‘What if We All Get Sick?’: Coronavirus Strains
China’s Health System
To fight the expanding outbreak, the country is relying
on a medical system that is overburdened even in normal times.
Waiting for medical attention
at the Wuhan Red Cross Hospital on Saturday.Credit...Hector
Retamal/Agence France-Presse — Getty Images
By Sui-Lee Wee
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Published Jan.
27, 2020Updated Jan. 28, 2020, 1:01 a.m. ET
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o
o
o
o After suffering from a fever and
breathing problems for more than 15 days, Xiao Shibing, a 51-year-old resident
of Wuhan, China, finally sought help at a hospital. Despite the symptoms, he
was not tested for the new coronavirus — a lapse suggesting that
there may be far more cases of the virus than are being officially reported.
Instead, Mr. Xiao was told that he had
a viral chest infection, so he went back home. As he grew sicker, he went to
three other hospitals. But they told him they did not have
enough beds.
Like
many of the thousands of Chinese patients who are concerned
about the new coronavirus, Mr. Xiao is scrambling to get help
from a health care system straining to serve even the basic needs of patients.
“It
is like kicking a ball from here to there,” said his wife, Feng Xiu.
Mr. Xiao, who was eventually hospitalized
on Sunday — about a week after his initial attempt — still hasn’t been tested
for the pneumonialike virus.
As it struggles to combat a coronavirus outbreak that has sickened more than
4,500 people and killed 106, the Chinese government is relying on a medical
system that is overburdened and overwhelmed even in normal times. While other
parts of everyday life in China have significantly improved in the past decade,
the quality of health care has stagnated.
In major cities like Beijing and
Shanghai, many people have to stand in line in the wee hours of the morning to
secure appointments with doctors. When they do get an appointment, patients get
only a couple of minutes with a doctor. During flu season, residents set up
camp overnight with blankets in hospital corridors.
China does not have a functioning
primary care system, so most people flock to hospitals. On an ordinary
day, doctors are frustrated and exhausted as they see
as many as 200 patients.
Those
weaknesses are most pronounced in the poorer areas of China — like Wuhan,
the epicenter of the coronavirus. Panicked residents of the city are heading to
the hospitals if they have any sign of a cold or cough. Videos circulating on
Chinese social media show doctors straining to handle the enormous workload and
hospital corridors loaded with patients, some of whom appear to be dead.
Despite having dealt with the SARS
coronavirus nearly two decades ago, many Chinese hospitals in smaller cities
are not fully prepared to deal with a major outbreak like the current virus.
Wuhan hospitals have posted messages online urgently appealing for medical
equipment. The situation is even more desperate in poorer, rural areas nearby.
Last
week, eight hospitals in Hubei Province — where Wuhan is situated and where
most of the cases have appeared — put out a call for N95 masks, goggles,
surgical masks and surgical gowns. In the absence of proper equipment, some
medical workers have resorted to cutting plastic folders to jury-rig goggles.
Workers in Wuhan are rushing to construct a new hospital to treat
patients infected with the virus.Credit...Hector
Retamal/Agence France-Presse — Getty Images
Yanzhong Huang, a senior fellow for
global health at the Council on Foreign Relations, said that China had invested
a lot in building a robust public health infrastructure in the wake of SARS and
that many of them were mostly well equipped to deal with infectious diseases.
“But they apparently didn’t anticipate
something so sudden, so acute and so tremendous,” he said.
The government’s response to the crisis
could exacerbate the problems. Across China, the authorities
are sealing off cities, closing down schools and checking on residents. But the
lockdown — affecting 56 million people — could make it difficult to get medical
supplies to hospitals that desperately need them.
Chinese
officials have acknowledged that they are struggling to deal with the outbreak.
At a news conference last week, the Wuhan health commission said there were
long lines and a shortage of beds. In response, it said it had designated
hospitals as “fever clinics” for people to go to for treatment.
With medical facilities in short
supply, the local government has also pledged to build a new 1,000-bed hospital
in 10 days, and vowed that another new 1,300-bed hospital would be ready by the
middle of next month. It is taking a page out of the government’s playbook
during SARS, when it built a new hospital in Beijing in just a week.
Yet it is still not clear that there
will be sufficient beds to deal with the virus, which remains highly
contagious.
Chen Xi, an assistant professor of
health policy and economics at the Yale School of Public Health, said it was
more important to have a working system of family doctors who can act as
gatekeepers for the hospitals.
“Without an efficient screening
process,” he said, “these two hospitals would not be very effective.”
The central government is under
increasing pressure to show that it is adequately coping with the crisis. On
Monday, Premier Li Keqiang, who has been assigned to oversee the national
response to the outbreak, visited Wuhan to inspect efforts to contain the
disease. He pledged to provide local health centers with 20,000 pairs of safety
goggles.
As the government scrambles to contain
the outbreak, the sick are just trying to get medical attention.
Cai
Pei, 41, of Wuhan, said his wife had begun coughing and developed a fever three
days ago. He wrote on Weibo, a popular social media platform, that hospitals
would not admit her, and that he had difficulty finding masks and cold medicine
in pharmacies.
Making matters worse, three Chinese
medical companies have said that they do not have the capacity to make enough
test kits for the new coronavirus, according to local news media reports.
Mr. Cai and his wife still do not know
whether she is infected with the coronavirus or another more common ailment.
“Sometimes I can only hide and cry, but
I couldn’t tell her and had to reassure her that it is not the virus,” Mr. Cai
said by telephone. “It is very scary. If it’s real, we have a child and elderly
parents at home. What if we all get sick?”
With no proven drugs to treat the new
virus, the health authorities have told doctors to prescribe a combination of
treatments — anti-viral H.I.V. drugs as well as traditional Chinese medicine —
to patients. Some of the medicines being prescribed are a mixture of
ingredients like buffalo horn, jasmine and honeysuckle as well as anti-viral
H.I.V. drugs like Lopinavir and Ritonavir.
As
happened with SARS, traditional Chinese medicine — an industry that the
government has pledged to develop — is prominently being touted as a way to
treat this new coronavirus. But there is no clinical evidence that the
gallstones of cattle, the roots of plants and licorice could work in combating
it.
Medical workers accompanying a patient, second from left, to a
hospital in Wuhan on Sunday.Credit...Agence France-Presse —
Getty Images
Journals
have published studies by Chinese scientists saying that traditional Chinese
medicine helped alleviate symptoms of SARS. China’s ministry of science and
technology said in 2003 that it had found banlangen, the root of the woad
plant, as well as a liquid made up of ingredients like cholic acid, jasmine,
buffalo horn and honeysuckle to be effective in curing an acute inflammation of
the lungs.
“There has never been a good antiviral
agent, so that means that people would try things that have some effect,” said
Dominic Dwyer, a medical virologist at the University of Sydney. “But there’s
no evidence of significant benefits with any antiviral drugs or traditional
Chinese medicine.”
The problem with finding a drug that
can effectively fight an infectious disease like this coronavirus, SARS or
Middle East Respiratory Syndrome is that it needs to be tested in sufficient
numbers in a randomized way in proper clinical trials. Patients must also give
informed consent.
“That is very difficult in an outbreak
situation,” said Kanta Subbarao, a senior researcher on respiratory illnesses
at the Doherty Institute in Melbourne, Australia.
In Wuhan, Mr. Xiao’s daughter, Xiao
Hongxia, said her father had been diagnosed with severe pneumonia and was now
labeled a “highly suspicious case.” He is relying on ordinary fever medicines
and anti-inflammatory drugs, she said.
“There is no special medicine for the
coronavirus so far,” Ms. Xiao said, “so we can only rely on the patient’s own
immunity.”
Amber Wang, Yiwei Wang
and Elsie Chen contributed research.
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