By Nectar Gan, Natalie Thomas and David Culver, CNN
February 15, 2020
(CNN)Ning Zhu, a nurse in Wuhan, the central Chinese city at the heart of a deadly coronavirus outbreak, is restless.
Instead of helping on the frontlines, she has been under self-quarantine at home for weeks, after a chest scan on January 26 revealed that she had a suspected case of the novel Coronavirus.
Zhu was told to wait for a nucleic acid test that would provide the final verdict, but it never came.
“Right now, it’s really a problem. Our hospital already has more than 100 people who are quarantined at home,” she told CNN over the phone. An additional 30 medical workers have been confirmed to have the virus, she said.
“If the tests are fine, we can go back to work. I actually don’t have any symptoms, there’s just a slight problem with my CT scan, it seems there’s a bit of infection,” she said.
Zhu estimates that of the 500 medical staff at the hospital, more than 130 may have been stricken by the virus, which has so far infected more than 60,000 globally. She declined to publicize the name of her hospital and asked to use a pseudonym as she was not authorized to speak to the media.
The situation at her hospital is not unique. A nurse from the Wuhan Central Hospital said on Weibo, China’s Twitter-like platform, that around 150 colleagues at her hospital have been confirmed or suspected to be infected — including herself.
The nurse, who had been under self-quarantine at home since being infected last month, was finally admitted into the hospital she works at for treatment on Tuesday.
“The (in-patient) floor I live on is basically filled with colleagues from my hospital,” she wrote in a post on Wednesday. “These are mostly double or triple rooms, with my colleagues’ names and bed numbers clearly written in black and white on the doors.”
Every time fellow medics came to check on her, she said, she would hold her breath. “I’m afraid the virus inside my body will come out and infect these colleagues who are still standing fast on the frontline,” she wrote.
On Friday, it was revealed that 1,716 healthcare workers nationwide had been infected by the virus, six of whom had died, according to China’s National Health Commission (NHC). Nearly 90% (87.5%) of those medics came from Hubei province, of which Wuhan is the capital.
More than a thousand infected in Wuhan
Health care workers have long faced a high risk of infection during major outbreaks, including the severe acute respiratory syndrome (SARS) epidemic that swept China from late 2002 to 2003. In Wuhan, the epicenter of the noval corronavirus outbreak, however, that risk is now exacerbated by a dire shortage of medical resources to cope with the influx of patients, as well as the government’s belated warning of the high-infection rate.
In Wuhan alone, 1,102 medical workers have been infected, accounting for 73% of infections in the province and 64% nationwide.
The city of 11 million people has 398 hospitals and nearly 6,000 community clinics. However, the Wuhan Municipal Health Commission has designated nine hospitals to treat coronavirus cases, as well as an additional 61 hospitals whose outpatient clinics will receive patients with fever — believed to be a common symptom of the pneumonia-like illness.
In some of these designated hospitals, medical staff have made up a significant percentage of infected patients.
For example, at Zhongnan Hospital, one of the 61 hospitals dealing with cases, 40 health care workers had been infected, accounting for nearly 30% of the 138 coronavirus patients admitted by the hospital from January 1 to 28, according to a research paper published in the Journal of the American Medical Association last week.
Peng Zhiyong, director of acute medicine at the Zhongnan Hospital who co-authored the paper, told Chinese investigative news magazine Caixin that “the ratio is already very small compared with other hospitals.”
At the Wuhan No.7 Hospital, another of the 61 facilities, two thirds of the ICU staff were infected due to shortage of medical resources, Peng said, citing his deputy director who was sent to assist that hospital, according to the report.
The Wuhan government has acknowledged the shortage of medical supplies, such as specialist N95 respiratory masks, goggles and protective suits. Hospitals across Wuhan have pleaded for helprepeatedly on social media, calling for more donations of the protective gear, which are vital in protecting frontline staff from catching the virus from patients.
On Weibo, a post by the state-run People’s Daily showed medical personnel in a Wuhan hospital creating protective gear out of plastic trash bags.
Apart from the lack of masks, gloves and protective suits, medical workers have also been stretched to their limits by the crushing workload. Cross-infections among hospital staff are thought to have taken place in tea rooms and meeting areas, after long grueling shifts, according to David Hui Shu-cheong, a respiratory expert at the Chinese University of Hong Kong, citing doctors who were sent to assist hospitals in Wuhan from Beijing.
On Friday, the NHC vowed to “tangibly improve the work conditions of frontline medical workers” and better protect their rights and interests.
“I am full with respect and gratitude towards all medical workers at the frontlines, but what we really need to do is to give them more care and solicitude,” said the commission’s deputy director Zeng Yixin.
The seed of the problem, however, had been sown early in the crisis — even before medical resources started running out.
The government’s initial delay in releasing information about the outbreak meant medical staff were unaware of the potential dangers during its early stages. Wuhan Mayor Zhou Xianwang admitted on CCTV late last month that his government did not disclose information on the coronavirus “in a timely fashion.”
Chinese authorities repeatedly stressed in the early days of the outbreak that no health care workers were infected — an important sign for possible person-to-person transmission used to suggest that the virus was not that contagious.
Li Wenliang, a Wuhan doctor who died from the coronavirus, had tried to warn others early on in the outbreak but was silenced and punished by police for “spreading rumors.” The suppression of Li, along with other medics who tried to sound the alarm on the virus, has likely led to unnecessary cross-infections inside hospitals, as well as in families and communities.
China’s Supreme Court said in a commentary on January 28 that had people listened to Li’s warnings they could have “adopted measures such as wearing masks, strict disinfection and avoiding going to the wildlife market.”
Instead unaware of the health risks, many doctors and nurses were only wearing disposable masks when treating potential coronavirus patients at the beginning of the outbreak. Ivan Hung, chief of the Infectious Diseases Division at Hong Kong University, said those masks alone are “definitely inadequate” in fending off the virus.
“Basically, medical staff should be wearing N95 masks, goggles or face shields, and protective suits not only in isolation wards, but also at emergency departments and medical wards — basically anywhere that one might get in touch with coronavirus patients,” he said.
Li, 34, was an ophthalmologist at the Wuhan Central Hospital. He later died after contracting the virus unwittingly from a patient on January 10, sparking an outpouring of grief and outrage, as well as calls for freedom of speech. “I was wondering why (the government’s) official notices were still saying there was no human-to-human transmission, and there were no healthcare workers infected,” Li said in a post on Weibo.
According to a study of the first 425 confirmed cases of the coronavirus in Wuhan published in the New England Journal of Medicine last month, seven health care workers in Wuhan had already shown symptoms of infection between January 1 and 10.
But on January 11, the Wuhan Municipal Health Commission was still insisting that “as of now, no infection among medical staff has been found,” reiterating that there had been “no clear evidence for human-to-human transmission.”
The World Health Organization also said in its statements on January 14 and 17 that China had not reported any cases of infection among health care workers.
It was not until January 20, when Zhong Nanshan, a government-appointed respiratory expert, declared on state broadcaster CCTV that the new coronavirus could spread from person-to-person, that the infection of medical workers was revealed.
As evidence for human transmission, Zhong, an 83-year-old doctor known for fighting the severe acute respiratory syndrome (SARS) outbreak 17 years ago, disclosed that 14 medical workers in a hospital had been infected by one patient.
The next day, the Wuhan Municipal Health Commission admitted in a statement that as of January 21, “a total of 15 health care workers have been diagnosed with the new coronavirus,” and another one was suspected to have been infected, too. One of them was in serious condition, the statement added.
Since then, however, the commission has not announced any updates on the number of confirmed or suspected cases among the city’s hospital staff, even as Chinese media have published multiple reports offering a glimpse into the true scale of infections in hospitals.
Spread of the problem
The infection of medical workers is not only happening at the designated Wuhan hospitals, but is also being seen at other facilities and cities across China.
In the Wuhan Mental Health Center, the largest psychiatric hospital in Hubei province which isnot supposed to treat coronavirus patients, 50 patients and 30 medical staff have been diagnosed with the novel coronavirus after being cross-infected inside the hospital, the state-run China Newsweek announced last week, citing multiple sources at the hospital.
When reached for comment on the cases, the hospital’s director told China Newsweek: “We now have discipline requirements and cannot accept phone interviews anymore,” the report said.
Meanwhile, the virus has spread to every region in mainland China, including the far western frontier of Xinjiang and the remote region of Tibet. Authorities in Beijing and the provinces of Guangxi, Jiangxi and Hainan have all reported individual cases of infection among hospital staff, amounting to two dozens people.
By Tuesday, a fund set up by ByteDance, the Beijing-based startup behind popular short video platform TikTok, to help health care workers stricken by the coronavirus had already sponsored 190 infected medics, including five who have died, the company said in a statement to CNN.
Before Friday, the NHC had not provided a tally of infected medical workers. It finally released the numbers more than two months into the outbreak, at an inter-agency briefing arranged by the State Council on the safety of medical workers.
During SARS, the Chinese authorities appeared to become more forthright about the infection of medical staff following an initial attempt to cover-up the outbreak. By mid February 2003, the Guangdong provincial government had announced that 105 of the 305 SARS cases found in the province were medical workers. The Ministry of Health, the predecessor of the National Health Commission, also included the number of health care workers in its briefings of infection numbers, with breakdowns by provinces.
By May 30, 2003, a total of 966 medical workers had been infected, accounting for 18% of the 5328 cases across China, according to the ministry.
For now, the infection rate of health care workers appears to be much lower than during SARS. The 1,716 infected medical staff as of Tuesday only account for 3.8% of all confirmed cases, the NHC said.
Hung, the professor at Hong Kong University, said he was confident that frontline medical workers are now equipped with better protective gear than those produced 17 years ago during the SARS epidemic. He also believed that they are being churned out in factories to meet the demand.
“The main problem is what happened early on in the outbreak, which had repercussions that have lasted till today,” he said, referring to the cross-infections in ill-prepared hospitals.
“When you have no idea what you’re facing, there’s bound to be negligence,” he said.