On january 21st yuan guoyong, a member of the national health and health commission`s high-level expert group and professor of microbiology at the university of hong kong, suggested that "the super communicator may have appeared ", stating that 14 of the 15 infected health workers in wuhan were infected by the same patient.
Subsequently, Wuhan Mayor Zhou Xianwang`s speech in the media directly locked the "super communicator" in the neurosurgery of the Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology. On january 21st he told cctv`s journallist:" the cross-infection at the union hospital affiliated to huazhong university of science and technology was in a patient in brain neurosurgery, not in the infectious department." Because neurosurgery ignored the patient`s new coronavirus before he was admitted to hospital. So after the operation, the patient developed a fever, when a doctor,13 nurse, was infected. "
"There is no`neglect`! A neurosurgeon from Wuhan Concorde wrote:`There are no respiratory symptoms before operation, pulmonary infection occurs three days after operation, consider "suspected unexplained pneumonia" on the fifth day after operation, report it actively, and carry out isolation, disinfection and treatment under the guidance of hospital staff and infection and respiratory specialists. The 14 people who were diagnosed with the infection were actually 10 neurosurgical nurse, and four medical staff in pediatric surgery, gynecology, cardiac surgery and cardiology, the statement said.
At 16:00 on January 21, at a news conference organised by the Guangdong Provincial Government Information Office, Zhong Nanshan revealed that "there was a case in Wuhan where a patient affected 14 medical staff, which did not appear in an infectious disease hospital, but in a place where it was not an infectious disease patient - a neurology department. So we need to focus on all the health care workers."
In an interview with China Newsweek, an expert at Peking University noted that the patient, who had been infected with a number of medical personnel, could be identified as a super disseminator. The expert said that in terms of the number of infected people, if the number of infected people is more than three, it can be considered within the scope of the super communicator; if the number of infected people is more than ten, it should be the more accurate super communicator.
"Super Communicator"
A month ago, Zhao Junshi with pituitary tumor finally lived in Wuhan Concord Neurosurgery,69 years old his heart function is not very good, have coronary heart disease, sinus bradycardia and other problems, for this 12 days hospital, preoperative examination and evaluation.
"The patient has no history of exposure to the South China Seafood Market," he said.
Before the operation, Zhao Junzhen did not have any respiratory symptoms, normal body temperature, white blood cells and lymphocyte values are normal. Routine preoperative chest radiographs showed that his "left rib phrenic horn area was seen in a film ", considering that he was older and had a history of smoking, it was normal for his lungs to have inflammation or lung texture thickening. According to the medical staff, Zhao Jun was very angry at the time and was in good mental condition, and there was little reason to suspect that he had the possibility of "unexplained pneumonia" infection.
However, on the night of the operation on January 7, doctors also told each other," Careful protection "... A week ago, on December 30,2019, the hospital received an internal notification that the Wuhan Health and Health Commission`s Emergency Notice on the Treatment of Pneumonia with Unidentified Cause: an immediate inventory of patients with unexplained causes of pneumonia with similar characteristics received in the last week. On january 5,2020, health and health commission again circuitanotice, in accordance with the unexplained disease toxicity pneumonia diagnosed 59 patients, no clear evidence of human transmission, no medical staff found infection.
"In this case, how can the patient be quarantined and protected at the next level? "said the medical staff.
According to the relevant regulations, medical protection is divided into one, two and three levels. Level 2 protection requires medical personnel to enter the isolation room and special ward must wear more than 12 layers of cotton mask, wear work clothes, isolation clothing, shoe cover, wear gloves, work cap, each contact with the patient immediately after hand cleaning and disinfection. Third-level protection is suitable for medical personnel who carry out sputum suction, tracheotomy and tracheal intubation for patients.
But it was hard for medical staff at the time to persuade a patient without any respiratory symptoms to do isolation, and the third-level protective equipment was medical supplies that involved expenses and reimbursements.
According to the routine operation of the hospital, the patient was transferred to the ward three times in total, and lived in the 19 floor ward of neurosurgery before the operation. The operation went smoothly. In the early hours of january 8th, the operation was transferred to the ward on the 3rd floor of the second floor of god`s outer building.
In the meantime, on january 9th, the chinese health expert group circuitanotice, a pathogen of unexplained disease toxicity pneumonia in wuhan, was initially identified as a new type of coronavirus.
On january 11, mr. zhao suddenly developed symptoms of fever, but it is extremely difficult to identify the causes in the clinic. The causes of non-infective postoperative fever include stress change, cerebrovascular stimulation, intracranial pressure changes, and heat absorption in the lesions.
Neurosurgeon immediately issued a lung CT examination, the image shows: double lung multiple flaky blur with right pleural effusion, grinding glass exchange consider interstitial pneumonia. There`s been an obvious lung infection. At the same time, Zhao Junshi`s white blood cells were significantly elevated, mainly neutrophils, and lymphocytes were normally low.
The attending doctor immediately reported to the hospital department according to the relevant regulations, and asked each specialist to consult and sample the sputum and pharyngeal swabs of the patients. Because the new coronavirus kit was not in place, a series of virus tests such as respiratory syncytial virus RNA were negative.
So the question is: when was the patient infected? If it is a pre-hospital infection, the patient`s incubation period has been more than 15 days, which is not consistent with the expert`s new coronavirus incubation period of up to 12 days.
If a post-hospital infection is considered, the patient has changed the ward three times after operation," several wards are far away from each other, and there is no way to clarify where the infection is. The medical staff said two patients near the third-floor ward were later diagnosed with a new type of coronavirus pneumonia. But another doctor said," In addition to this patient, there were other patients and doctors who were later isolated. "
On the fifth day after operation, Zhao Junshi`s pneumonia symptoms showed a worsening trend that was difficult to reverse, with lung CT as a "double lung multiple blur," and a number of medical staff in contact with him also developed fever symptoms one after another. Under the guidance of the infection department and respiratory department, the hospital immediately transferred the patient into the expanded infection ward for isolation, disinfection and treatment. By this time Zhao Junshi had been transferred to the fourth ward after operation.
For the fever of medical staff, the hospital immediately opened a special isolation ward for isolation placement. By January 15, Zhao Junshi was diagnosed with a new type of coronavirus infection and immediately referred to Wuhan Jinyintan Hospital as required. The medical staff said:" the doctors can do the best protection, not the so-called`neglect`."
In the notice issued by the Wuhan Health and Health Commission at 23:55 on the 16th, there was no mention of infection among medical staff.
Information suppressed
Looking back on the spread of the new coronavirus in Wuhan, the emergence of such a "super communicator" is almost inevitable.
On December 30,2019, a red-headed document with the official seal of the Department of Medical Administration of the Wuhan Municipal Health Commission was circulated on the Internet to inform "Wuhan Seafood Market in South China of unexplained pneumonia ".
Lin Yu, a doctor at Wuhan Union Hospital, recalled that at the beginning of the epidemic, Wuhan`s strategy was "cold treatment ". His hospital informed that it was not allowed to talk about the condition privately on the public platform without a unit`s authorization, not to be interviewed privately by the media, not only the clinical system, including hospital sense, CDC`s news control was more serious," The only thing doctors could do at that time was to instruct patients:" Masks, masks, must buy masks, wear masks" and even jokingly ordered not to go to the South China Seafood Market. "
On december 31, the city of wuhan government announced that a total of 27 cases were found, seven of them serious, no obvious phenomenon of human transmission, no medical staff found infection. People`s Daily official Weibo news:" The cause is not yet clear, cannot be determined is the online rumor of SARS virus. "
After investigation and verification, Wuhan`s public security organs also summoned eight illegal personnel who posted and forwarded false information on the network, handled it according to law, and released the news through the official Weibo on the first day of 2020.
From January 6 to January 10, Wuhan Health and Health Commission no longer issued a circularanotice on "unexplained pneumonia ".
"12.31 I went to buy a mask, the drugstore lined up and ran out of goods. The next few days, we were told "no rumors ", and we relaxed when we said" no one has passed on ". More than a week later, with no increase in cases, we thought it was over. "wrote a Wuhan netizen on a personal social platform.
"No new cases have been found since January 3,2020," the Wuhan Health and Health Commission said in an updated circular notice on January 11. At present, no medical personnel were found to be infected, and no clear evidence of human transmission was found. "
A few days later, Thailand and Japan reported new cases of coronavirus pneumonia.
From January 12 to 17, the third session of the 13th Hubei Provincial People`s Congress was held in Wuhan. On the 18th, the Baibuting community also held the 20th "Wanjia Banquet ". On the afternoon of the 20th, the emergency management office of Wuhan province held the Spring Festival party. On the 21st, the provincial chinese new year`s rendezvous was held in the hongshan auditorium. The official account number of the Hubei Provincial Folk Song and Dance Troupe, which participated in the performance, wrote that there were provincial leaders and representatives from all walks of life in the province," in Wuhan: everyone wearing layers of masks, to overcome pneumonia panic, with dedication, dedication, earnest efforts. "
Before January 20, few people were wearing masks on the streets of Wuhan. Lin Yu asked Wuhan subway workers why they did not wear masks, the other side said that the leadership did not let the belt, afraid of causing panic. If the authorities had made the situation clear in the first place, five or sixty people would have protected themselves. "Lin told China Newsweek.
"Realized that the matter is serious, is after Zhong Nanshan academician (20th) comes out to speak (" the person passes on "). "This was expressed by a number of respondents. At this time, the Wuhan Union Hospital has temporarily requisitioned the medical examination center as the "infection ward ", the first floor is the infusion room, the second to third floor is the patient`s ward, the fourth floor has set up the medical staff isolation room, the suspected infection medical staff has been placed in the hospital on the 19th, and more than 20 medical staff are suspected to be infected at the peak of the highest peak.
After zhongnanshan`s speech on january 20th, chaos continued. On the 22nd, Liu Fang, a pregnant woman who is suspected to be infected with a new type of coronavirus, was living in the Department of Xiehe Infection in Wuhan until the fourth day. For fear of having an impact on the fetus, she hasn`t done a CT, and the kit that can detect a new type of coronavirus hasn`t been discharged to her because of the shortage.
"On the day of the cut, the doctor, dressed like an astronaut, gave her a C-section because she had to do so. "Lin told China Newsweek.
The reply of the Wuhan Municipal Health and Health Commission on several questions of concern to the public issued on the 23rd mentioned that in the previous period (before January 22nd), the whole city had "more than 200 samples of detectable samples per day ", but nearly 200 people were queuing every day in the fever clinic of Wuhan Concorde, which is only one of the seven designated diagnosis and treatment hospitals in Wuhan.
At that time, Wuhan Concorde queued for the longest more than 5 hours, short 2 to 3 hours," the patient reported, a few days did not respond, and then said that there are still waiting, too many people, resulting in many doctors, patients cannot be diagnosed. "At the time, there were close to 30 medical staff in the hospital.
In addition to the fever clinic staff equipped with goggles, masks, isolation clothing and other three-level protective equipment, other departments and ward doctors and nurse, except masks, basically no other protection.
"Ask for support! "The aforementioned neurosurgeons compiled a list of more than 20 hospitals in Wuhan and sent it on a personal social platform," he said. "
(To protect the privacy of the respondents, the authors named Liu Fang, Zhao Junshi and Lin Yu)
