Wuhan Diary #38: The 42nd Day of the Wuhan City Closure — March 4, 2020

March 4 The Forty-second Day of the Wuhan City Closure

As of today, the Wuhan city closure has already lasted three half-months.

Yesterday, the number of new confirmed cases fell to one hundred. Many people got very excited hoping that the city closure will end soon. Some people optimistically estimate that we will be able to go back to work on March 10.

I am not so optimistic however because those figures are not very reliable.

Caixin Feb 26th. According to the Fifth edition of the New Coronary Pneumonia Diagnosis and Treatment Program issued by the National Health and Health Commission on February 4, it is clear that asymptomatic infection may also become the source of infection. It is also very important to determine the infectivity and scale of infection of asymptomatic infection for the prevention and control of the epidemic . However, in data published on the epidemic notification, these cases have not yet been disclosed.

This is the current standard for including a case as a suspected case of coronavirus:

  • Suitable epidemiological history (there are four possibilities);
  • Suitable clinical presentation (three types of symptoms with a CT scan image being one of them).

Both conditions must be satisfied at the same time. If the first condition cannot be satisfied then all three clinical presentations must be satisfied. For there to be a confirmed diagnosis, in addition to the conditions for a suspected diagnosis being satisfied, the nucleic acid test must be positive as well.

What are the consequences of setting such standards? If an infected person does not have clinical symptoms, even if the nucleic acid test is positive, then that person is not included as a suspected case. Or if an infected person has all the clinical symptoms, including a CT scan showing lung lesions but the nucleic acid test is negative then that will not be counted as a confirmed case. The worst thing is that the nucleic acid test is only 30% to 50% accurate.

When we get this point, things are like someone whose underpants have been stolen but are still covering their ears not to hear the burglar alarm. What good does that do?

My only hope is that they do not give us false hopes.

The hospital hardest hit by this epidemic is probably the Wuhan Central Hospital. According to press reports, over two hundred workers there have been infected by the coronavirus, including three deputy hospital heads, one deputy director of nursing. Many department directors are on Extracorporeal membrane oxygenation (ECMO), many physicians are on respirators. Three physicians there have already died in the line of duty: Li Wenliang, Jiang Xueqing, and Mei Zhongming.

I have always felt that the top management of this hospital are bureaucrats. From the very beginning of this epidemic when decisive corrective action was taken against the rumor-mongering physician of that hospital, the hospital has manifested a strong “Party character”. “All medical personnel are ordered not to discuss among themselves in public the medical situation and not to leave any trace in written or graphic form that could serve as evidence of discussions of the medical situation”.

Another physician who was reprimanded was Ai Fen, director of the Emergency Department, said in an interview that she “had informed the hospital of the admission of patient but did not get any response. After she didn’t get any response, all she did was order the medical personnel in her own department to wear N95 face masks.” Not only was there an insensitivity to medical matters, there were not even any measures taken to increase protection for medical workers.

From all these many details, we can see that the effort has not focused on reducing the effect the contagious disease has on the hospital staff, ordinary people and the people of the city. Instead the focus has been on reducing insofar as possible the effect the outbreak has on political security and on their own official careers. That way of doing things is completely in line with the way bureaucratic factionalism works in the Chinese Communist Party. That is incompatible with being a medical professional. Or even less, not even the way a modern person with any common sense would have acted. Sure enough, I learned from a friend who knows this hospital that the party secretary of Central Hospital came out of the public health sector, was previously a department head of the Wuhan Municipal Health Commission and certainly lacks a specialized medical background and experience as a front-line physician.

Even more astonishing is that the latest propaganda from Central Hospital unexpectedly stated that “during the course of this epidemic, over twenty physicians and nurses from the Oncology Department, 19% of the staff, were infected by the coronavirus. Most were husbands and wives both working on the front-line against the epidemic. Director Wang Chun, despite the infection of many family members including his father-in-law, mother-in-law, and child took the lead is remaining at his post diagnosing fever cases. An Oncology Department nurse returned to the front-line just ten days after her miscarriage. Nurse Guo quarantined herself at home because there were no hospital beds available. Dr. Yang after serving a shift in relief diagnosing fever patients did all kinds of support tasks including working as a porter….” So many medical workers were infected. They don’t see them as shameful. Instead they see it as an honor. Those references of a “couple both medical workers”, “several family members infected”, “ten days after her miscarriage”….. when I came across those words I felt that they were bloody words. All these very terrifying things they list one-b-one, flaunting them.for

I am really frightened for those doctors and nurses. [Note for more details, see this Google Translate machine translation of a mid February article entitled “Witnesses Tell: the infection of medical staff in Wuhan Central Hospital” from China Newsweekly. End note.]

On the Weibo microblogs under the category “Coronavirus Patients Asking for Help”, I see very many postings from coronavirus patients looking for someone to help them. Recently I saw a posting about a three-year-old patient who was diagnosed with a malignant tumor in 2019. Before the epidemic began he had already had seven chemotherapy treatments and 25 radiotherapy treatments. He needs five more chemotherapy treatments. After the outbreak of the epidemic, however, the hospital where he was getting his treatments was requisitioned and so he was unable to continue his chemotherapy treatments. He had looked everywhere to get help without any result. Therapy had already been delayed for a month and his condition might take a turn for the worse at any time.

I can never understand why prisoners who have completed their sentences are allowed to leave the city while seriously ill people who are not infected cannot be smoothly transferred to a hospital in another province to get treatment?

I don’t know what to say. Should I be just heart-broken? Or sad that the lives of the people are so difficult? Why, after an entire month has gone by, why is there still so many clear gaps and chaos? I don’t know.

Chinese text:

3月4日  武汉封城第42天


















武汉市中心医院是当地 27 家三级甲等医院之一,官网显示,该院职工总数有 4300 多人。其前身为汉口天主堂医院,有 140 年的历史,主要有后湖和南京路两个院区,均位于汉口,两者相距五六公里,其中后湖院区距离华南海鲜市场不到两公里,这也是武汉市中心医院较早接触到新冠肺炎病例的重要原因。

截至 2 月 4 日,武汉市中心医院在全市定点医院中,收治的发热病人仅次于金银潭医院,开放床位 510 张,已用床位 525 张。然而,在此次参与新冠肺炎救治的过程中,武汉市中心医院的职工中,截至 1 周多前达到新冠肺炎临床确诊标准的已达 230 多人,其中 130 人住院,100 多人居家隔离,多位科主任与院领导都 ” 中招 “。


2 月 14 日,国新办就疫情防控最新进展特别是关爱医务人员举措举行发布会。发布会上,来自国家卫健委的数据是,截至 2 月 11 日 24 时,全国共报告医务人员确诊新冠肺炎病例 1716 例,其中湖北省 1502 例,而武汉市的医务人员确诊人数达到了 1102 例,占湖北的 7 成多。


艾芬 1997 年毕业于华中科技大学同济医学院后,进入武汉市中心医院工作,现任该院急诊科主任。据她介绍,2019 年 12 月 18 日,一名 65 岁的男性个体经营者来到医院南京路院区看急诊。在五天前,他出现发热症状,体温高达 39.1 ℃,发热前有寒战,但无鼻塞、流涕、呼吸困难、咳嗽等症状。此前在 12 月 16 日,该男子先是到医院门诊就诊,经过阿莫西林克拉维酸钾、奥司他韦及乐松片等三天对症治疗无好转后被收入急诊病房。急诊科医生给该男子尝试了碳青霉烯类高级的广谱类抗菌素,依然无任何好转迹象,而其肺部感染表现为 ” 双肺多发散在斑片状模糊影 “。

12 月 22 日,该男子转入该院呼吸科救治,12 月 25 日转入同济医院,再之后,转入专门收治传染病人的金银潭医院。在后来的追溯过程中,艾芬了解到,该男子是华南海鲜市场的一个送货员。

12 月 27 日,艾芬接诊了第二例此类病人,是一名 40 多岁来自武汉远郊区的年轻人,无华南海鲜市场接触史,在当地诊所治疗了一周多,高烧不退,肺部感染严重,指脉氧为 90%。这个年轻人随后被收入呼吸科,做了纤维支气管镜与肺泡灌洗液检验。12 月 30 日,送检的结果出来,该男子感染的是一种冠状病毒。看到化验单上标注有 “SARS 冠状病毒 ” 字样,艾芬感到 ” 很可怕 “,第一时间向医院公共卫生科和院感部门报告,但医院有没有再向上级疾控部门报告,她并不清楚。

这份检测报告,于 12 月 30 日下午被该院眼科医生李文亮发在同学微信群里,并被大量转发。艾芬称,当时大学同学私下问她关于冠状病毒的消息,她就把检测报告发了过去,并特别用红圈对 “SARS 冠状病毒 ” 进行了标注,但不知这份报告后来是怎样流出去的。

几乎同时,12 月 28 日,医院后湖院区急诊科接诊了 4 例和华南海鲜市场有关的发热病人。到 2020 年 1 月 1 日前后,医院共收治了 7 例 ” 不明原因肺炎 ” 病例。12 月 29 日,艾芬所在的急诊科向医院公共卫生科上报了这 7 例发热病人中急诊科收治的 4 例。公共卫生科回复称,已上报江汉区疾控中心。江汉区疾控中心说,湖北省中西医结合医院与武汉市红十字会医院之前也已接到类似病例。在急诊科上报的 4 例病例中,有一对母子,儿子在华南海鲜市场工作,母亲去海鲜市场送饭,并没有接触过华南海鲜市场的物品,但依然染病,而且病情较重,艾芬当时就推断,这个病可能 ” 人传人 “。

1 月 1 日凌晨,后湖院区急诊科又收到了一位由武汉市红十字会医院转入的 65 岁男子。该男子在华南海鲜市场附近开诊所,最近收治了很多发热病人,之后自己也有了症状,病情严重。艾芬分析认为,这位诊所老板的病很可能就是他诊所的病人传给他的。

1 月 1 日,她再次向医院公共卫生科和医务处报告了该诊所老板收治了多例病人的相关消息,希望能够引起重视。她担心,” 一旦急诊科医生或者护士被感染得病了,就很麻烦 “。

12 月 31 日,武汉市卫健委通报了 27 例 ” 不明原因病毒性肺炎 ” 的相关情况,称到目前为止未发现明显人传人现象,未发现医务人员感染。就在这天凌晨,李文亮受到了市卫健委和医院的警告和批评。1 月 1 日,武汉市公安局发布通报,称有 8 人因 ” 发布、转发不实消息 ” 而遭传唤。

1 月 1 日晚将近 12 点,艾芬也接到了医院监察科的信息,要求其第二天到监察科谈话。1 月 2 日,在和监察科纪委谈话过程中,领导批评她 ” 作为专业人士没有原则,造谣生事,你们这种不负责任的行为导致了社会恐慌,影响了武汉市发展、稳定的局面。” 艾芬提及了这个病可以人传人,但没有获得任何回应。

1 月 2 日起,医院要求医务人员之间不许公开谈及病情,不得通过文字、图片等可能留存证据的方式谈论病情,病情只能在交接班必要的时候口头提及。对于前来就诊的患者,医生们也只能讳莫如深。

林媛是武汉市中心医院的一名护士,在 1 月初听到这一疾病的相关消息后,只能隐晦地提醒身边亲友,要戴口罩。

在和医院反映情况无果后,1 月 1 日起,艾芬只得要求自己科室的医护人员先戴起了 N95 口罩。

” 战友 ” 倒下

1 月 1 日后,武汉市中心医院接收到的发热患者愈发增多,像 ” 火山喷发 ” 一样。艾芬所在的急诊科在 1 月的第一个星期内,先将后湖院区急诊外科病房改造成呼吸科隔离病房,有 20 张左右的床位。第二周,又改造了急诊内科病房,随后,南京路院区也将急诊病房改造成隔离病房。随着病人越来越多,所有的隔离病房都逐步搬到别处,急诊内外科的病房又改成留观门诊,一共能接纳五十多个病人,但依旧无法满足激增的患者。

倪芳是医院呼吸与危重症医学科专科护士长。1 月 10 日,她所在科室的病房也被征用,开设了 22 张床位,当天床位就全部收满,她所负责的病房一直处于满员状态。

1 月中下旬起,武汉市中心医院步入收治新冠病人的顶峰期,一床难求的状态一直持续到了 2 月初。艾芬称,1 月 21 日急诊量和发热门诊总计达 1524 人,其中发热病人 655 人。如果按照现在湖北省临床确诊标准来讲,这 1524 人中,90% 左右都是新冠肺炎患者。而在疫情发生前,中心医院的日均急诊量为 550 例左右。

病人激增过程中,医护人员感染的情况开始出现。1 月 10 日,急诊科发现了医护人员被感染的第一个病例,是后湖院区的一名护士。” 我们后来分析,她可能是口罩没有戴好,” 艾芬说。

1 月 1 日,急诊科医护人员开始戴口罩。1 月 10 日,穿上了隔离衣。再过几天,防护等级升高,穿上了防护服。但感染的医护人员在不断增加。该院急诊科共有 200 名医护人员,包括 50 名医生,150 名护士。到目前为止,急诊科医护人员 CT 显示肺部感染、临床诊断确诊的有 30 多人,核酸检测呈阳性的有 7 个,艾芬的团队处在 ” 边战斗,边倒下,边补充的状态 “。

武汉市中心医院医护人员在抗疫前线。 图 / 央视新闻截屏

艾芬分析说,急诊科医护人员感染的原因主要在于其工作强度大,急诊室空间有限,临时搭建的穿脱防护服的地方也不很规范。” 突然来了这么多病人,还有家属,围着我们,空气中的病毒的密度太大了 “,” 护士给病人进行打针、抽血等操作时,因为近距离接触,导致了感染。” 不过,好在急诊科病情严重、住院的医护人员并不多。

倪芳称,她所在的呼吸科从 1 月初就对这一疾病保有着警觉,” 我们科室要求口罩都要戴好,勤洗手,要用手消 “,在进驻隔离病房后,先后穿上了隔离衣、防护服。该院呼吸与危重症医学科医护人员总计 160 人左右,感染的人数大约有 16 个。

但并不是所有科室都有这样的防护意识和装备。李文亮是武汉市中心医院较早的感染者之一。他是在 1 月 8 日接诊一位 82 岁的女性青光眼患者后被感染的,接诊时 ” 没有做特殊防护,病人来的时候也没发热,就大意了。”


甲乳外科主任 1 月 16 日左右做肺部 CT 显示出症状,而两天前他还在给患者做手术。心胸外科一名副主任医师 1 月 22 日在一场主动脉手术未做完时,就出现了畏寒的症状,手术后测体温出现了高烧,其所在科室同事推测称,该医生是在手术前后和患者、患者家属谈话时近距离接触感染的。被感染且病情较重的还包括一名泌尿外科主任医师,其中三名医生都在武汉市肺科医院救治,最重的还用上了 ECMO 进行抢救。此外,这次被感染的还有医院的三位副院长,其中一位副院长病情较重。

据统计,武汉市中心医院截至 1 周多前达到新冠肺炎临床确诊标准的职工已达 230 多人,其中 130 人住院,100 多人居家隔离。

” 最开始可能只有部分科室对疾病的信息了解多一点,比如说急诊科、呼吸科,而别的科室不一定知道,” 艾芬说。而且,在 1 月 15 日之前,新冠病毒 ” 未明显人传人 ” 的说法广为传播,让前来看病的民众与其他科室的医护人员都放松了警惕。

王宇是武汉市中心医院儿科医生,平时也会接诊很多传染病患者。他告诉《中国新闻周刊》,1 月初他就听说了医院有收治这类病人的消息,但对于新冠病毒到底多大的传染性、毒力强弱并不了解,因此,包括他在内的很多医生最初只是戴了一层口罩简单防护。而对于很多不接触呼吸道传染病的外科科室来说,可能平时看病连口罩都不戴。

中心医院护士李媛所处的是非发热门诊这样的一线科室。1 月 16 日,她所在科室的一位病人 CT 显示疑似感染,她和同事这才警觉危险就在身边。

多位受访者称,大约在 1 月 15 日后,随着身边相继有 ” 战友 ” 倒下,医院内的医护人员对这一疾病变得重视起来,开始加强防护。心胸外科在这前后自购了一批 N95 口罩。王宇大约在这个时间听说了武汉协和医院已有多名医护人员感染。1 月 17 日,医院开了院感会,下发了关于这一疾病的一些相关资料。也在这天前后,武汉同济医院发热门诊穿隔离衣、防护服的短视频在网上热传。



17 年前的 ” 非典 “,武汉并不是重灾区。看到这样 ” 全副武装 ” 的视频,武汉市中心医院疼痛科主任蔡毅起初还是感到奇怪,” 即便当时有防护意识也不知道要穿防护服 “,” 同济接收了很多发热病人,他们可能更早意识到这个问题。”

艾芬称,当年非典,她还在心内科,当时只强调多通风、戴口罩,也没有戴 N95,身边好像没有一个人倒下。

在院感会后,王宇上班开始穿隔离衣。但隔离衣、防护服并不是所有科室都能有。王宇说,” 有可能接触感冒、发热、咳嗽这类病人的科室应该都是配了 “。艾芬觉得这也没有办法,毕竟这类防护物资不是那么多,难以做到每人一件,只能优先保证重点科室。李媛所在科室的监护室收治了一名疑似的新冠病人,同事问能否配发防护服,医院则害怕医生如此穿着,会引起病人恐慌,并称还没有到防护级别。

1 月 21 日,护士赵刚去隔离病房支援,在那里,他见到了正住院治疗的李文亮以及其他本院工作人员。当时,他所在病区收治的院内职工已经有 20 余位。1 月 22 日,汉口医院成为专门收治发热病人的定点医院,中心医院收治的病人暂时向汉口医院转移。在汉口医院,赵刚见到中心医院院内疑似感染的职工差不多已有 40 位。而在最近十来天,在医护人员做好防护,且就诊人数开始减少时,艾芬称,医院医护人员的新增病例也变少很多了。

从 1 月 21 日起到 1 月底,武汉市政府先后征用了三批共 23 家医院作为收治发热病人的定点医院,以缓解武汉市仅有的两家专门传染病医院——武汉市肺科医院、金银潭医院的压力。武汉市中心医院后湖院区作为第二批被征用的三家医院之一,进行了病房改造,从 1 月 27 日左右开始集中收治病人。医院绝大部分专科门诊也先后停诊,集全院主力,前来支援。

1 月 29 日,福建与甘肃两个援鄂医疗队进驻武汉市中心医院,分别接管了后湖院区的一个和两个病区。但 2 月 2 日,福建医疗队 ” 转战 ” 武汉市金银潭医院,甘肃省医疗队成了中心医院的唯一外援。该省医疗队有 100 多人,负责两个病区的 80 多名病人。中心医院绝大部分的病人救治还是要靠自己的人力。

大量的人力投入也带来了巨大的物资消耗。赵刚记得,1 月 21 日早上,他到南京路院区隔离病房支援时,还有医用级的 3M 口罩可以戴,到晚上,口罩的量就不是那么充足,” 护士长说,后面的物资不知道什么时候可以到 “。1 月 22 日,防护服、口罩的级别、质量就变得差一些,此后每天的物资就有了微妙的变化。


1 月 23 日,武汉市中心医院发出了向社会求助捐赠物资的公告。2 月 10 日,在李文亮去世三天后,中心医院再次向社会求助,而由于受李文亮事件的影响,一些网友也发出不再向中心医院捐物资的声音。记者了解到,中心医院物资来源主要是社会捐赠,通过武汉疫情防控指挥部调拨获得的数量不多。记者致电武汉市红十字会与指挥部宣传部。红十字会称,他们只负责物资的筹集,分配由防疫指挥部下设的应急保障组负责。而指挥部宣传部称,应急保障组不接受记者的采访。

医院一名负责物资筹集的工作人员在 2 月 11 日接受《中国新闻周刊》采访时称,物资目前只能按照以天为单位供应,也还是只能优先保障一线科室,而且物资医院自身也难以采购到。” 但这个病有潜伏期,其他普通科室也需要防护。” 倪芳说。

物资的消耗是巨大的。倪芳称,以呼吸科在后湖院区最先开设的三个病区为例,三班倒,护士医生查房,每天消耗防护服、口罩等一套完整防护装备的数量是 100 套。《中国新闻周刊》获得的一份武汉市中心医院物资需求清单显示,该院医用防护服每天消耗量为 2280 件,N95 口罩 4560 个,一次性隔离衣 4560 件,防护面屏 2280 个。但 2 月 14 日,倪芳在接受《中国新闻周刊》采访时称,过去两天,由于没有隔离衣穿,只能将质量不好的防护服当作隔离衣,再在外面穿一件防护服。赵刚说,由于防护服质量不好,表面有沙眼,只能用胶带粘裹住,而且有些防护服穿上一蹲下来打个针就破了。而因为面屏、鞋套不足,医院医护人员还不时有拿黄色塑料袋套在头上、脚上替代的现象。倪芳称,近日医院物资又筹集到了一部分,短缺的状况暂时得到缓解。

武汉市中心医院医护人员在抗疫前线。 图 / 央视新闻截屏

艾芬说,由于方舱医院、火神山医院开始接收病人,过去一两周,中心医院急诊病人的数量也开始下降。2 月 13 日,后湖院区发热门诊量只有 400 多,南京路院区只有几十个,而且很大一部分是之前积压的不重的病人来做核酸检测的。但床位依然很紧张,甚至是超负荷运转的状态。

赵刚说,2 月 12 日,医院一位医生想要住进来,也要等床位。而医疗设备的欠缺也是中心医院面临的难题,疼痛科主任蔡毅说,他所在的病区有 4~5 个重症患者,呼吸不畅,需要上呼吸机,但他的病区只有一两台这样的机器,其他病区有的甚至一台都没有。

但医院对病人的收治还在继续。经过调整,倪芳所在的病区床位最近从 22 张增加到 40 张,集中收治重症患者。据了解,中心医院后湖和南京路院区还将总计增加 300 张床位,” 还有很多病人没收进来 “,艾芬说。

让倪芳感到有些欣慰的是,2 月 14 日,医院又给她调配了 10 个护士,这意味着,她的部分同事可以轮换休息一段时间了。



About 高大伟 David Cowhig

After retirement translated,with wife Jessie, Liao Yiwu's 2019 "Bullets and Opium", and have been studying things 格物致知. Worked 25 years as a US State Department Foreign Service Officer including ten years at US Embassy Beijing and US Consulate General Chengdu and four years as a China Analyst in the Bureau of Intelligence and Research. Before State I translated Japanese and Chinese scientific and technical books and articles into English freelance for six years. Before that I taught English at Tunghai University in Taiwan for three years. And before that I worked two summers on Norwegian farms, milking cows and feeding chickens.
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1 Response to Wuhan Diary #38: The 42nd Day of the Wuhan City Closure — March 4, 2020

  1. Naomi says:

    Thank you so much for translating these. Could you comment on the social media discussions on Fang Fang in recent days – Starting with an open letter from a supposed student addressed to her?


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