'Made of meat, not iron': China's doctors fight Covid-zero output wave

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China’s medical staff are being asked to work while sick and retired workers are being called back to duty as frontline health workers bear the brunt of Beijing’s about-face from its tough Covid-zero policy.

Experts have warned that the situation will deteriorate as the virus spreads from China’s big cities to rural areas with poorer health systems, as the country grapples with one of the world’s biggest Covid outbreaks.

“We can work hard, we can work overtime, but at the end of the day, medical staff, like others, are made of meat, not iron,” said a Beijing doctor surnamed Ning. “As dedicated as we are, we have physical and mental limits.”

Beijing’s abrupt decision to abandon its zero Covid containment strategy – which used mass testing, quarantines and lockdowns – has allowed the virus to proliferate in China’s biggest cities. After lifting some restrictions this month, the National Health Commission announced on Monday that arriving travelers would not need to be quarantined from Jan. 8 as it downgraded its classification of the disease.

Spotty vaccination coverage among the elderly and low supplies of oxygen and fever medication have led to overcrowded emergency rooms in places like Beijing, Shanghai and Guangdong, putting a particular strain on health workers.

The Financial Times interviewed five doctors and nurses, who reported that working conditions were rapidly deteriorating as staff infected with Covid. Some of those interviewed did not give their full names for fear of reprisals from their employers or the government.

“The policy turnaround doesn’t mean we’re moving from the hard way to the easy way. Instead, we are entering a new hard mode,” said a doctor surnamed Ying, who works at one of Shanghai’s biggest hospitals. “We have to postpone all non-emergency operations to secure emergency room manpower.”

Coronavirus patients in a hospital lobby
Coronavirus patients wait in a hospital lobby in southwest China’s Chongqing © Noel Celis/AFP/Getty Images

A doctor named Dong in the southern province of Guangdong said health authorities had requested his clinic to treat positive cases after designated Covid hospitals were raided. But Dong’s clinic has yet to receive the drugs and antigen testing kits it needs to handle coronavirus patients.

A group on the WeChat messaging app that Dong created for patients “multiplied a dozen times” in members last week. “I can’t do much for our patients right now,” he said. “I’m not sure how much longer we can go on without medication and guidance from above.”

Doctors at Shanghai Huashan Hospital said their fever clinics in the city center saw a five-fold increase in patient numbers, according to an interview with state media.

After closely monitoring the health of its citizens with mass testing, China stopped providing comprehensive public data on the latest outbreak and drastically reduced the official definition of Covid cases and deaths.

The country has reported no new deaths on Christmas Day and the day after and only a handful of deaths since the outbreak began this month. FT reporters, however, discovered a sharp increase in activity at Beijing crematoriums and witnessed bodies in Covid hospital wards. Internal estimates show that 250 million people may have contracted the virus in the first 20 days of December.

Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations think tank, said local authorities had taken a “laissez-faire approach” and were pushing for “the population to achieve herd immunity as soon as possible”. He added that the sudden removal of restrictions caused “maximum spread of the virus” and “maximum pressure on hospitals”.

Some hospitals in Beijing are trying to hire retired doctors and nurses to deal with the surge in patients, according to recruitment notices seen by the FT, or have instructed staff to work while the temperature is below 38C.

Duan Xiaoqing, head nurse at the department of neurology at No. 3 Luoyang Hospital in central China’s Henan Province, said all 38 staff had been infected but continued to work with sore throats and high fever. “We have nowhere to go. It is our duty and obligation,” she said in a video clip widely circulated on WeChat and local TV.

But concerns have grown over the safety of health care workers after the sudden death from heart failure of a medical student surnamed Chen, who was working as an intern at a hospital in Chengdu, southwest China. He was asked to continue working after testing positive days before he died, according to two of his colleagues.

Graph showing that China's western provinces have fewer doctors to deal with the Covid surge

Experts have expressed fears that the pressure on hospitals in coastal cities will be magnified in the country’s poorer interior. China’s western provinces have fewer doctors and nurses per capita of the population, provincial statistics show.

“Now we are seeing more people getting infected in rural areas,” Huang said. “A lack of confidence in the rural health system will lead to an influx of people leaving rural hospitals for urban centers, which will increase stress.”

In a city in southwestern Sichuan province with a population of less than half a million people, a doctor at the local hospital said staff were feeling increasingly stressed as fever patients crowded the offices. “It is the first time in three years that we have dealt directly with Covid cases,” said a doctor named Xu. “We have little related experience and training. 🇧🇷 🇧🇷 and the medicines are in short supply.”

Xu tested positive but was asked to continue working. “More than half of the medical workers are sick, but every hour more patients come here for treatment. [We] have no choice but to keep working.”

Doctor Ning, from Beijing, said one of the most stressful aspects for medical staff is that they are being blamed by the public for the difficult situation, with videos online accusing doctors of failing to treat Covid patients properly or in a timely manner.

He also felt guilty and worried about the legal risks of working infected because of the danger of exposing vulnerable patients to Covid.

“No matter which path we choose, medical staff are the border fighters who are taking the hit,” he said.

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