Medical workers at the epicenter of the coronavirus outbreak say overwhelmed services and a dearth of protective equipment are putting them at risk of the infection, which claimed the life Friday of the heroic doctor chastised for warning about the SARS-like virus.
A respiratory physician working at Renmin Hospital, in the central Chinese city of Wuhan, took to Weibo and other social media in the past week to post videos and comments about his illness, which he said, came close to killing him. His wife caught the so-called 2019-nCoV virus while she was caring for him in a hospital lacking front-line health workers, he said.
China is bolstering medical support, especially intensive care unit nurses, the government’s National Health Commission said Friday. Reports circulated on social media earlier in the week showing the Wuhan virus was transmitted among 15 or more patients and staff in 13 of the city’s hospitals. Dozens were infected in four weeks at one hospital alone, according to a study published Friday.
“It appears that the involved hospital had a serious challenge with infection control,” said James M. Wilson, a former chief of operations with the Department of Homeland Security’s National Biosurveillance Integration Center, in a text message Saturday.
Wilson, a pediatrician who has monitored health-security threats for 25 years, said he’s gauging the severity of the epidemic by how well ICUs cope. So far, he’s not seen any reports of them collapsing, he said.
Almost 35,000 cases have been reported in more than two dozen countries. Wuhan accounts for more than a third.
About 82% of cases are mild, 15% are severe and 3% are critical, the World Health Organization told reporters during a briefing Friday. Of the more than 700 fatal cases, most have been in older patients and those with underlying medical conditions such as diabetes and hypertension.
Disease trackers are focusing on the spread of 2019-nCoV in hospitals because they were implicated in the amplification and spread of the coronaviruses that cause both severe acute respiratory syndrome, or SARS, and Middle East respiratory syndrome, or MERS, during the past two decades.
Most infections are occurring in the community, with health-care workers making up less than 10% of cases, Benjamin Cowling, head of epidemiology and biostatistics at the University of Hong Kong, told a forum on the new coronavirus at Melbourne’s Peter Doherty Institute for Infection and Immunity on Thursday. That compares with about 25% in SARS and MERS cases, according to Cowling, who assisted the Chinese CDC last month with analyses of transmission dynamics.
Hospital Infections
Still, some examples of hospital-associated infections are emerging, including a study at Zhongnan Hospital of Wuhan University. Among 138 patients with 2019-nCoV, 57 were probably infected in the major teaching center -- including 17 patients hospitalized for other reasons and 40 health-care workers -- in the first four weeks of 2020.
Of the medical staff infected, more than three quarters worked on general wards, with 18% of cases occurring in the emergency department, and 5% in the ICU, according to the study published Friday in the Journal of the American Medical Association.
The epidemic response in the city of 11 million people has since been strengthened with more than 11,000 medical staff, including 3,000 ICU doctors and nurses, the National Health Commission said Friday, adding that the government is trying to reduce infections among health workers.
Wuhan Union Hospital may have had as many as 262 such cases since Jan. 11, according to a photo circulating on social media of a presentation slide bearing the logo of the Chinese Center for Disease Control and Prevention.
Staff at the city’s Union Hospital, which was founded in 1866, say they have been stretched by the addition of a medical shelter opposite to the hospital, as well as a shortage of medical supplies. Face masks and protective gear are used longer than they should be, adding to the risk of exposure to virus, they said.
Mask Shortage
The WHO is taking an unprecedented step of negotiating directly with suppliers to improve access to gloves, face masks and other forms of personal protective equipment, the Geneva-based agency said Friday. Demand for face masks has increased as much as 100-fold, and prices are up to 20 times higher than normal, Director General Tedros Adhanom Ghebreyesus said.
The shortfall has been exacerbated by “widespread inappropriate use” of protective gear outside of patient care, leaving less for health workers at the front line of the epidemic in China, he said. “As a result, there are now depleted stockpiles and backlogs of four to six months.”
The outbreak is even straining hospitals treating relatively few cases. That’s mostly because of the need to isolate patients confirmed or suspected to have the 2019-nCoV infection, according to a doctor working at a hospital in Xianning, a city of about 2.5 million people in southeastern Hubei province.
Each suspected patient needs to stay in a separate room, said the doctor, who declined to be identified by name because he’s not authorized to speak with the media. It means that, while some of the hospital’s 600 beds are unoccupied, most of its wards are full.
Xianning, about 78 kilometers (48 miles) from Wuhan, is seeing fewer 2019-nCoV cases than a week ago, the doctor said over the phone on Friday. He’s also noticed less panic among people he’s observed and met, he said.
