A “Tragic Battle”: At the Forefront of China’s COVID Crisis

Seated in wheelchairs or stretched out on stretchers, patients crowd every corner of the hospital emergency room in northern China.

They crowd into the narrow spaces between the elevator doors.

They surround an inactive metal detector.

And they line the walls of a corridor that echoes with coughs.

At best, Chinese hospitals were already overwhelmed, underfunded and understaffed.

But now that COVID-19 is spreading freely in China for the first time, so is the medical system up to the limit of its possibilities.

The scenes of despair and misery at Tianjin Medical University General Hospital, captured in one of several videos reviewed by The New York Timesreflect the growing crisis.

Even as COVID cases rise, frontline healthcare workers are also battling rampant infections within their own ranks.

So many have tested positive for the virus in some hospitals that the few remaining say they are forced to do the work of five or more colleagues.

To make sure there are enough staff in the room, some centers have waived requiring doctors and nurses to get tested before work.

A doctor in the central city of Wuhan said his hospital staff had been so depleted that a neurosurgeon in his department recently had to perform two operations in one day battling the symptoms of COVID.

“The hospital was operating at its limit,” said Dr. Judy Pu, whose ward usually has 10 to 15 nurses and now just a couple.

“Between 80 and 90% of the people around me have been infected.”

China was the first country to experience the COVID panic when it emerged from Wuhan in 2019.

Then, over the past three years, the country has largely suppressed the virus with a costly mix of mass testing, stringent lockdowns and border closures.

The government could have used the time to strengthen its health system by stockpiling medicines and building more intensive care units.

It could have launched a huge vaccination campaign targeting the millions of vulnerable elderly people who were reluctant to get a shot or a booster.

Yet China did little, slipping back into crisis mode as it did in the early days of Wuhan.

The true extent of China’s health emergency has been difficult to gauge, in large part because the government suppressed mass testing after abruptly lifting the country’s strict “zero-COVID” measures.

The country’s inadequate vaccination levels, as well as a lack of herd immunity, have raised fears that the death toll could reach the levels seen at the start of the pandemic in places like the US, Western Europe and, more recently , Hong Kong.

The data released by local authorities in recent days seem to confirm that the virus is spreading, with reports from various cities and provinces recording hundreds of thousands of daily infections.

Doubts also abound about the number of COVID-related deaths China is reporting, as authorities only count deaths from respiratory failure directly related to a COVID infection.

Officially, seven people have died from the virus since pandemic rules were relaxed on Dec. 7, a number that belies mounting anecdotal evidence from across the country, from hearses piling up outside a Beijing crematorium to overflowing yellow sacks for the corpses in some funeral homes.

A hospital in Shanghai predicted that half of the city’s 25 million people would eventually become infected and warned staff of a “tragic battle” in the coming weeks, according to a now-deleted statement the hospital posted last week on social media platform WeChat.

“In this tragic battle, all of Shanghai will fall and all hospital staff will be infected.

All our families will be infected! All of our patients will be infected!” the statement read.

“We have no choice and we cannot escape.”

Work is so tight in some hospitals that retired doctors are being asked to return to work.

It has been reported that doctors and nurses are being withdrawn from the eastern provinces of Shandong and Jiangsu to strengthen medical facilities in Beijing.

Medical students working as residents and interns in hospitals have protested the deteriorating working conditions.

They are demanding that they be allowed to go home for the winter break if they choose, demanding equal pay and better protection from the virus for those who choose to work.

These students are among the lowest paid healthcare workers, despite being required to work longer hours.

Their demonstrations coincided with the December 14 death of a 23-year-old medical student working at Sichuan University’s West China Hospital in the southwestern city of Chengdu.

The hospital said the student suffered a heart attack, but his colleagues disputed the claim, saying he collapsed from overwork while infected with COVID.

The personnel crisis is expected to worsen as winter progresses and millions of migrant workers will return home before the Lunar New Year holiday in January.

Healthcare workers are already experiencing a behind-the-scenes chaos marked by policy changes, physical and mental exhaustion, and widespread frustration that the government has not given them time to prepare for the surge in patients.

“We weren’t informed about anything. I heard about the easing of restrictions from the news,” Pu said.

Medical staff say they could have prevented a medicine shortage that has forced some centers to ration them.

There may also have been more time to put a more effective triage system in place to prevent overcrowding.

One of the fundamental problems of the Chinese health system is its excessive dependence on hospitals for even the most basic treatments.

Large urban centers like Tianjin Medical University General Hospital account for just 0.3 percent of all health care workers in China, but last year they handled nearly a quarter of all outpatient clinics in the country, according to data from the National Health Commission .

“In the United States, people have their own family doctor, but in China they do few ways to get attention of the medical system, except going to the emergency room of a large hospital,” says Dr. Qiao Renli, a pulmonologist and critical care physician at the University of Southern California who has taught and practiced medicine in both China and the United States.

To ease the burden on hospital workers, the government has been working to increase the number of “fever clinics” across the country.

These facilities are separate wings within hospitals or independent clinics designated to treat patients with fever, whether they have COVID or not. In the southern city of Shenzhen, officials have set up fever clinics in booths previously used for COVID testing. In Beijing, the government said it had converted empty stadiums and quarantine centers into similar facilities, bringing the number of fever clinics to more than 1,000 in recent weeks.

The push to build more fever clinics underscores how quickly the government has tried to adapt to the fast-moving virus, albeit sometimes too quickly, according to some health workers.

Adela Xu, a nurse at a cancer center in Shanghai, said that before restrictions were eased, staff and visitors had to present negative COVID tests to enter her hospital.

As of a week ago, the hospital, by government order, started building a fever clinic to help screen patients who may have COVID.

But by the time it opened, the facility had already become obsolete because the city council stopped requiring a COVID test to enter an emergency room.

At the same time, more and more people were getting infected.

“Last week, about 20 of the 700 ER patients tested tested positive,” Xu explains.

“Now about 100 out of 700 are positive.”

The onslaught of COVID patients isn’t the only challenge hospitals face.

One of the side effects of the outbreak has been a widespread shortage of blood for transfusion due to a decline in the number of suitable donors.

In the southwestern city of Kunming, a blood bank said the city receives a fraction of the 500 daily donors it needs to meet demand, and shortages have started hitting pregnant women and patients in treatment units intensive.

In response to the shortage, the National Health Commission this month revised its 2021 blood donation rules, allowing people who have recovered from COVID to donate blood after seven days instead of six months.

The new guidance also lifted restrictions that had been placed on prospective donors who are close contacts of COVID patients.

Some hospitals in Hebei province, near Beijing, are reportedly suffering from severe shortages of ventilators, oxygen tanks and intensive care beds.

In a video recorded by Associated pressA health worker at a hospital in Zhuozhou, a city in northern Hebei, is heard urging a group of people to transfer a patient to another, better equipped hospital, saying the center was sold out without oxygen supplies.

“If you can’t even give him oxygen, how are you going to save him?” said the worker. “If you don’t want delays, turn around and move fast!”

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