Dr. Kang Yan is Director of the Intensive Care Unit of West China Hospital, SCU, and the leader of the 3rd Wuhan-aiding medical team. Upon their arrival on February 7, the 130-strong group took over two critical care wards of the East Branch of Hubei Provincial People’s Hospital.

In the past ten days, they had admitted a total of 128 NCP patients, 61 of whom were already transferred to a mobile cabin hospital or a designated hospital for mild cases, but two of whom died. Compared with the mortality rate of nearly 5% for NCP patients in Wuhan, such treatment result was not easily achieved, although Director Kang felt sorry for the two patients who died when the hospital was short of oxygen supply at the early stage of dealing with the epidemic.

Here is Kang Yan’s dictation: 

“Red, yellow and green” patients

“We divide the wards into three levels: green, yellow and red: the green wards admit patients with mild symptoms, for which only ordinary treatment is required; the yellow ones admit those who are not severely affected by the novel coronavirus, but suffer from underlying diseases such as diabetes, coronary heart disease or hypertension, so such complications would be easily induced or worsened by the novel coronavirus; and the red ones admit those who suffer from serious organ dysfunction, thus requiring organ function support, namely, high-flow oxygen or use of respirators.

According to rough statistics, the Covid-19 patients in the red, yellow and green wards account for 10%, 15% and 75%, respectively.

Different schemes of varied medical treatment and nursing strength are adopted in these wards; for example, a majority of medical workers have been allocated in the red wards to provide precise diagnosis and treatment to the patients. As a result, the mortality rate there has declined accordingly. As for the green wards, just a couple of nurses are enough for taking care of all the patients.”

More than ten-fold of oxygen is required

“Our team is composed of 99 nurses, 30 doctors and one medical engineer. We brought a medical engineer because the previous support teams reported that most hospitals here have problems with oxygen supply.

In normal conditions, a whole ICU will accommodate only 20 beds; generally, a patient breathes in 2 to 5 liters oxygen per minute, and not all patients need this. Given that the Covid-19 is a respiratory failure disease, so most of critical patients need to inhale oxygen; moreover, many of them need high-flow oxygen, namely, 60 liters per minute, over ten folds than the normal condition.

Finally, the medical engineer rebuilt the oxygen supply system, adding new oxygen supply equipment and oxygen supply pipes. By the evening of February 15, the oxygen supply problem was basically solved. This has reminded us of the need to reserve pipes for medical gas load for special occasions in the construction of a hospital.”

“A couple of factors probably caused the high mortality among the Covid-19 patients in Wuhan at the early stage. Currently, the general mortality is not higher SARS or bird flu.

In fact, the medical quality in Wuhan is not bad. The occurrence of high mortality is due to the sudden emergence of a large number of patients and unavailability of medical resources; outside of the province, the mortality is comparatively low thanks to sufficient medical workers and materials. I’m confident that the mortality in Hubei and Wuhan would go down once the medical aids from other parts of the country had been put in place, and the patients had been given correct treatment.”