Mounting case numbers tackled as restrictions eased

Health workers prescribe medicine on Sunday at a fever clinic converted from a nucleic acid testing center in Suzhou, Jiangsu province. (PHOTO PROVIDED TO CHINA DAILY)

Editor's note: Medical teams have been working under immense pressure around China this month following the introduction of the optimized COVID-19 control policy. Five doctors share their fight against the virus.

Tang Youqing's battle against the COVID-19 epidemic started at Huoshenshan makeshift hospital in Wuhan, Hubei province, where he served as deputy director of the intensive care unit in 2020.

Now director of the emergency department at Guangdong Second Provincial General Hospital, Tang urged his staff members to prepare for great difficulties as COVID-19 control measures were eased.

We suggest that patients with mild symptoms stay at home to recover, which will not only be good for themselves, but will save more rooms for seniors, expectant mothers and patients with obesity.

Zhang Jing, dean of the department of infectious diseases at Weihai Munici-pal Hospital in Weihai, Shandong province

"I was fully aware of the potential difficulties and stressed them repeatedly. My team was not caught by surprise," Tang said.

"I told them we would be infected sooner or later. I also told them to protect their families, especially the vulnerable members, and to try to avoid going home for the time being."

Tang had not been home for nearly two months since his hospital became one of those designated to treat COVID-19 patients. The hospital is situated in Haizhu district, the area of Guangzhou worst hit by a COVID-19 outbreak in October.

Tang tested positive for coronavirus on Sunday. Most of the 21 doctors in his department were infected, with the first group of them returning to work on Monday.

The number of patients in Tang's department, including those in serious condition, rose sharply after the hospital, like many others, relaxed requirements for accepting patients as COVID-19 control measures were eased.

Internal medicine doctors in the department and those responding to emergency calls are bearing the brunt of the workload, with the internal medicine section working 12-hour shifts.

"Many of our team members took medicine for fever and continued to work," Tang said.

His job also involves coordinating with other departments at the hospital — a task that has become more demanding with the influx of patients.

Tang also keeps a close watch on the quality of medical treatment in his department, as well as the physical and mental conditions of his staff members. By interacting with his colleagues, he tries to help them relieve some of the pressure they face.

Tang placed himself on a 24-hour response to help tackle the problems his team encounters at work.

He said the situation will stabilize, as most of the staff members have been infected with COVID-19 and will recover, but the intense demand for medical services is expected to remain before the infection peaks.

Nurses prepare medication at Shengjing Hospital of China Medical University's fever clinic in Shenyang, Liaoning province, on Dec 15. (YANG QING / XINHUA)

Zhang Yi, deputy director of the Guangzhou Health Commission, said at a news conference on Monday that the outbreak in the city is forecast to peak in the first 10 days of next month.

One medic has likened working in the emergency center of a diagnosis and treatment area for COVID-19 patients to fighting a ferocious and lengthy battle.

This description was used by Fan Kailiang, director of the second unit of the emergency and intensive medical department at Shandong Provincial Hospital of Traditional Chinese Medicine in Jinan, Shandong province.

Fan oversees work in a building for the diagnosis and treatment of diseases at the hospital, which since this month has been designated to serve only COVID-19 patients.

The hospital boasts a diagnosis and treatment process that covers services such as outpatients, emergencies, intensive care and CT scan checkups — providing all the treatments initially needed by patients.

Work has been a big challenge. Even though they wear protective medical suits, 70 percent of the doctors and nurses in the building have contracted COVID-19, Fan said.

"There is a high risk of becoming infected, especially in the emergency and intensive care units, where we repeatedly need to have contact with patients," Fan said.

Fan, who has lived at the hospital for more than one month to handle emergencies promptly, said the number of patients in Jinan with severe symptoms could peak late next month, based on analysis of epidemiological data.

"There's great pressure, but we will do our best at this special time to win the battle," the doctor added.

Early every morning, Zhang Jing, dean of the department of infectious diseases at Weihai Municipal Hospital in Shandong, repeatedly reminds her colleagues that to avoid becoming infected, they should wear their protective suits properly.

"Two-thirds of people who come to the fever clinics are COVID-19 patients," said Zhang, who begins her daily work at 7:30 am and finishes her duties nearly 12 hours later.

She has become used to the heavy workload. When she worked in a fangcang, or makeshift hospital, for the past two weeks, Zhang only got one or two hours' rest each day.

A doctor attends to a patient at the fever clinic at Hongqiao Community Health Service Center in Changning district, Shanghai, on Monday. (YIN LIQIN / CHINA NEWS SERVICE)

The rising number of patients at fever clinics has created great pressure for the medical staff members, as well as the medical resources at the Weihai hospital. Doctors and nurses from other departments are being deployed to the fever clinics.

Zhang said, "We suggest that patients with mild symptoms stay at home to recover, which will not only be good for themselves, but will save more rooms for seniors, expectant mothers and patients with obesity."

Pediatrician Peng Anmin, 50, said this winter is the most stressful she has experienced since she started work 28 years ago.

"Our pediatricians are basically working around the clock. We expected patient numbers to surge, but did not expect this to happen so soon," said Peng, chief pediatrician in the infectious diseases department on the Tiyu Xincheng campus of Dalian Municipal Women and Children's Medical Center, Liaoning province.

"We work eight to 10 hours a day, seven days a week. Each day, more than 300 children with fever come to see the doctors," Peng said.

According to Peng, infants seldom have a fever in the first six months of life. But now, medical workers are treating more than 10 infants with fever each day who are younger than two months.

As the condition of newborns can alter rapidly, they need to stay in hospital so that any change in their condition can be discovered quickly and potential risks prevented.

There are nine pediatricians in Peng's department. Except for herself, the other eight have tested positive for COVID-19.

Pediatricians from other departments at the medical center have been assigned to provide support. "We can have backup when we're short of personnel, but drugs are the biggest challenge now," Peng said.

For example, the drug Ibuprofen, which is packed in fours, is now being sold one bottle at a time. Paracetamol is also in high demand, Peng said.

"The patients' family members generally understand the situation and the medical staff members' problems. Over the past three years, people have become more aware of the efforts made by the medical team," she added.

Peng said her team has remained united in fighting COVID-19. Due to different outbreaks, they have often had to work under closed-loop management systems and had to stay in a hotel. However, there have been no complaints from the team members or their families.

Peng said the team members once stayed in a hotel, where they lived on a monotonous diet, and no delivery services were available.

"Patients were testing positive every day. At that time, we were not allowed to have any infections in the hospital, but you can imagine the pressure we were under," she said.

Peng said she is moved by her teammates. "When their symptoms eased after they became infected, they all asked to return to work as soon as possible," she said.

She expects the next six months to be tough, but she is prepared to face the difficulties with her team.

When the situation returns to normal, Peng wants to enjoy life on the coast with her colleagues, as they did before COVID-19 emerged.

"Work should be combined with rest. These past three years have been all about COVID-19, all about work. I have never left Dalian," she said.

Peng also dreams about taking a vacation overseas — for example, visiting Europe for two weeks.

"However, the maximum amount of time I can take off is one week, due to my work. Maybe I can only fulfill my dream after I retire," she said.

Medical workers attend to visitors on Saturday at a fever clinic converted from a gymnasium in Beijing. (NG HAN GUAN / AP)

Xia Yangyang, 35, a doctor in the nephrology department at Nanjing Drum Tower Hospital, a leading hospital in the Jiangsu provincial capital, said the institution was fully prepared for its doctors and nurses to become infected with COVID-19.

However, the number of medical workers who contracted the disease still exceeded estimations.

"Infected medical workers could call in sick, and many of the doctors who weren't infected were asked to assist at the fever clinic," Xia said.

The clinic has been flooded with patients recently, and Xia is now helping his colleagues there.

He said: "One of my colleagues who assisted at the fever clinic became infected and developed a high fever. I also experienced fatigue and body aches after treating some patients."

Xia tested positive for COVID-19 on Dec 15, but he continued to work at the fever clinic because his temperature was not that high. He now works throughout the day to help ease the burden the clinic faces.

"My symptoms have abated in the past week, but I feel exhausted due to a lack of rest," Xia said.

At Nanjing Drum Tower Hospital, as of Tuesday, about half the doctors and 60 percent of the nurses could not go to work, as they had COVID-19. Medical workers developing symptoms outnumbered asymptomatic cases.

The hospital has urged doctors and nurses with light symptoms to continue working, and has asked all its employees to help at the fever clinic. It is doing its best to normalize urgent surgeries and prevent patients from becoming infected.

Special zones have been set aside in wards and operating rooms for infected patients and doctors. Doctors who have become infected have been operating on patients with COVID-19 to guarantee prompt and effective treatment while reducing the infection rate.

To care for medical workers, the hospital has introduced measures such as providing quarantine rooms, along with free meals, toiletries and psychological counseling.

Some hospitals in Nanjing have also launched COVID-19 consulting clinics on the internet to reduce the number of patients visiting them for treatment.

Patients only need to register on the hospitals' apps or through WeChat, consult the doctors, and obtain their prescriptions. The hospitals can also mail them medication on request.

The online hospitals have been enthusiastically welcomed.

For example, the number of patients at the online hospital launched by Children's Hospital of Nanjing Medical University has risen by 25 percent every month since October. The hospital has asked its doctors to respond quickly to ease patients' anxiety.

Contact the writers at zhangxiaomin@chinadaily.com.cn