From the coronavirus frontlines
The Jack Ma Foundation and Ali Baba Foundation have released a report prepared from real-time notes of Chinese medical professionals who worked on containing and dissipating coronavirus in the past few months. These notes were compiled by the First Affiliated Hospital in Zhejiang and sent to various governments across the world as a model to follow in times when global infections are rising while China is limping back to normalcy.
Business Standard studied this report and found that many of these stringent measures would require a high degree of efficiency, discipline, obedience and massive infrastructural facilities hard to replicate in India.
One of the priority areas highlighted in the report is to re-design hospital areas to minimise cross-infection risks from those wheeled in for coronavirus diagnosis and treatment. The Chinese set up an exclusive fever clinic within a hospital and designated exclusive passages leading up to it. The Chinese adopted a ‘three-zones-two-passages’ strategy at these hospitals to control the flow of citizens. That involved demarcating a separate zone for contaminated people, another one for potentially contaminated people and a third one reserved as a clean zone for non-infected people. Each of these zones was separated by two buffer zones many feet apart. A fourth passage was specifically dedicated for contaminated medical items and other articles whose movements were monitored perpetually.
Identifying and isolating suspects
The Chinese used a stringent screening process to isolate as many suspected citizens as possible into special ‘suspected Covid-19 patient zones’. Chinese databases were harnessed to identify people who had travelled to risky regions in China, had been in contact with people with respiratory disease symptoms or were part of housing localities, offices and schools where two or more people had displayed coronavirus symptoms. If any two of such epidemiological events were observed, the citizen was a suspected coronavirus case. They, along with others who voluntarily reported symptoms, were made to undergo clinical tests.
A computed tomography (CT) scan along with a blood test was conducted. If their lungs showed patches and opaqueness, they were most likely infected with coronavirus. If the white blood cell count showed a decline, an analysis of the epidemiological and clinical manifestations would determine if the citizen would be classified as a suspected or a confirmed case.
The Chinese followed a strict code of separating suspected and confirmed patients. Suspects were isolated in separate rooms with their own bathrooms. Confirmed patients were housed in the same ward with each patient’s bed being arranged four feet apart. Families were strictly prohibited from visiting them but patients could communicate with the outside world using cell phones.
Controlling doctors and nurses
A crucial part of the Chinese strategy was to efficiently regulate the workflow of its medical staff. The report states that every member of the medical staff underwent a strict training regimen followed by an examination on wearing personal protection equipment. Anyone who failed the examination was not allowed to work in infected and infection-prone wards. The staff was divided into different teams with no team working more than four hours in an isolation ward. The frontline staff — doctors, nurses, technicians and logistics personnel — working in isolation areas were housed in separate ‘isolation accommodations’ and not allowed to step out or meet their families without the permission of authorities. Those permitted to return to a ‘normal life’ were subjected to Nucleic Acid Testing (NAT) to detect coronavirus, in addition to being tested for Severe Acute Respiratory Syndrome (SARS). Even if they tested negative, they spent 14 days in an isolation ward before reuniting with their loved ones.
Scorched earth approach to disinfection
Like people of most nations today, the Chinese were unsure about the method and levels of disinfection needed to be carried out in infected and isolated areas. The Chinese adopted the American ‘scorched earth’ military approach when it came to disinfection. Floors and walls of isolated areas were rubbed vigorously for 30 minutes with disinfectants containing a gram of chlorine in every litre of the disinfectant solution (safe levels of chlorine to disinfect water is between one milligram and four milligrams). This was done three times a day and whenever there were any signs of contamination.
The faecal matter of infected patients was treated with disinfectants containing at least 40 milligrams of chlorine in every litre of the solution for at least 90 minutes before being discharged into the municipal sewage network. Small blood spills of infected persons were covered, wiped and then absorbed with material containing 5,000 milligrams of chlorine for every litre of disinfectant. Bigger blood and other body fluid spills were treated with disinfectants containing double that quantity of chlorine.
If the patient defecated or vomited in the ward, her excreta and vomit were to be put in a container and treated with a disinfectant containing 20,000 milligrams of chlorine in every litre for two hours. The containers were further disinfected with a 5,000 milligrams chlorine-containing solution before being disposed of as medical waste. All syringes were put in a plastic box and similarly disinfected before disposal.
Plasma purifiers were switched on continuously and regularly disinfected to keep the air free of the virus. Dead bodies of patients were cautiously disposed of. All body openings like the nose, ear, mouth and anus were filled with cotton balls disinfected with chlorine or peroxyacetic acid. The dead body was draped in four disinfectant-filled layers of cloth and plastic before being sent off for cremation ‘as soon as possible’.
Chinese medical professionals also learnt about significant and specific symptoms of coronavirus patients and survivors while looking at their lung scans (see image below)
. In the initial stages, the scan of a victims’ lungs showed patches or ‘ground glass opacities’ generally located at the lungs’ periphery. As the disease progressed over the course of a week or so, the patches or wounds enlarged throughout the lung.
Chinese doctors found that in worst-case scenarios, when patients became critical, they developed a ‘white lung’. These scans were critical because even if nucleic acid testing were found negative, such patches in lungs could be taken as symptoms of a coronavirus infection and the victim would be isolated and put through treatment. A patient was discharged only after there was a significant improvement in these lung wounds caused by the virus. Any so-called ‘treated patient’ could not be discharged before her body temperature was normal for at least three days, nucleic acid testing was found negative in two consecutive tests, there were no other co-morbidities or complications from other diseases, respiratory problems had improved and the discharge was approved by a ‘multi-disciplinary medical team’.
Those discharged were asked to continue their isolation for at least two weeks in a separate room in their homes with their body temperatures being recorded twice daily. A specialised doctor was arranged for every patient after discharge. The doctor visited the patient within 48 hours, a week, two weeks and a month after discharge to conduct all tests and scans for coronavirus all over again during every visit. The doctors were asked to make follow-up phone calls three and six months after the patients’ discharge.
As the Chinese try to tell the world about their struggles and experiences in combating the outbreak which has claimed thousands of lives over the last few months, it remains to be seen what India can learn from its neighbour which has already ‘been there and done that’ in this fight against coronavirus.