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‘What if We All Get Sick?’: Coronavirus Strains China’s Health System ‘What if We All Get Sick?’: Coronavirus Strains China’s Health System
(3 days later)
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.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.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.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.“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.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.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.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.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.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.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.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.
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.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.“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.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.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.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.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.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.”“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.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.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.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.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.Mr. Cai and his wife still do not know whether she is infected with the coronavirus or another more common ailment.
Updated June 5, 2020 Updated June 12, 2020
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
“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?”“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.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.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.
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.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.”“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.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.“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.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.”“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.Amber Wang, Yiwei Wang and Elsie Chen contributed research.