H5N1

Coronavirus: Wuhan densely woven three-dimensional prevention and treatment network

After weeks of silence, the Hubei province media are now wall-to-wall coronavirus stories. The Yangtze River Daily is four solid pages of outbreak news; this is an example from the front page: Wuhan densely woven three-dimensional prevention and treatment network. Excerpt from the Google translation:

 In order to better curb pneumonitis infected by a new type of coronavirus, Wuhan City quickly linked up and down, and weaved a three-dimensional prevention and control treatment network, from classification and screening at the grassroots level to isolation and treatment in hospitals to ensure that fever patients should be examined and treated. Rule it out.     

Pre-examination and triage to ensure that all patients with fever should be examined     

The classification and classification of consultation procedures in our city are as follows:     

Fever patients should go to the community medical center first, and medical staff will screen and classify the condition.     

For patients who need to go to the fever clinic, the districts will arrange vehicles to be sent to the designated fever clinic. The designated fever clinic shall not refuse to accept the patient for any reason;     

For the patients who do not need to go to the hot clinic, each community will implement home observation, and the community will be responsible for the home observation service of citizens.     

First screening to the community, treatment to the hospital.     

If the citizen has identified or is highly suspected of having pneumonia due to the new coronavirus infection, the municipal health and health committee will be responsible for arranging the vehicle for treatment at a designated treatment point;     

If the public is a suspected fever patient, they should stay in the fever clinic for observation;     

If the fever is mild and the patient cannot be identified as suspected, the districts will be responsible for taking back the designated place for isolation and observation;     

It is determined that patients with pneumonia that are not infected with the new coronavirus will be sent home for observation by each district.     

Enlarging beds to ensure that patients are fully receivable     

Firstly, 61 outpatient clinics were set up in the city, and 24-hour consultations were fully implemented. Then, based on the two hospitals of Jinyintan Hospital and Pulmonary Hospital, 24 general hospitals were requisitioned in three batches and temporarily transformed into specialized hospitals for fever patients.     

The first batch of 7 hospitals includes the Hankou Hospital of the City, the Red Cross Hospital of the City, the Seventh Hospital of the City, the West Hospital District of the Fourth Hospital of the City, the Ninth Hospital of the City, the Wuchang Hospital of the City, and the No. 5 Hospital of the City. 941 empty beds.     

The second batch of three hospitals were the Houhu District of the City Center Hospital, the Guanggu District of the No. 3 Hospital, and the No. 2 Hospital of Wuhan Iron and Steel. They treated suspected and confirmed cases.     

The third batch of 14 hospitals and 2 private hospitals are in the process of reforming in accordance with the expropriation requirements.

At the same time, two new specialized hospitals for treating fever patients in Caidian District Vulcan Mountain Hospital and Jiangxia District Lei Shenshan Hospital were built.     

It is estimated that by February 5, the city will provide more than 13,000 beds.

China coronavirus: Premier Li Keqiang orders Wuhan hospitals to admit patients as city struggles to cope

Via the South China Morning Post, which has covered the outbreak brilliantly: China coronavirus: Premier Li Keqiang orders Wuhan hospitals to admit patients as city struggles to cope. Excerpt and then a coment:

Chinese Premier Li Keqiang has ordered authorities in the central Chinese city of Wuhan – the epicentre of a deadly coronavirus outbreak – to ensure that all patients with the illness are admitted to hospital, as countries around the world impose travel restrictions and start pulling their citizens out of the city. 

Li inspected efforts to contain the outbreak in Wuhan on Monday, as the death toll rose to 82. So far all of the fatalities have been in mainland China, where there are also more than 2,800 confirmed cases. 

The head of the World Health Organisation, Tedros Adhanom Ghebreyesus, also arrived in Beijing on Monday to discuss ways to slow the spread. 

Top Chinese leaders are scrambling to ensure that preventive measures are adequately implemented to minimise the risk of further expansion in an outbreak that has already seriously disrupted public life and even elite politics.

Yunnan province and the city of Qingdao in Shandong province have cancelled annual legislative meetings planned for February, just weeks before the National People’s Congress was expected to convene in Beijing in March. 

Li – who is heading the high-level group charged with fighting the outbreak – visited patients and medical personnel, while also directing virus prevention work in the city. 

Inspecting the construction site of a temporary hospital that will have up to 1,000 beds, Li said China was racing against time to curb the coronavirus, which has spread to other countries and all parts of China with the exception of Tibet. 

“Every effort should be made to ensure that all patients are admitted [to hospital],” Li said, adding that quality and safety standards would apply to the new facility irrespective of how quickly it would be built. 

He said 2,000 more nurses would be sent to Wuhan over the next two days, along with 20,000 pairs of protective medical goggles. 

“Authorities in Hubei and Wuhan are responsible for safeguarding the province, and should try their best to contain the spread. This is their top task,” Li said. 

Addressing medical staff at Jinyintan hospital, one of the Wuhan facilities for treating infected patients, Li said: “You are trying every means to save lives. When you are putting your efforts towards saving lives, you have to protect yourselves too.” 

In a written order, President Xi Jinping said cadres at all levels had to put the public’s interest “higher than anything” in the fight against the illness.  

Public anger at authorities has mounted as the outbreak has grown and medical workers have reported shortages of everything from hospital beds to face masks. Medical facilities have been so overwhelmed that people with suspected symptoms have been turned back and told to isolate themselves at home.

As medical supplies and personnel are pouring into Hubei and other coronavirus hot zones, the whole Chinese healthcare system will feel the impact. This will not be the time to have any other kind of medical emergency, never mind routine medical care for chronic conditions.

And before long the rest of the world will find itself dealing with shortages of Chinese-made medical supplies and pharmaceuticals. This outbreak, like Ebola in West Africa and the DR Congo, will inflict enormous collateral damage on people never exposed to the virus itself.

Coronavirus contagious even in incubation stage, China’s health authority says

Via the South China Morning Post: Coronavirus contagious even in incubation stage, China’s health authority says. Excerpt:

China’s National Health Commission (NHC) said on Sunday that the new coronavirus is contagious even in its incubation period, which lasts up to 14 days, and that the virus’ ability to spread is getting stronger. 

Ma Xiaowei, the minister in charge of the NHC, told a press briefing that the authorities’ understanding of the virus was “limited” and they were also unclear on the risks posed by possible mutations. “

The outbreak is expected to continue for some time,” he said. 

Since the outbreak was first reported in December, more than 2,070 people have been infected with the new coronavirus and 56 killed. 

Ma said that unlike Sars (severe acute respiratory syndrome) the new coronavirus was infectious during its incubation period. 

He also reiterated earlier reports that people infected with the virus might not immediately show any symptoms. 

This had added to the difficulties faced by the authorities to control its spread and prevent further infections, he said. 

As well as locking down cities, the government was sending more doctors and nurses, and more medical supplies to Wuhan, Ma said. 

More than 1,350 medics had already arrived in the city to help battle the epidemic and a further 1,000 would follow, he said.

Coronavirus: Wuhan is building two hospitals to address 2,300 beds

Via Sina News: Hubei Province Governor: Wuhan is building two hospitals to address 2,300 beds.

At 21:30 on January 26, Hubei Province's new coronavirus-infected pneumonia epidemic prevention and control headquarters held a press conference to report the epidemic situation and prevention and control work. Hubei Provincial Party Committee Deputy Secretary and Governor Wang Xiaodong, Wuhan Municipal Party Committee Deputy Mayor Zhou Xianwang introduced the situation and answered reporters' questions.  

Wang Xiaodong: Receivables should be collected, treatment should be exhausted, and important responsibilities that must be taken in response to our epidemic prevention and control. 

Three major measures have been taken. One is to fully integrate medical resources, organize 1,000 vacancies in accordance with the four-concentration principle, mobilize 800 doctors to support designated hospitals, and strive to improve healing power. 

Second, speed up the screening and shunting of fever patients and widen the entrance. The outstanding problem of long queues has been resolved. The province's 549 second-level medical structures have set up checkpoints to classify and distribute patients with fever. 

There are 112 designated hospitals in the province to treat patients unconditionally. The medical expenses incurred will be borne by the local government after the medical insurance is reimbursed. 

Every effort has been made to improve medical capabilities. Wuhan is currently constructing two hospitals, which will be officially put into use on February 3 and February 5, respectively, and can solve about 2,300 beds. 

Reconstruction of 6 hospitals in Wuhan increased the number of beds by about 10,000 and focused on treating suspected cases. 

With the support of the Central Military Commission and the Health and Medical Commission, 2430 people (medical teams) have already arrived in Hubei, which is our strong support and will effectively alleviate the problem of insufficient resources for diagnosis and treatment.

Another Sina News report says the mayor of Wuhan expects another 1,000 confirmed cases; the current rapid expansion should permit considerable surge capacity.

Wuhan leaders blamed for spread of China coronavirus as hospitals beg for supplies, death toll rises

Via the South China Morning Post: Wuhan leaders blamed for spread of China coronavirus as hospitals beg for supplies, death toll rises. Excerpt and then a comment:

Pressure is mounting for local leaders to be held accountable for their response to the Wuhan coronavirus outbreak, in the central Chinese province of Hubei, which has so far killed 56 and infected more than 1,900 people in the country. 

Doctors in Wuhan have been among those calling for health officials to be held to account and, in an unusually blunt statement on social media platform Weibo, a senior reporter from the province’s official Communist Party newspaper Hubei Daily said the city’s leaders should be removed “immediately”. 

“Like many people, I used to believe that a temporary decision to replace leaders with those less familiar with the situation would not be good for pushing through the [antivirus] work, but based on the worsening situation that is getting increasingly severe, those currently in the role have no capability of leadership,” reporter Zhang Ouya wrote on Friday. 

“For Wuhan, please change the leadership immediately,” he added. The post was later removed. It is particularly rare in China – where any criticism or scepticism is closely controlled under the country’s strict media censorship policy – for a journalist with a state-owned media outlet to make such a call publicly. 

Hours after the post was published, Hubei Daily released a statement, apologising to the city government and leaders for “making negative publicity” and confirming it had ordered Zhang to remove the post. 

The statement, which was widely circulated online, urged local reporters to “spread positive spirit” and said Zhang’s comments did not represent the newspaper “but still made a negative impact”. Neither the newspaper nor Zhang responded immediately to inquiries from the South China Morning Post. 

In a public letter to China’s top health authority, the National Health Commission, a doctor who claimed to be from a top hospital in Wuhan laid the blame for the serious nature of the coronavirus outbreak on the slow response by local health officials. 

The doctor, who did not give his real name, said the numbers of patients infected with the disease had been growing since January 12 but the local health authority had failed to report new cases.

“These patients were not given proper quarantine nor medical treatment and they could travel in every corner of the city,” the doctor wrote. “Later, when we warned patients and the public to wear masks and avoid crowded areas, they didn’t take it seriously and thought we were exaggerating, and even some medical staff, including surgeons didn’t believe it and were not willing to take basic precautions.”

This is precisely the kind of challenge to legitimacy that an outbreak poses—especially to a powerful authoritarian government. That's why, as I tried to explain in my recent article in The Tyee, an outbreak like this is a serious threat to the status quo, far beyond the mere number of people who fall ill and die. From any government's point of view, the case count is irrelevant; the economic and political consequences are what matter.

China coronavirus: Death toll rises to 41; more than 1,000 cases of infection confirmed in mainland

Years ago I spoke with a European healthcare worker who talked about "the pandemic" (H1N1 in 2009) the way combat veterans talk about "the war." He even had the thousand-yard stare I'd seen in Vietnam veterans. 

 

Today's healthcare workers are likely to talk about "coronavirus" the same way, and with the same faraway stare. Via the South China Morning Post: China coronavirus: Death toll rises to 41; more than 1,000 cases of infection confirmed in mainland. Conditions in Wuhan presage conditions in healthcare systems around the world: 

A medical doctor suspected to have coronavirus died on Saturday in Hubei – marking the first death of a medical professional since the outbreak of the virus – as the number of confirmed cases in mainland China exceeded 1,000. 

Liang Wudong, a surgeon at Xinhua Hospital in Hubei province, died at 7am at the age of 62, Shanghai-based news portal thepaper.cn reported. 

Liang was suspected of being infected last week, before he was transferred to Wuhan’s Jinyintan Hospital for treatment.

Some 29 provinces in China have reported 1,287 cases of the deadly pneumonia-like virus, with 729 in Hubei, the epicentre of the outbreak, according to data released by local governments on Saturday. 

Hubei’s death toll was 39, with the other two fatalities in the provinces of Hebei and Heilongjiang. 

Cases have also been reported in Hong Kong, Macau, Taiwan and eight other countries.

Tens of millions of people in Hubei are effectively on lockdown as a travel ban has been imposed on most of the province. 

Flights, trains, buses and ferries connecting Wuhan to other cities in Hubei have been suspended. Wuhan is the hub for several major high-speed rail lines. 

Eighteen Chinese provinces have activated a top-level public health emergency response to the outbreak, meaning public events, businesses and schools can be suspended and the migrant population quarantined in these areas. 

In Wuhan, video footage of people desperately seeking help was widespread on social media. Some nurses and doctors were reported to be suffering emotional breakdowns in hospital consulting rooms while outpatients crowd corridors with some pictured lying on the floor. 

More than 20 hospitals in Wuhan have posted statements pleading for aid from various sectors as there has been a shortage of masks, latex gloves, protective goggles and surgical gowns.

Hubei has also tightened restrictions on private vehicles from Wuhan. A notice posted by a petrol station in Chibi, next to Wuhan, said all fuelling stations in the city were now off-limits to vehicles with Wuhan licence plates, on orders of the Chibi municipal government. 

On Friday, China Development Bank granted a 2 billion yuan (US$288.3 million) emergency loan to Wuhan for virus prevention and treatment. On Thursday, China’s finance ministry announced an allocation of 1 billion yuan to be used by Hubei authorities to halt the contagion’s spread.

China coronavirus: Wuhan residents describe ‘doomsday’ scenes as patients overwhelm hospitals

Via the South China Morning Post: China coronavirus: Wuhan residents describe ‘doomsday’ scenes as patients overwhelm hospitals. SCMP is a pretty reliable source, or I wouldn't post such a lurid report. But it does sound like what happens when hospitals run out of surge capacity. (The report also gives the current case numbers in China as 1,112, with 41 deaths. World case count is now 1,138.) Excerpt:

Hundreds of patients in Wuhan who have yet to be confirmed as carrying the new strain of coronavirus are becoming increasingly desperate as the city struggles to cope with the numbers reporting pneumonia symptoms. 

One 36-year-old, speaking by phone outside a major hospital in the city, said she had spent the past week taking her sick husband from hospital to hospital in a vain attempt to get him tested for the virus, which has already killed 41 people and infected hundreds more. 

“I have nothing. No protective clothing, only a raincoat, and I am standing outside the hospital in the rain,” said the woman, who gave her name as Xiaoxi. 

“I am desperate, I have lost count of time and days. I don’t know if we will both live to see the new year.”  

She said that Lunar New Year’s eve felt like “doomsday” as there was nowhere for her and her sick husband to go in the locked-down city. 

A video shared by Xiaoxi appeared to show the hallway to the fever ward of the hospital packed with anxious patients seeking attention from medical staff. The footage also showed medical staff in protective clothing and what Xiaoxi said were the bodies of patients who had died in the hospital and been left in the corridor wrapped in linen.

“I handed a pack of tissues to a nurse. She was crying as she tried to get some people to come and move the bodies but no one responded,” she said. 

Xiaoxi said her husband had now joined those waiting in the emergency unit in the hope that medical staff would admit him. 

She said he had first come down with a fever 10 days ago and had started coughing up blood, but four hospitals had turned him away, saying they had run out of space and were unable to perform further tests. 

Xiaoxi even said they had been turned down when they called an ambulance. 

“The first hospital told us to go home and gave us some flu medicine. But my husband’s fever continued and we ending up going from hospital to hospital only be told to go home with some antibiotics,” she said. 

“My husband hasn’t eaten much for days and his condition kept getting worse. And people just keep dying, no one is taking care of the bodies. If this goes on like this, we will all be doomed.”

Wuhan coronavirus: Hospitals turning people away as doctors say ‘home is best’ in many cases

Via the South China Morning Post: Wuhan coronavirus: hospitals turning people away as doctors say ‘home is best’ in many cases. Excerpt:

After more than a week of worry and multiple talks with doctors, a woman from Wuhan was relieved on Thursday when her uncle – a suspected coronavirus patient – was finally admitted to hospital. 

Wang, who declined to give her full name, said her uncle began coughing on January 15. Five days later, he went to Tongji Hospital and after having a CAT scan was diagnosed with viral pneumonia, though the doctor said he could not be sure if it was the new coronavirus. 

“They said it might be, but also might not be, but didn’t have any test kits to make sure,” Wang said. “They could only base the diagnosis on blood tests and the CAT scan.” 

After being given some medicine, Wang’s uncle was sent home. 

On Wednesday, he went to the Wuhan Red Cross Hospital in the hope of being properly tested for the new virus. But because he did not have a fever, he was told he would not be able to see a doctor. 

On Thursday, he did have a fever, so his family called an ambulance, which took him to Hankou Hospital where he had another CAT scan and was admitted. The hospital said he had secured the last available bed. 

Wang said she was relieved her uncle had been admitted to Hankou, as it is one of a dozen hospitals in the city designated to handle suspected and confirmed coronavirus cases.

But as the epidemic has developed, with the city on lockdown, hospitals are starting to run short of medical supplies and hospital workers are feeling the strain. 

Local people are also becoming increasingly worried, with many taking to social media to air their concerns, fears and complaints about how the government is handling the crisis. Many are angry about not being admitted to hospital as suspected patients, while others have complained about not being told what to do or where to get treatment. 

As of Friday night, the number of confirmed cases on the Chinese mainland had passed 890, with 26 deaths. There had also been 20 confirmed cases elsewhere in the world. 

A Wuhan doctor, who declined to give her name because she is not authorised to speak on the matter, said not all patients could be tested for the coronavirus. 

“There’s not enough staff at the local Centre for Disease Control and Prevention,” she said. “They can’t test all the patients. Some people have begun to panic and want to do the tests immediately, but that’s impossible.”

‘It’s a ghost town’: Shortages in Wuhan as China coronavirus transport bans take effect to contain deadly pneumonia threat – but is it too late?

Via the South China Morning Post: ‘It’s a ghost town’: shortages in Wuhan as China coronavirus transport bans take effect to contain deadly pneumonia threat – but is it too late? Excerpt:

The central Chinese city of Wuhan and three neighbouring cities went into lockdown to help contain the spread of a deadly virus on Thursday, a day before the World Health Organisation (WHO) was due to meet to decide whether to declare the outbreak an international emergency. 

Medical experts said it would take some time to determine whether the citywide public transport stoppages and checks on private cars in the Hubei cities would help curb the rapid spread of the coronavirus, with many people having already left for the Lunar new Year holiday. 

George Gao Fu, head of the Chinese Centre for Disease Control and Prevention, urged the public to stay at home over the festive season, saying now was a crucial time to stop the spread. 

The Civil Aviation Administration ordered airlines and travel agents to give refunds to any passenger who wanted to cancel a flight. Previously only flights in and out of Wuhan could be refunded.  

As of Thursday night, cases of the illness had emerged in 23 provinces, four municipalities, the special administrative regions of Hong Kong and Macau, and six other countries. Mainland China had reported 632 confirmed cases and 17 fatalities, according to a website jointly operated by People’s Daily and Dxy.com. All of the fatalities were in Hubei province. 

In Wuhan, the epicentre of the outbreak with at least 444 confirmed cases, hospitals, universities and charities appealed for donations of much-needed protective equipment, including face masks, caps and gloves. The city’s health commission also appealed for volunteers to help deliver supplies to hospitals. 

Sichuan province was sending 130 health workers to Wuhan, according to People’s Daily.

Medical personnel in the city told the South China Morning Post that there were dire shortages of medical supplies. “We are short of everything, from face masks to goggles,” a doctor said, declining to be named.

There were also runs on food and other necessities in the city, with the price of some staples on the rise. 

“A cabbage now costs 35 yuan (US$5), several times more than before the crisis,” Wuhan resident Alex Wang said. “Stocks of some supermarkets with online delivery services have run out. 

“The shopping malls, main roads and restaurants that are usually busiest are now so empty. The roads are also empty, even during peak traffic hours. It’s like a ghost town.” 

Chinese pharmaceutical firms were ramping up production of surgical masks in response to mass panic buying of medical protective gear nationwide, Hubei Daily reported.

Authorities were also racing to convert regular hospital wards into isolation wards to cope with the influx of patients, one person working on the conversions said. 

At the same time, the city government was aiming to build a temporary hospital with prefabricated materials in six days, online news portal Jiemian reported. The report said the facility would be similar to one built in Beijing during the severe acute respiratory syndrome, or Sars, outbreak 17 years but did not say how many people it would accommodate. 

Under the new restrictions, all public transport in and out of Wuhan, including trains, buses and ferries, stopped at 10am. Hours later, three neighbouring cities of Huanggang, Ezhou, and Chibi also announced a lockdown, halting public transport and trains out of the cities. 

People in these cities were ordered not to leave unless in exceptional circumstances.

Supplies of N95 mask running low in Hong Kong as Wuhan virus scare sparks panic buying and marked-up prices

Via the South China Morning Post: Supplies of N95 mask running low in Hong Kong as Wuhan virus scare sparks panic buying and marked-up prices. Excerpt:

Supplies of a mask widely used during the 2003 Sars outbreak in Hong Kong are running low amid the mystery pneumonia scare in the city, with some retailers doubling prices of limited stocks. 

At least three online platforms and 15 of the 21 pharmacies contacted by the Post said they had no more N95 respirators, but a doctor assured the public there was no need for panic buying as there was no sign yet of the disease spreading from the mainland Chinese city of Wuhan.

As of Monday, 59 cases were reported in Wuhan, with 21 suspected infections in Hong Kong. Some of the local cases have been found to involve known viruses or the flu, with others still pending test results. 

There has been no confirmed case outside the mainland city or evidence to suggest human-to-human transmission, according to health authorities there.

A check by the Post on Monday on three local online platforms selling N95 respirators and recommended by manufacturer 3M showed they were out of stock. 

“Due to the huge number of mask orders, the delivery time will be a bit delayed,” mall.builderhood.com, a website selling hardware materials, stated on its page.

Checks on other online retailers such as HKTVmall and Henry Chemical also showed that the respirators, with prices ranging from HK$8 to HK$12 each, were unavailable. 

A salesperson from Henry Chemical said they had been receiving a lot of orders from medical institutions since last week. “The masks should arrive at the end of this week. You can get them next week at the soonest.” 

Disposable surgical masks on the three sites were also out of stock. 

On Monday afternoon, the Post also conducted phone inquiries with 21 drug stores citywide on stocks for N95 respirators. Fifteen said they had no more supply, with four of the remaining six stores doubling prices to more than HK$24 [US$3] a piece. 

Some retailers told the Post they marked up prices because suppliers had raised costs as customers rushed to hoard the item. 

The N95 is a disposable mask that can guard against hazardous substances, and was widely used during the severe acute respiratory syndrome outbreak in 2003 which killed 299 people in the city. 

One staff member at a pharmacy in Sheung Shui told the Post that a new product batch would arrive on Monday afternoon, but he complained that the supplier had raised the wholesale cost. 

“The supplier’s price is crazy. It’s HK$480 [US$61.76] for a box, which means HK$24 per pack. I used to sell these at HK$10 to HK$14 each,” he said on the phone.