Doctors from East China's Jiangsu Province deployed to Wuhan use ECMO to treat a COVID-19 patient in critical condition at Wuhan First Hospital. (Photo: Global Times)
Some of China's best doctors in respiratory and infectious diseases are still in Wuhan tasked with treating COVID-19 patients in critical condition, trying their best to save more lives as the nation is close to the final stages to cure or discharge the remaining patients.
Although the majority of China's COVID-19 patients have been discharged from hospital, 1,160 are still in treatment, while 176 patients remain in critical condition as of Wednesday. Wuhan still has 398 confirmed cases, including 135 critical cases, according to the National Health Commission.
It is a remarkable contrast to just a month ago when Hubei Province alone reported more than 60,000 patients, a figure exemplifying the achievement of the whole nation in the costly COVID-19 fight.
Doctor Cao Zhaolong, 56, came to aid Wuhan from Beijing in February along with more than 130 colleagues.
He was responsible for treating critical patients at an intensive care ward with 50 beds at the Sino French New City Branch of Wuhan Tongji Hospital.
Some critically ill patients receiving treatment are those who have been saved by invasive ventilators and ECMO, but there is still pulmonary fibrosis in their lungs. Some are being treated conservatively with oxygen therapy, Cao said.
Some have shown stable symptoms of COVID-19, but those with serious comorbidities such as kidney failure and heart disease require treatment from multiple departments.
As there is no specific drug to treat COVID-19, those in critical condition need to be clinically treated based on their symptoms, Cao said.
By April 5, the ICU ward where Cao works had received 101 patients, of whom 47 were listed as severe and 26 as critical. They ranged in age from 18 to 88. Among them, 81 patients have been discharged, and four have died. Three patients were transferred to other wards for dialysis due to chronic renal failure and six were transferred to other ICU wards. Seven patients received treatment for other diseases in the intermediate ward.
The COVID-19 fatality rate at Sino French New City Branch dropped from 6 percent to 2.8 percent since they received support from doctors coming from outside Wuhan.
The use of invasive ventilation and ECMO is a treatment of last resort to keep critically ill patients alive, but it also carries high risks. About 30 to 35 percent of patients who have been on invasive ventilators and ECMO improved for the better, Cao noted.
Most of the critical COVID-19 patients are elderly with weak immunity. Invasive treatment with machines brings them higher risk of infection. Some children of elderly patients do not want their parents to suffer from that pain.
The use of ECMO requires a high accurate dose of anticoagulants while the blood is being pumped outside the body to be reoxygenated, allowing the heart and lungs to rest. If the anticoagulant dose is insufficient, the blood clots and the tubes become blocked. And if the dose goes over, the patient will suffer bleeding.
Some severe patients will still have pulmonary fibrosis after recovery from COVID-19. Their oxygen saturation drops when they move, leading to breathing difficulties.
Cao advises them to be inactive for three months after discharge. The symptoms of pulmonary fibrosis are reversible, and after two or three years, it is estimated that the lungs can be restored to good health.
Drawing experience from SARS
As a member of the national critical disease emergency expert team, Cao was involved in the treatment of major respiratory infectious diseases such as SARS in 2003 and H1N1 in 2009.
During the SARS epidemic, patients received excessive hormone therapy, which left them with a condition known as femoral head necrosis - a lack of blood supply to the hip bone. But with COVID-19 treatments, hormones are used with caution, so there will not be any joint problems, Cao said.
"I accumulated a lot of experience in actual combat against major respiratory diseases, so I was determined to aid Wuhan," Cao said.
Our country, government and hospitals accumulated precious experience in fighting SARS, which helped in the prevention and control of COVID-19, he said.
Many hospitals established respiratory and critical disease departments after SARS for the diagnosis and treatment of respiratory and internal diseases, as well as to train medical and nursing talent. They have become the main force in the battle against COVID-19, Cao said.
Facing life and death in the ICUs, COVID-19 patients' will to live has always touched Cao, and this spiritual power is important for recovery, he said.
The life of a patient in his 40s was at stake when he was admitted to hospital. Cao and his colleagues discussed whether to use an invasive ventilator or ECMO to save him. However, given the risks to his condition, he was treated with modest oxygen doses.
To everyone's surprise, the patient recovered slowly. "I must get out alive. I have three children, waiting for their dad," the patient told Cao.
The man lost his father to the virus, and his mother was also infected. His wife, who experienced mild symptoms, was treated at the Fangcang field hospital, and later recovered.
To maintain a positive attitude, the man watched short videos that featured humorous and positive content on the Douyin platform and avoided watching depressing videos related to the epidemic. This is not easy to do in Wuhan, which is filled with sad news on the outbreak, Cao said.
When reviewing the case, Cao and his colleagues believed that strength of will helped the patient more than medication.
Doctors are also careful to convey optimism in their interactions with patients.
Cao can communicate with patients in their local dialect, as his hometown is Suizhou, Hubei Province, and the patients have also been willing to talk to Cao.
"Many couples, or mothers and sons are in our ward, asking me about their family's situation. I would tell them how well their families were recovering and encouraged them to have confidence to fight the disease," Cao said. He added that "they will be happy, more willing to cooperate with the treatment, and look forward to the recovery and discharge to reunite with their families."