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‘The Last Downer’: China and the End of Down Syndrome

With screenings for Down syndrome becoming more advanced, there are less and less babies being born with Down in China every year. Unborn babies with Down syndrome are allowed to be aborted to up to nine months of pregnancy.

Manya Koetse

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New screenings that can predict if an unborn baby has Down syndrome have sparked wide debate across the world – mostly because their results often lead to parents choosing for abortion. The ethical debate that is so alive in many countries seems practically non-existent in China, where Down syndrome is slowly disappearing from society. Unborn babies with Down syndrome are allowed to be aborted to up to the ninth month of pregnancy; 21% of Down-related abortions in China occur during or after the seventh month.

Last month was World Down Dyndrome Day (世界唐氏综合征日, March 21) and next month marks China’s National Disability Day (全国助残日, May 15) – both are occasions when Chinese media pay extra attention to Down syndrome, a disorder that is slowly disappearing from Chinese society.

On World Down Syndrome Day, Chinese state media broadcaster CCTV wrote on its Weibo account: “Currently, medical science does not have effective prevention and treatment methods for Down syndrome, but it can be detected early through prenatal screening. You might have seen this kind of face: mouth slightly open, a blank expression, eyes somewhat wide apart,.. break your prejudices and understand them!” This text is accompanied by different facts about Down syndrome pictured with a cartoon baby on CCTV’s account page (pictured below).

angrbaby

“I’m still nervously awaiting the results of the amniotic fluid test,” one netizen responds to the post: “I hope my baby is healthy and normal.”

On Chinese social media, many expecting mothers express their worries about screening results and the health of their unborn child. But the ethical debate that is so alive in many other countries about Down syndrome screening and abortion seems practically non-existent in China. One Weibo user comments: “In foreign countries, there are many mothers raising kids with Down, because their religion does not allow them to abort the baby.”

 

THE LAST DOWNER

“New medical techniques and the ethical questions that come with it have caused ample discussion on Down syndrome in many nations across the world.”

 

Down syndrome (DS) is a congenital disorder caused by a chromosome defect, that exists in all regions worldwide. Children with DS often have an intellectual disability and are also affected physically in their appearance and general health. Down syndrome has an incidence of 1 in 600–1000 live births, differing per country (UN; Wang et al 2013, 273). The disorder was named after John Langdon Down, the British physician who first classified this genetic disorder in 1862. In Chinese, it is known as 唐氏综合征 (Tángshì zònghézhēng) or as 先天愚型 (Xiāntiān yúxíng), the latter literally meaning ‘naturally stupid-type’.

With new techniques, it has become easier for doctors to safely detect whether or not a fetus has Down syndrome. In many countries, women can now choose for first-trimester prenatal screenings that can indicate the likelihood they are carrying a baby with Down syndrome. These tests can be followed up with diagnostic tests, either through amniocentesis (amniotic fluid test) or a DNA blood test, that can give a conclusive answer. If the unborn baby turns out to have DS, parents often have the option to abort it.

These new medical techniques and the ethical questions that come with them have caused ample discussions on Down syndrome in many nations across the world. Denmark introduced national guidelines for prenatal screening and diagnosis as early as 2004, which has led to an all-time low of Danish infants with Down syndrome – 95%-98% of pregnant women choose to abort a fetus with DS (Vice 2015). This means that Down could become something of the past; not just in Denmark, but also in other countries that have followed its example after 2004.

According to anti-abortion media, what is happening in Denmark is a “targeted form of genocide.” In the United States, the test has also become a focus of controversy, as it is intertwined with America’s general debate over abortion.

NRC

The Dutch TV-series ‘The Last Downer’ explored the gradual disappearance of Down Syndrome. The show was co-hosted by two young adults who were born with DS themselves. Photo via NPO/NRC of TV Show “De Laatste Downer.”

 

In the Netherlands, a TV show revolving around ‘the end of Down syndrome’ was recently aired on national television. The series, that was titled ‘The Last Downer’, explored what society loses if Down syndrome disappears. It also talked about the ethical, social and psychological consequences of having a child with Down syndrome. ‘The Last Downer’ also triggered debate, as some critics deemed that it was too much in favor of the pro-life movement.

 

DOWN SYNDROME IN CHINA

“21% of abortions related to DS in China take place after the 28th week of pregnancy.”

 

In China, it is estimated that 1 out of 700 infants are affected with Down syndrome. Although this percentage is relatively low compared to other countries, it is an enormous figure nevertheless due to China’s huge population (Deng et al 2015, 311).

China’s Ministry of Health has promoted nationwide prenatal screenings for birth defects since 2003 (312). As pointed out in recent Chinese research, there has since been a sharp increase in the percentage of prenatal diagnosis and consequential birth termination (Deng et al 2015, 315).

The detection of Down syndrome through prenatal diagnosis in China went from nearly 13% in 2003 to over 69% in 2011 – with urban women having better access to early screenings and diagnosis than women living in the more rural areas of China. Around 95% of women terminate their pregnancy after learning the baby has DS, which is close to similarly high numbers in countries like Denmark or Hungary.

What is different in China, is that abortions can take place up to the ninth month of pregnancy.* In nearly 80% of the cases where the DS diagnosis led to abortion, this termination took place before 28 weeks. In the other cases, the pregnancy was terminated later than 28 weeks; meaning that 21% of abortions related to DS take place after the 28th week of pregnancy (ibid. 2015, 315).** In, for example, the Netherlands, abortion can take place up to 24 weeks of pregnancy, which is determined as the moment after which a fetus would be able to survive outside the uterus. Denmark allows for abortions to take place until the 12th week of pregnancy.

Chinese doctors encourage screening more strongly when pregnant women are older. According to current regulations in China, pregnant women aged 35 or above will be suggested to have an amniocentesis test directly, and, as research points out, “most Chinese women opt to abort fetuses with malformations” (Deng et al 2015, 316). Overall, the prevalence of prenatal diagnosis of DS and the number of related abortions is higher in urban areas than in China’s rural areas due to better medical facilities in cities. This also suggests that the majority of babies with DS are now born in the countryside, where parents do not always have access to the medical care they need.

 

ABORTION IS OKAY

“Bright-pink advertisements on ‘painless abortions’ depict smiling women, butterflies and flowers.”

 

On Weibo, many netizens share their experiences with prenatal screening. One pregnant woman says the test has cost her 191 RMB (±30 US$), another netizen responds: “In my hometown, these screenings are free of charge!” Another Weibo user shares her anxiousness: “I’ve been worrying about this Down screening all week,” she writes on April 21st. The following day, she replies to the comments with crying emoticons.

Although the screenings are a big issue on Chinese social media, the ethical question of the abortions is seemingly not. This might relate to the fact that abortion is not as contentious in China as it is in many other countries.

Pregnancy termination became quite common in China during the 20th century in relation to the one-child policy. By now, China has the highest abortion rate in the world. According to the National Health and Family Planning Commission, 13 million abortions are carried out in China every year. The actual number is probably much higher, as the official number does not include the abortion numbers from private clinics, nor the estimated 10 million induced abortions per year through medicine (Xinhua 2014), nor the numbers of sex-selective abortions– a practice that has officially been illegal since 2004.

The prevalence of abortions in China has led to a booming industry focused on abortion procedures. Bright-pink advertisements on ‘painless abortions’ depict smiling women, butterflies and flowers.

beaqueen

Some even promise that the abortion will be over within ‘a dreamlike three minutes’ (for more on this read: Glamorous & Painless – China’s Booming Abortion Industry). Although China has a painful past when it comes to forced abortions, the personal choice for abortion is not as controversial as it is in many countries where the Down syndrome detection debate is more alive.

abortion

“I’m drinking fresh rosedew after my abortion,” one netizen writes: “It’s good for my cold womb.”

 

THE HARDSHIPS OF DOWN CHILDREN IN CHINA

“Giving a child with Down syndrome up for adoption is very difficult, as China’s DS children are generally deemed ‘unadoptable’.”

 

Besides the fact that abortion is considered relatively uncontroversial in China, the high rate of abortions for DS-diagnosed babies might also relate to the fact that disabled children face many difficulties in China due to stigmatization and practical hurdles.

Raising a handicapped child is a heavy burden for many parents in China, who receive little government support and often do not have the means to make sure their child gets the medical care and education they need. This means that abandoning the child sometimes is the only solution for parents to make sure their child is taken into an institution (Yoxall 2008, 25).

downer

Giving a child with Down syndrome up for adoption is very difficult, as China’s DS children are generally deemed ‘unadoptable‘. Until recently, it was legally not possible to adopt a child with Down within China. Since this has now changed, international organizations like the Bamboo Project help parents who want to adopt a child with Down syndrome from China.

 

SCREENINGS FOR DOWN: ANXIETY & CONFUSION

“If your baby has Down syndrome, you can’t keep it – you do understand this, don’t you?”

 

In China’s urban areas, first-trimester screenings for DS (唐氏筛查) through a blood test have become practically mandatory. Some clinics have 100% screening guidelines for all of their patients, but do ask parents to sign for consent first; other hospitals simply proceed to include the test with general pregnancy check-ups without any permission.

Screening procedures differ per hospital and can be confusing for expecting mothers: “Today my doctor told me that because I am already 35, I should do an amniocentesis test,” one netizen writes on Weibo: “but the blood test in my first trimester indicated I had low risk of having a baby with Down. I’m very confused if I should do it or not.”

China’s screening procedures and prevalent attitudes on how to deal with a baby that possibly has DS can be shocking to some. A 31-year-old Dutch mum named Anna (alias), who lives in Shanghai, recently shared her experiences on Facebook. Anna, pregnant with her second baby, writes:

I was unable to come on Facebook for some time due to problems with my VPN. During this period, I’ve come across something that I loathe even more than China’s internet censorship. “They’ve tried calling you but you didn’t pick up,” the Chinese nurse tells me while looking up from a form, as she points me to an examination room. I walk in, and ask the doctor what’s going on – I vaguely remember a ‘standard’ blood test (..) – “‘You have an increased risk for a child with a mental disability,’ the doctor straightforwardly tells me. ‘Excuse me?’ – I ask her to repeat her sentence. ‘The child might be retarded,’ she tells me.

Anna writes: “In the Netherlands, the availability of prenatal tests for Down syndrome has caused quite some controversy earlier this year. It is not allowed for doctors to proactively encourage women to do this test unless there’s an increased risk for them to have a child with an intellectual disability – because they are above the age of 40, for example. But this is not the case in China, where every pregnant woman, no matter her age, is tested for heightened risk through blood screening. I ask the doctor what the test results are, since I’m only 31. ‘Well, that’s not like being 21 anymore, now it is?’ she snarls at me.”

Anna explains that the results of her blood test showed there was a 1-in-200 chance her baby had Down syndrome. After informing Anna about this, the doctor says: “You can choose if you now want an amniocentesis or a DNA test. The first is more expensive and needs to be done in a private clinic, here’s an information leaflet, just think about it.”

She chooses to do the DNA test, which is safer for mothers and their unborn babies than the amniocentesis. She says: “I was initially just shocked to hear there was an increased risk for me to have a child with a disorder, but it also bothered me that the initial screening was done without my consent. I ask the doctor what happens if my baby turns out to have Down syndrome. ‘Then you can’t keep it,’ she gives me a piercing look: ‘You do understand this, don’t you?’

Anna writes: “She advised me to timely book a possible abortion, but that the procedure would be possible until 32 (!) weeks.” Anna receives the DNA test results a week later through text message, and her baby shows no signs of abnormalities. Despite her relief, she feels uncomfortable about the intrusive way in which her prenatal screening and its possible outcome was handled.

Another foreigner living in Beijing told What’s on Weibo they also were tested for Down syndrome risks in the first trimester of pregnancy at Beijing United hospital without being asked for permission first. Although they were surprised to get the results, they did not react strongly to it as the test turned out to be very low risk.

Although the ethical debate on this issue is generally lacking from mainstream media, one story did make headlines last year when a woman from Hubei was determined to end her pregnancy at 16 weeks because of the Down syndrome screening. The initial blood screenings showed an increased risk of DS, and the woman arranged an abortion – in spite of the doctors convincing her that she should wait for the actual diagnoses screening first. This story also shows how intertwined prenatal screenings and abortion have become.

 

DS IN CHINA: TABOOS AND SOCIAL STIGMA

“I think my sister’s baby has Down syndrome, but I am too afraid to ask her.”

 

Chinese netizens share their experience with Down syndrome on various online message boards. One netizen tells how it is growing up with a brother with Down syndrome. “My brother was born prematurely and was in weak health. The doctor told my parents to just give up on him. But my father refused to give up, because it was a boy, and he thinks boys are worth more than girls. So my brother lived.” The netizen tells how his parents were told by doctors that their child was simply “hopeless”, and that his brother was always teased in school.

On message board Douban, multiple netizens share how doctors encourage couples to have an abortion if their unborn baby is diagnosed with DS.  The discussion of Down on Chinese social media shows that DS is heavily stigmatized and that it is sometimes also considered a taboo.  Some netizens tell about former classmates with Down who were constantly bullied, and one netizen writes: “I think my sister’s baby has Down syndrome, but I am too afraid to ask her.”

Now that rapidly advancing medical techniques have decreased the prevalence of DS in China, chances are that the less common the disorder is, the more stigmatized it will become. It is also probable that over the next one or two decades, if rural areas get better access to medical care, Down syndrome will altogether disappear from China.
downsscreening

For China’s upcoming ‘day for the handicapped’, multiple organizations try to raise more public awareness for Down syndrome. This year, the day will specifically focus on handicapped orphans. For this occasion Chinese media recently wrote about an orphanage in Tianjin, where one-third of all children are Down syndrome babies who were left behind by their parents.

Although the article describes children with DS as little “happy angels”, one Chinese birth clinic seems to think otherwise. In their ad (see image), their message is loud and clear: “Reject children with Down syndrome! Give birth to a healthy baby!” Angels or not, modern-day China seems to have no place for Down syndrome children.

– By Manya Koetse

[rp4wp]

References

Wang, S.-S., Wang, C., Qiao, F.-Y., Lv, J.-J. & Feng, L. 2013. “Polymorphisms in genes RFC-1/CBS as maternal risk factors for Down syndrome in China.” Arch Gyneocol Obstet 288: 273-277.

Deng, C., Yi, L., Mu, Y., Zhu, J., Qin, Y., Fan, X., Li, Q. & Dai, L. 2015. “Recent trends in the birth prevalence of Down syndrome in China: impact of prenatal diagnosis and subsequent terminations.” Prenatal Diagnosis, 35(4), 311–318.

Yoxal, James W. 2008. China’s Social Policy: Meeting the Needs of Orphaned and Disabled Children. Master Thesis, Union Institute & University.

NB: other references are linked to in-text.

* As written by Deng et al (2015): “Following a systemic and standardized diagnostic process, pregnancy affected by severe anomalies such as DS is allowed to be terminated at any gestational age following informed consent” (312).

** According to 2003-2011 surveillance data, study by Deng et al uses data from the Chinese Birth Defects Monitoring Network.

©2016 Whatsonweibo. All rights reserved. Do not reproduce our content without permission – you can contact us at info@whatsonweibo.com.

Manya Koetse is the founder and editor-in-chief of whatsonweibo.com. She is a writer, public speaker, and researcher (Sinologist, MPhil) on social trends, digital developments, and new media in an ever-changing China, with a focus on Chinese society, pop culture, and gender issues. She shares her love for hotpot on hotpotambassador.com. Contact at manya@whatsonweibo.com, or follow on Twitter.

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3 Comments

3 Comments

  1. Avatar

    Colette

    July 18, 2016 at 1:02 am

    In the UK termination for DS is also permitted until 9 months………Lord Shinkwin is trying to change this.

  2. Avatar

    jack

    October 27, 2016 at 3:40 am

    The truth is the chinese and the Japanese are a mongoloid race they were created from the daughters of a man called Lot the nephew of abraham in the bible read the story of Sodom and gomorrah this will tell of Lots two daughters and there plan…the modern day chinese are the moabites and the Japanese are the modern day ammonites,incest causes down syndrome or retardation these two nations are the product of incest…BASTARD babies…truth is hard to accept

    • Avatar

      Anonymous

      December 27, 2016 at 6:11 am

      Please go back to /pol/.

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Backgrounder

“Guarding the Green Horse” – How China’s Health Code System Provided Solutions and Generated Problems

The Health Code system and the ‘Green Horse’ meme have become part of everyday life in a zero-Covid China.

Manya Koetse

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Since 2020, China’s Health Code apps have become utterly ingrained in everyday life as a pivotal tool in the country’s ongoing fight against Covid-19. What is the health code system, what are its implications, and why have so many Chinese netizens become obsessed with holding on to their ‘green horse’?

 

This is the “WE…WEI…WHAT?” column by Manya Koetse, forthcoming publication in German by Goethe Institut China, visit Yì Magazin here.

 

There is the Grass Mud Horse,1 the River Crab,2 and now another mythical animal is living in China’s social media jungle: the Green Horse. The Green Horse is a cute bright green horse-like animal, a treasured creature that will protect you during your travels and keep you safe from quarantines and lockdowns at a time of China’s zero-Covid policy. The Green Horse will watch over you, but in return, you have to do everything you can to defend it.

‘Green Horse’ in Chinese is 绿马 lǜmǎ, which sounds exactly the same as the word for ‘green code’ (绿码), referring to the green QR code in China’s Covid health apps, which have become a part of everyday life in China since 2020. In a social media environment where homophones and online puns are popular and ubiquitous, it did not take long for the ‘green code’ to turn into the ‘green horse.’

The Green Horse, image via Weibo.

China’s health code system was designed as a solution to resume work and daily life during the pandemic and is widely praised in the country as a pivotal tool in combating the spread of the virus. But it has also given rise to new problems and has triggered resistance against a new kind of digital governance.

 

A SHORT INTRODUCTION TO CHINA’S HEALTH CODE SYSTEM

 

In February of 2020, when China was in the midst of the fierce battle against the novel coronavirus, the country’s tech giants competed over who would be the first and the most efficient in providing digital solutions to aid the anti-epidemic fight.

Within eight weeks after the start of the initial Wuhan Covid outbreak, Alibaba (on Alipay) and Tencent (on WeChat) developed and introduced the ‘Health Code’ (jiànkāngmǎ 健康码), a system that gives individuals colored QR codes based on their exposure risk to Covid-19 and serves as an electronic ticket to enter and exit public spaces, restaurants, offices buildings, etc., and to travel from one area to another.

Scanning a green code (image via Tech Sina, 2020).

Hangzhou, Alibaba’s hometown, and Shenzhen, Tencent’s home base, were the first cities in China to introduce the Health Code in early February of 2020, and other cities soon followed in collaboration with either Tencent or Alipay. By late February, a nationwide health code system was first embedded in WeChat (Chen et al 2022, 619).

Now, people can receive their Covid-19 QR codes via ‘mini programs’ in Alipay or WeChat, or via other provincial government service apps. Apart from the personal health code apps, there is also the ‘Telecommunications Big Data Travel Card’ (通信大数据行程卡), better known as the ‘green arrow code,’ which tracks users’ travel history and is also available inside WeChat or can be downloaded as a standalone app. Its goal is to track if you’ve been to any medium or high-risk areas over the past 14 days.

The Green Arrow Code is used to track people’s travel history of past 14 days (Image via 人民视觉).

The health code system is not as centralized as you might expect it to be. Instead, it is fragmented and sometimes complicated. There are basically two kinds of Health Codes in China. One is the ‘Health Information Code’ (防疫健康信息码) provided by China’s national government service platform (link) which can also be used by those without mainland ID cards (including people from Hong Kong, Macao, and Taiwan).

The other kind of Health Code, which is the one that is most used across China, is the local version of the health code system provided by each province/municipality. There are at least 31 different regional health code applications, from Beijing’s ‘Health Kit’ (北京健康宝) to Shanghai’s ‘Suishenma’ (随申码), from Jiangsu’s ‘Sukang Code’ (苏康码) to Anhui’s ‘Ankang Code’ (安康码). There are sometimes also separate health code apps being used within one province (e.g. in Shenzhen both the local Shen-i-nin 深i您 app as well as the Yuekang Code 粤康码 are being used).

These local Covid health apps are developed by different provinces and cities, and they are not always compatible with each other. This means that those traveling to different provinces or municipalities need to go through the inconvenient process of applying for different local health code apps depending on where they go. Although one single centralized system has been proposed ever since 2020, the process to unify the system is not easy since the various apps have varying functions and are managed by different local government departments (JKSB 2022; Lai 2022). In early September of 2022, China’s National Health Commission announced that it was working with relevant departments to improve the interoperability and mutual recognition of health apps across the country.

Do you get a Green, Yellow, or Red QR code? That all depends on personal information, self-reported health status, Covid-19 test results, travel history, and more – the health code system operates by accessing numerous databases. The Green color means you’re safe (low-risk) and have free movement, the Yellow code (mid-risk) requires self-isolation and the Red color code is the most feared one: it means you either tested positive or are at high risk of infection. With a red code, you won’t have access to any public places and will have to go into mandatory quarantine. Once the quarantine is finished and you’ve consecutively tested negative, the code will switch back to green again.

Three color codes in the Health Code (image via Tech Sina, 2020).

By the end of 2020, around 900 million Chinese citizens were using Health Code apps and although there are no official records of the latest numbers, virtually anyone visiting or traveling anywhere within China will now use the health code system. Besides keeping records of your latest nucleic acid test results, the Health Code app also includes Covid vaccination records since 2021.

 

LEAVING THE ELDERLY BEHIND

 

Despite the efficiency of China’s health code system, it has not been without controversy. One major issue is that it basically forces Chinese citizens to have a smartphone and to download and properly use these apps. This creates a problem for younger children, those without access to smartphones, or those with lower levels of digital skills, including senior citizens.

Although the use of smartphones, the internet, and QR codes are widespread in China, where mobile payments are far more common than cash, more than 60% of Chinese aged 60 years and over still did not use the internet in June of 2020. In China’s ‘Zero-Covid’ era, it is becoming almost impossible for China’s digital illiterate to live a ‘normal’ life.

Chinese authorities have attempted to simplify things for Chinese seniors by making platforms more user-friendly and introducing alternative ways to enter venues, such as offline codes. But at a time when systems differ per region and some venues do not have the tools to check offline (paper) codes, many elderly still struggle (see Gu & Fan 2022).

“They did nucleic acid testing in my grandma’s community compound today,” one woman from Shanxi writes on Weibo: “There are many elderly people in my grandma’s area, and I saw that so many of them had no smartphones, just senior mobile phones, but now they have to swipe a code to make an appointment for testing. One grandpa asked a staff member what to do without a smartphone, they just said it would be better to bring your son or daughter to do it for you. But all results also are processed digitally, so there’s no way for them to see it, and it’s really not easy for them to go to public places.”

On Chinese social media, there are many stories showing the difficult situations that some senior residents are caught up in because they do not have a smartphone or do not know how to get a Health Code.

In August of 2022, there was one viral story about an elderly man from Shandong walking ten kilometers every day because he could not take the bus without a health app. There was also another story about a visually impaired Hengyang resident who was unable to set up the code and was barred from using public transport. In May, a 70-year-old man got stuck inside the Wuxi train station for three days because he had no smartphone and had to scan a code in order to leave.

In another video that went viral, an old man got on a bus in Shanghai but had a hard time using his mobile phone to do the ‘venue check-in’ (场所码). When the bus driver got impatient, the man eventually got off the bus, saying he felt bad about delaying the other passengers.

“Heartlessness is scarier than the epidemic,” some Weibo commenters wrote in response.

 

RED CODE: CONTROVERSIAL DIGITAL GOVERNANCE

 

Another problem that concerns netizens in this Health Code era is that the code could pose an infringement of privacy and could be abused to limit citizens’ freedom of movement for reasons that are unrelated to Covid-19. There are still unclarities surrounding the app, such as what kind of information is exactly being collected, who is authorized to access the data, and how the data is processed and stored (Zhang 2022, 2).

Some people complain on social media that they do not understand why their Health Code is changing colors: “After I did a Covid test the other day, my Health Code was green. The day after, I woke up to a yellow code and after I had done my nucleic acid test again, it was still yellow. On the third day, it turned green. In the afternoon it turned yellow again. On day four, it was green again. Besides doing tests, I’ve been at home all this time. I’m stupefied.”

One incident where people who came to the city of Zhengzhou to protest suddenly saw their Health Codes turn red sparked major outrage on Chinese social media in June.

Earlier this year, thousands of Chinese depositors struggled to recover their savings in light of a major banking scandal in Henan Province. When dozens of affected depositors traveled to the provincial capital of Zhengzhou in June of 2022 to demand their money back, they suddenly saw their Health Codes turn red. The red code was unexpected and strange, considering that there were no new reported Covid cases in their vicinity. Accompanying family members who made the exact same journey reportedly did not see their Health Codes change, raising suspicions that the duped depositors were specifically targeted and that their Health Codes were being manipulated.

“Who is in charge of changing the Health Code colors?” became a much-asked question on social media platform Weibo, with many blaming local Henan authorities for abusing their power and trying to stop rural protesters from raising their voices in Zhengzhou. Although Henan authorities claimed they did “not understand” what had happened, five local officials were later punished for their involvement in assigning red codes to bank depositors without authorization (Wu 2022).

The incident sparked more discussions on the legal and privacy risks surrounding the health code system. Although many people in China support the use of Health Code apps (also see Chen et al), there is also a fear that a lack of transparency and management could allow the health code system to turn into a surveillance tool used by the wrong people for the wrong reasons.

The influential media commentator Hu Xijin also gave his view on the matter, saying that Health Codes across the country should only be used for “pure epidemic prevention purposes.”

“The fact that Henan can make the health codes turn red of people who come to the city to protest says a lot about the power of the IT,” one Weibo tech blogger wrote. Another Weibo user wrote: “As ordinary people, we have voluntarily given up too much of our personal privacy and rights in order to cooperate with the epidemic prevention. The current abuse and misuse of health codes have caused serious infringement on the legal rights of citizens (..) The state should quickly incorporate health codes into a unified system and place it under strict management, and once the epidemic is over, the health code system should stop running immediately.”

 

A GREEN HORSE FUTURE?

 

But will the Health Code and the ‘Green Horse’ ever disappear from daily life in China? And if so, how would the collected data be handled? Although the pandemic era is not over yet (and the question remains what would qualify as ‘the end’), local Chinese governments and tech firms are already looking to see how the health code system could be implemented and how its uses could be expanded in a post-pandemic future (Chen et al 2022, 619).

Back in 2020, the China Healthcare platform (健康界) already published an article exploring the post-pandemic use of the health code system as a digital health passport and information system that could continue to play a significant role in medical care, social security, public transportation, and tourism.

On social media, some people worry that the health code system – and everything that comes with it – is here to stay indefinitely. One Henan-based blogger wrote: “In the future, I hope my son will visit my grave and tell me, ‘dad, now we no longer need our Health Code, nucleic tests or masks when we go to the malls and take trains or airplanes.'”

“If I would wake up tomorrow in a world without health codes, travel codes, Covid tests, lockdowns, wouldn’t that be great,” another person wrote on Weibo, another netizen adding: “My health code is normal. My nucleic acid test is normal. It’s just my mental state that has become abnormal.”

The fears of receiving a ‘Red Code’ are also palpable. Earlier in summer, videos showed people in Shanghai fleeing out of a local mall once they heard that someone in the building had received notice of an abnormal test result.  The same happened at a local IKEA store. Afraid of Health Codes turning red and getting locked in, people rushed to get out as soon as possible. Some even compared the scenes to a ‘zombie apocalypse.’

People fleeing from a local IKEA store after someone in the building got an abnormal test result.

Although there are serious concerns regarding the health code system, social media users also make light of it through the ‘Green Horse’ meme. The phrase “Bàozhù lǜmǎ” (抱住绿码/马) is often used on Chinese social media, a wordplay meant to mean both “Keep your code green” as well as “Hold on to your Green Horse.”

Selection of ‘Holding on to the Green Horse’ memes.

Following the trend, Wuhan set up a giant green horse at a public square in the city, which soon became a popular place for people to take selfies. The meme is also a profitable one for businesses. On Chinese e-commerce sites, you’ll find there are ‘Green Horse’ keychains, stickers, toys, mooncakes, and coffee mugs.

Green Horse merchandise on Taobao.

As cases of Covid surged again in Chengdu, Shenzhen, and elsewhere in late August and September, worries over ‘keeping the green code’ grew again among those living in affected regions. One local Weibo blogger wrote: “I just couldn’t sleep the past few days, I kept checking my green code and latest Covid test results. It makes me anxious.”

“I feel safest at home,” others write: “This is where I can guard my Green Horse.”

“I hope this epidemic will go away soon,” one netizen wrote: “I hope we can all have our Green Horse and just keep it.”

 

By Manya Koetse
Follow @whatsonweibo

 

1 Grass Mud Horse or Cǎonímǎ (草泥馬) is one of China’s social media ‘mythical creatures’ and an online meme. It is a word play on the vulgar Mandarin term càonǐmā (肏你媽), which literally means “f*** your m*m.”

2 River Crab is another ‘mythical creature’: Héxiè (河蟹) is literally ‘river crab’ but sounds the same as héxié (和谐),”to harmonize,” referring to online censorship.

 

References (other sources linked to inside the text)

Chen, Wenhong. Gejun Hang, and An Hu. 2022. “Red, Yellow, Green, or Golden: The Post-Pandemic Future of China’s Health Code Apps.” Information, Communication & Society 25 (5): 618-633.

China Healthcare 健康界. 2020. “国家卫健委推行”一码通”健康码未来不止于”通行.”” CN Healthcare, 21 December https://www.cn-healthcare.com/article/20201221/content-547951.html [Accessed 22 Aug, 2022].

Gu, Peng and Yiying Fan. 2022. “In ‘Zero-COVID’ China, the Elderly Are Becoming Ever More Marginalized.” Sixth Tone, 9 Aug https://www.sixthtone.com/news/1010908/in-zero-covid-china-the-elderly-are-becoming-ever-more-marginalized [Accessed 22 Aug, 2022].

JKSB 健康时报网 [Health Times]. 2022. “国家健康码和地方健康码区别何在?专家:国家平台更接近理想状态.” JKSB, August 27 http://www.jksb.com.cn/html/redian/2022/0827/177853.html [Accessed 1 Sep, 2022].

Lai, Xianjin. 2022. “Unified Health Code Can Bring More Convenience, Efficiency.” China Daily, April 6 https://global.chinadaily.com.cn/a/202204/06/WS624ccc73a310fd2b29e55269.html [Accessed 31 August].

Liang, Fan. 2020. “COVID-19 and Health code: How Digital Platforms Tackle the Pandemic in China.” Social Media + Society (Jul-Sep): 1-4.

Wu, Peiyue. 2022. “Zhengzhou Officials Punished Over Red Health Code Saga.” Sixth Tone, 23 June https://www.sixthtone.com/news/1010627/zhengzhou-officials-punished-over-red-health-code-saga- [Accessed 22 Aug, 2022].

Zhang, Xiaohan. 2022. “Decoding China’s COVID-19 Health Code Apps: The Legal Challenges.” Healthcare 10 (1479): 1-14.

 

Featured image by Ama for Yi Magazin.

This text was written for Goethe-Institut China under a CC-BY-NC-ND-4.0-DE license (Creative Commons) as part of a monthly column in collaboration with What’s On Weibo.

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China and Covid19

Chengdu City-Wide ‘Lockdown’ Sparks Panic Buying and Worries

Chengdu’s ‘lockdown’ is called ‘staying at home.’

Manya Koetse

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“All Chengdu Residents are to Stay Home from 6pm Today” (#成都今日18时起全体居民原则居家#) is the hashtag that is trending on Weibo today, receiving over 670 million clicks by Thursdaynight.

In light of rising Covid cases in the city of Chengdu, Sichuan Province, the local Epidemic Prevention and Control authorities announced mass testing campaigns in the city starting from 1-4 September and ordered people to stay at home.

Over the past seven days, the city reported a total of 606 new positive cases, almost one-third of all the newly reported cases in mainland China this week.

Local supermarkets saw an increase in shoppers coming to stock up on groceries since August 29, when rumors about an upcoming lockdown started spreading like wildfire.

Although authorities warned people not to “stock up blindly” (#成都官方说不必盲目囤积生活物资#), panic buying was visible across the city, with many images going viral on WeChat showing people stocking up on meat, vegetables, condoms, and even live chickens.

One of the netizens who first started the rumor of Chengdu locking down on August 29 was detained by Chengdu police the next day for “provoking trouble.” The person, whose social media ID was ‘Tropical Rainforest’ (热带雨林), received a 15-day sentence and a fine of 1000 yuan ($145).

Some memes circulated about the incident, saying that the social media user sparked “the August 29th Tropical Rainforest Shopping Festival.”

“The 8.29 Tropical Rainforest Shopping Festival” meme.

“Tropical Rainforest told us to start lining up.”

But just two days later, the rumors seemed to hold truth after all when the authorities announced the 4-day stay-at-home order. Families can still send one person out once per day for groceries.

The word ‘lockdown,’ however, was not used by authorities and the hashtag “Chengdu Lockdown” (#成都封城#) was also taken offline at the time of writing. “Ah, so it was all just rumors after all! This is not a lockdown, this is just ‘staying at home,'” some commenters wrote.

“Stay at home is just another word for lockdown,” others wrote, although others suggested that this kind of measure was far more relaxed than an actual strict lockdown.

There were also those who were confused: “On the one hand they’re telling us to do mass testing and go outside, on the other hand they’re telling us to remain at home and stay inside.”

During the night of September 1st, the hashtag “Chengdu Nucleic Acid System Collapses” (#成都核酸系统崩了#) also attracted attention online, as the system registering the nucleic acid tests allegedly could not handle the peak. “I’ve been standing in line for over two hours,” some people wrote, complaining about long testing queues that seemed neverending.

Weibo users also shared their worries about the epidemic situation in Chengdu and how long these measures would last. Previously, the ‘phased lockdown’ of Shanghai was only supposed to last for five days but ended up lasting two months.

“Great, I don’t have any rice, no oil, no noodles, all I have is a bag of nuts and some candies,” one commenter wrote.

A recurring comment on Chinese social media said: “Ah, when will this epidemic ever end?” “I just hope the lockdown will be soon lifted.”

Also read our update here: Second Day of Lockdown in Chengdu

Read more about China and Covid-19 here.

By Manya Koetse and Miranda Barnes

 

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