D. Joy Riley, M.D., M.A.
Executive Director
One thing is clear: COVID-19, the newest coronavirus to infect humans, has our attention. Locally, people planning to travel—almost anywhere—are wondering about where to obtain face masks. As of Tuesday of this week, reports the New York Times, the United States had 57 cases, with 40 of those related to the Diamond Princess cruise ship that docked in Japan. The NYT article further reported,
| “We cannot hermetically seal off the United States to a virus,” Alex M. Azar II, the secretary of health and human services, told a Senate panel on Tuesday. “And we need to be realistic about that.”
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Azar estimated that U.S. health care workers may need up to 300 million masks if there is an outbreak of the virus here.
Wuhan, China, has had several months lead-time in dealing with this virus. A 34-year-old ophthalmologist, Dr. Li Wenliang, saw in December seven cases of a viral infection that reminded him of Severe Acute Respiratory Syndrome (SARS), caused by another coronavirus. He sent a message to other physicians in a chat group to warn them about the virus, and to suggest they wear protective gear. Within days, he was summoned by the Public Security Bureau, who reprimanded him for “making false comments” and “solemnly” warned him about inter alia his “impertinence” and “illegal activity.” Dr. Li returned to work, where he contracted COVID-19, and sadly, after three-plus weeks in the hospital, died from the virus. At some point, there was apparently an apology made to Dr. Li for the treatment he had received from officials early in the outbreak.
Others besides Dr. Li have expressed concern about the COVID-19 situation in China. On 24 February, The Lancet Global Health published online (open access) a letter from two of the 14,000 nurses who have come from other parts of China to Wuhan to help with the outbreak. Yingchun Zeng and Yan Zhen wrote a letter, “Chinese Medical Staff Request International Medical Assistance in Fighting Against COVID-19.” The nurses reported:
| The conditions and environment here in Wuhan are more difficult and extreme than we could ever have imagined. There is a severe shortage of protective equipment, such as N95 respirators, face shields, goggles, gowns, and gloves. The goggles are made of plastic that must be repeatedly cleaned and sterilised in the ward, making them difficult to see through. . . . When wearing a mask to speak with patients, our voices are muted, so we have to speak very loudly. Wearing four layers of gloves is abnormally clumsy and does not work—we can’t even open the packaging bags for medical devices, so giving patients injections is a huge challenge. In order to save energy and the time it takes to put on and take off protective clothing, we avoid eating and drinking for 2 hours before entering the isolation ward. . . .Some nurses have fainted due to hypoglycaemia and hypoxia.
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The nurses end with a plea for “nurses and medical staff from countries around the world to come to China now, to help us in this battle.”
By 27 February, however, the article had been retracted by The Lancet. Perhaps a few red flags were missed in this document?
1) The nurse-authors (or “nurse-authors”?) state they traveled to Wuhan on 24 January 2020. It is unclear, however, how that would have happened. On 22 January, China advised against traveling to Wuhan. Additionally, “Chinese authorities have suspended air and rail travel in the area around Wuhan.”
2) The nurse-authors (or “nurse-authors”?) report quadruple gloving, and how hard that makes it to take care of patients. The description of quadruple-gloving is given despite the claim at the outset of the article of severe shortages—including of gloves! Compare this to precautions for Ebola virus. Ebola has an approximate 50% mortality rate, and physicians and nurses are required to double-glove.
3) The nurse-authors (or “nurse-authors”?) describe inhuman working conditions, yet somehow they have found the time to write an article for The Lancet. Exemplary is one possible description, but then, so is suspension of belief.
4) The plea at the end of the letter seems rather unattainable, given the current travel advisories and restrictions globally. The U.S. Department of State has issued a Level 4 Travel Advisory: “Do not travel to China due to novel coronavirus.”
5) Finally, a letter to The Lancet is certainly more public than a posting to a chat group. The international reach of such a letter is inevitable. If the authors do exist, one wonders about the consequences of such an article—besides a black eye to The Lancet.
MORE:
See article on quarantine ethics here.