On the Other Side of the Rails

The First 72 Hours at Wuhan Jinyintan Hospital Fighting Against COVID-19: From the Medical Mission Diary of a Nurse

Authors:
Weiying Zhang, MD,Xueyan Li, BSc,Jun Xu, BSc,Chunlong Zhong, MD, PhD,Li Xu, MM

The author of this diary, Ms Jun, is a nurse with 10 years of ICU nursing experience and a mother of 2 children living in Shanghai. With the support of her family, she was the first volunteer from Shanghai East Hospital to respond to Wuhan during the Covid-19 outbreak. We were deeply moved by her story, the unique perspective, and the context it provides around our joint experiences in China. While working in Wuhan for more than 60 days, Ms. Jun kept a diary that included special events, including nursing the first COVID-19 patient treated with ECMO, handling sudden and unexpected death, and meeting other colleagues from Shanghai to support the Wuhan Fangcang Shelter. Reflecting upon the impermanence of life, her unique experiences, and her feelings and reactions through journaling, she records these poignant memories and valuable experiences. The excerpts below are from Ms. Jun’s journal and provide insight into personal experiences while the commentary by Li and Xu explore the way in which this virus grew from an outbreak to a pandemic.

January 24, 2020, Chinese New Year’s Eve: Urgency

I set out with the first group of the Shanghai medical team, which was made up of 136 members, to support Wuhan in fighting against the COVID-19 outbreak. Less than 2 hours before that I had received the order to assemble at the airport. Many people assembled at the airport, including my husband, who was born and raised in Wuhan, a city more than 800 kilometers away from Shanghai. The city felt both strange and familiar to me. At that moment, I had no time to imagine the situation in Wuhan or think about what I would face in the coming days. Not to mention how long I would be away.

Arrived, but I am feeling so cold. Although the hotel accommodation is good, use of the heating system is forbidden. I hid in the thick bedding and told my family and colleagues in Shanghai that I was safe. They repeatedly told me to pay attention to my personal protection and to use strict infection control. I feel a little uneasy now, and suddenly begin to miss Shanghai soup dumplings.

An outbreak of novel coronavirus that began in Wuhan late last December has spread successively to other regions of China.¹ The government has encouraged people to stay at home, has prevented mass gatherings, and has canceled or postponed major public events.² In Shanghai, the city we live in, purchases of protective and disinfection products have soared, and supplies of face masks have become scarce. In addition, health care workers have begun to cancel vacation plans for the Chinese New Year holiday.

On January 23rd, China raised its national public health emergency level to Level 1—the highest of the 4-level Chinese Emergency Response System, defined as an “extremely serious incident.”³ On January 24th, the first Shanghai medical team to support Wuhan in fighting against COVID-19 was assembled from 52 hospitals and included members from the respiratory, infectious disease, hospital infection management, critical-care medicine, and specialized nursing departments.⁴

January 25, 2020, Lunar New Year's Day: Tension

In the morning, I received personal protection equipment (PPE) training that was very different from my previous experience. Two people helped each other to confirm the details of the PPE process. It took at least 20-30 minutes to complete the full personal protection, including dressing, and applying protective gowns, goggles, and N95 masks. Only when our own safety is ensured will more people be saved. I told myself over and over again that I would be safe.

In the afternoon, our team was assigned and began to take over the 3rd floor wards of the north building of Wuhan Jinyintan Hospital. There were 28 patients, 15 of whom needed noninvasive ventilation. Each ward accommodates 4 patients. One shift is staffed by 8 nurses and 3 physicians, with 1 nurse coordinating work outside the isolation ward, including delivering health care supplies and meals, collecting medical prescriptions, etc. The supplies here are relatively sufficient, which can basically ensure that all health care personnel complete the level III protection. However, there is a relative shortage of nurses.

Today I feel very tired. My husband told me that it might be due to the pressure. Maybe so, who knows. I would like to take a pill to help me sleep well tonight so that I can wake up tomorrow in high spirits and full of energy.

Wuhan Jinyintan Hospital is an infectious disease hospital and was used exclusively to admit COVID-19 patients during the outbreak. At the beginning of the outbreak in Wuhan, medical workers were repeatedly reported to have been infected. Inadequate and ineffective PPE may have led to the nosocomial transmission of COVID-19.⁵ In the early stages, not all of the medical staff were fully aware of isolation measures to prevent transmission of COVID-19, nor were they skilled in effectively wearing all levels of PPE such as goggles, face shields, and long-sleeved waterproof gowns. This lack of confidence in one’s professional competence is the contributing factor that made Wuhan’s medical staff feel nervous and uneasy. Our team received results from a recent qualitative study with these personnel. This study made it clear that effective training and guidance on PPE is essential before starting formal work.⁶ Whether it is necessary to increase the proportion of this content in clinical medicine and nursing education merits further consideration.

January 26, 2020, The second day of the year: So busy there is no time to worry

My shift today is from 8:00 to 14:00.

In the morning, I walked 10 minutes to Jinyintan Hospital with 8 colleagues. I was responsible for all the treatment, care, and daily life of the patients in ward 304.  Two patients were on high-flow oxygen and 1 was on a noninvasive ventilator and sedatives. It seemed that they could say a few words to me, but they were very weak. Their psychological stress response often varied, from excessive fear, to anxiety, to indifference. With so much protection, my hearing was noticeably reduced, and I had to get as close to them as possible.

Six hours of wearing protective clothing for the first time was a bit suffocating and terrible, and it took another 20 minutes to remove the protective clothing after work. I had stopped sweating, but my clothes were still wet. When the wind blew, I couldn't help shivering.

After she returned to Shanghai and completed 14 days in quarantine, we asked her, “Tough work?” With tears in her eyes, she replied, “Leaving my family and children to work on the front line with such high intensity was certainly very hard. But compared to a patient in pain, I am lucky to be able to eat, drink, and move. As a critical care nurse, to cherish and guard life is the value of my job.” That value brings a sense of faith and determination to nursing work.

In China, a nurse’s income is not high, while the intensity of work is considerable. The density of registered nurses in Shanghai is 3.6 per 1,000 people,⁷ which is a medium level in China and a medium-to-high level in the world. In this outbreak, among the medical team members supporting Wuhan, 68% were nurses, their work demonstrating Hippocrates’ spirit of fearlessness and bravery.

Evidence-based health workforce policies are essential to ensure the provision of high-quality health services and to support universal health coverage.⁸ We hope that the government will support further increases to the nursing workforce for public health care institutions. We also hope that the government will work to actively improve the perception and work conditions of specialized nursing. With society’s increasing support and trust for medical workers, we anticipate more and more excellent young people will be willing to join the ranks of health care workers.   

Funding:

This work was supported by the following grants: Special subject of “Fighting Against Epidemic Situation of COVID-19” (Grant No. 20TJBXKY16), Tongji University College of Arts and Communication, Shanghai East Hospital Institute of Disaster Medicine. Shanghai “Medical New Star” Young Medical Talent Training Program Tongji University Affiliated East Hospital “Sunrise” Talent Training Program. Key Discipline Construction Project of Pudong Health Bureau of Shanghai (PWZxk2017-23), Top-level Clinical Discipline Project of Shanghai Pudong (PWYgf2018-05),The Outstanding Leaders Training Program of Pudong Health Bureau of Shanghai (PWR12018-07), Important Weak Subject Construction Project of Pudong Health and Family Planning Commission of Shanghai (PWZbr2017-13).

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