Editor's note: This article was originally published on the Southern Weekend website on February 19, 2020, and has been deleted.
Author: Southern Weekend journalist Tang Yucheng, Southern Weekend intern Yan Liyuan
Editor-in-charge: Qian Haoping, Assistant Editor: Wen Cuiling, Network Editor: Wu You
(This article was first published on February 20, 2020, in the "Epidemic Report" special issue of Southern Weekend on the fight against COVID-19)
This is a corner in the epidemic area that should not be ignored. However, under the COVID-19 epidemic, nursing homes and welfare homes where the elderly gather have become the most vulnerable places.
Welfare homes hope that family members will take the diagnosed and suspected elderly out for treatment. However, the reality is that some family members cannot leave due to quarantine. Some family members are worried that once they take the elderly out of the welfare home, they may not be able to return during the epidemic period. In addition, with the implementation of closed management in various communities, it may be difficult to find a place for the elderly to stay in the short term.
Wang Hong refused to bring her 78-year-old father back home because she was worried that he could not withstand the turmoil and was also worried about cross-infection. "We have a large family. What should we do if we bring the elderly back?"
On the morning of February 16, the Wuhan Qiaokou District Social Welfare Home notified Wang Hong that her father's nucleic acid test result was positive and he was diagnosed with COVID-19. The staff of the welfare home's medical office also told her that many elderly people had a fever, and out of the 6 nucleic acid tests conducted, her father was the only positive one.
In the evening of that day, the father was transferred from the two-person room on the 19th floor of the welfare home to the 3rd floor for isolation, but the hospital beds still needed to be waited for.
Previously, there were people in this welfare home who tested positive for nucleic acid, and some elderly people who tested positive had already passed away.
Although Wang Hong refused the request of the welfare home to "bring back the elderly", she was anxious. On February 15, after she learned that her father had a fever and underwent nucleic acid testing, she posted on Weibo for help, stating that the welfare home had confirmed one case of COVID-19 and that several elderly people were currently having a fever. The medical and protective materials in the home were exhausted and assistance was urgently needed.
Wang Hong's anxious experience is not unique. In Weibo and volunteer WeChat groups, more and more requests for help are related to the elderly in nursing homes.
According to the Southern Weekend journalist, since late January, various welfare homes in Wuhan have implemented closed management. However, this does not seem to prevent the spread of the virus. Recently, several nursing homes in Wuhan have reported cases of COVID-19 infection. A notice issued by the Wuhan Civil Affairs Bureau to the directors of various welfare homes stated, "When elderly people from nursing institutions in Wuhan go out for medical treatment and return to the nursing home, accidents of cross-infection of COVID-19 among personnel in the nursing home occur."
This is a corner in the epidemic area that should not be ignored. However, under the COVID-19 epidemic, nursing homes and welfare homes where the elderly gather have become the most vulnerable places.
As the number of elderly people with fever increases, hospital beds are still in short supply, and there are still concerns about isolation within the homes. What is happening in the most vulnerable places?
Three elderly people have passed away
The Qiaokou District Social Welfare Home is a large public nursing home with 532 beds, mainly accommodating destitute individuals and socially dependent elderly people.
In normal days, the welfare home arranges activities for the elderly every day, such as watching movies, singing, painting, and doing handicrafts. Since the "lockdown" of Wuhan on January 23, these activities have been canceled.
The measures taken afterwards became stricter step by step. On January 25, which was the first day of the Lunar New Year, the welfare home began closed management. The directors of several other nursing homes in Qiaokou District confirmed that before and after the first day of the Lunar New Year, the district civil affairs bureau issued a document stating that the elderly in nursing homes should not go out, and family members should not visit.
On January 23, the Ministry of Civil Affairs issued a notice requiring "the formulation of epidemic prevention and control plans for civil affairs service institutions such as nursing homes and children's welfare institutions." However, according to a nursing staff member, after that, there were still people who sporadically entered the Qiaokou District Social Welfare Home building. It was not until January 29 that they were completely isolated from the outside world.
Most of the elderly people here are between 70 and 90 years old. Many of them are unable to take care of themselves and have low immunity. With the outbreak of COVID-19, they have become one of the most vulnerable groups.
As of February 18, at least 3 elderly people in the Qiaokou District Social Welfare Home have passed away after having a fever. Among them, some tested negative for nucleic acid, while others tested positive. An internal staff member of the welfare home introduced that the first person to leave was Wang Jun, who lived on the 25th floor. He started to have a fever on February 1. After 6 days, he went to Wuhan Fourth Hospital for a CT scan, which showed a lung infection, and he passed away the next day.
Five days later, Xiao Banyi on the 20th floor passed away. Another day later, on February 13, Zou Tianyin on the 18th floor also left. Zou Tianyin tested positive for nucleic acid, and he had a fever since January 31. Prior to this, other elderly people on the 18th floor also had a fever.
Pan Yangsheng on the 25th floor was relatively lucky. He had a fever on February 3 and the fever subsided on February 7, but he still feels weak.
Medical staff at the welfare home told Southern Weekend that both Pan Yangsheng and the first deceased, Wang Jun, had been taken care of by nurse Zhou Hong. Zhou Hong was the first caregiver in the welfare home to show abnormal physical symptoms.
Before Wang Jun had a fever, on January 28, Zhou Hong felt unwell. She thought it was just a common cold and did not go to the medical office, but only told the floor supervisor. Looking back, this information did not reach the management of the welfare home in a timely manner.
Zhou Hong struggled to work until February 2, when she could no longer support herself and went to the medical office. The doctor took her temperature and found that she had a fever. She was then isolated in a single room on the 3rd floor. The 3rd floor was originally the "Senior University" of the welfare home and is now used as an isolation area.
Chen Jie, the director of the welfare home, said that it was not until February 6 that a batch of nucleic acid test kits was allocated by the district, and the welfare home conducted the first test for the feverish caregivers and elderly people.
Among the first batch of nucleic acid samples tested, 2 were positive, one was Zou Tianyin, and the other was Zhou Hong. After being transferred to the cabin hospital on February 8, Zhou Hong ate and slept, and the fever quickly subsided, but she still felt weak.
Risk of cross-infection
The welfare home where these feverish individuals are located is a 25-story building. Caregivers, elderly people, and many family members who visit the elderly usually move around inside.
According to their health conditions, the elderly are distributed on different floors from the 7th to the 25th. Most of the elderly on the 17th to 25th floors have difficulty taking care of themselves, and Zhou Hong is responsible for taking care of the elderly on the 25th floor. Although closed management has been implemented before, personnel circulation within the building has been normal. Over a hundred caregivers are scattered on different floors during the day and return to the 6th-floor staff dormitory to rest at night.
Zhou Hong initially believed that she would not contract COVID-19 because the welfare home provides food and accommodation, and caregivers rarely go out. In the month before she fell ill, she hadn't even left the gate of the welfare home. However, she did come into contact with family members who visited the elderly, "Some family members come once a week, and some haven't seen their relatives for a month." Zhou Hong also couldn't say when she was most likely infected.
After the diagnosis of 2 cases, on February 9, at the suggestion of the medical office, the management of the welfare home became stricter, and isolation was implemented by floor. Caregivers lived on the same floor as the elderly they took care of, and personnel from different floors no longer circulated.
However, not all suggestions made by the medical office were adopted. A staff member of the medical office revealed that they had also reminded the management that all feverish individuals needed to be isolated, but the management did not comply.
On February 15, the welfare home conducted the second batch of nucleic acid tests. One day later, Wang Hong's father became the third confirmed case in the welfare home. He was moved to a separate isolation room on the 3rd floor. Previously, he had been living with other non-feverish elderly people.
A staff member of the medical office said that this kind of isolation is the most worrying. He revealed to Southern Weekend that information is sealed within the welfare home, and the director did not inform caregivers and patients of suspected cases. Many people still thought it was just a common fever.
An insider of the welfare home told Southern Weekend that as of January 17, the welfare home had conducted nucleic acid tests on 15 people in three batches, which means that at least 15 people in the welfare home had fever symptoms.
According to Southern Weekend, the welfare home has not conducted nucleic acid tests on close contacts of confirmed cases. Some close contacts are still engaged in caregiving work. An elderly person living in the self-care area told his family that his caregiver did not know about the presence of the COVID-19 virus in the welfare home and did not wear protective clothing. The caregiver who had close contact with the "positive patient" has not stopped working. This has made the elderly person feel fearful.
The protective measures of the welfare home are not standardized. A medical staff member told Southern Weekend that the elderly people there rarely wear masks, and some caregivers wear masks while others do not. After the outbreak, some medical staff put on industrial protective clothing and were ridiculed by caregivers, "Do you need to wear a diaper inside?"
"Isolation is in vain"
Cross-infection has become a hidden danger in many nursing homes in Wuhan under the policy of "treat every case and isolate every patient".
Zhang Xiuxiu runs a small nursing home in Qiaokou District. At the end of January, when a caregiver had a fever, Zhang Xiuxiu isolated her, and later, 2 caregivers and 4 elderly people had a fever one after another. However, Zhang Xiuxiu only isolated the caregivers individually until they were picked up by their families or transferred to isolation centers, and there was basically no isolation for the elderly.
"Isolation is in vain," Zhang Xiuxiu once isolated an elderly person with a persistent fever. Not to mention the rudimentary and non-professional isolation conditions of the nursing home, the elderly person needed care from caregivers, and after taking care of one elderly person, the caregiver had to take care of the next one. Zhang Xiuxiu believed that this could also cause cross-infection. Therefore, when other elderly people showed symptoms of "fever sometimes, no fever sometimes," considering that isolation was "useless," Zhang Xiuxiu no longer isolated them.
Not only in Qiaokou District, but also in Jiang'an District, there are several welfare homes with similar problems. The Wuhan Civil Affairs Bureau stipulates that "after elderly people go to the hospital, they should not return to the nursing home" and "when elderly people with a fever are found in nursing homes, they should be reported to the community and street according to the procedure and treated as suspected cases of COVID-19." However, after interviewing multiple nursing homes, Southern Weekend found that there is still a phenomenon of feverish elderly people not being properly isolated before being diagnosed and sick elderly people returning to the welfare home after CT scans at the hospital.
Le Dan's grandmother lives in the Yixin Nursing Home in Jiang'an District. She started to have a fever on February 3. The nursing home notified the families of the patients to have a CT scan. On February 5, Le Dan took her grandmother to the community hospital for a CT scan, which showed a suspected infection of the COVID-19 virus. Only then was her grandmother moved from the original 5th floor to a separate isolation room on the 4th floor. Previously, she had been living in a room for three people.
Liu Wangzhen's father, Liu Yunxi, 80 years old, has been living in the Jiang'an District Social Welfare Home for 8 years. On February 15, Liu Yunxi began to feel unwell, and three days later, the home asked family members to accompany the elderly for a CT scan. The result confirmed that the elderly person had contracted COVID-19. However, due to the lack of beds, the elderly person was sent back to the welfare home. He did not have lunch at noon, and Liu Wangzhen called him at 9 o'clock in the evening and learned that he had not eaten yet. In a state of anxiety, she made more than a dozen calls to the supervisor, but no one answered.
According to Liu Wangzhen's account, the welfare home has been isolated from the outside world since January 23, but there are no further isolation measures inside the home. Until February 16, Liu Yunxi still went downstairs to the nursing home canteen to buy meals every day, eating with many other elderly people.
Liu Yunxi lived in a two-person room and continued to live in the original room until he was clinically diagnosed with COVID-19. After the diagnosis on February 18, he was isolated separately. As of the time of writing, he has not been transferred to a designated hospital for treatment, and his family is seeking help everywhere.
Who should be responsible?
While families are waiting for beds, the welfare home also hopes that family members will take the diagnosed and suspected elderly people away to seek medical treatment.
Chen Jie, the director of the Qiaokou District Social Welfare Home, explained his position: "We only have some ordinary medicines here and do not have the ability to treat serious illnesses."
However, the reality is that some family members cannot leave due to quarantine, and some family members lack protective equipment and are afraid of cross-infection. They hope that the welfare home can help them solve the problem. Some family members are worried that once they take the elderly out of the Qiaokou Welfare Home, they may not be able to return during the epidemic period. In addition, with the implementation of closed management in various communities, it may be difficult to find a place for the elderly to stay in the short term.
For elderly people who cannot be taken away by family members, Chen Jie believes that they should still be isolated and treated within the home. He does not advocate transferring the elderly to isolation centers during the epidemic. He said that the welfare home has many bedridden elderly people, and if they are sent to isolation centers without proper care, accidents may occur. "These special groups may need further special isolation. Therefore, in the current situation, we generally report to the community and isolate within the home."
This is also Wang Hong's idea. An employee of the Yijia Street Office in Qiaokou District, responsible for collecting information, said that he had communicated with Wang Hong on February 16. Wang Hong's request was to isolate the entire welfare home and upgrade the medical resources within, rather than transferring the elderly to other isolation centers. "She is afraid that the elderly cannot withstand the turmoil and will leave."
The employee admitted that the street office does not have the ability to upgrade the medical conditions of the welfare home and can only report the situation. He further explained the difficulty of resolving the issues in the welfare home. The welfare home is directly managed by the civil affairs department, and the street office does not have detailed information. "The welfare home has its own system. If they ask for help, we will help. At least the building is under our jurisdiction."
In addition, the person believes that the current requirement for the public to register by community and to transport patients by community is inconvenient for the elderly living in welfare homes from various streets and jurisdictions.
However, the Qiaokou District Civil Affairs Bureau has a different statement. The staff of the Civil Affairs Bureau office told Southern Weekend that when leaders went to conduct research, they clearly stated that "coordination matters belong to the jurisdiction, and communication should be made with the community and street."
Under the policy of "treat every case and isolate every patient," the staff member of the street office said, "The leaders have instructions. Although the welfare home is not directly managed by our community, no matter what the family members think, if the person is in life-threatening danger, we will definitely try our best to send them to the hospital." After Wang Hong posted on Weibo, her father left the Qiaokou District Social Welfare Home and was transferred to a designated hospital on the afternoon of February 17.
"We don't even have syringes"
With the severe epidemic situation, the Qiaokou District Social Welfare Home has taken some protective and treatment measures for the elderly and staff members who are still in the home, although they are not very professional. What is worse is the lack of hardware. Some patients have more severe symptoms, and they are also worried every day, but the welfare home has almost nothing left. "It's not that we lack them, it's that we don't have anything left, not even syringes." On February 16, a medical staff member felt helpless.
Next to the welfare home is the Qiaokou District Public Health Service Center. However, the two are under different systems. "We do not share medical supplies with the welfare home, we are just located next to each other," said a staff member of the Qiaokou District Public Health Service Center on February 17.
According to Southern Weekend, the protective clothing and other equipment of several welfare homes in Qiaokou District were only delivered by the Civil Affairs Bureau in the past two weeks. However, they are only industrial protective clothing, and the protective goggles are pasted on. Medical staff usually wear three-layer ordinary masks, and they are afraid. Isolation clothing is reused and worn for more than a week, otherwise it is not enough. "We have to be very careful not to break it." Zhang Juan, the director of another nursing home in Qiaokou District, said.
Zhang Xiuxiu received 4 sets of isolation clothing sent by the Civil Affairs Bureau to her nursing home in the past two days. There are about twenty caregivers in the home, and these are obviously not enough.
The shortage of supplies is just one aspect of the difficulties. Nursing homes also face the disorder caused by the epidemic to the entire social system.
Not long ago, a resident of Zhang Juan's nursing home had edema throughout his body and had difficulty urinating. Normally, as long as she called a private clinic, the doctor would come quickly. However, on that day, no doctor was willing to come, even if she offered to pay double the price.
Zhang Juan's nursing home has more than 30 elderly people and more than 10 caregivers. The doctors and nurses in the medical office have returned home before the Chinese New Year. She said that larger-scale or medical-nursing combined welfare homes have more abundant medical resources and more professional medical staff to deal with the epidemic. Her small nursing home appears more vulnerable if it encounters an epidemic. She can't sleep at night and has also thought about what to do if someone in her nursing home gets sick. "I can only seek help from the Civil Affairs Bureau."
Wu Mingrong, the director of the Hanxing Sunshine Nursing Home, and more than 50 employees have been stationed in the nursing home. On the fourth day of the Lunar New Year, an elderly person passed away. Wu Mingrong sought help from the mayor's hotline to arrange transportation for the body. He waited for 15 hours from 4 am to 7 pm. Normally, the body should be transported within 2 hours.
In an interview with Phoenix TV, Wu Mingrong said, "This is a place for end-of-life care. We hope that the elderly can leave peacefully and quietly at the end of their lives. When the elderly pass away and cannot receive the appropriate treatment, it is indeed something I worry about."