Around December 25, 2019, I heard that medical personnel at two hospitals in Wuhan were suspected of contracting viral pneumonia of unknown virus and were quarantined, including medical staff in the respiratory department. I felt at the time that the situation might not be simple.
Medical personnel from the respiratory department should be the most cautious in protecting themselves from the virus. Their contamination indicates that the virus could be very contagious.
Viral pneumonia occurs every year, but this time is different. My colleagues told me that some patients do not cough or have a fever, but their CT scan of lungs is awful.
Later, the more I thought about it, the more I worried. When I attended the briefing session of the hospital management on the afternoon of January 2, 2020, I suggested launching a fever clinic with standard quarantine arrangements.
As far as I know, many Wuhan hospitals do not have a separate fever clinic, because of its low profitability.
The next afternoon, the hospital received a request from the city administration to set up not only a fever clinic but also a specialized ward to treat patients with unexplained pneumonia.
Our hospital is not the one specialized in dealing with infectious diseases. However, our hospital endeavoured to set one floor with quarantine standard. Around January 6, we received three patients with suspected lung infections and a family of multiple suspected cases.
On the 10th, we were unable to cope with the situation. The respiratory ward is full, and I suspected that two-thirds of them infected with the pneumonia viruses.
During this period, only the medical personnel in the fever ward were wearing protective clothing. People of other departments, including the respiratory department, were wearing white coats and general medical masks.
The lack of protection and free movement of patients has likely escalated the epidemic. The data released by the authority recently showed that many confirmed patients had been active around January 10 in Wuhun.
Around January 18, I heard that the medical staff of Wuhan Xiehe Hospital started to wear protective clothing, and also vacated a building to treat fever patients. I realized that the situation was getting worse.
Monday, January 20, at 7 am, I sent a text message to the principal of the nearby high school to inform the situation and suggested better to dismiss the students. The principal took my advice and immediately evacuated students.
That night, China Central Television broadcasted an interview with Zhong Nanshan, (an authoritative figure in the fight of SARS in 2003) he confirmed that it was a new type of coronavirus pneumonia virus and could pass on from person to person.
The official acknowledgement of this disease to me was no earlier than anyone, which was through the national news broadcast channels. We had training on viral pneumonia on January 3 but only told it might be different. Nobody said then it was a new type of coronavirus pneumonia.
On January 21, we received a notice from city administration to vacant the whole hospital before 6 pm on the 23rd and only to accept feverish patients.
We are severely short of equipment such as heart rate monitor, ventilator, and finger oxygen meter. We had less than 100 sets of protective clothing in stock. We don’t even have enough hooks for infusion.
At 5:30 pm on the 22nd, hospital dean suddenly asked us to start the consultation. But at the time, the entire system had not tested. Moreover, we had no protective clothing, N95 masks and goggles.
I responded firmly to the boss that we can not start the consultation. I told the boss without protective equipment; we would be naked in front of the virus. Later, a head nurse borrowed seven sets of protective clothing from other departments, but we were still short of N95 masks. We had to wear double or triple medical surgical masks instead. We had no choice.
The crowd was rushing into the clinic when we opened to the public. It was as messy as the vegetable market. Patients, many with their family members, were rubbing shoulders and even pushing at each other. Some took videos blaming us for not having a proper arrangement and complaining they were infected here.
Ten people transferred from the emergency department to us for infusion at one time, but everyone requested to call themselves first. This batch had not been processed yet; the next batch came in again. Throughout the night, the nurses gave injections without stopping. Patients had to raise the bottle themselves while seeking a seat. Some patients were angry and required the nurse to find a place for them.
The nurses sometimes have to take off their goggles for injection, because the sweating makes it blurry. They should have worn a facemask, but so far we have no facemasks.
On the second day, it was so crowded that people were difficult to find a place standing. The hospital did not have the manpower to keep order. Patients were walking everywhere. Roughly they wait 4 hours to see a doctor and 4 hours to take a lung CT.
Some patients were so sick that their lungs were like cotton wool in the CT film. The family members begged us in tears, but we have no beds to hospitalize them.
On January 21, when the authority specifically assigned our hospital to receive feverish patients, a doctor came to me asking for her resignation. She said her child was very young. I understand her, and I am scared too. I told her that “I could approve your departure, but it would leave you a “stain”. In the future, you will be regarded as a “deserter” wherever you go for a new job.”
She did not resign but stuck to her post as a frontline doctor on the evening of January 22, the most chaotic day in the hospital. Unfortunately, when she returned home early the next morning, she began to develop symptoms of infection. After examination, she was considered a suspected patient. We had no testing kit to confirm.
I asked her to go home and rest right way, but she said, “Chief, I will find a place to confirm it. If not, I want to come back and fight with everyone.” She is only in her 20s. In case something goes wrong, how can I live as her chief? How can I compensate her family for a daughter and a mother?
I felt sad, for fear of hurting the morale of the team, I went outside alone and cried for a long time.
We have a doctor whose child is only seven and a half months old. She could leave for a holiday and celebrate the Chinese New Year at home. In the face of the outbreak, she did not go and decided to end breastfeeding to her child.
Another doctor asked her relatives to bring her two children back to her hometown. Her doctor husband was fighting on the frontline for some time already. One night we were desperately short of staff, she stayed for all night. Considering her situation, I scheduled her free for the next day. Having seen the schedule, she came to me and said she was prepared on call at any time. She expressed that she could work as long as she could.
A retired chief in his 70s sent me a text message saying he could come to the hospital at any time if needed.
To be honest, everyone here is scared. If someone says not frightened, that is cheating. We knew that we are in an extremely contaminated area, but we still fight for our duties.
For fear of infecting families, everyone chooses to live in the hotel assigned to the doctors, which is ideal for stand by. We are more confident to be together as we can seek comfort from each other. My house is near to the hospital. I often cook some dishes for my doctors.
Being in the high-risk category, I have to let my son live outside. My relatives are reluctant to accept my son to their homes because of fear. My son orders meals from online or eats instant noodles every day as he does not cook. On New Year’s Eve, I called my relative to cook some dishes and put it downstairs of my son’s residence for him to pick it up. At least he can eat a decent meal for the New Year.
I cook at home for my doctors, but no one prepares food for my son. It is hurting！
On New Year’s Eve, several videos showing doctors crying in the office are circulating on social media. The videos are true. One of the doctors appearing in the video is from our hospital. The male doctor who was shouting emotionally in another video is also from our hospital. Many doctors in our hospital had cried many times because of extreme pressure and exhaustion.
Patient deaths make me cry. I saw one patient; her lungs were utterly fibrotic. I watched her blood oxygen drop from 80 to 70, 60 and down. She held my hand and begged me to save her. How can a doctor bear it?
We are willing to work hard, but our basic needs should be guaranteed. The protective clothing makes everyone sweat a lot, but the hospital only supplies hot water at two periods. If you missed, you could not have a shower. The hotel rooms are not enough. Two people had to squeeze in one bed. Some of the hospital personnel do not have protective clothing and N95 masks.
The situation has eased a lot these days. The execution of a classified diagnosis and treatment system by Wuhan authority leads some feverish patients to the community health service centre for screening. The number of patients in hospital has reduced.
At 3 pm on January 28, it took one to two hours for a patient to see a doctor and have a CT image taken. But infusion took three or four hours. Now the security and cleaning staff are wearing blue isolative suits. Hospital order has improved, but we are still worrying. N95 masks are not enough; I don’t know if the supply can keep up.
I started my doctor career at 21 and became one of the youngest department chiefs in the hospital at 34. I will be 52 this year. I sincerely hope that I will not see an epidemic again. I hope hospital management will improve and the control of infectious diseases will be better in the future.
One day before starting work, I told my colleagues that we were going to the frontline to fight. We had to take care of ourselves. We have to survive and cut a bloody way through. When the epidemic passes, I will invite everyone in my team to holiday abroad, all at my expense.
Interview to Dr Lu Xiaohong, Chief of Digestion Medicine Department, Wuhan Fifth Hospital. Published by China Youth Daily January 28, 2020
Translation Ren Zegang
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