n the coronavirus epidemic, doctors on the front lines take on the greatest risk and best understand the situation. Dr Peng Zhiyong, director of acute medicine at the Wuhan University South Central Hospital, is one of those doctors.
In an interview on Tuesday with Caixin, Dr Peng described his personal experiences in first encountering the disease in early January and quickly grasping its virulent potential and the need for stringent quarantine measures.
As the contagion spread and flooded his ICU, the doctor observed that three weeks seemed to determine the difference between life and death. Patients with stronger immune systems would start to recover in a couple of weeks, but in the second week, some cases would take a turn for the worse.
In the third week, keeping some of these acute patients alive might require extraordinary intervention. For this group, the death rate seems to be 4 per cent to 5 per cent, Dr Peng said. After working his 12-hour daytime shifts, the doctor spends his evenings researching the disease and has summarised his observations in a thesis.
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I've observed that the breakout period of the novel coronavirus tends to be three weeks, from the onset of symptoms to developing difficulties breathing. Basically going from mild to severe symptoms takes about a week. There are all sorts of mild symptoms: feebleness, shortness of breath, some people have fevers, some don't. Based on studies of our 138 cases, the most common symptoms in the first stage are fever (98.6 per cent of cases), feebleness (69.6 per cent), cough (59.4 per cent), muscle pains (34.8 per cent), difficulties breathing (31.2%), while less common symptoms include headaches, dizziness, stomach pain, diarrhea, nausea, vomiting.
But some patients who enter the second week will suddenly get worse. At this stage, people should go to the hospital. The elderly with underlying conditions may develop complications; some may need machine-assisted respiration. When the body's other organs start to fail, that's when it becomes severe, while those with strong immune systems see their symptoms decrease in severity at this stage and gradually recover. So the second week is what determines whether the illness becomes critical.
The third week determines whether critical illness leads to death. Some in critical condition who receive treatment can raise their level of lymphocytes, a type of white blood cell, and see an improvement in their immune systems, and have been brought back, so to speak. But those whose lymphocyte numbers continue to decline, those whose immune systems are destroyed in the end, experience multiple organ failure and die.
For most, the illness is over in two weeks, whereas for those for whom the illness becomes severe, if they can survive three weeks, they're good. Those that can't will die in three weeks.
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Based on my clinical observations, this disease is highly contagious, but the mortality rate is low. Those that progressed into the life-threatening stage often occurred in the elderly already with chronic diseases.
As of Jan 28, of 138 cases, 36 were in the ICU, 28 recovered, five died. That is to say, the mortality rate of patients with severe conditions was 3.6 per cent. Yesterday (Feb 3), another patient died, bringing the mortality rate to 4.3 per cent. Given patients in the ICU, it is likely to have more deaths. The mortality rate is also likely to edge up but not significantly.
Those hospitalised tend to have severe or life-threatening conditions. Patients with slight symptoms are placed in quarantine at home. We have not gathered data on the percentage of cases that progress from slight symptoms to serious symptoms. If a patient goes from serious conditions to life-threatening conditions, the patient will be sent to the ICU. Among 138 patients, 36 were transferred to the ICU, representing 26 per cent of all patients.
The percentage of deaths among life-threatening cases is about 15 per cent. The mean period to go from slight conditions to life-threatening conditions is about 10 days. Twenty-eight patients recovered and were discharged. Right now, the recovery rate is 20.3 per cent, while other patients remain hospitalised.
It is notable that 12 cases were linked to South China Seafood Market; 57 were infected while being hospitalised, including 17 patients already hospitalised in other departments; and 40 medical staff, among 138 cases (as of Jan 28). That demonstrates that a hospital is a high-risk zone and appropriate protection must be taken.
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Peng: Based on my observations, a third of patients exhibited inflammation in their whole body. It was not necessarily limited to young adults. The mechanism of a cytokine storm is about whole-body inflammation, which leads to a failure of multiple organs and quickly evolves into the terminal stage. In some fast-progressing cases, it took two to three days to progress from whole-body inflammation to the life-threatening stage.
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Peng: I often cried because so many patients could not be admitted to the hospital. They wailed in front of the hospital. Some patients even knelt down to beg me to accept him into the hospital. But there was nothing I could do since all beds were occupied. I shed tears while I turned them down. I ran out of tears now. I have no other thoughts but to try my best to save more lives.
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The deputy director of our department told me one thing, and he cried too. Wuhan 7th Hospital is in a partnership with our hospital, South Central Hospital. The deputy director went there to help in their ICU. He found that two-thirds of the medical staff in the ICU were already infected. Doctors there were running "naked" as they knew they were set to be infected given the shortage of protective gear. They still worked there nonetheless. That was why ICU medical staff were almost all sickened. It is too tough for our doctors and nurses.
