What We Can Learn from Chinese Frontliners during the Outbreak
The unusual pneumonia cases seen in Wuhan in December 2019 has now developed into a full-blown global pandemic: the 2019 nCov. China has been criticized for keeping the virus secret and underplaying the burgeoning epidemic for weeks. Now it has spread across the country and eventually overseas.
Its efforts to contain the virus and flatten the curve were also compared to its Asian neighbors, like South Korea, which received global praise for its transparency and efficiency and taking it seriously based on its previous experience with SARS and MERS.
China’s Situation During the First Wave of the Virus
The virus and its effects were underplayed and not acted earlier upon.
The coronavirus has taken its toll on the residents of its origin. Thousands of Chinese doctors and medical frontliners are under-equipped to face the onslaught of infected people, catching the virus themselves. Supplies and protective gear needed by medical workers are scarce as they have to constantly keep changing out of them.
As of March, the number of total cases has risen to 81,439 (3,300 were deaths from the virus), with around 50 people coming up positive every day, and medical workers are being infected at an alarming rate, which greatly reduces the number of frontline available for hospitals being flooded by patients every day.
A big part that’s playing into the seemingly losing battle against the virus is the lack of attention given to it early on during the outbreak. No one knew yet that the virus could be transmitted from one human to another. People were fewer cautions about physical contact, and doctors did not wear protective gear to avoid contamination for the earlier confirmed cases.
By the time scientists were able to confirm just how easy it was for the virus to transfer from person to person, there was not enough protective equipment for the frontliners themselves, let alone the civic population going out for their everyday jobs.
The spread of the virus from Wuhan to other parts of China and eventually to becoming a global pandemic can partly be traced to the lack of Wuhan’s medical staff that’s fit to deal with the issue, leading to around 6,000 medics from other parts of China being sent in despite the risks.
Apart from the lack of equipment and test kits for the general population, being in medical quarantine is a near-impossible task-- the general hospitals in regions of China, being flooded with patients coming in every day, are simply unable to maintain the proper distance needed to keep confirmed cases in medical quarantine. There is a lack of beds, rooms and overall space for a healthy work environment.
China has pledged to open more hospitals and did so in February, but even so, the shortage in space led to event and exhibition centers being converted into makeshift quarantine facilities. This made everything much more difficult because there was inadequate equipment, heating, and even a lack of electricity.
Working conditions have placed medical workers under enormous stress.
Doctors and other medical workers are going for as long as a week without a break, some unable to go home in fear of exposing their families to any of the symptoms they might have caught.
Some articles have been posted of nurses being infected and passing the virus to the older residents of their homes, who are reported to be more vulnerable to the symptoms. Li Wenliang, the doctor who was punished earlier when he tried to explain exactly how deadly the virus could be, died at the age of 34, after being infected.
Some of the medical staff in Wuhan have little time to even use the bathroom, resorting to wearing adult diapers instead to also avoid tearing their hazmat suits. Hands are becoming sensitive and practically being bleached from the constant disinfectant, and the precautions don’t always work-- one in 30 of the total number of cases is a medical worker.
China Flattens the Curve
Towards the mid-March, China made a 180-degree turn from receiving fear and suspicion to being the first one to declare itself to be on the other side of the coronavirus pandemic. While some of its Asian neighbors have only just begun its quarantine period and Western countries like Spain, US, and Italy reporting more and more cases every day and are nowhere close to flattening the curve, China is now declared to have wrestled the virus into submission when reports began saying that there were either no new local cases or only one per day.
Wuhan has reported a fifth day without a new case. Its response towards the pandemic, previously criticized as too authoritarian and undemocratic, are as follows (these measures are now being implemented across the world as well):
- Locking down cities.
- Banning international and inter-regional flights.
- Shutting factories.
- Mass testing.
Granted, people remain suspicious about the numbers and are more worried about how China has dealt with post-coronavirus society: is it more concerned with restarting its economy or fully containing the virus?
There might still be many asymptomatic infected people that can cause the virus to act up again once the quarantine is lifted (Wuhan is still under quarantine; other regions have returned to normal and have been urged by Xi Jinping to restore economic and social order with urgency). Numbers might have been manipulated, or patients showing symptoms might have been denied testing.
It has also been confirmed that China does not include asymptomatic infections or recovered cases who have retested as positive, in its tally of positive cases. Strict measures remain at the borders and on international flights because while there have been no new cases caught from the local transmission, most of the reported cases daily are imported cases.
China, as well as other Asian countries like South Korea, are now on guard against a second wave of the coronavirus that’s coming from abroad.
Lessons we can take from Chinese Medical Frontliners
1. Army medical teams bore the heaviest responsibility along with the medical workers in hospitals in taking a frontline role.
Xi Jinping has deployed the People’s Liberation Army in Wuhan to help in controlling the outbreak by controlling the distribution of medical supplies and to help in actually treating patients in hospitals. They frontline medical workers were composed of both civilian and military medical staff.
Many of the PLA include experts in biochemical warfare and experienced epidemiologists and virologists. The problem with the lack of protective gear was also addressed--the PLA logistics troops deployed the army system in distributing protective gear, which proved more efficient than that of the local hospitals’.
2. Transparency is important to lower the risk for both non-infected civilians and medical workers.
China has already been criticized for not taking appropriate measures to contain the virus early on. Despite this, the lack of transparency regarding its infected cases and even medical frontliners testing positive is evident: for example, the New England Journal of Medicine has reported seven (out of the 450 cases in Wuhan) health care workers that were symptomatic in early January.
It was not until the person-to-person transmission had been confirmed on the broadcast that the infection of medical workers was also revealed, and there has been no update since then regarding the infected frontliners (self-quarantine, recovery, re-infection, etc.) from the commission itself-- most of the information that the general public knows comes from social media.
3. Frontliners need special intervention, too.
Around 50.4% of participants in a psychosocial study held in 760 hospitals in Wuhan showed symptoms of depression, anxiety, insomnia, and overall mental distress, and the overwhelming workload and lack of breaks, the stress, and information overload were most of the reasons cited.
The fear of being infected themselves and passing it on to their families because of the lack of equipment is rampant among the medical workers. Health care workers also require protection from the virus despite being in the frontlines, and special interventions need to be implemented to help them engage in healthy coping strategies.
We Are Better Together
Abrantie and Signora supports Samaritan's Purse as they work to meet the needs of people around the world. They are setting up a 68-bed Emergency Field Hospital in Central Park in New York City to provide critical care for people sickened with the coronavirus. A convoy of trucks headed north from North Carolina on March 28, arriving that night with the respiratory care unit and urgently needed medical supplies.
Max Roser, Hannah Ritchie and Esteban Ortiz-Ospina (2020) - "Coronavirus Disease (COVID-19) – Statistics and Research". OurWorldInData.org. Retrieved from: https://ourworldindata.org/coronavirus
The Lancet. "Study details first known person-to-person transmission of new coronavirus in U.S: Person-to-person transmission of SARS-CoV-2 occurred between two people with prolonged, unprotected exposure while the first patient was symptomatic." ScienceDaily. Retrieved from: www.sciencedaily.com/releases/2020/03/200312123641.htm.
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