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A health worker runs tests in a temporary facility at the Chulalongkorn University Health Service Center, Thailand. (Photo by Akira Kodaka)
The Big Story

'We should have been more prepared, and I don't know why we're not'

On the coronavirus front line, exhausted medical workers and overwhelmed hospitals

Nikkei staff writers | East Asia

Li, intensive care unit physician at a Los Angeles area hospital, U.S.

"There was no preparation at all. The hospital administration didn't react till things hit the fan, which led directly to the lack of personal protection gear and other equipment we're in need of right now. Now the health care system is more overwhelmed than it should be; nationwide, it is just panickedly reacting.

"There was no training about how to treat patients before they sent everyone to the COVID wing. The reality is that, as of now, we have no effective treatment for COVID-19. We doctors are trying different things, and other people are grasping at whatever options they have. There is still lots we don't know about the virus, which leaves room for misinformation. The most valuable information we have is from colleagues, and peers in other hospitals who have already dealt with the influx of patients. I get firsthand information through a WhatsApp group, where my residency colleagues in New York are sharing live updates about what they are doing; what's working and what's not; what they need, et cetera.

"Because I'm Chinese, I have been closely watching the situation since the outbreak began in China earlier this year. In February, I tried to talk to the admin in my hospital and ask them to stock up on [personal protection equipment], but they just said they were still assessing the situation. And in mid-March, when we already knew an outbreak was inevitable here and were in dire need of PPE, I suggested to them to buy some from China, because I'd read news saying Chinese factories were up and running and had extra mask supplies. But they rejected my proposal, citing reasons like "U.S.-China tensions." Doctors and nurses are feeding information back up the chain, but the problem is they might not be listening."

As told to Yifan Yu in Palo Alto, U.S.

Jack, first-year resident at a hospital in New York, U.S.

"I've had many sleepless nights the past few weeks, seeing patients lie on stretchers and, one by one, being hooked up to cardiac monitors that beep endlessly through the night. It's like a war zone. We should've been more prepared, and I don't know why we're not.

"The truth is, we are learning about COVID-19 the hard way, because we don't know much about it. We discover new information from each patient we take in. In the past weeks, I've treated patients ranging from 20 to 90 years of age, with pneumonias with rapid progressions I have never seen -- so we can only treat them through trials and see what works.

"Even now, the health system is not fully prepared for the virus. In my hospital, we basically get one mask per day, and we have to wipe it clean between shifts. One face shield for one week. I've heard from colleagues in other hospitals that they've put on trash bags as coveralls. Some physicians are still rotating between different hospitals, which will likely lead to cross-infection among hospitals with insufficient protection gear, but what can they do? The patients need doctors.

"Within the hospital, I think the communication is pretty good. The hospital knows what we need, and is working hard to ensure our work can be done more easily. I'm sure the hospital management is feeding information to the authorities. But I don't know why the national-level authorities are not reacting to what we've told them, like that we need to clear up more COVID wings and have more ventilators. That's why a lot of us are seeking help from individuals and companies through social media and asking for donations of PPE, instead of waiting for the government."

As told to Yifan Yu in Palo Alto, U.S.

A doctor in Jinan, Shandong Province, China

"We first heard rumors about coronavirus in mid-January, but the hospital notified us only after [epidemiologist] Zhong Nanshan spoke out [on Jan. 20].

"We suffered a shortage of medical supplies until the end of February. Usually, hospitals stockpile a small amount of protection gear; in our case, when the coronavirus hit, we had 10 to 20 protective suits in stock and several hundred N95 masks. Those quickly ran out. My colleagues at the respiratory department had no choice but to continue working without proper protection, though with normal surgical masks.

"This was a political mission. Even if doctors did not want to go to work, they had to. They complained in private, but stayed on duty regardless.

"The hospital has tried to mitigate risks. In the past, patients could just walk in. Since the outbreak, multiple checkpoints have been set both in and outside the hospital. All the patients have had to go through temperature screening before entering the building, and anyone with fever will be immediately taken to quarantine zones.

"Even so, those measures cannot guarantee the safety of medical workers. One patient passed all the checks, but showed symptoms of coronavirus and tested positive several days later. Luckily, no one at the hospital contracted the virus from him.

"Most recommendations in the guidance do make sense, but the Ministry of Health has also advised us to use Chinese medicine, which is controversial. Some doctors have reservations, but have decided to follow the rules anyway."

As told to Coco Liu in Hong Kong.

Kate Leung, emergency room nurse, Hong Kong

For the past three weeks, Kate Leung has been living in a hotel near the hospital where she works to prevent her family members from contracting the coronavirus. These days, a date with her fiance entails sitting at separate restaurant tables and talking via phone.

Since the beginning of the outbreak, the 29-year-old emergency room nurse has volunteered to work on her hospital's "dirty team," the unit dedicated to treating COVID-19 patients. Many hospitals in the city draw lots to decide who takes up shifts and duties in their own teams.

"I feel like I am the right person for this risky role," said Leung. "I'm still single and do not have children, so I have less to worry about compared to my colleagues."

Hong Kong was battered by the SARS epidemic 17 years ago, which killed 299 -- over a third of the global total -- and taught the city's public health system a painful lesson on battling the spread of highly contagious diseases. Names of doctors who died from SARS are still well-remembered by the general public.

"We might be in a more fortunate situation compared with the other parts of the world, where people lack experience in handling such public health crisis, but, frankly, I'm not proud of it at all," said Leung. Leung took part in a strike of 9000 medical workers in February, who demanded border closure and better protective gear for front-line workers.

"Many of our colleagues believe that if it weren't for the strike, the Hong Kong government would have been even slower in responding to the crisis," she said. "It seems like the citizens here have learned more from the SARS tragedy than the government did."

Reporting by Michelle Chan in Hong Kong.

Dr. Vit Suwanvanichkij, epidemiologist and public health adviser at the Mae Tao Clinic, Thailand

Dr. Vit helps to run a clinic in Mae Sot, on the Thai-Myanmar border, that caters for thousands of migrant workers and refugees escaping conflict in Myanmar. "The situation changes very quickly, day by day, and health care workers have to mobilize, adjust quickly," he said.

International funding for the clinic has been cut, just at a time when a new disease is spreading through an impoverished and mobile group of people. "This pandemic will challenge any health system and expose the most fragile. The coronavirus has imposed new stresses that were not anticipated."

According to another doctor in Bangkok, who spoke anonymously due to government cautions on speaking to media, medical workers are "paranoid" about all hospital visitors in fear of contracting coronavirus. Patients admitted for other illnesses are believed to have caught the disease from visiting family members.

Dr. Ananchai Thaipratan, a 60-year-old surgeon recently retired from a central hospital in the tense border province of Yala, has returned to help with the COVID effort. "This is the first time in my life as a doctor that I have experienced so much anxiety among our health workers," Ananchai said. "It is probably the same in all hospitals across the country."

Reporting by Marwaan Macan-Markar in Bangkok.

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