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 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 in Hubei province, of which Wuhan is the capital.
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 help repeatedly 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 protective 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 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 Lis'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.
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