A man walks past buildings in the central business district in Beijing, China, on February 6 2020. Picture: AFP/GREG BAKER
A man walks past buildings in the central business district in Beijing, China, on February 6 2020. Picture: AFP/GREG BAKER

Beijing/Hong Kong — Musician Zhang Yaru’s grandmother died on Monday after slipping into a coma. She was repeatedly turned away from hospital.

John Chen, a college graduate, is desperately seeking help for his mom. She has a high fever, but isn’t strong enough to stand in line for hours to be tested for the virus raging through their city.

On the front line, a 30-year-old respiratory doctor has slept only a few hours in two weeks.

Scenes of chaos and despair are emerging daily from China’s Hubei province, the landlocked region of 60-million people where the new coronavirus dubbed 2019-nCoV was first identified in December, and where it has since cut a wide, deadly swathe.

While cases have spread around the globe, the virus’s effects have been most keenly felt in Hubei, which has seen a staggering 97% of all deaths from the illness, and 67% of all patients.

The toll, which grows larger every day, reflects a local health system overwhelmed by the fast-moving, alien pathogen, making even the most basic care impossible. It’s also an ongoing illustration of the human cost extracted by the world’s largest-known quarantine, with China effectively locking down the region from January 23 to contain the virus’s spread to the rest of the country, and the world.

But Hubei — known for its car factories and bustling capital Wuhan — is paying the price, with the mortality rate for coronavirus patients there 3.1%, vs 0.16% for the rest of China.

“If the province was not sealed off, some people would have gone all around the country to try to get medical help, and would have turned the whole nation into an epidemic-stricken area,” said Yang Gonghuan, former deputy director-general of China’s Center for Disease Control and Prevention. “The quarantine brought a lot of hardship to Hubei and Wuhan, but it was the right thing to do.”

“It’s like fighting a war — some things are hard, but must be done.”

Wuhan, home to 11 million people, is a “second-tier” Chinese city, meaning it’s relatively developed but still a step below China’s major metropolises of Shanghai, Beijing and Guangzhou. It has well-regarded hospitals, but resources lag behind those of more prominent cities.

In the early days of the virus’s spread, prevarication and delay by local officials also allowed the pathogen to circulate more widely among an unsuspecting public.

While doctors first noticed the virus — thought to have been passed from an animal to humans at a Wuhan food market — in early December, and signs it was being transmitted among people were seen at the beginning of January, authorities still allowed large-scale public events to take place. The scale of the crisis only became fully apparent to the wider public in the days leading up to the start of China’s annual Lunar New Year holiday on January 24, as cases emerged elsewhere.

Caught out

It came “like a sudden downpour that caught Wuhan off guard,” said Zeng Yan, a professor at the school of medicine at Wuhan University of Science and Technology.

The 110 intensive care unit (ICU) beds in the city designated for virus patients had already been filled many times over when China announced on January 23 that it would take the unprecedented step of sealing off Wuhan, preventing possible pathogen carriers from travelling out, but also preventing most people from coming in. The quarantine soon widened to encompass nearly the entire province.

In the chaotic, confused days that followed, which coincided with China’s week-long national holiday, the quarantine restrictions coupled with an already overwhelmed city infrastructure meant that supplies of essential medical equipment including masks, protective suits and high-grade disinfectant were slow to get to Wuhan’s hospitals.

“We were advised to use masks, gloves and protective clothing in a thrifty manner, and avoid drinking water so we would not have to go to the bathroom, which would require a change of protective clothing,” said one frontline doctor working at the Third People’s Hospital of Hubei Province, who declined to give her name for fear of reprisal.

Supplies stymied

Ding Ze, whose family owns an eyewear company located in another part of China, said that their delivery of medical goggles to Wuhan was delayed by 10 days.

“We sent the supply on January 25, and they arrived at hospitals on February 2,” he said. “All deliveries from outside to the province were slowed by the strict quarantine procedures.”

While China’s government activated eight cargo carriers on February to ship in 58 tonnes of supplies to Wuhan, and donations are starting to flow in from all over the world, the shortages in those crucial days — combined with the virus’s rapid spread as the surge in patients saw hospitals turn people away for lack of space — had devastating consequences.

Between January 23. and February 4, the number of officially recorded deaths from the coronavirus in Hubei grew by over 25 times, to nearly 500. Scores more likely went unrecorded because they weren’t admitted to hospital in time to be diagnosed.

Zhang Yaru’s grandmother was turned away from hospital at the end of January because her symptoms were mild. She slipped into a coma shortly after and died without being diagnosed.

“She didn’t manage to say a word to us before she died, she probably had no idea what happened,” said Zhang, a native of E’Zhou, a smaller city adjacent to Wuhan that’s also being quarantined. “Our family is now driven into a corner, desperate, all my family members are potentially infected and my grandfather is showing the same symptoms.”

While virus cases within Hubei province are still growing by the thousands every day, infections are slowing in the rest of China — an early sign that the aggressive containment may have worked to limit the coronavirus’ spread nationally and globally.

The quarantine was the right thing to do for the good of the wider population, said the doctor at the Third People’s Hospital. “Some may say Hubei was sacrificed, but it did effectively stem the spread to elsewhere.”

The quarantine in Hubei dwarfs previous efforts in other parts of the world. In Liberia in 2014, an impoverished neighbourhood of about 70,000 people was shut off during an Ebola outbreak, triggering violent riots. As the lockdown continues with no end in sight, it’s raising ethical and legal questions.

“The lockdown may be necessary to contain the spread of the virus, but you have to ensure there’s enough medical resources to meet the demand for care in those cities,” said Zhang Qianfan, a professor at Peking University Law School. “The lockdown shouldn’t mean the city gets deserted and people are left to survive or die on their own.”

Priority

Reports of potentially preventable deaths in Hubei worsened by the quarantine restrictions have been coursing through China, said Yanzhong Huang, director of the Center for Global Health Studies at Seton Hall University in New Jersey, and a senior fellow for global health at the Council on Foreign Relations.

Comparing the “draconian measures” in Hubei to the mass surveillance prevalent in China that would seem intolerable to many in the west, he said: “If you ask Chinese people, eight out of nine will say they can live with that.”

In the days after the quarantine order, China’s government sent medical assistance into the province, while maintaining restrictions on people leaving.

More than 8,000 medical workers from across the country have gone into Hubei, mostly to the 27 hospitals in Wuhan designated for treating coronavirus patients. The rest have fanned out to smaller cities nearby. Two new hospitals, with 2,600 beds in total, were completed in 10 days, built by more than 2,000 migrant workers, while stadiums, offices and hotels are being converted into isolation units.

But hospitals in Hubei are still short of supplies, said a doctor working in the testing department at the Wuhan Tongji hospital. He also declined to give his name on concern he’d face backlash.

“Things are improving, but we are really overloaded and running diagnostic tests 24-7, and still struggle to complete them,” the doctor said on Tuesday. “I think we have not reached the peak of infections yet.”

No blame

For those seeking help and medical care in Hubei, resignation has set in — there has been markedly little unrest in the province despite the circumstances. The idea of sacrificing one’s self for a greater, national goal is deeply-embedded in Chinese culture, and is invoked by the country’s leaders in times of hardship.

People are queuing for eight hours just to get tested for the coronavirus, said the college graduate, John Chen, who is 23. His feverish mother is yet to be tested.

“At first I was upset that the hospitals and officials I called for help weren’t willing to do their job, but later I realised that it’s not that they are unwilling to help, but that everywhere is way too short of resources,” he said.

“I don’t blame anyone, because if you grow up in China, you learn that’s how the system works.”

Bloomberg 

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