The first report of the previously unknown pneumonia at Wuhan in Hubei province, China, to the World Health Organization (WHO) dates back to December 31st of last year. Two months and a half since then, COVID-19 has swept through all of China at a rapid rate. Today on March 17th, the number of confirmed COVID-19 patients in China is 81,116, whereas the death toll is 3,231. Hubei patients take up 80% of the confirmed cases and 95% of the dead. There were no precedents or manuals to consult since this was the epicenter. The rate of contagion in China has been winding down since then but there are wounds where the virus has passed through.
Hao Huang, M.D. at the First People's Hospital of Tianmen, Hubei province, the People's Republic of China, is a physician among others on the frontlines of COVID-19. "We would like to share our experiences and describe the current situation, [and] ultimately hope to provide some effective advice to help people in South Korea and around the world," he says. During the interview with SisaIN, he emphasized the spirit of unity using the Chinese expression “tongzhougongji (同舟共济), gongkeshijian (共克时艰).” It means "to overcome times of hardship together in a spirit of unity."
Back on March 1st, Doctor Huang, along with eight other doctors at the hospital, published a research paper entitled "Scarce Health-Care Resources and Higher Case-ffatality Rates Early in Epidemic: Analysis of Hospitalized Patients with COVID-19 in Tianmen," in the medical journal The Lancet. Tianmen, a medium-sized city with a population of 1.2 million, observed athe fatality rate of 8% during the early stages of the contagion, twice as high as that of Wuhan. The aforementioned paper analyzed how scarce medical resources led to a high fatality rate, base on cases of in-patients at the hospital. SisaIN conducted two e-mail interviews with Doctor Huang.
What is your assessment of the epidemic in Hubei at the moment (March 17th)?
Honestly, the epidemic is basically under control in China and no new cases appeared in Hubei Province for many days, except for Wuhan. This may be related to the tough measures adopted by the Chinese government early in the epidemic. Transportation and production systems are gradually recovering nationwide. But the management measures for the epidemic are still relatively strict. The Chinese Center for Disease Control and Prevention (CDC) updates the risk level of each region in China every three days. For high-risk areas such as Wuhan, strict quarantine measures are still in place: people cannot leave their residences and government officials and volunteers provide them with daily supplies. For other regions such as Tianmen City or Yichang City, healthy people are allowed to leave home and go to work, while masks are still required for those who step outside.
What kinds of measures are used in regards to patients with COVID-19 in China?
Each person has his or her own health code expressed in QR code form in WeChat and Alipay, which are Social Networking Services (SNS) widely in use in China. These codes are produced from big data that contains personal temperature data collected by government officials as well as self-reported cases. There are two colors: green, in which case the coded individual is healthy, and red when the individual has a fever or a history of high-risk exposures such as travel to epidemic areas or previous contact with COVID-19 patients. For public health reasons, each citizen is required to show his or her health code when shopping or taking public transportation. Apart from this, most of the activities are increasingly contactless. For example, I would pay for a cup of milk tea online and go to the store to pick it up after a notification, all without exposing myself or others to risk. In short, the entire society and our lives are gradually recovering, and I believe that the Chinese people will return to their ordinary lives soon.
Has your hospital returned to normal?
The First People’s Hospital of Tianmen where I work was the only designated center for the treatment of COVID-19 patients with critical condition in Tianmen. A total of 415 COVID-19-positive patients have been admitted and all 15 fatality cases of COVID-19 in Tianmen occurred at our hospital. During the period of transmission, we closed the clinic and only treated COVID-19 patients. With the discharge of COVID-19 patients, we restored normal clinics on March 13 after disinfecting the entire hospital, leaving only a few units as quarantine and treatment areas for COVID-19. The good news is that we currently find that COVID-19 patients admitted to the hospital are mostly in slight and mild conditions, which occurs in the later stages of an epidemic. In this post-peak stage, multiple RT-PCR tests and antibody monitoring of patients are needed to avoid the emergence of virus carriers in discharged patients. Since the virus may have mutated, we would also need to be on the lookout for changes in symptoms during patient screenings.
What was the most difficult thing for you on the frontline of COVID-19?
Because the source of transmission was unknown, some of my colleagues in Wuhan were infected by COVID-19 and a number of them even passed away. I would say that the current epidemic is similar to the previous case of SARS in 2003, where we lack an understanding of the viral pneumonia and do not have vaccines or specific drugs for the virus. Since our healthcare workforce lacks information about these infectious diseases, we need to be on alert for the emergence of mass contagion and need to find ways to completely protect the workers as soon as possible. In order to reduce the risk of in-hospital transmissions, patients with similar symptoms should be screened and isolated.
How is COVID-19 different from previous epidemics such as SARS and MERS?
Similar to SARS (Severe Acute Respiratory Syndrome) and MERS (Middle Eastern Respiratory Syndrome), COVID-19 can also cause death by triggering an acute respiratory failure. However, COVID-19 has a relatively longer incubation period and the initial symptoms are more subtle. Cases of patients who do not show any symptoms, or asymptomatic carriers, and released patients who turn out to be positive after discharge make it difficult for the medical workers to diagnose. This is why the present epidemic seems to be of far more consequence than SARS or MERS. Fortunately, however, the fatality rate is relatively low.
In the paper you published with your colleagues, you focused on the relationship between the lack of public health resources and the high fatality rate in Tianmen. Can you talk about that?
We decided to publish this piece in order to warn those in the medical community outside of China of the cruelty of COVID-19. An uneven distribution of medical resources is quite common globally. Developed regions have significant medical input. Such a gap is not easily reflected in the diagnosis and treatment of daily diseases. However, in an emerging event such as an outbreak of infectious diseases, insufficient reserves of medical staff, equipment, and infrastructure will inevitably lead to medical overload. For example, due to the relatively backward economy of the city where our hospital is located, we do not have enough resources or equipment to provide advanced life support such as Extracorporeal Membrane Oxygenation (ECMO) for critically ill patients.
At the same time, hospitals in our provincial capital Wuhan and surrounding cities were nearly saturated early in the contagion, and we were not able to transport critical patients to superior units for better healthcare treatments in time. As we mentioned in the paper, the per capita medical resources in our city are relatively low. Therefore, the fatality rate of COVID-19 in our hospital and this city was quite high in the early stages of the epidemic. Thankfully, with the continuous support of medical staff, equipment, and supplies from other regions of China (more than 150 healthcare workers from other provinces came to help us), many patients have been treated adequately. At the same time, strict quarantine measures reduced the severe illness rate and the fatality rate, and significantly improved medical shortages caused by the outbreak.
A growing number of patients die while waiting for treatment due to a lack of hospital beds around the world.
To reduce the fatality rate, it is important to conduct patient screening to distinguish critically ill patients and patients with high risk of death (elderly, combined with chronic disease, a history of smoking, etc.), and provide them with adequate treatment. And we need to avoid using too many advanced medical resources for slightly and mildly ill patients. Based on this principle, the Chinese government has established a large number of Mobile Cabin Hospitals by transforming hotels, schools, government offices, etc. to treat patients with mild symptoms. Only a small amount of medical care resources was needed in Mobile Cabin Hospitals but they produced the excellent effect of blocking the transmission and saving the advanced medical resources as well. Of course, some quarantine space should also be allocated for people with high-risk exposure and for recovered patients released from the hospital.
What does it take for a country to prepare for an infectious disease beforehand?
Preparation refers not only to medical resources such as medical supplies, equipment, beds, etc., but also to soft infrastructure such as health education for the masses, popularization of self-diagnosis and protection methods, measures for the public to avoid unnecessary travels and encouragement of individuals with symptoms to quarantine themselves, comprehensive preparations for quarantine supplies, and psychological counseling for the patients after the outbreak. Building this medical and non-medical system is a difficult and complicated task and needs to be prepared in advance.
How do you see the future of COVID-19?
I am not optimistic. Although East Asian countries such as China, South Korea, and Japan have taken great actions, there are still many countries that have not paid much attention to this epidemic. COVID-19 is by no means a simple flu. It is deadly for high-risk groups. Moreover, developing regions in the world lack basic medical care and thus more strict measures on population movement are required to prevent the spread of COVID-19 in these regions.
What lessons can we learn from the COVID-19 crisis?
COVID-19 is destined to be written into the history of human disasters. Infectious diseases are different from natural disasters such as earthquakes and tsunamis. The fast spread and high uncertainty of infectious diseases can easily cause public panic and confusion, such as an instability of the social order in some areas. Abandoning stereotypes and establishing an internationally shared information system for infectious disease surveillance may be more conducive to a human response to public health emergencies.
We must not underestimate any infectious disease. In the face of disasters for all mankind, we can only survive when we lay down stereotypes, enhance information exchange and cooperation, and commit to working together globally. For those who battle COVID-19 in South Korea, my hope is for them to have adequate access to resources that ensure their safety.
translated by Jaehyun Lee
translation supervised by Franz Maier, Sumi Paik-Maier
