Du and her team of 26 volunteers at any one time working across time zones to answer them – and this in a country where scant few would have previously dared to ask for such help. The volunteers categorised the public response to the outbreak in two phases. During the first phase, which lasted until the end of February, they answered an average of 50 calls a day. The team came up with a system to measure the severity of the call: general consultations would last around 15 minutes, with follow up calls for people who still needed support lasting up to 90 minutes. During this phase Du said she received a high number of calls from people dealing with anxiety about living in the middle of a public health crisis. Many had only minor physical ailments, but were panicking about their severity. Others were just desperate to talk with someone, desperate to feel heard.
As hospitals became overwhelmed, callers also contacted Du as a potential lifeline. Even after the call ended some would continue to ask about their conditions via WeChat, a Chinese messaging app. Others were simply struggling with having their daily routines upended by the lockdown: the hashtag #howtodealwithfeelingveryanxiousathome started trending on Weibo.
Young people have cried to her over the phone, saying they don’t want to share their fears with their parents. Older people who were initially more guarded would open up once they heard from the hotline host that other people were having similar experiences. Parents called to express anxiety about how to homeschool their children after classes were suspended. Wives called to describe the stress of being quarantined with their mothers-in-law. Spouses wanted to talk about marital problems that boiled over during the quarantine period. “Some people say they will go through the divorce procedures after the epidemic is over,” Du said. Calls from people who had lost family members to the virus were the hardest ones for her, said Du, but helplessness, hopelessness and anxiety register in the voices of all her callers. “As an individual, you can feel very acutely the stress and nerves coming from the entire society,” she said.
Du tried to reassure those who were panicked that they had an ally in her and others at the hotline, and tried to help them better understand and process what they were feeling. “You have to tell your fear: ‘yes, it’s true, I am really afraid. I am afraid to lose my own life and I am afraid for my son to lose his mother’,” Du told the woman who called her that late night, “and then slowly you will be able to calm down.”
Du guided callers through breathing exercises, cognitive behavioural therapy, techniques to relax their muscles and music therapy to evoke emotional responses that would be calming and help to combat agitation. Du also tried to help people find the inner strength needed to get through the situation, helping them to accept that the lockdown would probably continue for some time, and arming them with strategies to manage their stress. “No one is ready for this state,” she told the woman. “It’s fighting a war without guns and we still have to grit our teeth and keep going.”
Hotlines have become a standard part of emergency response in China during times of crisis. Crisis lines were set up during the SARS outbreak in 2003, a time when there was a “psycho-boom” in China with a popularisation of counselling and psychotherapy services, according to Hsuan-ying Huang, a professor of medical anthropology at the Chinese University of Hong Kong. After the devastating Wenchuan earthquake in south-west China in 2008 hotlines were again set up to help people deal with the aftermath.
Despite social stigma and a shortage of trained psychiatrists, support for mental health in China has grown in recent years. There are some non-traditional counselling services, such as Jiandanxinli, a website devoted to mental health consultations, and KnowYourself, a pop-psychology platform with a focus on mental health that is published on WeChat. These services have been tested during a lockdown when face-to-face counselling is impossible. Last month, a group of doctors at West China Hospital in Chengdu in western China published a report about psychological crisis intervention that used social media as the sole conduit for providing support and suggested that remote interventions should be integrated into treatment.
For the Chinese Communist Party, attempting to co-ordinate and control the psychological response to the outbreak of covid-19 is part of an effort to maintain order and social stability. The virus poses an existential threat to a government that claims to have absolute power to protect its people. The National Health Commission, responsible for formulating health policy in China, issued guidelines in February for how to ameliorate the mental toll of the crisis, including the use of hotlines.
Many people do not trust the information they have been given, suspecting that they weren’t being told the truth about the scope and severity of the epidemic. This feeling came to a head after the death of Li Wenliang, a doctor in Wuhan who tried to warn colleagues months before the government acknowledged it, and who was punished for “spreading rumours”, only to end up dying from the virus himself. The shock news – and conflicting ways in which Chinese state media reported it – provoked an outpouring on social media by users railing against the government’s methods to control information about the virus.
The death of Li Wenliang in early February was a low point for the city – and for Du. “I was disappointed about his fate,” she said. “I felt like it wasn’t meant to be this way, that he should’ve lived, that he didn’t have to die. It was very heartbreaking to see how a life got robbed this way because of an epidemic.” This event made every other effort to stop the virus seem much harder. “At that moment, you feel that the virus is too powerful and people are too small,” she said. It reminded Du of her own mortality and limitations: that she risked burnout if she wasn’t careful.
Like everyone in Wuhan, Du has had to adjust to a completely new rhythm of life. Her parents live nearby, but she hasn’t seen them since the beginning of February when she was still allowed to move selectively around the city after it was sealed off. Since then, communities have become like islands, with no movement between them. Du and her parents send each other daily updates about the goings-on (or lack thereof) in their respective communities. Even Du’s friends sometimes come to her for ad-hoc advice about their own virus-related fears.
Since the start of March, the outbreak has entered the “second phase” and the volume of calls has begun to subside. The shock of the lockdown has passed and fewer people phone in the middle of the night. But the hotline has also recorded some of its most serious calls at this stage. Volunteers received calls from people with psychiatric conditions that worsened during the lockdown and one from someone who was suicidal. In these situations, Du said volunteers have helped connect the person to a psychiatrist and advised them about how to find and buy the medicine they need online if they can’t get to the hospital. Such calls show the depth of social deprivation in the city and the way those effects have accumulated during the crisis.
Restrictions inside Wuhan are now slowly being relaxed. Virus-free residents are being allowed to go back to work and public transportation is starting to resume. The lockdown is expected to be lifted on April 8th. Once people get their mobility back many of the short-term concerns that Du was being called about during the peak of the outbreak will settle down, but other emotions will take longer to process and those whose mental disorders were exacerbated by the crisis will continue to need help. The hotline is expected to continue operating for the next year.
For Du the disruption felt by those in Wuhan is a chance to reflect on our personal reactions to a looming crisis over which we have limited control. “It is only when we quiet down and think about what is happening and what it means to each individual, to society, and to mankind, that we can accept what is happening for what it is,” she said. “The novel coronavirus is another wake-up call – about food, about limits, about freedom about being alive.” Though the people of Wuhan will soon be able to move freely again, the anxieties and dissatisfaction provoked by the outbreak of coronavirus may nonetheless have a lasting legacy.
Translation and contributing research from Jaime Chu