Fewer Confirmed People: Wuhan Pneumonia Epidemic Outbreaks; Wuhan doctors: draconian reporting criteria, they said we report too many cases
BeWater
(26 Feb)According to Bin Dian Weekly, Wuhan Municipal Health Commission issued a notice on 11th Jan requiring hospitals to make sure they can robustly meet the requirements of “early detection, early diagnosis; early quarantine and early cure through prioritising and focusing experts and resources to save the patients.” The principle is different from National Health Commission which repeatedly demands a lower level of Health authorities to “early detection, early escalation, early isolation and early curing.” In Wuhan, early diagnosis replaces early reporting. However, members of the expert panels of the National Health Commission told journalists from China Youth Daily and Youth.CN during their interviews that they never create such diagnosis criteria.
The National Health Commission published a national version of diagnosis guidelines and criteria on 16th Jan. Before that, Wuhan as the plague epidemics breakout zone created their own exclusion tests and curing guidelines based on how they figured out from clinical behaviours of earlier patients.
The upward reporting criteria mentioned by numerous doctors (identities protected) from local hospitals of Wuhan actually refer to the “Inclusion and Exclusion Testing Requirements of Unknown Virus Infected Pneumonia” enacted by Wuhan Municipal Health Commission. Pathological cases that do not meet these standards are not required to notify the Central Government.
A person who knows the details provided the standards to media. It specifically required the patient needs to fulfil one of the clinical behaviours of the epidemiological history before they can be classified.
The four requirements of epidemiological history are:
1. People who work or conduct trading activities at the Huanan Seafood Wholesale Market on long term basis since 1st Dec 2019.
2. The patient has been involved in food processing, food trading, animal slaughtering, process and removal of animal bodies more than 3 hours within two weeks before they showed symptoms of sickness since 1st Dec.
3. The patient has clear contacts history with animals or live poultry (direct physical contacts or close distance watching the animals or poultry within less than 1-meter distance) at Huanan Seafood Wholesale Market in the last two weeks before showing symptoms of sickness since 1st Dec 2019.
4. People who meet the clinical definitions of a patient who co-habit, learning, companion nursing, patients within the same wards or medical staff who do not take adequate protective measures in the processing of providing diagnosis, nursing and other medical services.
The four clinical behavioural requirements are:
1 Having a body temperature higher than or equal to 38℃
2. Displays characters of pneumonia infection through medical imaging.
3. Normal or reduction in total numbers of leukocytes or reduction in lymphatic cells during early stage of symptoms.
4. No explicit improvements or become worse after being treated with prescribed antibiotics.
According to these inclusion and exclusion requirements, all patients who cannot be diagnosed as other virus induced pneumonia cases have to simultaneously meet these clinical behavioural requirements and one of the four epidemiological history tests before they can be included. After being included, the patient have to go through further rounds of exclusion tests including flu virus test, adenovirus tests and other virus causing pneumonia, such as mycoplasma, Chlamydia and bacteria pneumonia, etc to exclude any other clearly diagnosable causes.
However, the expert group members from National Health Commission interviewed by China Youth Daily and Youth.CN indicated that they did not set down the inclusion and exclusion criteria and testing requirements.
“I did not participate in setting out these criteria. The National Health Commission does not know the existence of these criteria from the beginning.” One of the expert group members who were among the first lot of experts being sent to Wuhan told the media. “These criteria are subsequently added by Wuhan.”
The second lot of experts group members provided a copy of green cover guidelines to media. The title is “Guidebook for treatments of unknown cause viral pneumonia.” The green booklet has the printed name of Wuhan Municipal Health Commission. The contents of this booklet include Trial Curing of Unknown virus pneumonia and working requirements for focus saving of the unknown virus pneumonia. The guidebook also includes nine other documents in relation to the collection of samples of pathogens, virus transmission, transfer of patients and autopsy of bodies.
The expert explained that the recognition criteria between the white cover book and the green cover book are different. The criteria set down in the green cover book are jointly made by the national and Hubei expert groups around 3rd Jan.
The green book shared some common criteria with the white book by mentioning previous history of exposure at Huanan Seafood Wholesale Market but does not enlist this as essential criteria. It treats this as floating criteria. If the patient’s symptoms can meet 3 of the four clinical behavioural as defined, the individual can be classified as a case of unknown virus pneumonia.
Three doctors from Wuhan Xiu LIU, Kun JING and Xia LI (anonyms) told media that they never see the green book. They consider that the inclusion and exclusion criteria set down in the white book are too draconian; it makes it harder for early detection and early diagnosis.
These several tens of patients cannot meet the requirements. None of them can totally fulfil the inclusion and exclusion criteria. Many patients do not have an exposure history at Huanan Seafood Wholesale Market. Some do not have any fever ≥38℃ nor receive treatments of prescribed antibiotics. Most of them are in coma, inserted with tubes or put on with ECMO. They just lie there, motionlessly. CT images of these patients show one common result: fully whitened lungs.
”I have seen the green booklet. Since then we introduce the nucleic acid test, therefore, we add one more confirmation case testing criteria, other parts remain the same.” One of the expert group members told the journalist. According to this expert, a Wuhan doctor called many days later admitting that he/she did not tell the truth to the experts. Infected people are not recognised (by local authorities and hospitals).
Source: CNews (26-Feb)
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