Struggle to Survive

With the city in lockdown and no public transportation, Jiang Fei’s mother, 64, who suffers from kidney failure, staggered through the heavy snow to get her dialysis. At the same time, 56-year-old Wang Dechang, who also suffers from kidney failure, was waiting in a hotel for his wife to bring him some instant noodles. He had been discharged from his hospital bed to make way for Covid-19 sufferers. 　

Referred to as non-Covid-19 patients, many people with chronic diseases were marginalized due to the epidemic and forced to leave the hospitals where they were undergoing treatment. They include those suffering from cancer and kidney failure, where the lack of access to medication and treatment could be as fatal as exposure to the coronavirus. Alongside the economic and psychological impact of the ongoing health crisis, the effect on patients already suffering from chronic health conditions has been disastrous. 　

Things changed after the cancer center was designated to treat Covid-19 cases on February 11. Although the hospital planned to separate the Covid-19 patients by isolating them in two wings, many patients worried they would eventually be driven out to prevent cross-infection. 　

Zhang, 28, was diagnosed with nasal cancer in October 2019, and was being treated at the Union Hospital, one of the best hospitals for nasal cancer in Wuhan, since early November 2019. His doctor had prescribed three rounds of chemotherapy and 33 sessions of radiotherapy. By the end of his third chemo round, tests showed Zhang’s tumor had shrunk, and his prognosis was good, if treatment continued at the hospital. Without it, Zhang worried the tumor would grow back. 　

He called Wuhan Municipal Health Commission for help, only to be told there was no information about non-Covid-19 patients and they were waiting for orders from above. Zhang also called the mayor’s hotline which was set up to solve difficulties for local citizens, but received a similar reply. 　

On February 13, the cancer patients’ worst fears were realized when they were asked to vacate the hospital due to fears of cross-infection. The hospital had started treating Covid-19 patients that afternoon. 　

Zhang’s oncologist told him he had been talking with the hospital’s leaders about how to continue treating the cancer patients, such as allowing them to stay if they signed a letter acknowledging the risks, or giving them one more round of chemo before they left. None of the suggestions were accepted. 　

According to Zhang, he later discovered that the building the hospital planned to move them to had only admitted 30 patients who were not residents of Wuhan, and he found that they had not received any treatment since they were moved to the new building. 　

Some of the 30 patients confirmed Zhang’s account, telling NewsChina on condition of anonymity that their radiotherapy was replaced with some oral medication and nurses barely assisted them, except to give anti-side effect medicines and temperature checks. 　

According to media reports, since January 22, 46 hospitals in Wuhan, plus some small private and specialized hospitals were designated for Covid-19 treatment and most had no plans for the non-Covid-19 patients who had to make way. 　

“Nobody gave us any advice about follow-up treatment and in-home care, and even nothing about pain relief for the patients. The whole hospital was out of bounds,” Liu Jun, a relative of a patient who was forced to leave hospital on February 5, told NewsChina. 　

According to Liu, his relative had been admitted to a cancer hospital in Wuhan for hospice care, when they suddenly received notification that patients had to leave. Just 10 minutes later, 15 patients in hospice care were moved out of the wards, with the abrupt cessation of life-prolonging nutritional treatment. 　

On the night of February 13, Zhang Yifei walked out of the Union Hospital as three buses carrying Covid-19 patients drove up. 　

“I felt like I was being abandoned,” he told NewsChina. 　

What troubled Wang was his hospital, Wuhan Third Hospital Guanggu Branch, would not admit suspected virus carriers. A doctor told Wang that he would be readmitted once he was confirmed to have the virus, as it was designated for Covid-19 treatment, and if he was clear, he would be transferred to the hospital’s Shouyi Branch, a non-Covid-19-designated hospital. 　

But there was no hospital designated for suspected patients like Wang. Although Wang Dechang’s son Wang Lang believed that the majority of patients on dialysis would develop lung problems as a side effect of their treatment, a doctor from the Shouyi Branch told him that no hospital could confirm by a CT scan that the inflammation was definitely not due to Covid-19, so they were at risk of cross-infection. 　

Wang senior then had two reagent tests, both showing negative. But considering the error rate, he was not removed from the list of the suspected. According to Wang Lang, many dialysis patients in Wuhan were suspected to carry the coronavirus. 　

Wang’s son tried district-level hospitals, but all were either full or refused suspected patients. Transferring his father to a hospital out of his district was even more difficult, since this came under the municipal command center for epidemic control. 　

“The policies [related to non-Covid-19 patients] vary between districts, since it depends on medical resources and the deployment efficiency of each district,” Wang Lang told NewsChina. 

Other non-Covid-19 patients, who refused to reveal their names, agreed with Wang Lang’s account. They told NewsChina that the policies on non-Covid-19 patients changed frequently and they had no way to get the latest information except for constantly calling district departments and health commissions at different levels. 　

Zhang Yifei said he has made so many calls, the operator recognizes his voice. An official from Wuhan Municipal Health Commission called him on February 19, but even that official was not sure which hospital could admit Zhang. When Zhang asked if his department could help arrange for a car to take Zhang to a hospital that was far away, he refused. 　

Thanks to Wang junior’s constant calls, his father was sent to a field hospital on February 16. But given such hospitals were built for Covid-19 patients with mild symptoms and Wang senior was not confirmed as infected, his wife raised fears about cross-infection. Three hours later, Wang was crammed into a big box in the trunk of a car and transferred to another hotel for quarantine. 　

On the morning of February 19, community representatives from Wang Dechang’s residence suddenly came to send him and two other patients back to the Guanggu Branch Hospital, only to find that the hospital still refused suspected patients. As the driver had already left, Wang was stuck at the hospital gate until his family borrowed a tricycle to pick him up.　

By February 19, Wang Lang had not had dialysis for six days, putting him in a critical condition, since hyperkalemia, a major symptom of kidney failure, can cause sudden cardiac arrest. He later underwent a dialysis treatment in the emergency room at Guanggu Branch Hospital. 　

“Considering Guanggu has been admitting confirmed Covid-19 patients, we were reluctant to do dialysis there, but my father’s critical condition did not allow us to care about the risk anymore,” Wang Lang told NewsChina. 　

Desperate, Jiang turned to the internet for help. Within an hour of her post, she was called by a volunteer and the Wuhan Municipal Health Commission, which promised to solve the problem as soon as possible. Later that night, Jiang’s mother was given a bed in the hospital’s observation room. Meanwhile, Jiang deleted her plea for help as requested by the municipal public security bureau, the third call she received following the post. 　

Social media seemed to be the last hope of people in urgent need of help. According to one online help platform, on February 15, they received 29 appeals for help, 19 from non-Covid-19 patients. 　

Zhi An, a founder of an online platform for dialysis patients told NewsChina that since late January, they have collected information from dialysis patients and connected them to media. Thanks to those efforts, the local government, according to Zhi, paid attention to dialysis patients earlier than other non-Covid-19 patients.　

A public policy expert who refused to reveal his name told NewsChina that the rise of online help information indicates the big potential of non-governmental organizations, but also proved the deficiencies in the government response. 　

Such deficiencies, said Huang Yanzhong, a global health researcher at the Council on Foreign Relations, are rooted in China’s laggard medical reform. 　

“As top hospitals in China always serve as the pillar to treat major diseases, such as cancer and kidney failure, lower-level hospitals couldn’t take up the slack once the top-level ones were requisitioned for epidemic control,” he told NewsChina. 　

“China has promoted a hierarchical medical system for a few years now, but the public still prefers big hospitals. The problem does not lie in the hardware, but the talent. We do not have sufficient medical workers in bottom-level hospitals,” he said. 　

Huang believes that the imbalance in medical resource distribution between Covid-19 patients and non-Covid-19 patients is largely an outcome of China’s top-down mobilization system, under which local officials are inclined to solve problems that upper management have set requirements or targets on, while ignoring those that have little influence on their performance appraisal. 　

But due to the shortage of beds, Zhang Yifei was still at home and in pain. He had lost his sense of taste two weeks before, and every bite felt like chewing sand. Zhang said the side effects of the radiotherapy would get worse, and would not disappear until six months to a year after his radiotherapy ended. But as his treatment was curtailed due to the epidemic, he had no idea how long he would have to struggle. 　

Zhang was not re-hospitalized until February 23 when he received a call from his doctor who told him that the Union Hospital had restarted chemotherapy for non-Covid-19 patients. To get a bed, Zhang agreed to undergo one more round of chemo, even though this part of his treatment was already supposed to have ended. 　

Compared to Zhang, Huang Kui was luckier as she was able to get a bed for her mother in the provincial cancer hospital soon after the government published the list of cancer-designated hospitals. Even so, a doctor from that hospital told Huang that her mother had to leave following the first phase of the radiotherapy which lasted three days, and nobody knew whether or not her mother could be readmitted by the time he needed the second phase of her radiotherapy. 　

“I can only care about today. It’s like we are in a war-nobody knows what will happen tomorrow,” Huang told NewsChina. 　

According to Zhang, information about the cancer-designated hospitals has been circulating and exchanged between cancer patients since February 22, but many hospitals only admitted patients that have received calls from their oncologists. But not everyone is able to access the help. 　

Li Ling has been locked in her village in Hubei Province for more than a month. She told NewsChina that her doctor only prescribed one month’s medication, but as the village has blocked all the roads to the outside, she has trouble buying daily necessities, let alone medicines. 　

Liu Jun’s relative died a week after she was forced out of hospital. According to Liu, they found neither a hospital to admit her nor any way to buy nutrient solutions or painkillers to relieve her suffering, as all of them are controlled drugs.　

“She groaned in pain all the time till she gradually became insane, crying and getting mad. But she soon became too weak to even groan,” he told NewsChina. 　

“She didn’t eat or sleep since February 5 [when she left hospital] ... If there had been some way to ease a bit of her pain, we would have felt better,” he said. “I hope your report on my family’s story will help more people and families,” he added. 　

“Wuhan is wound like a tight string that’ s at breaking point,” Huang Yanzhong warned, adding that the government should take more specific and practical measures to enable non-Covid-19 patients to be treated and hospitalized, if necessary.