Medical workers in protective suits attending to coronavirus patients at a new shelter in Wuhan, China. Photo / AP
It's not clear how patients are screened or treated in China's makeshift wards, nor even how long they are to remain.
As the new coronavirus continued to spread unabated within the city of Wuhan, China, government officials last week imposed draconian measures.
Workers in protective gear were instructed to go to every home in the city, removing infected residents to immense isolation wards built hastily in a sports stadium, an exhibition centre and a building complex.
"There must be no deserters, or they will be nailed to the pillar of historical shame forever," said Vice Premier Sun Chunlan, who is leading the government's response to the virus.
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Many experts are sceptical that isolating thousands of patients in shelters can stanch the spread of the coronavirus. There are more than 40,000 cases in China now, in every province, although the wide majority are in Hubei province.
"This is a bit like closing the barn door after the horses are already out," said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville, Tennessee.
And the shelters, so reminiscent of those erected in the United States during the Spanish flu pandemic, raise other concerns.
Chinese authorities have said that only residents with confirmed coronavirus are being sent to shelter but have not fully explained how they are being screened, raising the possibility that many patients may actually be infected with flu or something else.
Inside, narrow beds are laid side by side, or stacked in bunks, in wards separated by temporary walls — perfect for the transmission of respiratory viruses. Little is known about the treatments patients are to receive or how long they will be kept.
The containment measures in Wuhan are reminiscent of steps taken in 1918 in the United States to halt the Spanish flu. But they are being put in place on a far grander scale: Wuhan is a city of 11 million.
In New York City in August 1918, after reports that an arriving Norwegian ship was carrying sailors and passengers infected with the Spanish flu, health officials dispatched ambulances to transport 11 patients directly to hospitals.
The city's health commissioner, Dr. Royal S. Copeland, eventually put the entire port under quarantine, according to the Influenza Encyclopedia, produced by the University of Michigan Center for the History of Medicine.
As the epidemic spread that fall, cities across the country prohibited public gatherings. Officials in Los Angeles closed the schools in October and banned funerals, theatres, pool rooms — and the filming of mob scenes for movies. Baltimore ordered churches and schools closed, but not saloons, citing the putative "medicinal" uses of alcohol.
Many cities left the ill to recover at home, in quarantine. In New York, families were instructed to keep sick members in their rooms and limit contact with them; patients living in cramped tenements were isolated in city hospitals.
In Richmond, Virginia, there were 10,000 influenza cases by early October 1918 after efforts to contain an outbreak at a large military base nearby failed. City officials converted an unused high school into a 500-bed emergency hospital and began filling it with patients.
Though there were nurses providing care at shelters like these, the conditions were grim, said Dr. Howard Markel, professor of the history of medicine at the University of Michigan and author of the book "Quarantine."
Patients were essentially warehoused, and those who survived recalled poor or even hostile treatment from health care workers, and inadequate food and bathing facilities, Markel said. Patients became delusional; fights often broke out.
"It was not the Four Seasons," he said.
The makeshift shelters in Wuhan do not have adequate heating and have suffered power failures, according to early reports. Staffing is inadequate, and medical equipment is in short supply.
"This is taking us back to the 19th century," Markel said. "It's an old-fashioned approach to an epidemic because you care more about the healthy than the people who are sick."
Wuhan's makeshift shelters may yet become breeding grounds for infection, especially if patients are not properly screened, Markel and other experts said.
The patients already are in a weakened state, and facilities like these make it easy for viruses and bacteria to travel — not just the coronavirus, but also any of the dozens of pathogens that may thrive when people gather in tight quarters.
"Whenever we put people in facilities together, even during a hurricane, we are concerned about them getting infectious diseases," said Nicole A. Errett, a researcher at the University of Washington who is a co-director of the Collaborative on Extreme Event Resilience.
People in a shelter who may have a misdiagnosis of coronavirus infection — when in fact they had, say, the flu — are in a particularly paradoxical situation. They would have been far safer from coronavirus at home than in a large open ward, cheek by jowl with the infected.
And there are intangible benefits to isolation at home. Removing patients from a supportive environment, where they are cared for by relatives, and placing them in a shelter can be stigmatising and deprives them of emotional support at a critical time, Errett said.
Whether patients in warehouselike settings will receive appropriate medical care is often uncertain, as these shelters historically have opened when local hospitals were already overburdened.
In the past, it often has been unclear how long the isolation should last.
During the influenza pandemic of 1918, officials in Richmond, Virginia, lifted many restrictions in November, allowing churches to hold services and schools to reopen.
By early December, hospitals were near capacity again, and the flu had returned to near-epidemic levels.
Yet it is possible the sequestration of patients in Wuhan could succeed in stemming further spread of the coronavirus, Markel said.
"In the best of all circumstances, by warehousing the sick and potentially sick and keeping them away from the healthy, it could prevent further spread," he said.
"But it will probably come at the expense of the medical attention that's needed by those in the warehouses. That's what I worry about."
Other scientists believe it would be preferable to let sick people remain in their homes, with family members trained to provide care and to protect themselves from infection.
Instead of providing shelters, officials might distribute food and hygiene kits, including personal protective equipment for caregivers, and set up a telephone hotline to dispense information.
Making hospital facilities available for the most severely ill patients instead of spending health care resources on the less ill is critical, said Jennifer B. Nuzzo of the Johns Hopkins Center for Health Security.
"Attempting to stop the spread of the virus at this point is the wrong goal," she said.
"I don't think there's evidence that we can stop a respiratory virus moving as quickly and silently as this one is."
Written by: Roni Caryn Rabin
© 2020 THE NEW YORK TIMES
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