Chindia Alert: You’ll be Living in their World Very Soon
aims to alert you to the threats and opportunities that China and India present. China and India require serious attention; case of ‘hidden dragon and crouching tiger’.
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Image copyright GETTY IMAGESImage caption Testing everyone in 10 days would be a huge challenge
China is drawing up ambitious plans to test the entire population of Wuhan, the city where the Covid-19 pandemic began.
The announcement came after the emergence of six new coronavirus cases in the city – the first ones since early April.
The authorities had originally promised to test all 11 million people in 10 days.
But it now appears they might be aiming for a less ambitious timetable.
How long will the testing take?
In late April, the Hubei provincial government reported 63,000 people were being tested in Wuhan every day.
And by 10 May, that figure had dropped to just under 40,000.
There are more than 60 testing centres across the city, according to the official Hubei Daily newspaper.
These have a maximum capacity of 100,000 tests a day at most, making it hard to see how a target of testing the entire population in just 10 days could be met.
So the authorities have indicated the tests will not all start and finish within the same 10-day period.
“Some districts [in the city] will start from 12 May, others from 17 May, for example,” the Wuhan Centre for Disease Control said.
“Each district finishes its tests within 10 days from the date it started.”
The authorities say they have now tested more than three million people in the city.
Wuhan University pathogen biology department deputy director Yang Zhanqiu told the Global Times newspaper he believed up to five million Wuhan residents may have already been tested.
The population of the city – originally 11 million – has also fluctuated over time.
The authorities said up to five million people had left the city for the lunar New Year holiday before it was locked down on 23 January.
The lockdown then lasted until 8 April, but it is unclear how many of these residents have now returned.
Should everyone be tested?
Wuhan University’s Yang Zhanqiu said there was no need to test everyone living in neighbourhoods with no reported cases.
Image copyright GETTY IMAGESImage caption There are worries about asymptomatic coronavirus cases
The authorities have said they will begin with people considered most at risk – for example in the older, more densely populated areas, as well as those in key jobs such as healthcare.
Also, people who have been tested in the previous seven days will not need to be tested again.
But Chinese Center for Disease Control and Prevention chief epidemiologist Wu Zunyou told state TV: “The virus could take longer to manifest itself in patients with weak immunity and these people are also prone to ‘on’ and ‘off’ symptoms.”
Yang Zhanqiu adds: “You’ll never know if people were infected after testing negative.”
And US-based Council for Foreign Affairs senior fellow for global health Yanzhong Huang said: “There would still be the possibility of isolated outbreaks in the future, which even large-scale testing will not address.”
Throughout the world, overworked health care professionals are being infected with Covid-19, yet the Lion City has kept numbers low
Preparation, planning, patient ratios and protective equipment have all played a part. Still, even the best gear cannot guard against discrimination
Medical staff walk to the National Centre for Infectious Diseases building at Tan Tock Seng Hospital in Singapore. Photo: AFP
Uncooperative patients, long hours and a lack of protective equipment are hampering health care workers across the world as they take the fight to the coronavirus, leading many to fall sick themselves.
In Malaysia, a pregnant woman who did not disclose that her father was infected tested positive after giving birth, leading to the shutdown of the entire hospital for cleaning. In the Philippines, nine doctors have died, two of whom had dealt with a patient who lied about her travel history.
In Spain, where more than 5,400 health care workers have been infected, accounting for about 14 per cent of the country’s patients, there are no longer enough workers to care for patients.
In Italy, which has more than 69,000 patients, the virus killed a doctor who had no choice but to work without gloves.
In the United States, which has surpassed China to become the world’s most infected nation with more than 83,000 people testing positive for Covid-19, hospitals are being overrun with patients.
Health care staff in the country say patients are packed into emergency wards and intensive care units (ICUs), further raising the risk of infections. They also report shortages of ventilators, face masks, gowns and shields.
The US Centres for Disease Control and Prevention on March 7 released interim guidelines saying health care workers exposed to the coronavirus could be asked to return to work as long as they wore face masks and were not showing symptoms, if their employers had no other manpower available.
Malaysian health workers at Kuala Lumpur International Airport. Photo: AFP
A REASON FOR OPTIMISM
However, amid all the gloom, Singapore’s experienceis being held up as a reason for optimism. The city state has reported more than 630 cases of infection, all of which are being treated in hospital, yet only a handful of its health care professionals have been infected. What’s more, even these cases, according to Vernon Lee, director of communicable diseases at the Ministry of Health, are thought to have been infected outside the health care setting.
Experts suggest this has been more than just luck, pointing to a case in which 41 health workers were exposed to the coronavirus in a Singapore hospital yet evaded infection.
The workers had all come within two metres of a middle-aged man with Covid-19 who was being intubated, a procedure which involves a tube being inserted into the patient’s trachea. The procedure is seen as being particularly hazardous for health workers as it is “aerosol generating” – patients are likely to cough.
The workers had not known at the time that the man had the virus and all were quarantined after he tested positive. However, on their release two weeks later, none of them had the virus.
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The case has come to widespread attention partly because the workers were wearing a mix of standard surgical masks and the N95 mask, which doctors see as the gold standard as it filters out 95 per cent of airborne particles.
The conclusion, published in The Annals of Internal Medicine this month, was this: “That none of the health care workers in this situation acquired infection suggests that surgical masks, hand hygiene, and other standard procedures protected them from being infected.”
Surgeon and writer Atul Gawande mentioned the case in an article for The New Yorker on how health care workers could continue seeing patients without becoming patients. He said there were things to learn from Asia and that some of the lessons came out of the “standard public health playbook”. In other words, there is much to be said for social distancing, basic hand hygiene and cleaning regimens.
A health worker in protective gear walks into a quarantine room at a hospital in Banda Aceh, Indonesia. Photo: AFP
COMING TOGETHER
With critical supplies running short in many countries, experts say it is increasingly vital that countries share both knowledge and resources.
To this end, China has been donating personal protective equipment to places including the Philippines, Pakistan and Europe. China’s richest man Jack Ma is donating 1.8 million masks, 210,000 Covid-19 test kits and 36,000 pieces of protective clothing to 10 countries in Asia.
At the same time, doctors are encouraging the Western world to learn from Asia.
Infectious diseases expert Leong Hoe Nam said that being “bitten by Sars” (severe acute respiratory syndrome) in 2003 had prepared Asia for Covid-19, while Western countries were not similarly prepared and hence lacked sufficient protective equipment.
He pointed to how about 2,000 health care workers had fallen sick in China early in the outbreak because workers did not initially have protective gear. The trend reversed as equipment became available.
“Once the defences were up, there were very few health care workers who fell sick at work. Rather, they fell sick from contact with sick individuals outside the workplace,” he said.
Malaysia is a case in point. While it has reported 80 health care workers falling ill, most are thought to be community infections.
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In a webinar organised by Caixin Global on Thursday night, Peng Zhiyong, an intensive care specialist at Zhongnan Hospital of Wuhan University, shared how they managed a shortage of personal protective equipment early on in the outbreak by rationing workers to two sets of gear per shift.
Meanwhile, in the Philippines, doctors from Manila’s Chinese General Hospital held a video conference call with doctors in Zhejiang to learn from China’s experience of treating Covid-19 patients.
Crowdsourcing platforms have also been created to share advice. The Brigham and Women’s Hospital in Boston has released guidelines for treating critically ill patients and its website includes information from Chinese doctors.
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The Jack Ma Foundation has also launched an online platform for doctors and nurses around the world to share knowledge on fighting the virus. “One world, one fight,” it said in a tweet.
Associate Professor Jeremy Lim from the global health programme at the Saw Swee Hock School of Public Health said it was crucial for countries to work together.
“Viruses don’t respect borders. Countries have to share information and help each other as we are only as strong as the weakest link. Any country can become a reservoir of disease and the world may then be forced to endure a ping-pong of outbreaks over and over again.”
And the advice of Lee, at Singapore’s Ministry of Health? “Practise good hygiene and wash hands regularly.”
Indonesian medical staff administer mass testing for Covid-19 in Bekasi, West Java. Photo: AFP
SINGAPORE, A CASE STUDY
Amid this sharing of advice, it is often Singapore that is held up as an example to replicate. Despite the country grappling with a rising load of Covid-19 patients, most of whom have recently returned to the city state from abroad, its health care system has continued to run smoothly. Doctors say this is because it has been preparing for a pandemic ever since Sars caught it by surprise. During the Sars outbreak, health care workers accounted for 41 per cent of Singapore’s 238 infections.
Consequently its hospitals swung into contingency planning mode early on in the coronavirus outbreak, telling staff to defer leave and travel plans after its first cases emerged.
Meanwhile, its hospitals swiftly split their workforces into teams to ensure there were enough workers if the outbreak worsened, and to ensure workers got enough rest.
Singapore has 13,766 doctors, or 2.4 doctors for every 1,000 people. That compares to 2.59 in the US, 1.78 in China and 4.2 in Germany. Places like Myanmar and Thailand have fewer than one doctor for every 1,000 people.
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“The objective is that you can run essential services with the greatest amount of security. Make sure functional units have redundancy built in, and are separate from each other. It depends on what you feel is sufficient to carry on services if one team is affected, factoring in rest periods and some system of rotation,” said Chia Shi-Lu, an orthopaedic surgeon.
The key is to ensure a good doctor-to-patient ratio and ensure there are enough specialists for the critical work, such as doctors and nurses who can provide intensive care, and know how to operate mechanical ventilators or machines to pump and oxygenate a patient’s blood outside the body.
At the emergency department where paediatrics emergency specialist Jade Kua treats Covid-19 cases in addition to regular emergencies, doctors are split into four teams of 21. Each team takes alternate 12-hour shifts and does not interact with other teams.
“We are in modular teams so the teams move together. So you and I would both do morning, off, night, off, morning off. Together. And then the other teams would do the same and we don’t intermingle,” said Kua.
US now has world’s most coronavirus cases, surpassing China
Chia, who works at the Singapore General Hospital, said doctors had been split up according to their functions.
“We try not to meet at all with the other teams as much as possible. We’ll just say hi from across the corridor. Meals are the same. All our cafeterias and everything have got social distancing spaced in already,” said Chia, who is also a member of parliament and chairs a shadow committee on health.
Chia said the health care system could also tap on doctors in the private sector.
Not every country has a plan like this. Last year’s Global Health Security Index by the Economist Intelligence Unit found that 70 per cent of 195 countries scored poorly when it came to having a national plan for dealing with epidemics or pandemics. Almost three in 10 had failed to identify which areas were insufficiently staffed. In India, with a population of 1.3 billion, only about 20,000 doctors are trained in key areas such as critical care, emergency medicine and pulmonology.
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In contrast, Singapore published its first Influenza Pandemic Preparedness and Response Plan in June 2005 and has since honed it to a tee. Hospitals regularly war-game scenarios such as pandemics or terrorist attacks and the simulations are sometimes observed by the Ministry of Health, which grades the performance and recommends areas for improvement.
The plan also covers the need to stockpile equipment to avoid the sort of shortages many countries are now facing, another lesson inspired by Sars when masks, gloves and gowns were in short supply.
In a pandemic preparation paper published in 2008, Singapore public health specialist Jeffery Cutter wrote that Singapore’s stockpile was sufficient to cover at least 5 to 6 months’ use by all front-line health care workers.
During the Covid-19 outbreak, it has also told citizens to not wear masks so it can conserve supply for medical staff.
Having enough protective gear has reassured Singapore’s health care workers such as Kua, a mother of six who blogged about her experience fighting Covid-19. Kua said: “I’m safe and my family is safe.”
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SOMETHING YOU CAN’T GUARD AGAINST
Despite the many positives to emerge from the Lion City, its health care workers are struggling with another problem: discrimination.
While in France, Italy and Britain, residents cheer health care workers from their windows, in Singapore health care workers are seen by some people as disease carriers.
“I try not to wear my uniform home because you never know what kind of incidents you may encounter,” said one Singapore nurse. “The public is scared and wearing our uniforms actually causes quite a bit of inconvenience. One of my staff tried to book a private-hire car to the hospital for an emergency and she was rejected by five drivers.”
There is a similar stigma in India, where the All India Institute of Medical Sciences has appealed to the government for help after health workers were forced out of their homes by panicked landlords and housing societies.
“Many doctors are stranded on the roads with all their luggage, nowhere to go, across the country,” the institute said in a letter.
Lim, from the Saw Swee Hock School of Public Health, said the worst human impulses and “every man for himself” attitudes could emerge in crises and “that is exactly why governments have to step in”.
Discrimination could affect both the performance and motivation of health care workers, Lim warned.
Meanwhile, when health care workers are infected, it creates a “triple whammy” threat.
“It means one fewer professional in an already-strained system, another patient to care for and, potentially, a team of colleagues who need to be quarantined,” said Lim.
“We must do everything possible to keep our health care workforce safe and free from Covid-19.” ■
Teams from Shanghai, Guangdong – including experts who helped tackle Sars – arrive in Wuhan to lend their support
Tencent, JD.com, Lenovo among raft of private firms offering financial aid to those battling deadly outbreak
Doctors and nurses from across China are being dispatched to help tackle the coronavirus epidemic in Hubei province. Photo: Xinhua
Chinese authorities and private enterprises are stepping up their support for embattled medical teams in Hubei province as they continue to fight the coronavirus epidemic, while neighbouring governments ramp up their efforts to prevent its further spread.
Hospitals across Wuhan – the city at the centre of the outbreak – have been overwhelmed by the flood of patients and doctors are becoming increasingly frustrated at the lack of support, both in terms of supplies and personnel, they have received.
But national bodies say they are responding to the crisis.
On Saturday, China’s National Health Commission (NHC) said that six medical teams comprising 1,230 staff had been set up and dispatched to help fight the deadly virus in Hubei.
Three medical units from Shanghai, Guangdong and the armed forces had already arrived in the province, it said, though did not make clear if they were in addition to or part of the six teams.
Chen Dechang, a doctor from Ruijin Hospital in Shanghai who is among those sent to Hubei, said it was important there were more medical staff on the scene.
“We can help save more patients in the intensive care unit if we are on the front line,” he said.
Authorities in Shanghai have also sent 81 ECMO (extracorporeal membrane oxygenation) life-support machines to Jinyintan Hospital, which is one of the designated facilities treating patients in Wuhan.
The ECMO technique – which involves removing blood from a person’s body, removing the carbon dioxide and oxygenating red blood cells before pumping them back into the patient – has already been used on one critically ill patient at Wuhan University’s Zhongnan Hospital, according to Shanghai-based news outlet Thepaper.cn.
Though the report did not say how effective the treatment had been.
Medical teams in Wuhan have been under huge pressure since the outbreak began. Photo: Xinhua
The team from Guangdong comprised 42 doctors and 93 nurses, the NHC said. The deployment came after a group of current and former medical staff from Southern Medical University in Guangzhou – who had helped tackle the Sars (severe acute respiratory syndrome) outbreak in 2002-03 – signed a petition saying they were willing to help in Wuhan.
“We are a team of experienced practitioners who fought Sars,” they said in the petition, a copy of which was posted on the social media accounts of Communist Party mouthpiece People’s Daily.
“We cannot back away from our responsibility to help 17 years later as people are facing the outbreak of a new coronavirus. We are willing to be deployed to the front line to make our contributions.”
A team of 135 doctors from Chongqing arrived in Wuhan on Friday evening, the NHC said, without elaborating.
A medical team from Guangdong province prepares to travel to Wuhan. Photo: Xinhua
As well as the wave of medical support, several private companies said they had provided financial support to help fight the epidemic.
According to Chinese media reports, Shanghai Ocean Forest Assets has donated 10 million yuan (US$1.4 million) to the cause, while Shanghai-based asset management firm, Jinglin Assets is coordinating efforts to buy urgently needed medical supplies from South Korea and Japan.
Shenzhen’s Fantasia Holdings said it would donate 6 million yuan and send medical supplies, including surgical masks, to Wuhan, while tech giant Tencent said it would donate 300 million yuan from its charity. E-commerce platform JD.com said it had donated 1 million surgical masks and 60,000 other medical items.
Chinese smartphone manufacturer Xiaomi said on Friday it had sent a first batch of medical equipment – masks and thermometers worth more than 300,000 yuan – to Wuhan, while tech firm Lenovo said on Saturday it would donate all of the IT equipment required by the new specialist treatment centre being built in the city.
Authorities set a target to have the 1,000-bed facility up and running within six days of starting construction.
Aside from the support from the private sector, state lender China Development Bank on Friday issued a 2 billion yuan emergency loan to Wuhan, while a day earlier, China’s finance ministry said it had allocated 1 billion yuan to authorities in Hubei to help tackle the epidemic.
Across the country, authorities have introduced a number of measures to help prevent the further spread of the coronavirus, including the closure of all cinemas in Shanghai.
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Also on Saturday it was reported that Liang Wudong, a doctor at Xinhua Hospital in Wuhan, had become the first medical professional to die after treating people infected with the virus.
Liang, 62, was suspected of having contracted the virus last week and had been transferred to Jinyintan Hospital for treatment. He died at 7am on Saturday, Thepaper.cn reported.
According to official figures, 41 people have been killed by the coronavirus and there have been more than 1,280 confirmed cases. The vast majority are in the Chinese mainland, but there have also been confirmed cases in Hong Kong, Macau, Taiwan and eight other countries, including the United States and Europe.
Tens of millions of people in cities across Hubei are effectively on lockdown after the introduction of travel bans to help control the spread of the virus.
Image copyright GETTY IMAGES
Image copyright GETTY IMAGES
CHINDIA ALERT: You'll be living in their world, very soon 