国新办新闻局副局长、新闻发言人袭艳春（湖北日报 蔡俊 摄）
北京协和医院内科重症医学科主任、主任医师，中国医师协会重症医学医师分会会长杜斌（湖北日报 蔡俊 摄）
北京协和医院内科学系副主任、心内科主任医师严晓伟（湖北日报 蔡俊 摄）
北京协和医院感染内科副主任、副主任医师曹玮（湖北日报 蔡俊 摄）
北京协和医院消化内科副主任医师吴东（湖北日报 蔡俊 摄）
记者见面会主席台（湖北日报 蔡俊 摄）
SCIO briefing on the science-based treatment of severe COVID-19 cases
Du Bin, director of Medical ICU, Peking Union Medical College Hospital; chairman of the Intensive Care Medicine Branch, Chinese Medical Doctor Association
Yan Xiaowei, deputy chief of the Department of Internal Medicine, Peking Union Medical College Hospital
Cao Wei, associate chief physician, deputy head of the Department of Infectious Disease, Peking Union Medical College Hospital
Wu Dong, associate chief physician at the Department of Digestive Disease, Peking Union Medical College Hospital
Xi Yanchun, spokesperson of the State Council Information Office
March 16, 2020
Ladies and gentlemen, friends from the media, good afternoon. Welcome to today's briefing. Now, the COVID-19 epidemic has become a common challenge facing the whole world. In order to save people's lives, the Chinese government has acted decisively and launched a large-scale rescue mission. In a very short time, China has dispatched over 330 medical teams and sent more than 40,000 medics to the virus-hit Hubei province. Today, it is a great honor for us to invite four experts from among those 40,000 medics. All of them are from the Peking Union Medical College Special Aid Medical Team. They will share their experiences in the treatment of COVID-19, especially in severe cases in Wuhan. Before I introduce the distinguished experts, let's watch a short video about them.
Welcome back. Please allow me to introduce to you the four experts from Peking Union Medical College Hospital: Professor and Dr. Du Bin, director of Medical ICU. He is also the chairman of the Intensive Care Medicine Branch, Chinese Medical Doctor Association. Professor and Dr. Yan Xiaowei, professor of cardiology and deputy head of the Department of Internal Medicine. Dr. Cao Wei, associate chief physician and deputy head of the Department of Infectious Disease. Dr. Wu Dong, associate chief physician at the Department of Digestive Disease. Now, I would like to let them say a few words about their team and also about themselves. Dr. Du, please.
Good afternoon, ladies and gentlemen. This is Dr. Du Bin, again. I'm one member of the national expert team as well as a member of our team. I spent the last two and half days visiting five different hospitals in five cities to review the most critically ill patients with COVID-19 there, and I just rushed back to Wuhan a few hours ago. I would like to say a few more words about our team.
As you may know, Peking Union Medical College Hospital has been the number one hospital according to the "national best hospital rankings" for about 10 years. It's the responsibility of my colleagues and I to participate in the medical rescue team, when the local health care resources have been overwhelmed by the COVID-19 outbreak. We spent the first couple of days remodeling one of the general wards into an intensive care unit and started admitting the most critically ill patients with COVID-19 on Feb. 4.
It is not just ourselves fighting alone against COVID-19. We have strong support from the teams of Tongji Hospital, as well as other medical rescue teams. In addition, we also have very strong support from our colleagues in our hospital back in Beijing, through weekly teleconferences to communicate with them about the most difficult cases. This can maximize our efforts in order to rescue the lives of patients. Thank you.
Thank you very much Dr. Du. Professor Yan, please go ahead.
Hi, good afternoon, ladies and gentlemen. I'm Dr. Yan from the Internal Medicine of PUMC Hospital. My duty in Wuhan is to coordinate the different departments of internal medicine for successful performance. I also propose and organize the MDTs with PUMC Hospital. As a cardiologist, I'm also responsible for the management of COVID-19 patients complicated by cardiac events and those with previously established cardiovascular diseases. Thank you.
Thank you very much Dr. Yan. Dr. Cao, please.
Good afternoon, ladies and gentlemen. I'm Dr. Cao Wei from the same hospital. I'm a physician of infectious diseases, and I treat patients with different infections. I arrived in Wuhan on Feb. 7 and have been here ever since as a member of the national medical team of PUMC Hospital. As a team, we worked together, as Dr. Du said, to set up an emergency intensive care unit, and have been taking care of critically ill patients with COVID-19 in Wuhan. Personally, I participate in the clinical care of these patients and I'm also involved in the coordination of the clinical collaboration with local hospitals here in Wuhan. Thank you.
Thank you very much, Dr. Cao. Lastly, Dr. Wu, please.
Thank you, good afternoon. I'm Dr. Wu Dong, an associate professor in gastroenterology in PUMC Hospital. I've been working there since 2003, the year when SARS epidemic took place. I came to Wuhan about five weeks ago and I took the service here as a calling to myself, because last time I wasn't offered the opportunity to fight coronavirus, and I didn't want to miss it this time. So, currently I'm an attending physician working in the ICU, taking care of patients who are very sick. I'm very glad to share my experiences with you. Thank you.
Thank you very much to all the experts. You're doing a great job because you're saving people's lives, competing against death. The floor is now open for questions. Please identify your news outlet before asking your question. Please raise your hands. OK, in the left area, the first line, the gentleman in the blue shirt, please.
Hi, I'm from Reuters and I have three questions. First, what is the current risk of reinfection amongst recovered patients in China? Second, how does the weather affect infection rates, and should we expect higher or lower rates of infection as it gets warmer? Last, when can we expect to find patient zero in China? And what clues do you have so far? Thank you.
Dr. Yan, would you please answer the first question and Dr. Cao the second.
Thanks. The first question is about re-infection. Actually, reinfection is a problem after patient discharge from hospital. In China, a patient discharged from hospital in recovery from COVID-19 will be followed regularly at in two weeks and four weeks after discharge. The patient will also be monitored by local inspectors.
They will be asked to isolate themselves at home for at least two weeks. Also, they will be asked to take their temperature twice a day. If the temperature relapses, the patient will be sent to hospital for a chest CT scan and nucleic acid detection. One point I would like to address is that a positive nucleic acid test on its own doesn't mean that the patient has the intact virus particle in his body. Also, it doesn't mean the patient is infectious. So, a positive nucleic acid test alone which can be seen after virus infection is not a sign of reinfection.
So, if we think a patient is re-infected, we should check for fever and the progression of the chest x-ray. Thank you for your question.
And Dr. Cao, please.
I'll take the second question. I bet that's a question many people are interested in. Currently, there has been no data regarding COVID-19 and its relation with the weather. But if we take a look from the past experience of SARS, which was another coronavirus, we can see that there are multiple factors that influence the rates of infection. For example, the gradual loss of virulence with the progression of time or regaining of virulence, because of mutation and other joint measures of prevention and control, etc. among them. Unfortunately, the impact of the weather hasn't been confirmed yet. Thank you.
Next question, please. In the middle area, the first line, the gentleman in the dark suit. Thank you very much.
Thank you very much, I'm from China Global Television Network. Could you please introduce the latest situation of the combined method of treating COVID-19 patients with traditional Chinese medicine (TCM) and modern medicine? Also, what kinds of patients are generally being treated with TCM methods? And how effective have they been? Thank you.
I'll take the question. I think some of my colleagues might add some comments after my words. It's my belief that traditional Chinese medicine (TCM) is both familiar and unfamiliar to our practitioners of Western medicine. Every day in Wuhan, we're working together with our colleagues from the traditional Chinese medicine department. It seems to me, at least in my mind, that traditional Chinese medicine works quite well in patients with mild disease and in those who have been recovering from critical illness. However, I do notice that people are suspicious of the efficacy of traditional Chinese medicine. I would say that TCM and Western medicine do not share the same philosophy. They have quite different philosophies. They have quite different evaluation systems for efficacy.
For example, whenever we have the chance to test the efficacy of a specific medication in Western medicine, we will try to separate patients into different groups, and give those who are assigned randomly to the experimental group or the study group a specific drug at a fixed dose and fixed duration. Then we try to interpret any difference between the experimental group and the control group with regards to clinical outcomes as a manifestation or an evidence of the efficacy or safety of the specific drug. However, this is not the case for traditional Chinese medicine. From my own observation, when working with the TCM practitioners, I noticed that even for patients with quite similar appearances from my personal point of view, they would prescribe quite different medications with different doses every day. This makes the evaluation system futile or invalid.
So it's very hard for us to assess the efficacy and safety of TCM from the Western medicine point of view. But my belief is that we should respect each other. We should know that both Western medicine and traditional Chinese medicine have their own strengths and weaknesses, and we should learn from each other. We also encourage our colleagues in the TCM sector to adopt our system of evaluation or assessment in order to let not only us but also the international community understand what they're doing. Thanks.
Does anyone want to add some words?
I do have some comments. First of all, I agree with Professor Du that we don't have panacea here. We don't have any specific anti-virus drug or medication that has been proved effective. But from a perspective of gastroenterology, which is my specialty, I would like to say that at least in some cases, traditional Chinese medicine seems work well. Because we know that for some patients in ICU, their bowel movements just stop, and their abdomens are quite distended. In several cases, the condition is severe enough to force us to stop enteral nutrition, which we all know is essential for the patient to recover. So we use TCM to treat this type of patients. I would say that they have a very good laxative effect, which enables us to continue to feed them. Thank you.
Ok. Next question, please. The gentleman in the first row in the middle area, who, I guess, is from India.
Press Trust of India:
Thank you. First of all, let me compliment the doctors, not simply those who are here, but hundreds of their colleagues who went to this epicenter and tried to confront this virus or the vicious virus head-on. Definitely, today as the virus winds down as well as the figures in Wuhan and probably in Hubei and the rest of China, the question being asked is, will there be a relapse? Will there be a second wave that can come up at a later stage or anytime soon here, because it's happening all over the world now. Secondly, there is not much data that has come out about the virus' impact on children. Now that there is debate about when the schools should be reopened, not simply here, but as well in places where this virus is popping up perhaps. What exactly is or are you rather reading about this virus' impact on children of different ages? Thank you.
I'll ask my colleague, Dr. Cao Wei, to answer the question about the relapse. And I'll take the question about the children.
Thank you. I will take the first question. We all know that the status of pandemic has been declared by the WHO a few days ago, which means that the situation of the epidemic globally will not be solely dependent on the situations in China or any other single area or country in the world. Currently, after three months of fights, the outbreak in China, which started in December of last year, has almost come to an end.
I think we will still wait for another month to see and make a final judgment. But for me, a second domestic outbreak in China wouldn't be a great concern under such measures of prevention and control. But we all know that another important source of newly onset cases now comes from the imported patients from outside China. So it is most probable that the newly reported cases, including the imported ones, may be kept at a relatively low level, but may last for a certain period of time. Thank you.
Okay. The second question is concerning COVID-19 in children. Actually, from my observation and discussion with the pediatricians, we know that there are some children that contracted COVID-19. However, the majority of them are doing quite well. There are actually three recent publications, one in JAMA describing nine infants, all under the age of one year old. The other one is about six children, with ages ranging from two to seven years old. Among all these 15 children, only one was admitted to the intensive care unit requiring some sort of supportive therapy, including oxygen therapy; however, all children survived.
Another paper just published earlier today in Nature Medicine described that, among all the close contacts, the adults have a higher likelihood -- about 2.7 times -- of contracting COVID-19 than children. We currently don't know what the rationale is behind this phenomenon, but we do understand that -- despite the fact they got infected -- the majority of children exhibited a mild disease course, and all of them recovered. According to my understanding, this is what is happening in Wuhan, Hubei, and other provinces. Thank you.
Ok, next question, please. The gentleman in the right area in the 3rd row in the suit.
Dutch Public Broadcaster:
Thank you very much. With NOS the Dutch public broadcaster. Doctors, could you give us a bit of an insight into how the situation is now in the hospitals in Wuhan? We've seen that several temporary hospitals have been closed down. Also, what I would like to know, since we're talking to the best doctors of this country, what advice or lessons would you like to share with people on the frontline in other countries that are facing the start of the epidemic, for instance the Netherlands? Thank you very much.
Is there anyone who wants to answer the question? I'll answer first. Yes, you are right. I believe that all mobile cabin hospitals have been closed. Some of the designated hospitals for COVID-19 have also been closed, either discharging their patients or transferring their patients to other designated hospitals. It seems to us that, like Doctor Cao just said a minute ago, the outbreak of COVID-19 in Wuhan and Hubei has come to an end.
We should be alert, though, to any abnormal signals or sporadic cases that rise from communities, what is happening during these days, and the imported cases from other countries out there and anywhere else. The second question: what kind of lessons or cleanup experience we can share. There are so many things. However, I should say the most important thing when combatting infectious diseases, such as COVID-19, is to prevent and control the disease rather than treatment. Thus, treatment is only secondary. Prevention and control are the primary goals. Previously, I remember talking about planning. You must have a plan. Failure to prepare is preparedness for failure. So even now, in Wuhan and Hubei, we have fewer newly diagnosed cases, but we should remain alert and prepare for future sporadic cases and imported cases, as well as learn from our own experiences of success and failure. Thanks.
Yes, Dr. Yan, please.
To my overseas colleagues, I would like to address two points. The first is to the doctors: you should take good care of yourself from the coronavirus infection. This is the precondition for you to take care of patients. Also, it's a precondition to protect your colleagues and your family. My second point is the public should be educated widespreadly for the protection of themselves.
It is not complicated. Just wash your hands, wear a mask, and avoid gathering, etc. Otherwise, health care facilities and systems will be overwhelmed by the outbreak of COVID-19. Thank you.
Okay, Dr. Wu, please.
I want to share a few words with the general public of other countries. I want to say that we totally respect that every nation, every person, has their own condition that could be very different from others.
We are not saying that this is the Chinese example and you should follow. We're not saying this. We totally respect that you should take your own actions. But every one of us should take this very seriously, take necessary actions, change your behavior, and be responsible. As for the medical community, I would like to say that we have to protect them because, in the last few days, we know that our European colleagues have also contracted the disease during daily practice. And the proportion is quite similar to that in the early stages in Wuhan.
So we need to protect our medical staff working in the ICU. The environment is quite stressful. The mortality is relatively high. As a physician, you will lose some of your patients from time to time, no matter how hard you have been trying to save their lives. This could easily damage the morale of the ICU staff. So I suggest them to rest and relax. You need to take very good care of yourself. Thank you.
Ok. Next question, please. The gentleman in the right area in the second row, please.
Thank you very much. I am from the People's Daily English language app. As we all know, some countries are short of medical resources, so, the majority of patients with mild symptoms have to stay at home in isolation. My question is: which alarming signals should they heed to prevent dangerous escalation? Thank you.
Dr. Cao, please.
Thank you. First, if you have to stay at home in isolation because of other reasons, the first important thing is to identify or ensure that you are the right person who can accomplish this. This means you are not associated with identified risk factors of deterioration, such as elderly people, people with multiple comorbidities, including hypertension, diabetes, chronic lung diseases, or other chronic diseases. Secondly, if you are young and generally healthy, and you have decided to stay at home in isolation by yourself, then it is very important for you or one of your family members to keep a close eye on your symptoms or feelings.
Once you begin to have a persistent high fever or when you begin to feel short of breath, or maybe you feel altered mental status, it is time for you to go to the doctor and seek help. The last and most important thing during your home isolation period is to make sure not to let your family members get the virus from you. There are multiple measures of prevention and protection for the family members, and you can get the full version from the WHO website. I'm sure. Thank you.
Okay, next question. The lady in the middle area in the third row from South Korea.
The Kyunghyang Shinmun:
Thank you. I'm a journalist from South Korean newspaper. The problem of COVID-19 infection by medical staff in Wuhan is a little bit serious. What protective measures are the medical staff taking? Please explain the local situation as a medical team. Thank you.
Thanks for your question. I do believe that my colleague Dr. Yan has already answered the question. But any way, I may add a few words that as Dr. Yan said that there are multiple reasons, multiple factors, contributing to the infection of COVID-19 in the health care workers, especially during the initial stage.
One is the lack of knowledge that this is a human-to-human transmission disease. So you may know that a lot of health care workers have been infected in a couple of local hospitals in Wuhan, such as the Wuhan Central Hospital. This is the hospital that is located very close to the Huanan Seafood Market, that at the initial phase that many patients went there to see doctors, and the doctors didn't know.
They didn't know that this is a human-to-human transmission disease. And the second important factor is the lack of personal protection equipment (PPEs), especially during the initial phase. And you can see that, as many external assistances came to Wuhan, as the supply of the PPEs became adequate, that as just mentioned by my colleague Dr. Yan, that no healthcare workers has been infected anymore. I mean during the second phase—if we can call it that. And another important lesson we learned is that, even within the same hospitals, some of the specialists—let's say, ENT doctors, and eye doctors—became easily infected, than their pulmonary colleagues, than their emergency colleagues, or their ICU colleagues.
My personal interpretation is that, whenever you see an eye doctor or ENT doctor, he or she will have a very close contact with their patients, right? So that's the major reason for the phenomena that they got easily infected, in addition to the lack of knowledge of infectious diseases among these specialties. So, my belief is that it is important to let your colleagues—no matter what specialty they are—that they got educated, that they got trained about these infectious diseases, in order to prevent the nosocomial transmission of COVID-19. Thanks.
Ok, next question, please. Middle area, second line. The gentleman.
I'm from Bloomberg News. Thank you for taking your time to speak to us today. I'm sure you're all very busy. I have three questions. My first question is: What are the underlying conditions that really influence whether a patient survives or doesn't survive this disease? Dr. Cao mentioned various comorbidities, but are these the main factors you look for when you look at some patients who do and don't survive? My second question is: Now that you're saying that the outbreak in Wuhan and Hubei more generally are sort of petering out towards an end, what do you expect the case fatality rate to be across the whole province? I think in Wuhan, initially it was it was much higher than the rest of China. Do you expect the case fatality rate and Hubei to come down towards the rate in the rest of China? My third question goes back to the first question from Reuters: Do you expect to be able to trace the patient zero, where this disease cross from animals into humans? And is your expectation that will be linked to the seafood market that Dr. Du just mentioned? Thank you.
I'll take the first question. As I just mentioned, there are some risk factors already identified for COVID-19 patients, including the elderly people, comorbidities, etc. And these are the risk factors you could identify before you go to the hospital, once you have been diagnosed.
And there are also very important signals showing that you are transferring or you are processing from a mild type of case, or common type of case, to the severely or critically ill patients, which include the change or continuous decreasing of lymphocytes, which is the indication that your immune system is gradually being broken down. And also the elevation, or robust elevation of inflammatory markers, which is also another sign that the immune systems are activating. And also if there is progressing changes of the lung radiology, including the infiltrations of bilateral lungs. This is another important sign you should pay attention to, which indicates you might be going to the critically ill patients.
For the risk factors for mortality in patients with COVID-19, I do believe we are still waiting for more evidence coming from the investigations. Because previously during discussion with my colleagues, all of us believe that the hypertension is a risk factor for either the severe cases or the mortality rates. However, we also know that hypertension is associated with older age.
So currently we have no idea, which is the confounding factor. Because these two risk factors—older age and the hypertension, diabetes as well—are closely correlated with each other. So we're still waiting for more evidence. However, according to current data, I agree with Dr. Cao that the lymphocytopenia is one of the signals, and probably the cardiac injury biomarkers is another signal for mortality.
And the second question concerns the case fatality rate. I am sorry that I don't think this is the right time to calculate or estimate the case fatality rate. Even though, right now, the majority of the patients have been discharged back home, but we are still having more than 3,000 or 4,000 patients in the hospital. We still have no idea how many of them will survive, and how many of them will die. A certain number of them will die. Absolutely. So it's not the right time to estimate the case fatality rate at present. In my mind, the case fatality rate is a retrospective term rather than the terminology we can discuss right now. And we also know that the supportive, life-sustaining treatment employed in the intensive care unit may prolong the patient's life, which will make some early deaths into late deaths. That's one of the reasons for the later increase in the case fatality rate, as you can see.
And the reason for a higher case fatality rate in Wuhan than in other provinces—that I just can't remember if I have already answered the same question in the last press conference or not, but anyway—in my mind that the reason number one is that there is always a learning curve. Our colleagues—the healthcare workers in other provinces—they learn from our experience, and they learn from our failures, so they can treat their patients better than us. And the second reason: They have much fewer cases than what we have here in Wuhan, in Hubei, which means that patient there had a better chance for better medical care. They have enough resources; they have enough human beings, enough health care workers around them; they have enough ventilators, monitors, and all the other devices. I don't think the difference can be explained by any genome mutation at the present time. But if this is the case, I'm not surprised.
The last question concerns the number zero patient. I'm sorry, I'm not the right one to answer the question, because I think this is the task for the CDC staff. They should look for who is the index case for this whole outbreak. But currently, I have no idea what is going on there. Sorry for that. Thanks.
OK. Next question, please. The middle area, the lady in the fourth line with long hair.
Hong Kong China Review News Agency:
Thank you. Hong Kong China Review News Agency. My question is about ECMO. We know that ECMO is recommended for rescue treatment for severe cases. How do you assess the role that ECMO had played so far? Are there enough ECMO equipment for severe patients in Wuhan? Thank you.
Thank you very much, for that is a specific question for ICU doctors like me, but not for my colleagues. I don't believe ECMO plays an important role in the whole outbreak. For example, according to data, a couple of days ago, there were 260 patients still on the ventilator, and there are fewer than 30 cases treated with ECMO. Apart from this, we still have more than 4,000 patients hospitalized. I think that you can have your own judgment based on this number, that ECMO—although a technical innovation, and to some of my colleagues working here and working in other provinces, is a life sustaining treatment—but I don't believe, based on these numbers, it plays a significant role in decreasing the case fatality rate. Of course, it is a device to buy the time for the patient in order for the definitive therapy to have some effect. So, my personal impression is that, no.
OK, next question. Right area, third line. The gentleman.
Thank you very much. I'm from Japanese TV. It's called NTV. My question is: In China, various new technologies, including 5G network or robots are used to fight against coronavirus. How do technologies help doctors? What do you think about the most dramatic change by these technologies? Thank you.
Thank you. I will take this question. You raised the issue of new technology in this campaign. But first of all, please allow me to make clear that, I don't think it's new technology that we rely on to bring the situation under control. I think we have brought the situation under control because we are still following the classic theory of epidemiology, which is to control the source of infection, cut down the spread route, and protect those susceptible population.
But on the other hand, in terms of new technology, I'm glad to share with you that by utilizing the 5G network, we have established a virtual online consultation system. We routinely have those online meetings with experts in PUMC hospital back in Beijing, so we can discuss some difficult and complicated cases with them almost face-to-face. I think this enables us to provide high-quality care to all of our patients. And also in our daily practice, we routinely use mechanical ventilation, bedside ultrasonography, continuous renal replacement therapy. I think these new technologies will give us more weapons or opportunities to fight the coronavirus and protect people. Thank you.
I only have a few words apart from what Dr. Wu said. As far as I know, the teleconference with doctors and experts back in their mother hospital, thousands of miles away, is a common practice within each national medical team here in Wuhan or in other cities in Hubei. So this is number one.
And number two, the so-called virtual hospital, or virtual medical care system, is not only for us the doctors, but also for the patients. Whenever the patients are advised to stay at home, as patients with other diseases, other than COVID-19—especially in epicenters as like Wuhan or other cities in Hubei, that they are advised to stay at home—however, whenever they think there's any need to seek for medical advice, medical care, they can get access to the doctors through the virtual hospital or medical care apps.
And third, as far as I know, some of the investigators are now trying to do some research that, with the use of the wearable devices, for those patients who are asked to do the home isolation or home quarantine, that some kind of artificial intelligence will tell what is the probability that they have the COVID-19 or the disease progression, and when is the right time to go to see the doctor, or you should be okay to continue staying at home. Thanks.
Okay, the very last two questions: one for a foreign journalist and one for a Chinese reporter. The gentleman in the middle area, 3rd line.
Wall Street Journal:
Thank you very much. I'm from the Wall Street Journal. Thank you doctors for sparing the time to do this. Dr. Du, you mentioned the importance of preventing and controlling the disease rather than treating it. I was wondering if you could go into a bit more detail about what you think were the most effective steps that were taken in Wuhan to prevent and control the spread of the epidemic, and at what point those came into effect. I was also wondering, you spoke a little about the fatality rate and I take the point that it's a little early to calculate that. But, given the evidence that the fatality rate does seem to have been higher in Wuhan, I was wondering if you could go into some more detail about why you think that was, particularly amongst medical workers. You spoke a little in the last briefing about treatment with steroids and invasive ventilation and I wonder if you could elaborate on that a little? With hindsight, is there anything that could have been done to avoid that or was it simply inevitable? Is there anything that you could advise other countries facing similar problems now? Thank you.
Okay, thank you very much for the questions. The first question was concerning the specific measures to control the epidemic. I'm not an expert for this, but anyway: test, test and test. Whenever you fail to do the nucleic acid test for COVID-19, you don't know who is the carrier, who is the patient, who should be quarantined and who are close contacts.
I know there are different approaches than here in China, like what you're doing in the States. I'm not the one who make the judgment about which is right and which is wrong. But, apart from testing, I just have no idea how you can identify suspected cases and quarantine close contacts. I mean, there was just a question to Dr. Cao about what is the turning point. In my opinion, the major reason or decision that led to a turning point was when we had the opportunity to isolate all suspected patients and close contacts. That was the turning point of the outbreak here in Wuhan, and in Hubei.
Now for the second question about what specific factors contributing to the higher case fatality rates in Wuhan. I would say that a strong belief of mine is that delayed mechanical ventilation, delayed endotracheal intubation and long-term cortical steroids make a difference. I mean, they are major risk factors for mortality rates. I have seen dozens of cases who tried inappropriately or failed, an NIV trial – NIV meaning noninvasive ventilation.
They failed the NIV trial, but doctors maintained the noninvasive ventilator. They doctors did not intubate them. But eventually, even after endotracheal intubation, after the initiation of mechanical ventilation, the patients still died. So, we can actually make a huge difference, at the later stage, by encouraging every physician to intubate their patients as soon as possible – as soon as they see their patients fail an NIV trial. There's one study, although not a large one, from my colleagues in Tongji hospital. They found that an aggressive approach for endotracheal intubation will significantly improve the patient outcome.
I believe the paper has been submitted, but I have no idea whether it's accepted or not. Thanks.
Ok, the last question, please. Okay. Right area second line, the lady, please.
Thank you. Question from China Daily. It has been more than a month since medical workers from across China raced to Wuhan to help fight the virus – and we know that you are all part of that effort. So, my question is, what have those medical teams contributed in terms of treating COVID-19 patients in Hubei, and in Wuhan. Second, after weeks of intense work, what is on the top of your mind right now? What would you like to share with us the most? Thank you.
May I suggest each of you say a few words for this question please?
Thanks. I'm not quite sure if I'm the right person to answer the first question, because I think the question is to the healthcare authorities rather than us. But anyway, I'll come directly to the second question. Although this is a chance for us, my colleagues and I, to share our experiences to the international community, I would say that the Chinese approach for the control of the epidemics may not be the only approach.
We can see what has happened in Singapore and what has happened in Japan. I would say that my colleagues and I can learn from their experiences. Whenever you have a quite different situation, in terms of the number of cases and the community support system, you can adopt a quite different approach that achieves a similar success in controlling epidemics.
So, it's also an opportunity for us to learn from each other – just like we said for the Chinese medicine and western medicine. So, the last sentence from me is that the beauty of the world lies in its diversity, but not identity. Thanks.
Okay, Professor Yan, please.
I think it's my great pleasure to come to Wuhan as a doctor in the intensive care unit to save my patients. Yes, in the intensive care unit, I have had so many casualties – this kind of experience I will never forget in my life.
And also, I'm very glad to be here to share my experience with overseas friends and colleagues. Thank you very much.
Ok. Cao Wei, please.
I want to share some personal feelings. 17 years ago, when SARS came, I was still a medical student in college. At that time, I was the one to be protected. And this time, I was able to come here with my teachers and seniors to fight together for my people and my country. I'm very proud of that and I'm sure that's a common feeling of all the medical workers here in Wuhan – despite sacrificing a lot, personally, and being apart from our families for such a long time. But it deserves.
Lastly, I want to express my deep thanks and show respect for all the nurses that have been working with us. They have taken the same responsibilities as us and, not like me, many of the nurses who have come to Wuhan are actually very young. Most of them were born in the 1990s with only remote memories of the SARS season. But when it came, they all stood up and came here. Without them we wouldn't have achieved so much, especially for these critically ill patients. So, thank you very much.
Okay, Dr. Wu, please.
Thanks for the question. Also, some personal feelings. During the last five weeks, I was totally devoted to caring for patients in the ICU. The only thing I feel sorry for is that I couldn't take care of my own family, as a father and as a husband. Five weeks ago when I left Beijing for here, my eight-year-old daughter asked me, "dad, why are you going to Wuhan?" To be honest, it was a question that I couldn't quite answer at that time. But last week I had a patient in the ICU. She was a 57-year-old woman and she was very sick. So, our plan was to intubate her and put her on mechanical ventilation. That seemed the only way to save her life.
Before incubation, she whispered several words to me in Wuhan dialect, so it was difficult for me to understand what she was talking about. But finally, I figured out what she said and it was, "Doc, I don't want to die. The end of this month is my daughter's wedding day." At that very moment, and deep in my heart, I saw that many of our patients are parents too. They love their own kids, the same as I do. It also reminds me of the novel by Gabriel García Márquez, "Love in the Time of Cholera." What I learned from the novel is that human beings are mortal, but love is not.
So why did I come to Wuhan? It's not only about professionalism or responsibility; it is also about love. I love my daughter, I love my patients, I love my country and I love humankind. As humankind, we are all in this together and we will get through this together. Thanks.
Thank you. I'm quite touched by what all these experts have just shared with us. I'd like to say that the COVID-19 outbreak is neither the first nor the last challenge confronting all mankind.
The pandemic knows no borders. The only right thing for the world to do is to make concerted efforts. While combating the disease at home, China will work hand in hand with other countries and contribute our strength and wisdom to securing a final victory.
Today, the four experts from the PUMC hospital shared a lot of valuable experiences. When they came to Wuhan, they didn't know how long this would take and how many difficulties and challenges would be faced. But from what they just said, we know how important it is to have them with us when combating the virus.
I'm sure people in Wuhan and in Hubei will remember all of them forever. And the Chinese people will be very proud of them – all the Chinese doctors and nurses. So lastly, I suggest we take a group photo together and give a thumbs-up to all the Chinese doctors and nurses. Well done.
Thank you very much. That's the end of the briefing. Thank you. Bye bye.
国新办新闻局副局长、新闻发言人袭艳春（湖北日报 蔡俊 摄）
北京协和医院内科重症医学科主任、主任医师，中国医师协会重症医学医师分会会长杜斌（湖北日报 蔡俊 摄）
北京协和医院内科学系副主任、心内科主任医师严晓伟（湖北日报 蔡俊 摄）
北京协和医院感染内科副主任、副主任医师曹玮（湖北日报 蔡俊 摄）
北京协和医院消化内科副主任医师吴东（湖北日报 蔡俊 摄）