BeijingThe sweating and shivering arrived with Lunar New Year.
Wang Zhen was watching festive programs on television with his wife, two kids, and his parents on the outskirts of Wuhan when he became short of breath. Evening was settling over the village, while a knot in the center of his chest was tightening. He couldn’t sit up.
“The first thing that came to my mind was I must not pass the bug to my family—if it was not too late,” Wang, a 33-year-old philosophy lecturer at Hubei University, recounts.
He packed a small bag and drove by himself through a cold drizzle to his flat in the city. Major roads were blocked off, but as a Wuhan native, he knew his way around the checkpoints. When he reached the apartment, Wang sank into his sofa and read the latest news about the epidemic.
By the time this gloom descended upon Wang on January 25, China had reported 1,320 confirmed cases of the novel coronavirus—mostly in Hubei province, where Wuhan sits as the capital. During the early weeks of the outbreak, he had heard of people contracting the mysterious disease, but he hadn’t been too alarmed. Local officials initially said the virus came from wildlife but could not jump from person to person. (Read how more Chinese citizens are pushing to end wildlife markets)
The message changed five days before Wang became sick, when Zhong Nanshan, the lead investigator on a National Health Commission team deployed to Wuhan, told China's state television that the evidence for human-to-human transmission was strong. The government imposed citywide transportation restrictions in Wuhan, a megacity with a population of 11 million, and then expanded to the rest of the province. A region twice the size of Portugal with nearly 60 million humans was now locked down.
“The city was totally deserted,” he says. “There was an eerie atmosphere to it. It felt like the end of the world.”
In his flat, Wang’s condition deteriorated as he dialed 120, China’s emergency number. Busy signal. He put down the phone and sat in the dark alone, waiting—while outside the novel coronavirus spread like bush fire.
Wang’s story is akin to so many others from the frontlines of this viral war, which chart a familiar tale about the first month of any global health emergency.
As of this writing, the number of people infected in China has reached a staggering 28,000 cases. More than two-thirds of the afflicted live in Hubei Province, and 3,800 people have severe pneumonia—raising the specter of the Severe Acute Respiratory Syndrome (SARS) epidemic from 17 years prior, which inflicted 8,100 people globally and killed nearly 800.
Then, as now, a coronavirus is the germ behind the sickness, but this emergent strain has reached far more people in a shorter time frame. More than 200 people across two dozen countries and territories in Asia, Europe, and North America are suffering from the new infection, and the first deaths outside of China happened over the past week.
Catching the first cases
Zhang Li spent most of January 1 in the wards at Wuhan Jinyintan Hospital, the city’s premier infectious disease center, frantically trying to save gravely ill patients from an atypical pneumonia. The first patients had arrived on December 29, but more came the next day. Dozens followed. The hospital was at full capacity within a week. Zhang and her husband, both respiratory specialists at Jinyintan, along with the rest of the hospital staff, have been on overdrive ever since.
“It’s a battle of life and death,” Zhang says.
Her words echo Chinese president Xi Jinping, who has put the region on war footing to prevent and control the spread of the novel coronavirus. On Lunar New Year’s Eve, 450 military medical staff—experienced in combating SARS or Ebola—touched down in Wuhan, as part of the Communist Party’s effort to save lives. President Xi ordered the speedy delivery of medical supplies, including protective masks, gowns, and diagnostic tools, to areas under lockdown, and he vowed consequences for officials who were negligent in tackling the crisis.
Scientists rushed to decipher the infection’s ramifications. A study of the first 425 severe cases, published January 29 in the New England Journal of Medicine, shows the median age of those grave illnesses was 59 years old. The largest epidemiological study to date of the new coronavirus, it also presents clear evidence of human-to-human transmission, says lead author Benjamin Cowling, an epidemiologist at the University of Hong Kong.
“It’s unequivocal,” Cowling says, though adding on a positive note that the team witnessed no cases in children under the age of 15.
His study and another published in The Lancet—both led by University of Hong Kong’s dean of medicine Gabriel Leung—estimate that on average each patient has given the bug to 2.2 and 2.7 additional people, respectively. The new infection appears to incubate for five to six days before showing symptoms, based on Leung’s research and other analyses.
The contagion spreads primarily through close contact, particularly through droplets sprayed by an infected person’s coughs and sneezes. In a second study also published January 29 in the New England Journal of Medicine, scientists found signs of the virus in the loose stool of the first U.S. case, suggesting the disease might be transmitted via fecal matter as well.
To stop the viral fire from spreading, millions of people who departed Hubei before the lockdown as part of the Spring Festival mass migration are being tracked down and put under compulsory two-week quarantine. The holiday season has been extended, as people across the country are advised to stay put and work from home as much as possible. Tour groups have been suspended, and all domestic travel by bus, train, and airplane has been interrupted. (Read how coronavirus spreads on a plane—and the safest place to sit)
Despite being unprecedented and verging on draconian, the measures are commendable, some experts say. “The [Chinese] government deserves credit for having responded rapidly,” and for its commitment to containing the virus, says Ian Lipkin, director of Columbia University’s Center for Infection and Immunity in New York, whose lab worked with Chinese officials to develop early diagnostic tests for SARS. “It’s much much better than it was” when battling SARS in 2003, he says.
Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, echoed this sentiment right before his agency designated the novel coronavirus epidemic as a global health emergency on January 30. This designation is the WHO’s highest level of alarm, reserved for outbreaks that threaten those beyond the country of the pathogen’s origin and require a coordinated international response. Over the next three months, the WHO plans to spend $675 million on a response plan for vulnerable countries.
“This declaration is not a vote of no confidence in China,” Ghebreyesus said at a press conference in Geneva on January 30. "Our greatest concern is the potential for the virus to spread to countries with weaker health systems.”
But Zhang feels the situation is worsening at Wuhan Jinyingtan Hospital, which has been designated to treat the most critical patients.
“The mortality rate seems to be climbing. Three patients died in my wards alone today,” Zhang told National Geographic on Sunday evening. She sounded tired, her voice quiet, a sense of sadness and helplessness palpable. “I wonder if this is a sign that the virus is getting more deadly.” Zhang keeps losing her colleagues to illnesses: some are infected, others are sick out of sheer exhaustion. Li Wenliang, the doctor who alerted the public to the outbreak, died on Thursday as reported by The Washington Post.
In a study published in Lancet, Zhang and her colleagues show that 99 confirmed severe cases admitted to her hospital between January 1 and January 20 had a mortality rate of 11 percent. Nationwide, fatalities among severe cases are running around 15 percent.
The study identifies a list of factors that could help predict those worst cases, including a history of smoking, bacterial infection, high blood pressure, diabetes, and old age. “Early identification of those factors and early treatment are critical for preventing patients from developing fatal symptoms,” Zhang says.
Other experts doubt this bleak outlook will extend beyond the critical zone of the outbreak’s epicenter. The overall death tally is around 560, about 2 percent of the confirmed cases spread across the globe.
“The real fatality rate is likely to be much lower”, says Linfa Wang, director of the program in emerging infectious diseases at Duke-NUS Medical School in Singapore. This is because the confirmed cases represent only a fraction of total cases, given that many people with mild symptoms may not go to the hospital and the testing capacity is limited, he adds.
Internet interventions
Yet death was what Wang felt, alone in his city flat in Wuhan. The thought of not being able to see his children grow up was unbearable. He dialled 120 again. Still busy.
After trying and failing multiple times, Wang panicked and did what anyone might do in this digital age—he hopped on social media.
He started to send messages on the popular Chinese messaging app WeChat to his friends, colleagues, and students. Dozens responded. They volunteered to call the emergency number on his behalf. A friend of a colleague at Wuhan Tianyou Hospital offered to reserve a bed for him.
“Fear, anxiety, and ignorance of the disease are taking a heavy toll on populations in lockdown areas,” says Liu Hao, a physician at the Wuhan Ciming Health Checkup Group. “Thanks to the internet, there is a lot we can do.”
Liu, a Wuhan native, has gathered nearly a hundred or so volunteers from across the country, including over three dozen clinicians, to offer online support to neglected individuals. The group provides medical guidance and psychological counseling. It also gives advice on ways to ward off infection and on how to eat well and stay healthy during a quarantine.
Not knowing when the lockdown will be lifted, “we are in for a long haul,” says Liu. “People need to feel someone cares about them. They need to know someone will be there for them if necessary—even if hospitals can’t take care of them right now.”
Hours after sending up flags on WeChat, an ambulance arrived at Wang’s apartment. Two medical staff in protective masks and clothing ushered him to Tianyou hospital. Despite a raging fever, x-rays showed no signs of severe respiratory illness.
“At least I’m not dying,” he recalls thinking. But he could not be tested for the coronavirus because the scarce medical reagents were reserved for patients with clear symptoms of pneumonia. He was admitted for monitoring, sharing a room with two elderly male patients. A curtain separated each bed.
“We never chatted. We were quite wary of each other. Each of us was probably wondering if the others had got the virus,” Wang says. But his experience ranks among the lucky.
After the Wuhan lockdown, residents flooded the city’s hospitals. Chaotic images of packed fever clinics swamped state television, with countless people turned away and asked to quarantine themselves at home. Lacking space and proper quarantine advice, many family members report infecting one another. And those who perish at home may never be counted among the official fatalities.
Critics say there is an urgent need to properly quarantine suspected cases. “Failing that, there would be more ‘walking infectious sources’ and more cross-infections,” says Lei Reipeng, deputy dean of the School of Humanities at the Huazhong University of Science and Technology in Wuhan. She and a team at Huanzhong have been lobbying the provincial government to quarantine anybody who has symptoms but cannot be immediately handled by hospitals designated for the epidemic.
“You just cannot let them float around and potentially infect others,” Lei says. “Most hotels in Wuhan are empty. There is also space in many general hospitals. Why can’t we use them to cut the infectious sources?”
Fortunately, the helplessness felt by many people trapped in Wuhan might soon find relief. Early this week, the provincial government announced that identifying and quarantining suspected cases will be a top priority in the coming weeks, according to the Hubei Daily.
And to meet the unprecedented medical need, the government has rushed to build two new hospitals for Wuhan. The state television showed dozens of brightly colored diggers hoeing the ground at the building sites. More than 6,300 workers labored in round-the-clock shifts to ensure rapid construction.
The first hospital—named Huoshenshan, or “the mountain of fire god”—was completed in 10 days and opened on Tuesday. Leishenshan Hospital, the mountain of thunder god, is due to open later this week. Together, the new facilities will be staffed by 3,400 military medics and will house 2,600 beds.
Meanwhile, 24 general hospitals in the city are being retrofitted to admit patients with respiratory infectious diseases. A total of 13,000 new beds will be created through this process by the end of this week, project member Sun Fenghua told the state television.
“We will decide whether to retrofit more hospitals based on how the epidemic evolves,” she says.
Recovery road
After a few days of treatment at Wuhan Tianyou Hospital, including taking a couple of antiviral drugs, Wang felt much better. The fever broke. He could breathe again. The knot in his chest had loosened, and the hospital discharged him. While his recovery remains in progress, China is still reeling.
“It’s too early to tell when we can see the end of this,” says Zhang, the respiratory specialist at Wuhan Jinyintan Hospital. “There will be more cases.”
A study published in Lancet last Friday estimated that nearly 76,000 people in Wuhan had likely caught the novel coronavirus by January 25, based on modeling off the known number of cases and how the disease spreads. The authors reckon the epidemic was doubling every 6.4 days. But the epidemic growth might now be slowing because of “the unprecedented massive social distancing measures that have since been implemented,” Leung, who led the study, says in an email.
To date, no super-spreaders—patients who transmit a pathogen to many people at once—have been reported in peer-reviewed studies. At least one paper, published January 24 in The Lancet, shows that patients can be contagious when they have mild or even no symptoms. On Tuesday, China’s National Health Commission confirmed that many such cases exist, mostly among family members.
“This is in contrast to SARS, when you are infectious only when you have symptoms,” says Jeremy Farrar, director of London-based Wellcome Trust, a charitable foundation focusing on medical research. “This makes it extremely challenging to control.”
So, Wang is quarantining himself in his city flat in Hubei University, in case he is infected and still contagious. His students take turns grocery shopping for him.
“They leave the stuff outside the flat and then text me,” says Wang. “We don’t meet. We can’t take any chances.”
And he “sees” his family every day through video calls on WeChat: “I just want this to be over soon. I can’t wait to hold my kids again.”
