19 ms·

I Spent Seven Weeks in a Wuhan ICU

165 points by yfzhou 6y ago

redis_mlc 6y ago
"Indeed, in our experience, no medicine was particularly useful. Instead, the most effective solution was oxygen. For around 60% of our patients, oxygen saturation was improved by using oxygen masks with a reservoir bag. In more severe cases, we would also use a nasal cannula and an oxygen mask to increase the volume of oxygen."
- asdfasgasdgasdg 6y ago
  Because of my priors, I believe this is true. My prior being that we should not expect any given random drug to be efficient against a particular virus. But this doesn't count as strong evidence against these medicines any more than the French studies count in favor. (They both count, just very little.)
- Leary 6y ago
  "One of the first things we noticed was that our COVID-19 patients had a higher tolerance for hypoxia, a kind of oxygen deprivation, than typical viral pneumonia cases." Definitely heard that from doctors in NYC as well. [1] [1]: https://www.medscape.com/viewarticle/928156 https://www.medscape.com/viewarticle/928156
  - neuronic 6y ago
    Non-medical view: this sounds a bit like a sudden switch is happening at one point. In COVID-19 cases, large areas of the lungs (article states 60% as an example) may be affected and only mild symptoms experienced until some point in time. Then comes the switch and you have sudden deterioration into critical condition. In other viral pneumonia cases, more serious symptoms are subjectively experienced earlier, when much less area of the lungs is affected (article says 20% for H1N1). As if the problem causing breathing trouble is strong in H1N1 from the beginning and suddenly switches on in the affected area for COVID-19 which had time to grow large beforehand.
- djsumdog 6y ago
  > though many of our patients experienced severe side effects and couldn’t continue the treatment I took chloroquine years ago as a preventative anti-malaria when I was in India. I didn't get the weird dreams, but I got the harsh bowl movement, heart palpations, etc. I had to stop taking it and so did someone else on the trip. Had I got malaria I knew it would be worse, but I could start taking them again as a treatment drug as well. Others on the trip didn't have any issues so I'm sure it's individual, but it is a very serious drug that can be hard on your system. I don't think that's been made clear.
  - BiteCode_dev 6y ago
    Just out of curiosity, how long ago was it? Malaria nowadays is very easy to prevent and treat with a course of atovaquone/proguanil, which have low side effect on the short run. I want to know if doctors are still prescribing chloroquine despite of that. I know they do sometimes in the army.
  - chvid 6y ago
    COVID19 hits patients with health problems and old age harder; those patients are probably also more sensitive to the side effects of chloroquine or other drugs.
  - Mediterraneo10 6y ago
    > I took chloroquine years ago as a preventative anti-malaria when I was in India. I didn't get the weird dreams The weird dreams and other neurological consequences that some unlucky travelers report when taking antimalaria prophylaxis, typically come from mefloquine (Lariam) and not chloroquine.
- BiteCode_dev 6y ago
  So basically, our best chance now is not to cure them, but to help them survive until their immune system fight it off?
  - redis_mlc 6y ago
    It's more subtle than that. Here's some background before I answer your question. One doctor has said that corona patients should be treated like altitude sickness patients, not like viral patients (and this Wuhan article implies that.) All doctors say that ventilator intubation is the equivalent of major surgery, requiring anesthetics for the duration of ventilation and a long recovery period. High air pressure damages lung tissue, so afterwards you won't be walking or talking much for weeks or months. So when you put those together, the best US approach today so far is to provide supplemental oxygen with face masks or cannula until the patient faints repeatedly (turns blue or purple), then make a decision to intubate. (China learned and published this in Jan. or Feb., but we learned it in Mar. or Apr.) The only problem there is that mouth-breathing patients aerosolize corona virua and infect staff and other patients, so they should be moved out of the hospital to a quarantine facility or sent home. I don't think we are doing this yet, and it's an important step to stopping lockdown since we'll have thousands of new patients to monitor and help breathe. The US mistakes made pre-Apr. 1 were early intubation based on traditional oxygen level monitoring (and to prevent aerosolization to protect staff.) That had a 66% - 90% mortality rate and consumed too many ventilators. > out best chance now is not to cure them, but to help them survive until their immune system fight it off? There is no plan, cure or pattern except we give them oxygen and see what happens next. We have no diagnostic tools that tell us cause and effect. For example, X-rays can show corona virus lung congestion, but there's no measurement or inference we can draw from any image. All we know is that ventilators are a one-way trip for most patients. It is what it is.
    - fragmede 6y ago
      In a less political time with more open societies, we could confirm earlier research started by the Chinese, giving us lead times for our doctors to confirm their theories, which would help get to a scientifically proven and recommended course of action. (Like the pre-print that discusses COVID-19 attacking hemoglobin which then inhibits the ability for the blood to hold oxygen.) Unfortunately, nationalism has kicked in, and there are rumors that China is censoring any papers that discuss a possible origin, hindering progress. So now all we can do is give oxygen and hope for the best.
strider12 6y ago
basically no one died or got infected... lovely story. and as the great w would say, mission accomplished.
- s1artibartfast 6y ago
  >and as the great w would say, mission accomplished Sorry, but the use of this quote out of context is one of my pet peeves, and the similarity is striking. In the case of G.W, he was receiving sailors returning to port after completing their deployment in harm's way. Their mission was accomplished. The message was not that war is over, as the media insinuated. In fact, the counterpoint was made in the speech[1], although few have read it. >Our mission continues. Al Qaeda is wounded, not destroyed. The scattered cells of the terrorist network still operate in many nations, and we know from daily intelligence that they continue to plot against free people. The proliferation of deadly weapons remains a serious danger. The enemies of freedom are not idle, and neither are we. Our government has taken unprecedented measures to defend the homeland. And we will continue to hunt down the enemy before he can strike. The war on terror is not over; yet it is not endless. We do not know the day of final victory, but we have seen the turning of the tide. No act of the terrorists will change our purpose, or weaken our resolve, or alter their fate. Their cause is lost. Free nations will press on to victory. Similarly, in this article, if taken at face value, a volunteer went to Wuhan, risking their life, and returned. This does not mean that Covid is eradicated, but perhaps, their mission is accomplished too. [1] https://www.americanrhetoric.com/speeches/wariniraq/gwbushiraq5103.htm https://www.americanrhetoric.com/speeches/wariniraq/gwbushir...
  - mullingitover 6y ago
    The funny coincidence with that story: Osama bin Laden's stated purpose for the 9/11 attacks was, in part, the presence of US troops in Saudi Arabia. The US announced the withdrawal of troops from Saudi Arabia on April 29, 2003. Four days later Bush made that "Mission Accomplished" speech as the US was effectively complying with bin Laden's demand and surrendering their presence in Saudi Arabia.
    - 6y ago
blargmaster33 6y ago
Nice try chicomm operative
baybal2 6y ago
FYI, this publication, and its parent is pretty much People's Daily in disguise. It is made along the lines of Shanghai Oriental Morning Post 2.0. Without a doubt, it is an even more of a state organ media than it's spiritual predecessor, despite the mandate to push "dissenting" view. Unlike something like Southern Weekly, which had not a single party cadre in its editors, despite being overtly party ran, but closed for merely contemplating of having its own line. I read Southern Weekly during short stints in China a decade ago. Even it was an extremely stiff writing. I couldn't comprehend how people managed to spot "dissent" in it, except for the sole fact it had original writing not coming from the propaganda ministry, and it doing "a fact of life" reports. Give this some thought. Were they not doing this with 100% official blessing, they would've been "rectified" faster than you can blink.
- EdwardDiego 6y ago
  I'm surprised that they let him admit that he arrived to a ward covered in rubbish and medical waste staffed only by two opthamologists and two nurses tbh. At -2 (and counting) for this currently, any downvoters care to comment as to why? If indeed this publication is a propaganda mouthpiece, then my surprise that they're publishing something that reflects badly on their medical providers should be easy to understand
  - wakenmeng 6y ago
    Actually there are a lot of posts(pics, videos) on China social media from doctors showing they were lack of PPE, and using even plastic bags. It is not they said that china gov controls all media and social posts. And most of the videos u saw on twitter which gov staffs' violence are posted on Chinese social media first to explore and report this to the gov. They are just similar to other countries' gov staffs' enforcement violations. It happends sometimes, but when it happened in China, they tagged "CCP violence".
    - Melting_Harps 6y ago
      > Actually there are a lot of posts(pics, videos) on China social media from doctors showing they were lack of PPE, and using even plastic bags. Agreed. But, that still wouldn't stop the CCP from trying to deny that it happened or continues to take place, just as they're actively lying about the death count in just Wuhan as many locals reported that crematoriums were running 24/7 and urns were being delivered by the truckload daily for the families of the dead [1]. I don't think we'll ever truly know the death count from all of this on Mainland China, mainly because the CCP are trying to spin the optics away from their culpability in trying to cover it up and the censorship to do so while trying to change the narrative to suit their ends. 1: https://www.businessinsider.com/wuhan-residents-say-chinese-government-coronavirus-death-toll-is-low-2020-3?op=1 https://www.businessinsider.com/wuhan-residents-say-chinese-...
usr1106 6y ago
Interesting read. But always remember, China is a country that does not let their people know the truth what happens in the world (the great firewall). So I'm not all convinced that they let the world know the truth what happens in China. The article could be an honest personal report or it could be government-backed propaganda. How do we know?
- chrischen 6y ago
  Everything is propaganda, so put on your critical thinking cap and judge for yourself.
  - djsumdog 6y ago
    True. In America it's both propaganda and entertainment; which is why all the 24/7 hate networks are really super dangerous when something like this is going on. People want their news byte. It's one thing to sensationalize studies for mundane stuff to make some spicy science news, but to do it ever day, on every unpublished study and exaggerate or extrapolate the most bizarre information; it just washes audiences in conflicting information that helps no one.
  - BiteCode_dev 6y ago
    The question here is, "is is CCP propaganda, and how much of it?"
- seanmcdirmid 6y ago
  Sixth Tone was setup by the Chinese government to be more relatable to western audiences by sounding more critical, so you shouldn't take it at face value. On the other hand, it does provide useful information, and it could be seen as an attempt to provide higher quality news out of China. After the Xi era, I think Chinese propaganda will actually move in a more critical/informative direction like Sixth Tone, since the current overt methods are losing effectiveness. But again, that could also just mean real reporting depending on how the government evolves.
  - paul_milovanov 6y ago
bschwindHN 6y ago
What's up with the weird texture applied to all the photos?
- Operyl 6y ago
  I thought my eyes were just going blurry or something at first.
- BiteCode_dev 6y ago
  Wondering if it's not a way to prevent editing detection software to work. Anybody knows something about this?
  - chvid 6y ago
    I think it is done for aesthetics - surely you can do watermarks or edit detection without it being this visible.
Gravityloss 6y ago
Medical oxygen is very important. That should be secured. Doors and other facilities for isolation of patients should be built. Neither requires very high levels of technology
6510 6y ago
The wrinkles in the curtains :/
- winrid 6y ago
  What do you mean?
  - 6510 6y ago
    you get that if you open and close them lots of times
9nGQluzmnq3M 6y ago
The title would be more useful if it made it clear that this is a doctor's POV, not a patient's. (Not least because a patient spending 7 weeks in an ICU would likely be sedated for most of it.)
- jonnypotty 6y ago
  Yeah, heaven forbid you have to read an article to find out what it says. Doesn't matter though, HN has already dismissed this article as state fabrication, cos "China" so you don't need to read it anyway.
  - 9nGQluzmnq3M 6y ago
    I read it, but I almost didn't, because I've already read half a dozen "OMG I survived corona" stories from patients. I was (positively) surprised that it was actually the perspective of an ICU doc in Wuhan. Also, "HN" (who?) hasn't asserted anything like what you're saying. If that piece is propaganda, it's pretty well done.

165 points by yfzhou 6y ago

"Indeed, in our experience, no medicine was particularly useful. Instead, the most effective solution was oxygen. For around 60% of our patients, oxygen saturation was improved by using oxygen masks with a reservoir bag. In more severe cases, we would also use a nasal cannula and an oxygen mask to increase the volume of oxygen."

asdfasgasdgasdg 6y ago
Because of my priors, I believe this is true. My prior being that we should not expect any given random drug to be efficient against a particular virus. But this doesn't count as strong evidence against these medicines any more than the French studies count in favor. (They both count, just very little.)
Leary 6y ago
"One of the first things we noticed was that our COVID-19 patients had a higher tolerance for hypoxia, a kind of oxygen deprivation, than typical viral pneumonia cases." Definitely heard that from doctors in NYC as well. [1] [1]: https://www.medscape.com/viewarticle/928156 https://www.medscape.com/viewarticle/928156
- neuronic 6y ago
  Non-medical view: this sounds a bit like a sudden switch is happening at one point. In COVID-19 cases, large areas of the lungs (article states 60% as an example) may be affected and only mild symptoms experienced until some point in time. Then comes the switch and you have sudden deterioration into critical condition. In other viral pneumonia cases, more serious symptoms are subjectively experienced earlier, when much less area of the lungs is affected (article says 20% for H1N1). As if the problem causing breathing trouble is strong in H1N1 from the beginning and suddenly switches on in the affected area for COVID-19 which had time to grow large beforehand.
djsumdog 6y ago
> though many of our patients experienced severe side effects and couldn’t continue the treatment I took chloroquine years ago as a preventative anti-malaria when I was in India. I didn't get the weird dreams, but I got the harsh bowl movement, heart palpations, etc. I had to stop taking it and so did someone else on the trip. Had I got malaria I knew it would be worse, but I could start taking them again as a treatment drug as well. Others on the trip didn't have any issues so I'm sure it's individual, but it is a very serious drug that can be hard on your system. I don't think that's been made clear.
- BiteCode_dev 6y ago
  Just out of curiosity, how long ago was it? Malaria nowadays is very easy to prevent and treat with a course of atovaquone/proguanil, which have low side effect on the short run. I want to know if doctors are still prescribing chloroquine despite of that. I know they do sometimes in the army.
- chvid 6y ago
  COVID19 hits patients with health problems and old age harder; those patients are probably also more sensitive to the side effects of chloroquine or other drugs.
- Mediterraneo10 6y ago
  > I took chloroquine years ago as a preventative anti-malaria when I was in India. I didn't get the weird dreams The weird dreams and other neurological consequences that some unlucky travelers report when taking antimalaria prophylaxis, typically come from mefloquine (Lariam) and not chloroquine.
BiteCode_dev 6y ago
So basically, our best chance now is not to cure them, but to help them survive until their immune system fight it off?
- redis_mlc 6y ago
  It's more subtle than that. Here's some background before I answer your question. One doctor has said that corona patients should be treated like altitude sickness patients, not like viral patients (and this Wuhan article implies that.) All doctors say that ventilator intubation is the equivalent of major surgery, requiring anesthetics for the duration of ventilation and a long recovery period. High air pressure damages lung tissue, so afterwards you won't be walking or talking much for weeks or months. So when you put those together, the best US approach today so far is to provide supplemental oxygen with face masks or cannula until the patient faints repeatedly (turns blue or purple), then make a decision to intubate. (China learned and published this in Jan. or Feb., but we learned it in Mar. or Apr.) The only problem there is that mouth-breathing patients aerosolize corona virua and infect staff and other patients, so they should be moved out of the hospital to a quarantine facility or sent home. I don't think we are doing this yet, and it's an important step to stopping lockdown since we'll have thousands of new patients to monitor and help breathe. The US mistakes made pre-Apr. 1 were early intubation based on traditional oxygen level monitoring (and to prevent aerosolization to protect staff.) That had a 66% - 90% mortality rate and consumed too many ventilators. > out best chance now is not to cure them, but to help them survive until their immune system fight it off? There is no plan, cure or pattern except we give them oxygen and see what happens next. We have no diagnostic tools that tell us cause and effect. For example, X-rays can show corona virus lung congestion, but there's no measurement or inference we can draw from any image. All we know is that ventilators are a one-way trip for most patients. It is what it is.
  - fragmede 6y ago
    In a less political time with more open societies, we could confirm earlier research started by the Chinese, giving us lead times for our doctors to confirm their theories, which would help get to a scientifically proven and recommended course of action. (Like the pre-print that discusses COVID-19 attacking hemoglobin which then inhibits the ability for the blood to hold oxygen.) Unfortunately, nationalism has kicked in, and there are rumors that China is censoring any papers that discuss a possible origin, hindering progress. So now all we can do is give oxygen and hope for the best.

strider12 6y ago

basically no one died or got infected... lovely story. and as the great w would say, mission accomplished.

s1artibartfast 6y ago
>and as the great w would say, mission accomplished Sorry, but the use of this quote out of context is one of my pet peeves, and the similarity is striking. In the case of G.W, he was receiving sailors returning to port after completing their deployment in harm's way. Their mission was accomplished. The message was not that war is over, as the media insinuated. In fact, the counterpoint was made in the speech[1], although few have read it. >Our mission continues. Al Qaeda is wounded, not destroyed. The scattered cells of the terrorist network still operate in many nations, and we know from daily intelligence that they continue to plot against free people. The proliferation of deadly weapons remains a serious danger. The enemies of freedom are not idle, and neither are we. Our government has taken unprecedented measures to defend the homeland. And we will continue to hunt down the enemy before he can strike. The war on terror is not over; yet it is not endless. We do not know the day of final victory, but we have seen the turning of the tide. No act of the terrorists will change our purpose, or weaken our resolve, or alter their fate. Their cause is lost. Free nations will press on to victory. Similarly, in this article, if taken at face value, a volunteer went to Wuhan, risking their life, and returned. This does not mean that Covid is eradicated, but perhaps, their mission is accomplished too. [1] https://www.americanrhetoric.com/speeches/wariniraq/gwbushiraq5103.htm https://www.americanrhetoric.com/speeches/wariniraq/gwbushir...
- mullingitover 6y ago
  The funny coincidence with that story: Osama bin Laden's stated purpose for the 9/11 attacks was, in part, the presence of US troops in Saudi Arabia. The US announced the withdrawal of troops from Saudi Arabia on April 29, 2003. Four days later Bush made that "Mission Accomplished" speech as the US was effectively complying with bin Laden's demand and surrendering their presence in Saudi Arabia.
  - 6y ago

blargmaster33 6y ago

Nice try chicomm operative

baybal2 6y ago

FYI, this publication, and its parent is pretty much People's Daily in disguise. It is made along the lines of Shanghai Oriental Morning Post 2.0. Without a doubt, it is an even more of a state organ media than it's spiritual predecessor, despite the mandate to push "dissenting" view. Unlike something like Southern Weekly, which had not a single party cadre in its editors, despite being overtly party ran, but closed for merely contemplating of having its own line. I read Southern Weekly during short stints in China a decade ago. Even it was an extremely stiff writing. I couldn't comprehend how people managed to spot "dissent" in it, except for the sole fact it had original writing not coming from the propaganda ministry, and it doing "a fact of life" reports. Give this some thought. Were they not doing this with 100% official blessing, they would've been "rectified" faster than you can blink.

EdwardDiego 6y ago
I'm surprised that they let him admit that he arrived to a ward covered in rubbish and medical waste staffed only by two opthamologists and two nurses tbh. At -2 (and counting) for this currently, any downvoters care to comment as to why? If indeed this publication is a propaganda mouthpiece, then my surprise that they're publishing something that reflects badly on their medical providers should be easy to understand
- wakenmeng 6y ago
  Actually there are a lot of posts(pics, videos) on China social media from doctors showing they were lack of PPE, and using even plastic bags. It is not they said that china gov controls all media and social posts. And most of the videos u saw on twitter which gov staffs' violence are posted on Chinese social media first to explore and report this to the gov. They are just similar to other countries' gov staffs' enforcement violations. It happends sometimes, but when it happened in China, they tagged "CCP violence".
  - Melting_Harps 6y ago
    > Actually there are a lot of posts(pics, videos) on China social media from doctors showing they were lack of PPE, and using even plastic bags. Agreed. But, that still wouldn't stop the CCP from trying to deny that it happened or continues to take place, just as they're actively lying about the death count in just Wuhan as many locals reported that crematoriums were running 24/7 and urns were being delivered by the truckload daily for the families of the dead [1]. I don't think we'll ever truly know the death count from all of this on Mainland China, mainly because the CCP are trying to spin the optics away from their culpability in trying to cover it up and the censorship to do so while trying to change the narrative to suit their ends. 1: https://www.businessinsider.com/wuhan-residents-say-chinese-government-coronavirus-death-toll-is-low-2020-3?op=1 https://www.businessinsider.com/wuhan-residents-say-chinese-...

usr1106 6y ago

Interesting read. But always remember, China is a country that does not let their people know the truth what happens in the world (the great firewall). So I'm not all convinced that they let the world know the truth what happens in China. The article could be an honest personal report or it could be government-backed propaganda. How do we know?

chrischen 6y ago
Everything is propaganda, so put on your critical thinking cap and judge for yourself.
- djsumdog 6y ago
  True. In America it's both propaganda and entertainment; which is why all the 24/7 hate networks are really super dangerous when something like this is going on. People want their news byte. It's one thing to sensationalize studies for mundane stuff to make some spicy science news, but to do it ever day, on every unpublished study and exaggerate or extrapolate the most bizarre information; it just washes audiences in conflicting information that helps no one.
- BiteCode_dev 6y ago
  The question here is, "is is CCP propaganda, and how much of it?"
seanmcdirmid 6y ago
Sixth Tone was setup by the Chinese government to be more relatable to western audiences by sounding more critical, so you shouldn't take it at face value. On the other hand, it does provide useful information, and it could be seen as an attempt to provide higher quality news out of China. After the Xi era, I think Chinese propaganda will actually move in a more critical/informative direction like Sixth Tone, since the current overt methods are losing effectiveness. But again, that could also just mean real reporting depending on how the government evolves.
- paul_milovanov 6y ago

bschwindHN 6y ago

What's up with the weird texture applied to all the photos?

Operyl 6y ago
I thought my eyes were just going blurry or something at first.
BiteCode_dev 6y ago
Wondering if it's not a way to prevent editing detection software to work. Anybody knows something about this?
- chvid 6y ago
  I think it is done for aesthetics - surely you can do watermarks or edit detection without it being this visible.

Gravityloss 6y ago

Medical oxygen is very important. That should be secured. Doors and other facilities for isolation of patients should be built. Neither requires very high levels of technology

6510 6y ago

The wrinkles in the curtains :/

winrid 6y ago
What do you mean?
- 6510 6y ago
  you get that if you open and close them lots of times

9nGQluzmnq3M 6y ago

The title would be more useful if it made it clear that this is a doctor's POV, not a patient's. (Not least because a patient spending 7 weeks in an ICU would likely be sedated for most of it.)

jonnypotty 6y ago
Yeah, heaven forbid you have to read an article to find out what it says. Doesn't matter though, HN has already dismissed this article as state fabrication, cos "China" so you don't need to read it anyway.
- 9nGQluzmnq3M 6y ago
  I read it, but I almost didn't, because I've already read half a dozen "OMG I survived corona" stories from patients. I was (positively) surprised that it was actually the perspective of an ICU doc in Wuhan. Also, "HN" (who?) hasn't asserted anything like what you're saying. If that piece is propaganda, it's pretty well done.