by Xinlu Liang in SCMP, Jan 8, 2023
Shawn Yang, a thoracic surgeon in the southern Chinese city of Guangzhou, had not touched a scalpel for days. Instead, he was helping to treat Covid-19 patients in the emergency room.

“We’ve been encountering some difficulties, because we’re all surgeons and we have to get familiar on the spot,” he said, adding he had recently taken emergency rescue training before being assigned to help in ER.

“I was excited to help treat Covid-19 patients but also worried that I couldn’t do it well.”

Yang is one of millions of Chinese doctors and nurses who are battling unprecedented staff shortages to keep the healthcare system running amid the current Covid outbreak after Beijing abandoned its zero-Covid policy last month.

Staff at hospitals across the country are opening all wards and sending specialist doctors to help treat the influx of patients.

It has also become common practice for medical workers to treat patients with Covid-19 while infected with the virus themselves.

Doctors and nurses told the South China Morning Post that infections among patients and healthcare workers had peaked, but severe understaffing remained a problem.

And the number of severe cases is rising. According to Yang, at his hospital, the ICU’s 100 beds are fully occupied, with Covid-19 patients filling 80 of them.

A doctor surnamed Wu from the emergency unit of Yang’s hospital said the influx of patients peaked about 10 days ago when the volume spiked to five times more than usual, but there are still three times the usual number of patients compared with before the end of Covid restrictions.

“The work intensity has greatly increased and the workload of doctors is super heavy,” said Wu. “Lately, I’ve been under tremendous pressure at work and easily get grumpy.”

Two weeks ago, China’s capital Beijing managed to draw hundreds of doctors from several provinces to ease the burden, at a time when their own hospitals were struggling to cope with a surge in cases.

But hospitals in other regions have to rely on their own staff to bolster services, and healthcare workers must continue working even when they test positive or have not fully recovered.

Some six out of 10 doctors and nurses have been working while testing positive, according to a survey by Yimi Research, a medical platform. It found about 70 per cent of the surveyed 3,013 medical workers across China had contracted Covid-19 between December 20 to 26.

Nana, a nurse in a hospital in central Hunan province who goes only by her given name, said she had contracted the virus around December 16, but she and all her colleagues still attended to patients while they were sick, with “high fevers, tight chest, constant coughs and pumping heart”.

“There is not enough medical staff and beds are scarce. There are major shortages, especially in the internal medicine department, emergency unit and pneumonology,” she said.

There were so many patients with pneumonia caused by Covid-19, mostly in their seventies and eighties, that the hospital had to take over wards from other departments, such as paediatric, surgical and orthopaedic departments, and beds were filled as soon as they became available.

She also witnessed deaths, mostly of the elderly, more frequently than before the Covid-19 wave.

“Too many old people have passed away lately. One every day on average in our hospital. It used to be very rare. Maybe one in a few months,” she said.

Some facilities have tried to separate the positive cases from the negative to protect the most vulnerable groups – including the pregnant, the elderly and those with severe chronic conditions – but they soon found they did not have enough Covid-free doctors for the negative zone.

A doctor from the department of obstetrics and gynaecology of Renmin Hospital at Wuhan University in central Hubei province said her hospital initially designated an area for pregnant women to protect them. But a patient who tested positive after undergoing surgery on December 19 soon infected the entire department.

“As the situation worsened, you came to work as long as you could, whether you tested positive or not,” she said, speaking on condition of anonymity.

But she was more concerned about the prevalence of severe illness caused by Covid-19 among pregnant women.

“Fever is a dangerous situation for pregnant women and babies. When some babies are cut out of the amniotic fluid, it feels like they’ve been in boiling water. Many are sent to the ICU immediately after birth,” she said.

To ease pressure caused by the influx of patients, many hospitals have deployed medical staff from other departments for the emergency unit or fever clinics, or asked those departments to receive Covid-19 patients.

This reallocation of manpower has had an impact on surgery, according to a cardiologist from Shanghai’s Zhongshan Hospital who requested anonymity. He said non-emergency operations had been cancelled and surgeons were instead sent to support intensive care units, “overloaded” fever clinics and the department of infectious disease.

Some doctors without the necessary experience have first had to have training led by respiratory experts who taught them how to treat Covid-19 patients.

Yang from Guangzhou said his department had attended to 10 severe Covid-19 patients since December 20. They would take the patient’s medical history and ask higher-level doctors for prescriptions, according to protocol, and would call the respiratory department for consultation when they were unsure how to proceed.

Even medical students have been asked to volunteer after doctors became ill with Covid-19.

A graduate student specialising in vascular surgery said 142 of his fellow students at Beijing’s Anzhen Hospital had stepped in to keep the hospital doors open and services running in the past month.

Although they have not qualified to practise medicine, the students can help with duties such as recording a patient’s medical history.

“The frontline [healthcare workers] can’t spare a minute to do the work so the students can help because there are a lot of documents to be processed and paperwork filled,” said the student, who asked to remain anonymous.

Wang Xiaoqiao, a doctor in Dalian in Liaoning province, said her hospital had announced new rules to separate outpatients and inpatients to avoid mass infection, but many colleagues had to come to work while they were sick and a nurse in the ICU had fainted while working.

“We need psychological counselling urgently,” Wang said. “The doctors and nurses have been suffering from intensive pressure, both physically and mentally.” https://www.scmp.com/news/china/politics/article/3205833/overworked-and-forced-carry-working-after-testing-positive-chinas-medical-staff-feel-pressure