There has been no report of confirmed SARS cases in Guangdong Province for over ten consecutive days and clinical experts share their experiences in containing the disease.
South China’s Guangdong Province was caught off-guard by the sudden outbreak of the previously unknown SARS virus. Hundreds of people were infected during the first two months. Many people were driven to panic. Now five months have passed since the first reported case and there has been no recent report of a confirmed new case in the province. Experts from the World Health Organization (WHO) said that Guangdong has gained valuable experience in containing the disease and its methods should be adopted by the rest of China and the world.
Knowing that the No. 8 People’s Hospital was in need of medical workers, the provincial health department and municipal health bureau immediately coordinated with other hospitals and 60 plus medical staff, many of them experts in respiratory diseases, were sent there. Inside the wards, it was like a detachment of UN troops. Many faces are unfamiliar but everything is working in perfect order.
Life in Guangdong has returned to normality but experts still warn of a possible recurrence of the disease. Many medical institutes are making joint efforts to develop a vaccine for SARS. Researchers say a vaccine could be available in six months, based on preliminary animal tests of an activated strain of the SARS virus.
On April 21, something unexpected happened when flight CA174 from Beijing was landing in Guangzhou’s Baiyun Airport. One of the passengers was found to have a high fever, the local quarantine personnel responded quickly and soon boarded the plane to check the patient. Other passengers on the same plane began to grow tense and anxious when they were told the news. They were allowed to get off the plane and wait on the parking apron while the doctors finished the necessary checks and inquiries. A little more than one hour after the flight arrived in Guangzhou, all the data about this suspected patient was sent to the airport test room. The rest of the passengers had to wait till for result of the test to come back. 20 minutes later, they were taken to an isolated section in the airport lounge for medical checks. Every passenger was required to fill out a health declaration form while the medical staff took their temperatures. Only those with normal temperatures were allowed to leave. Two hours later, most of the passengers left, having given their phone numbers and addresses.
Mr. He Zhaofu is vice-director of the Anti-SARS Coordination Office of Guangdong Province. Treatment of emergency cases is one of the team’s major responsibilities.
“We have a coordination office. And we gave notice to the airport hospital after we received the report of a passenger with a fever. Passengers needed to be given treatment or put in quarantine. We are responsible for coordination,” said He Zhaofu, vice-director of Guangdong Anti-SARS Coordination Office.
Guangzhou Baiyun Airport takes the temperature of each and every passenger who departs or arrives. Over 20 emergency suspected cases were handled at the airport starting from March 25 this year. To strengthen prevention and emergency treatment of SARS cases, Guangdong Health Department also set up SARS quarantine stations at all large public transport ports.
Huang Huahua, was confronted with the SARS epidemic soon after he took office in January 2003. Guangdong spotted the first SARS case and people are wondering whether the epidemic has brought under control.
“The SARS epidemic in Guangdong has already been brought under effective control. We’ve entered a mild period, and measures are taken to prevent any further spread,” said Huang Huahua, governor of Guangdong province.
Statistics show that the entire province of Guangdong registered 101 SARS cases from November 16, 2002 to January 31, 2003, medical staff accounted for 21 of these. But 688 cases were reported in February and 201 were medical staff. March recorded 364 cases and 86 medical workers. April, 259 cases and 34 medical staff,.
Narration
Mr. Zhong Nanshan, academician of Chinese Academy of Engineering, director of Guangzhou Institute of Respiratory Diseases and director of the SARS rescue team, plays a vital role in SARS prevention and treatment.
“The major indicator of the epidemic is the daily number of new cases and deaths each day. There has been clear decrease of daily new cases since the end of April. This number has been below 10 recently. But one or two months ago, there were 40-50 cases every day. Judging from the situation, we can see that the epidemic is less severe and the disease has been effectively checked,” said Zhong Nanshan, director of Guangzhou Institute of Respiratory Diseases.
Right now the SARS epidemic in Guangdong Province is effectively controlled but over four months ago, the province was hit without warning by the sudden outbreak of the disease.
Huang Qingdao took the post of director of the Health Department of Guangdong Province in 1992 and assumed the role of vice-commander of the Anti-SARS Headquarters this April.
“On January 2, we received a report from the Heyuan Health Bureau, saying that Heyuan People’s Hospital had accepted two patients, but eight of the medical staff were also found to be infected after they sent the patients to Guangzhou. We got the news in the morning and sent experts in the afternoon for consultation. They soon recovered, and because of this, and to be honest, we didn’t pay too much attention to the disease,” said Huang Qingdao, vice-commander of Guangdong Anti-SARS Headquarters.
After the eight medical workers of Heyuan were infected, there was a report that 13 medical staff in Zhongshan City were taken ill on January 21.
Guangdong Health Department immediately reported the case to the state center for disease control and prevention and sent a specialist group of experts in clinical medicine, epidemiology and virology to Zhongshan to investigate. Mr. Zhong Nanshan and experts from China Center for disease control and prevention also went to the spot.
“When we went there, we were clear that the virus must be contagious since it could infect so many medical workers. So we had to find a cure and preventive and quarantine measures to handle the disease through on-the-spot investigation and research. We needed to find a solution,” said He Zhaofu, vice-director of Guangdong Anti-SARS Coordination Office.
Things were urgent, and the specialist group held discussions and finished a report on their findings the next night. In this five-page report, experts agreed upon diagnosing the disease as atypical pneumonia (the cause of the disease was still unclear, possibly viral infection); severely infected patients could be treated with cortical hormones or respirators. As preventative measures, they proposed that the patients be quarantined, and clean air and disinfection should be stressed. Medical workers in contact with patients were reminded to wear face-masks as the virus might be spread through water droplets. The report also emphasized the importance for all hospitals to reinforce the construction and management of intensive care units in treating dangerously ill patients. The provincial health department issued a paper, urging all medical institutes to learn and master principles of treatment and prevention. Most of the judgments in the report were later proved correct.
The provincial health department attached great importance to SARS, but nobody had expected that the epidemic would begin to accelerate from February 1 and SARS cases soared to 688 that month from 101 in January. This posed a great challenge in treating the disease. Tang Xiaoping is a medical doctor; he took the post of president of NO. 8 People’s Hospital in Guangzhou in September 2002. The hospital under his charge specializes in infectious diseases and was one of the earliest hospitals designated to treat SARS patients.
TANG XIAOPING，President
Guangzhou NO. 8 People’s Hospital
“We received our first five patients on February 2; they all had high a fever, cough and difficulty in breathing. We mainly received first and second generation patients with very strong toxicity. The number gradually increased. Thirty came on 6, 30 on 8 and on February 12, there were over 150 hospitalized. We were under enormous pressure then.
The No.8 People’s Hospital is a medium sized hospital in Guangzhou, only a little more than 200 medical staff were working on the SARS front. And in ten short days, 150 SARS patients were sent there.
“The first SARS patient in Guanzhou was a seafood salesman from the Fangcun District. He contaminated 20-30 medical workers in No.2 Zhongshan Hospital and then 20 or so in NO.3 Zhognshan Hospital. Professor Deng Lianxian was infected by him. Doctors and nurses in our hospital complained at first, saying why should such a critically ill patient on a respirator be transferred to our hospital. They called me and I told them that we had no choice but to admit him. We gave the so-called virus king the most meticulous care and treatment while he was in our hospital. One nurse called Wang Chunhua was infected while taking care of him. Wang had to draw phlegm for him very often and phlegm was strongly infectious. We didn’t wear masks or goggles then because we didn’t have any experience of the disease. We later found that secretions can be infectious if they contact the eyes. We had never encountered such a highly infectious disease even though I’ve been treating infectious diseases for more than ten years. Some experts and professors have been in this field all their lives,” said Tandg Xiaoping.
People had now come to understand the infectiousness of the disease and the importance of self-protection. But they lacked experience and protective measures to handle the disease as it spread so severely that medical workers in the hospital was taken ill one after another.
More and more medical workers were contaminated while treating SARS patients and this caused panic among the public. The Provincial Health Department held a pressure conference on February 11, announcing for the first time that 305 people had contracted the disease, five had died; 105 of them were medical workers.
Acknowledgement of the epidemic alleviated people’s anxiety to some degree, but nobody believed that the disease could be cured or contained if medical workers couldn’t protect themselves.
“The public grew tense because medical workers are infected. What should we do if you medical workers have no solution? I could hardly sleep during those days, feeling the responsibility on my shoulders. It’s not easy being a governor of a province. The epidemic was like fire and it was problem of life and death. No negligence would be tolerated,” said Huang Huahua.
The Provincial Health Department purchased 201 sets of medical equipment to disinfect the hospital. They also bought from Britain and the US 150 sets of shielding masks, each worth 600 USD, for doctors treating critically ill patients on the frontline. Due to a series of effective measures, the number of infected medial workers dropped from 201 in February to 34 in April.
“Protecting medical workers is not only to strengthen technical power, but to stabilize people’s anxiety. Once they saw that medical workers were no longer being infected, they knew that the disease could be cured or contained,” said Huang Qingdao.
While solving the problem of protecting the medical workers, hospitals were also trying to find a cure for the disease. To enhance the cure rate and minimize deaths was a bigger problem the medical experts had to face.
“The biggest challenge I had to face was probably ignorance about the disease. We didn’t know where to start: no clear diagnosis, no effective way for a cure,” said Zhong Nanshan.
The medical specialist group with Mr. Zhong as the head, however, have found a set of effective cures in their clinical practice treating SARS patients.
“We have accumulated some experience in how to shorten the course of the disease and minimize deaths. Specifically, there are four aspects. Firstly, we resorted to the combination of both Western and traditional Chinese medicine, especially traditional Chinese medicine for clearing heat and detoxicating, to lighten the symptoms during the acute phase of the disease if the patients have high fever and sore muscles. Secondly, when the patients reach a certain crisis, we use steroids or cortical hormones to prevent fibrosis or failure of the lungs. Thirdly, when the patients are in obvious need of air, we use an artificial respirator, but we don’t immediately use intubatton or cut the trachea. Instead we use what we call painless nose masks or face masks. Many patients survived this way. Fourthly, the patients’ immune system becomes weak from the disease, making other infections likely. So guarding against other infections is one of the most important ways to lower the death rate. That is one of the lessons we have learnt. Another is that in large and densely populated cities, severely affected patients should be treated collectively in one or two hospitals. For one thing, these patients are very infectious, more people will be infected if they are scattered in different places; for another, rescuing these patients requires certain specialized knowledge and skills and if they are placed in specialized hospitals, they should have a higher chance of recovery. The third lesson we have learned is that we should publicize instructions concerning the disease. In Guangdong, we issued instructions on how to diagnose and cure the disease, how to prevent the disease in public places, schools and kindergartens. These instructions were handed out through the whole province and have been very helpful in containing the disease,” said Zhong Nanshan.
On March 9, Guangdong Health Department once again issued a document on the accumulated experiences of these experts in the diagnosis, treatment and quarantine of suspected and confirmed SARS patients and sent it to all hospitals. As early as February, the Provincial Health Department set up three specialist treatment groups, epidemiological research and etiological detection. Experts in these fields have played a critical role in treating and containing SARS in Guangdong Province.
“The provincial committee and government attached great importance to the role of experts. We have set up specialist groups and consulted them before making any big decision. Experts have participated in defining the nature of the disease and proposing ways to diagnose, detect, confirm and treat the disease. Sometimes we didn’t quite understand the technical terms, but we extended our support and often talked with them to know what was going on. The provincial government is very supportive of their work in etiological analysis so that we can be practical and realistic and we hope that the true cause of the disease will soon be found. It was because of the experts that we were quickly able find a whole set of effective plans of treatment. Anyway, they have done a lot in SARS prevention and treatment,” said Huang Huahua.
In early April, the World Health Organization sent specialist groups to inspect the anti-SARS work in Guangdong Province. Having inspected the hospitals and research institutes and communicating with experts in Guangdong, WHO experts said that anti-SARS efforts in Guangdong had been effective and Guangdong should share their experiences with other places in China.
SARS cases were reported in a succession of other provinces and cities of China, after Guangdong. The sudden outbreak of the unknown epidemic had a severe effect on people’s lives. Here is how Mr. Zhong Nanshan sees the crisis management system and its role in handling this public health issue.
“China is rather weak in this aspect. When we look at it properly, we didn’t have any special pre-warning or detecting system when the disease broke out. Originally we had such a system, but it was not good enough in terms of material or financial investment as well as investment in necessary facilities and personnel. Some countries are quite good in this regard; Singapore is an example. Right now, they are also examining whether there is any problem with their pre-warning or emergency handling system. Inadequacies were also found. Mankind can be very good at accumulating material wealth, but capacities in handling natural and man-made disasters still need to be strengthened; especially when we might encounter other infectious diseases in the future. From this point of view, I think China should reinforce these areas,” said Zhong Nanshan.
Five months have passed since the first known SARS case in Guangdong Province and the disease now has been brought under effective control. The once panic-stricken people have again resumed their normal life.
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