The Washington Post - 22.02.2020

saturday, february 22 , 2020. the washington post eZ sU A

them to contact government hotlines instead of making their pleas public. The nationwide triage and the anger among some patients has become a politically sensitive issue, said Yanzhong Huang, who studies the Chinese health system at the Council on foreign rela- tions. “When you frame the issue as an existential threat and use war slogans, it might lead to extraor- dinary measures that have unin- tended consequences,” Huang said. But when ordinary Chinese hear stories of people being de- nied medical care, he added, “people might say, ‘ This is ridiculous.’ ” Suffering from advanced kidney cancer, Yu Hongwei was one of the patients discharged by Wu- han Union Hospital’s tumor center on Jan. 25 — just as he was about to enter surgery — to make way for coronavirus patients. Doctors apologized and said it wasn’t their decision, Yu’s sister Hongyan recalled. Back at home, Yu’s skin turned yellow as his pancreas failed. He vomited what little he ate and was kept alive by a nutrient drip. After a week of online petitioning and volunteer networks lobbying for Yu’s case, a smaller district hospital in Wuhan agreed to admit Hongwei. A surgeon from Wuhan Union rushed over to operate on feb. 16. A day later, a relieved Yu Hong- yan told The Post that what saved her brother was the kindness of volunteers and doctors, and a hospital that bent its rules, after Wuhan’s broader health system broke down. “We never gave up,” she said. “We had to beg for help online, because there was no other way.” g [email protected]

Wang yuan contributed to this report.

down with emotion. The family has been watching the baby doze round-the-clock. They celebrate when she opens her eyes. “We are waiting and taking care of her as best as we can,” Zhao said. “We only know that she is showing a strong survival in- stinct.” The circumstances have forced many Chinese to turn to remote consultations. Ping An Good Doc- tor, a Shanghai-based company owned by the Ping An insurance giant, said that patients have used its smartphone app to talk to doctors 1.1 billion times since the epidemic began, and that average daily consultations are nine times higher than usual. Still, the calls do little to soothe anxious patients.

‘We had to beg for help’ After being diagnosed feb. 15 with a five-inch tumor on her liver, a 27-year-old woman with the last name Liu said she was told by a doctor to travel urgently from the outskirts of Wuhan to the city center to seek a surgeon. A day later, her friends arranged a ride with one of the few designat- ed drivers still allowed on the streets, and Liu arrived in down- town Wuhan only to discover that surgical departments were closed. In the days since, she has phoned doctors about whether the tumor is malignant, Liu said. “That only lessens the psycho- logical affliction a little, but it does nothing about the underly- ing physical condition,” Liu said from her sister’s Wuhan apartment while she waits for oncology departments to open. “I still feel helpless.” A uthorities this week began censoring patients seeking help on social media and instructed

patients across China who have been turned away from hospitals, but there are countless more who don’t know how to use the Inter- net to ask for help. Chen’s colleagues call those seeking help, assess their condition and then connect the sickest with the few nearby hospitals that will still accept them. The patients often need dialysis or sur- geries or urgent medication re- fills, Chen said, but many are refused because hospitals don’t want to risk admitting patients or conducting invasive procedures that could leave them infected. The group has gotten help for more than 40 seriously ill patients, but five have died at home while awaiting treatment, Chen said. “We talk to people who are waiting two, three, four days while their condition steadily de- teriorates,” she said. At the end, she said, “they just run out of options.” With the clock ticking, many families with sick or dying say they face an array of obstacles. Week-old An An in southwest Hu- bei was suffering a blood disorder that needed an advanced hospital’s attention, her father and grandmother said. Large hospitals across Hubei were subsumed by the virus and had little capacity to handle special pediatric cases, they said. Au- thorities were offering to issue a special travel permit for them to leave the otherwise locked-down province, but hospitals in neigh- boring Hunan were wary of ac- cepting patients from Hubei because they are seen as more likely to carry the virus. “Does she have a week to live? A month? A day?” said An An’s grandmother, Zhao Yulong, taking over the speakerphone after her father, Wang Hongbin, broke

The government, meanwhile, has repeatedly asked the public for its sacrifice and forbearance. Chinese leader Xi Jinping often calls for a “people’s war” against the virus, and state media refer to the containment effort as “zh- anyi,” a Chinese pun that is a homophone with “military cam- paign.” “Since the onset of this epidemic, the Chinese government, put- ting people’s h ealth first, has done its utmost to make sure every patient receives timely treatment,” foreign ministry spokes- woman Hua Chunying told re- porters this month. “A t the same time, we have seen so many touch- ing stories of people sacrificing themselves for the greater good.”

An obstacle course Chen Xuanyi, a graduate stu- dent in Australia who is part of a network of 30 volunteers trying to lobby hospitals to accept people seeking medical attention, said she has compiled a list of 175 sick

across a country rejecting large numbers of patients as a precau- tionary measure is rare. “I’ve never heard of this hap- pening as a precaution,” s aid Eric To ner, a senior scholar at the Johns Hopkins Center for Health Security who has advised U.S. governments and hospitals on preparedness for catastrophic events. officials at the World Health organization have mostly praised Chinese leaders for taking “deci- sive” measures that few other governments would have been able to take. In late January, authorities locked down Hubei, effectively shutting off 55 million people from the outside world. Cities have rolled out draconian measures such as suspending vehicle traffic, limiting the number of days residents can leave their homes, and closing hospitals — steps national health officials say are proving effective in minimiz- ing contagion.

moan, his condition worsening.
“A ll the lives not touched by the
coronavirus — are those lives not
worth saving?”
As the outbreak’s second-order
effects ripple across China, the
breakdown of the health system is
posing a logistical and ethical
challenge for the government.
Chinese social media has been
flooded by so many pleas under
the hashtag “#NonPneumonia -
PatientSeekingHelp” t hat author-
ities this week began censoring
posts. Although nationwide sta-
tistics are not available, families
and networks of volunteers who
monitor such cases say there are
patients dying at home because
they cannot access timely care.

sacrificing some
to save others

In phone conversations with
The Washington Post, six families
with sick relatives across China
described their frustration as the
country mobilizes a vast opera-
tion to combat an epidemic its
leaders consider their public
health and political priority.
Some individuals asked that their
names be withheld in full or in
part for privacy reasons.
one western Hubei family was
near collapse seeking aid for their
week-old baby, whose blood dis-
ease case was being rejected by
hospitals. A man from Inner mon-
golia rented an apartment in Bei-
jing and walked to a hospital
every day for weeks to check if
doctors would operate on his fa-
ther’s tumor. Another woman in
the capital who was on the verge
of kidney failure pleaded for help
with operators on several city
emergency hotlines, who said
there were no facilities that could
provide dialysis. She was admit-
ted to a hospital Tuesday only
after she aired her case online and
volunteers came to her aid.
“I’m not saying there should be
equal weight between epidemic
patients and everyone else, but
why not set aside a few more
hospitals for non-fever patients?”
said Nie Wenjie.
In an interview, Gordon Liu, a
Peking University professor who
serves on the Chinese National
Health Commission’s e xpert advi-
sory committee on the novel coro-
navirus, said infection contain-
ment policies have “lost balance.”
“To avoid 1 percent chance of
infection, are we choosing 99 per-
cent chance of so many people
suffering?” Liu said. “To create a
situation that exacts a greater
human cost than the virus itself —
that would be the greatest regret
of all.”
Hospitals, including in the
United States, have been known
to turn away people trying to visit
patients during influenza out-
breaks. Hospitals worldwide also
seal off wards when transmissible
diseases break out inside, such as
during the SArS (severe acute
respiratory syndrome) epidemic
in 2003. But public health experts
say the phenomenon of hospitals

virus from A

China’s

health

system

struggles

BY LENNY BERNSTEIN AND SIMON DENYER

Twenty-eight U.S. residents
flown home from the Diamond
Princess cruise ship are infected
with coronavirus, and health offi-
cials expect to see more positive
cases among the evacuated pas-
sengers in coming days, the Cen-
ters for Disease Control and Pre-
vention said friday.
The passengers from the ship,
along with three infected people
previously returned from Wuhan,
China, bring the total number of
evacuees with the virus in the
United States to 31. An additional
13 people in the United States ei-
ther picked up the infection by
traveling to China or from close
contact with a family member
who h ad b een i n China.
The passengers are “considered
at high risk of infection and we do
expect to see additional cases,”
Nancy messonnier, director of the
CDC’s National Center for Immu-
nization and respiratory Diseas-
es, s aid in a media b riefing.
The sharp rise i n the number of
U.S. p atients came on a d ay o f grim
news about t he spread of covid-19,
the viral respiratory disease that
has afflicted more than 76,0 00
people and killed more than
2,300, mainly in China.

The number of cases in South Korea surged to 346 , with more than half linked to a secretive reli- gious movement with a messianic leader. Iran confirmed 18 cases, including four deaths, centered in Qom, a Shiite holy city south of Te hran. In Beijing, two hospitals were put under quarantine amid fears of a coronavirus outbreak in China’s capital, with one district reporting an “infection density” second only to Wuhan, t he e picen- ter o f the epidemic. The Japanese government quar- antined 3,700 passengers and crew members aboard the Diamond Princess for nearly two weeks, a decision that allowed the virus to sweep through the ship, which one Japanese expert has said was plagued by poor infection control. Now, 634 of those onboard have tested positive — the second- largest number in any place outside China. Last weekend, the State Depart- ment flew 329 U.S. residents home from the ship on two chartered flights. The Washington Post reported Thursday that the evacuation was delayed for hours by a last-minute disagreement among government officials. As the passengers arrived at the airport in buses, test results came back indi- cating 14 people waiting to evacu-

ate were infected with coronavirus. CDC officials did not want to put sick people on the plane with uninfected passengers, but they were overruled by the State De- partment and another top government health official. At friday’s briefing, Ian Brown- lee, principal d eputy assistant s ec- retary in the State Department’s Bureau of Consular Affairs, said the tests for those 14 people were conducted 48 to 72 hours before they boarded the buses, i ndicating they were i nfected o n the s hip. It’s not clear where all the infected Americans are being treated. E leven are receiving care at t he University of Nebraska medical Center. five are receiving care at hospitals around Travis Air force Base near Sacramento, where one plane landed, and two are being treated near Lackland Air force Base near San Antonio, where the other flight a rrived. Dozens of other Americans from the cruise ship who tested positive were taken off the ship before the evacuation and are still in Japanese hospitals. They in- clude Wayne and S usan Hidalgo of Kansas City, Kan., who wondered why the ship continued to allow people to mingle freely onboard, even after a passenger onboard was d iagnosed with the virus. one

of the people Wayne H idalgo regu- larly dined with had shared a bus with the infected passenger. “A s time went on, after a day or so, I wondered, why are we eating dinner with these people? Why is everybody out dancing? Why are they having these shows going on?” t he 77-year-old said in a tele- phone interview f rom his h ospital bed in Tokyo. Japan’s Health ministry said 88 Americans aboard the ship have been diagnosed with covid-19. most have been taken to hospitals on l and. The Hidalgos’ children want them brought home, arguing that it’s “not fair” t hey’ve been left in Japan while o ther A mericans were evacuated. Wayne Hidalgo said he knows the couple can’t leave until they are given the all-clear by Jap- anese doctors. They e ach need t wo consecutive negative tests. Wayne H idalgo s aid he is suffering from mild pneumonia. Susan Hidalgo h as no symptoms. Wayne Hidalgo said he has become “more and more confident” with the medical care he is receiving as time goes by, and is “totally impressed” with his hospital, his doctor — who speaks fluent Eng- lish — and nurses who are “won- derful a nd f unny.” “Susan, m y wife, and I h ave both

accepted the fact that we’ve got to stay m entally healthy, and exercise some, and stay h ere,” he said. An official from the U.S. E mbas- sy has visited, bringing them clothes and local currency, while Princess Cruises, the cruise line that operates the ship, h as been in contact every day. on feb. 1, a Diamond Princess passenger from Hong Kong, who had left the ship Jan. 25, was diagnosed with the virus. Princess Cruises said it learned about this on social media the next day and reached out t o Hong Kong a uthorities. on feb. 3, the captain told passengers the ship would wait in Yokohama while Japanese Health ministry officials assessed the situation. But passengers still min- gled, including at a buffet dinner on feb. 4. It was only later they were told t o stay i n their cabins. John Haering, 63, from To oele, Utah, said he came down with a fever that reached 103.6 degrees on feb. 10, but was not seen by a doctor until 5 p.m. the following day. f or 2^1 / 2 days, his wife, m elanie, put wet cloths on his forehead to keep him cool, replacing them every 20 m inutes. He wasn’t evacuated from the ship to a To kyo hospital until feb. 13. His fever had subsided by then. He h as been in isolation ever

since, with very little human contact. He takes his own tempera- ture, and meals are passed through a stainless-steel cabinet with doors on two sides. once a day, a nurse in full protective gear comes in to clean his r oom. He s aid h e has received j ust one phone call from the U.S. Embassy and no contact with Carnival Corp., the British-American company based in Doral, fla., that owns Princess C ruises. “I have, as my doctor described it, bad pneumonia. I’m fighting each day to stay positive and healthy,” he said. “I don’t need the uncertainty o f what will happen to me weighing o n my t houghts.” In a statement, the U.S. State Department said “ the welfare and safety of U.S. citizens abroad” i s one of its highest priorities, including providing “all a ppropriate consular assistance” to U.S. citizens remaining in Japan, and vis- iting those who have been hospi- talized from the Diamond Prin- cess. [email protected] [email protected]

denyer reported from yokohama. Lena sun in Washington, amanda coletta in toronto, anna fifield in Beijing and min Joo Kim in seoul contributed to this report.

Infections increase among cruise ship passengers evacuated t o U.S.

associated press Medical workers at a hospital in Wuhan transport the body of a person who died Feb. 16 after being infected with the coronavirus. Because Hubei province’s health system has been overburdened by the outbreak, many patients suffering from other health problems have had difficulty finding hospitals willing or able to treat them.

agence france-presse/getty images Doctors wearing protective suits treat a patient with coronavirus at Wuhan red Cross Hospital in Hubei province on Feb. 16.

The Washington Post - 22.02.2020

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