Originally published in Sanlian Lifeweek(三联生活周刊) on Jan. 30th, 2020
Interviewee | Chen, Dechang (陈德昌)
Reporter | Huang, Ziyi (黄子懿)
Dechang Chen, 57 years old, is the director of the Department of Critical Care Medicine at the Shanghai Ruijin hospital and the incoming committee chairman of the Chinese Society of Critical Care Medicine. He volunteered with the Shanghai medical team to urgently rush to Wuhan on New Year’s Eve to take care of the new coronavirus patients on the frontline. The first group of 136 medical personnel sent by the Shanghai Medical Teams includes 70+ general rescue team and 60+ severe-case rescue team.
Dechang Chen said that the situation of severely ill patients in Jinyintan Hospital is more serious. Sixteen of the twenty-nine patients in the ward under his supervision are on respirators, and now they are facing a shortage of medical supplies. When he and his colleagues from the Shanghai medical team arrived at the hospital, the local medical staff had been working continuously for nearly a month. This expedition is a lot more strenuous than expected.
We went through a day of protection training against infection of the virus ourselves before formally entering the Jinyintan Hospital in Wuhan on January 26th, 2020. The situation in Jinyintan Hospital is very severe.
This is a hospital in Wuhan that specializes in treating confirmed cases of Coronavirus COVID-19. Out of over 400 patients, there are approximately 130-140 severe cases. The hospital is divided into the South District and the North District. The Shanghai Medical Team is responsible for more than 70 patients on the second and third floors of the North District. Patients on the second floor are in better condition. Patients on the third floor are all severe cases. The general medical wards in the North 3 District were remodeled for emergency treatment with relatively crude facilities.
I’m in charge of the Northern 3rd district. There are 29 patients with a critical illness. 16 of them are on ventilators. Many of them only have 90-91% oxygen saturation while the normal value for a healthy person is 98%. Amongst the severe cases, the majority is the elderly population with a few cases of young people in their 30s. Severe patients’ symptoms are characterized by dyspnea, pulmonary fibrosis, and sometimes difficulty to inject oxygen.
The original medical staff at the hospital was exhausted when we went in. They are all working under extreme pressure, with a high level of intensity because of insufficient staff and scarce medical resources. There were only 7 to 8 ward doctors and 40 nurses in this district and everyone works nonstop day and night. For weeks, some of them can’t go home at night and stay at the hospital for almost 24 hours.
On the other hand, Jinyintan Hospital is constantly receiving new patients. Two days ago, two more wards opened. On my first day in the hospital, I saw an ambulance sending new patients to the hospital when I got off work. They’re in desperate need of backup. The Chinese government supports Hubei using the partner assistance model. In addition to us (doctors from other provinces), the Third Military Medical University also sent support and is responsible for the 4-6 floors in the Northern District.
The first dispatch of 136 members from the Shanghai medical team all came from the large hospitals in Shanghai, including 70+ general rescue team and 60+ severe case rescue team. More than 30 doctors and 90 nurses are specialized in critical medical care, infectious diseases, and respiratory diseases. Others have a background in physiology disciplines, such as digestive and blood diseases.
On January 23, Chinese New Year’s Eve, the head of Shanghai Ruijin Hospital informed us that the situation in Wuhan was urgent. Shanghai needs to organize a medical team to back it up. At that time, Wuhan needed experts in the field of severe illness, as a critical medicine practitioner, and I signed up immediately.
My wife and I both graduated from the Second Military Medical University. Though we have retired from the military, we feel a strong sense of responsibility as soldiers. I was also involved in the battle against SARS in 2003, but I didn’t go to the frontline. This time, I want to stand up for my country when she needs me because it is our duty to step up and go where we are needed most when our country is in turmoil.
On the morning of the day before the Chinese New Year, I got a call from my hospital and they told me that the National Health Commission has approved my registration and needed me to participate in a two-hour training immediately for the novel coronavirus(COVID-19) protection and defense techniques. After the training, I asked when I should leave at that time, they told me that I probably will be sent to a newly constructed hospital in Wuhan like the one they created for SARS in Beijing in a few days. Then I went back home for the New Year’s Eve dinner.
At 6 pm that day, just when our New Year’s Eve dinner was being served, I got a call and was told, “You need to go tonight! Come to the hospital and get your medical supplies, then get to the airport.” I quickly finished my dinner and left home.
My family is very supportive of me, but still, have some concerns about my safety. Before my leaving, my wife repeatedly asked me to “make sure you are well protected.” She helped me prepare some new clothes for the new year (a Chinese tradition to wear new clothes for the new year). I put them on that night as an amulet. I also packed a lot of personal daily items because I knew that I might not be able to come back for a while.
The Shanghai medical team arrived early on the morning of the first day of the Chinese New Year. We didn’t take over immediately after arriving. To achieve the goal of zero infection among medical staff, a healthcare specialist gave us a whole-day training session for self-protection. One of the highlights in the training is how to wear protective equipment, such as the correct order of dressing and undressing medical protection equipment. The process is very strict.
From the perspective of protection against further infection, the intensive care unit in the Jinyintan hospital is divided into three sections, a cleaning area, a buffer zone, and a contaminated area. Wearing clean protective gear can guarantee safety, but undressing the protective gear can be critical. After getting out of ICU, it’s vital to adhere to the correct order to undress the contaminated gear which has been exposed to the virus. It’s very dangerous if you panic and forget how to do it in a suddenly changed working environment.
On the first day after we arrived, we were practicing over and over again on dressing and undressing. It’s much more complicated than wearing an oxygen mask on an airplane. It takes 10-20 minutes to sterilize ourselves in each step. For larger people like me, clothes don’t fit very well, which makes it harder to dress and undress. Moreover, there’s a risk of exposure if your clothes don’t fit, which is why we should always pay constant attention.
For medical workers in the ICU, they should be equipped in second-level protection as requested, and when they need to do some dangerous procedures, such as setting up for intubation, third-level protection is required.
The good news is that medical workers in the Jinyintan hospital are doing a good job of self-protection. At present, almost all of our medical personnel are uninfected and they are taking special attention and efforts. Of course, it is not saying that severely ill patients are higher contagious than other patients. It’s just that severe patients may cough more and spit out more droplets than mild patients, giving a higher risk of infection.
Besides, it is very strange that the examiners in the Jinyintan’s Examination Department never have direct contact with patients. But four of them got infected nonetheless. How did they get infected? Experts speculated that one possibility is when performing high-risk operations such as blood tests. The patients’ blood sample was exposed to the air to form an aerosol and the virus carried in the aerosol was transmitted to the four examiners. If so, then the virus could be very dangerously powerful. People can be infected by being exposed to blood cell-containing aerosols. In that case, all of the three major ways of getting virus infection, including contact transmission, droplet transmission, and droplet transmission, could be related to aerosols.
So far, internally we followed the multi-layer protection procedure applied by the Third Military Medical University for the Ebola virus. I used to work at the ICU, we used general protection for preventing a lower level of contagious drug-resistant bacteria, such as protective clothing, surgical mask, and hat. But this time, we are not only wearing protective clothes, but also isolated covers from head to foot, safety goggles, face guard, face mask, two layers of gloves and two layers of hats. To prevent infection, some of the female members with long hair also had a haircut. We can only save more severely ill patients if we can protect ourselves.
Since we took over everything here, we took some time to make sure of a smooth transition. And Jinyintan Hospital left a contact person for coordination.
The shortage of supplies is more severe than we expected. We thought the hospital had enough supplies to last for a week, then we found out we had only 500 suits of protective clothes left here, which can last for two days. Supplies we brought here may last for a week, but they are all for emergencies. We have already reported the demand for supplies. We believe that our request will be addressed.
Because the hospital room of the Northern 3rd district is remodeled from the general ward, the capacity for operating as an ICU is still limited. Generally speaking, the hospital room could not be used as an ICU because the oxygen source for ICU must meet some requirements. The power system should have two sets to backup several devices, such as an oxygen tank, at most 16 for each patient due to the high usage rate. A power outage could happen if the equipment is overworked.
Each doctor has scheduled a day shift of 6 hours and a night shift of 12 hours for every 5-6 days. Working straight for six hours a day is intensive, especially if working in a special environment and wearing stuffy protective clothing. The working environment is incredibly tough, not only because there are many severely ill patients, but also we have scarce resources. Because of the inconvenience and safety issue for dressing and undressing protective gear, we normally have to endure six hours without eating and drinking, or going to the bathroom. We need to go into the ICU at any time when patients’ condition changes, which will cost new protective gear. Every single day consumes a lot of supplies.
When I first arrived here, we had a shortage of staff. The average patient to doctor ratio in ICU is normally 1: 0.8; ideally 1:1.2 for infectious disease, and one patient should be assigned to 3 or even 3.5 nurses. That means 29 patients require at least 87 nurses. Our district only had 48 nurses working eight hours a day, everyone was exhausted. It is inadvisable to work too long in ICU. The ideal working hours is four hours per day. When working longer than that, there will be a safety risk if their masks are moist, which lowers the protection. We can’t turn on the heating and air conditioning in the ICU in cold weather and have to keep working with our frozen hands. We are also afraid to use too much header in case of a power outage.
After coordination, we have been assigned another 15 nurses, and the original eight-hour shift was decreased to six hours. The second medical team from Shanghai with another 50 nurses has also arrived, greatly reducing our pressure. However, because of the shortage of supplies, we don’t want too much manpower, otherwise, we will consume too many supplies. This is our current dilemma.
It is a hard job, but we are all prepared for the hardships that come along. At the moment, everything is in order, including making rules and regulations and establishing a temporary Party branch. As a Party veteran, I keep calm and ready myself for a tough battle.
At present, generally speaking, some of our patients are getting better. There is a 30+ years old young man in my ward who has been in treatment for two weeks for dyspnea. He is on respirators. The first night I took over, his blood oxygen saturation was about 90%. This was a tough situation. After our team took care of him for a night, his blood oxygen saturation had risen to 93% the next day and he felt better; Another patient, 40-50 years old, has delirium and sometimes has delusions and is emotionally unstable. We have been comforting him and using medication. Currently, his condition is slowly stabilizing.
We also have a new patient who came in in a critical condition. The lowest level of blood oxygen saturation he got was only 40%. We did our best to save him, the patient’s blood oxygen saturation has now risen to 98% and regained consciousness. New patients are constantly sent in, and we have never even had a chance to think about when we’ll be able to go back. We must keep our morale up and can not afford to lose faith.