Monday, March 30, 2020

Doctor Questions Coronavirus Strategy

Is Mississippi making a mistake fighting the Coronavirus? A local doctor thinks so and fears Mississippi’s response to the pandemic endangers doctors and nurses.

Dr. Zilian Wang is a Flowood cardiologist and medical consultant. He is from China and was classmates with China’s Associate Secretary of the Department of Health. Another classmate led a team of 70 doctors and 120 nurses fighting Covid-19 in the Wuhan district. Dr. Wang studied the virus as well as China's response to the Covid-19 epidemic.

“America is right now like Italy, France, and Iran. It is making the same mistakes China made,” he said. The physician said “People initially brush off news of the virus. In Italy, people say “we are strong, we drink beer, we drink wine, we go to the gym, we brush it off.” Such strengths meant little to the virus as it ravaged Italy. Dr. Wang said Americans didn’t fear the virus as they should.

Dr. Wang said Mississippi health care facilities are very poorly prepared. China reported Covid-19 infected over 3,000 Chinese doctors and nurses and killed 30 doctors. Dr. Wang said the real numbers were over 8,000 infections of Chinese doctors and nurses while over 100 doctors died.

Chinese doctors are now fully protected and wear something akin to a Hazmat suit after learning this deadly lesson (Picture posted below). Dr. Wang said there were no deaths among the new group of doctors that wore the full suits.



Meanwhile, American health care professionals wear gloves, masks, and gowns, leaving part of the body exposed. Dr. Wang said “Being a physician, I’m in the front lines. I’m extremely worried.”

“The virus is following the same curve here as it did in the worst-hit countries” reported Dr. Wang. It doubles in number every 6.2 days (The interview took place on March 19.) He said people don’t understand why the virus is such a deadly threat.

Dr. Wang said COVID-19 is a Coronavirus but a nasty one: It has a very long period of incubation time, anywhere from 3 days to 28 days, average about 7 days. During this period time, infected patients are asymptomatic, they walk around and spread disease since no one suspects that he is the source of infection.

“The second characteristic of this virus, it is like HIV virus, it initially weakening your immune system, you will have a very weak reaction to fight against it when it enters into your body. So if you check CBC, these patients have low lymphocyte count. However, when the virus duplicated so much that your immune system begins weakening up and release more than needed cytokines and causing self damage to the lungs, it is when you will have shortness of breath, majority of patients die from acute respiratory failure,” he said.

Dr. Wang advocated centralized testing for the virus. Placing all the testing eggs in one basket protects other health care providers and allows non-infected patients to see their doctors. He said the biggest problem in China was the infection of doctors and nurses. The virus killed off medical staff while others spread the virus, creating more patients in a spiral of death. Health care workers become vectors instead of healers.

“The basic principle of controlling an infectious disease is to cut off the source of infection. With this principle, you would understand, it is good current strategy when we are dealing with Ebola or SARS, why? We screen all symptomatic patients. However, we are dealing with COVID-19. It is different, the source of infection is not just symptomatic patients, but also infected but not yet symptomatic patients. Since you can’t tell who is actually infected, it makes sense to screen everyone. It is exactly happening in Japan, South Korea, Singapore and China. It is one of the reason that their infection has died down,” he said.

Such advice conflicts with that given by the Mississippi Department of Health. The Department said on January 31:

In the U.S., there have been a total of six cases of the virus reported with more than 100 under investigation as possible cases. The risk of transmission of this virus in the U.S. is low. So far, Mississippi has no persons under investigation or confirmed cases.

“This is a rapidly evolving situation, but it’s important to note that the immediate risk to the Mississippi public is low at this time. We need to be prudent and monitor the situation, work with the CDC, and continue working with our healthcare systems throughout the state,’’ said State Health Officer Thomas Dobbs, MD. “There should be more concern in preventing the spread of seasonal flu than this coronavirus right now. We are in peak season and the flu is highly infectious.”

The Department has recommended those fearing an infection should contact their doctor. A March 13 press release stated:

Dr. Dobbs announced Thursday that MSDH is expanding access to COVID-19 testing that will allow physicians to submit specimens to the Mississippi Public Health Laboratory or commercial labs without prior consultation with MSDH. If individuals are worried about having COVID-19, they should call their healthcare provider.

MSDH and UMMC recently moved to provide testing at the Mississippi State Fairgrounds. However, testing was only provided to those showing symptoms even though the virus has a contagious phase of up to 14 days.


Dr. Wang said such advice raises the risk of infection among health care workers and ultimately the public as nurses and doctors transmit the virus.

The lack of proper protective gear is worrisome. While big healthcare facilities may have enough N95 masks, gowns, and goggles to protect those on the frontline treating patients, many doctors and nurses don’t have such equipment. They can’t buy them from vendors because the vendors are sold out. “If your doctor gets infected before he finds out he is infected, he is going to give it to nurses and patients. The protective gear is to protect the patient, not the doctor.

Dr. Wang pointed out several tools used to fight Covid-19 in China that are not used in the United States. One test used is similar to a glucose “finger prick test” used by diabetics. The test provides a result in 15 minutes and can determine the level of infection. Two companies providing such tests are Vivachek and Boun Biotech. The tests are approved in Asia and Europe but do not have FDA approval. The test was first deployed in China.


Dr. Wang proposed allowing only a few clinics in an area to test for the virus so as to limit the risk to health care workers.  He recognizes Mississippi is a rural state, unlike South Korea where most of the population lives in a large city and is thus easier to test.  However, the rapid-testing kits can be used at home and don't require the assistance of a health care worker.   The rapid deployment en masses of such tests could prevent health care workers from becoming virus vectors and catch the virus in the asymptomatic but contagious phase when it is most dangerous.


Dr. Wang said he found mask suppliers overseas who could provide masks to Mississippi health care professionals. He called the MSDH Coronavirus hotline but to no avail. One employee said “We don’t give out supplies” with an “I don’t care attitude.” He called again and was transferred to the Department of Epidemiology. He held for a long time only to be told the department couldn’t help him. He insisted on speaking to a supervisor. The supervisor wrote down his name and phone number, promising to let Dr. Todd know he called. No one ever called him back.


Such bureaucratic fumbling is frustrating. He said “It is simply not right to ask doctors and nurses in private practice to see patients while naked to the doctors. It is not right to treat private practice doctors and nurses as abandoned children. Ochsner Hospital in New Orleans reported a few days ago that over 50 employees are infected while 300 are in quarantine. Dr. Wang said it is only a matter of time before such problems occur in Mississippi.

41 comments:

Anonymous said...

"Dr. Wang said he found mask suppliers overseas who could provide masks to Mississippi health care professionals."

ALJAZEERA: Dutch officials have recalled tens of thousands of masks imported from China and distributed to hospitals battling the coronavirus outbreak because they do not meet quality standards.
~~~~~
Spain announced last week that it would return more than 600,000,000 rapid testing kits it had purchased from a Chinese company after testing on an imported batch revealed they had a 30 percent detection rate, reported Euronews.

'Merica, F YEAH said...

The free market is working as we speak to correct these problems

Anonymous said...

Thanks you FDA!!! I will now give my patients hydrochloroquine. I have seen this miracle of a drug work endless times on a virus... malaria, rheumatoid arthritis and Sars H1N1... it's been around since the 1940s. Also, very very cheap.

Anonymous said...

I wish someone cared this much about all the people dying in car crashes driving to courthouses.

Anonymous said...

Who cares who his roommate was or what 'another colleague did in China'?

By the way, if those masks don't meet 'quality standards', what about the thousands of masks 'home seamstresses' are cranking out and donating?

Anonymous said...

Maybe Mike Randolph will enter an order this morning requiring full body protective gear for all courthouse personnel who are forced to keep his court system open for bidness.

Anonymous said...

In a few weeks more of the isolation peoples will be fed up with this Covid-19 BS & start living normal lives again.

Anonymous said...

I fear Mississippi is about to experience some very very dark days.

Anonymous said...

The numbers of infected keep popping up on the news. These numbers are pretty irrelevant. We have good data that one-third or more of the population will get the infection. So day-to-day numbers don’t mean much. We also know that maybe 1% of people will die. And that many of the dead will be older people with underlying health problems. But there are (and will be more) 80-year olds with heart failure who live and there will be more 20-40 year olds with no underlying health conditions (“She was perfectly healthy. How did this happen?”) who will die.

How much social distancing is enough? We just don’t know. We thought early on that COVID-19 was not that contagious (though highly infective). But we are learning as we go. It could be that COVID-19 is more like measles in its spread than once thought (https://www.cdc.gov/measles/transmission.html). We are making guesses and there is evidence to suggest we don’t have all the answers: https://www.latimes.com/world-nation/story/2020-03-29/coronavirus-choir-outbreak. So when I am walking down the street or road, give me space when you zoom by running (huffing and puffing) or on your bicycle (huffing and puffing) and don’t laugh at me when I want 20 feet of social distance. I am trying to help with this emergency and I don’t want to have contact with the virus (and die) until at least November.

There are young and healthy people dying from COVID-19. Why? We don’t know. Could it be because of the type of lung receptors they have in their lungs (like variations in the ACE2 receptor, angiotensin converting enzyme receptor)? https://www.sciencemag.org/news/2020/03/how-sick-will-coronavirus-make-you-answer-may-be-your-genes#. Again, we just don’t know.

Early in the outbreak I helped direct my company to develop and deploy an antibody test. We have worked on it 24/7. We now have it and joyfully many other companies have one too. There are some sobering lessons from this process. Usually the first antibody that shows up is IgM. We have found it as early as after five days of incubation and sometimes even before symptoms. Obviously there is a huge national need for these test. The current viral detection tests (RT-PCR) suffer from human sampling issues and are only positive in 70% of samples from known carriers. (This isn’t the fault of the test. It is just that upper airway sampling is not as good as lower airway sampling, which is totally impractical). So the antibody tests (being deployed now and in the coming weeks) will very much help healthcare practitioners: Patient is sick. COVID-19 virus test (nasal-airway) negative. IgM positive. Treat as an infected.

It is good to see Dr. Scott Gottlieb (https://www.wsj.com/articles/the-road-back-to-normal-more-better-testing-11585503340?mod=searchresults&page=1&pos=1) endorse this plan.

The antibody test is also teaching us some surprises. IgA antibody is sometimes the first one found, more sensitively that IgM. So some labs and manufacturers are gearing their approach to that antibody class test.

This isn’t all good news. The most frequent (usually silent) immune deficiency in humans is IgA deficiency. Is this another reason for some young people dying of the infection? Again, we don’t know.

For those pleading for more testing (of all kinds) let me remind you that tests will help us triage patients (which may help us decrease the use of personal protective equipment) but it will not help you as an individual. Perhaps widespread testing with the antibody will help us identify people who have had the infection (with an IgG antibody) and lead them to donate plasma ( https://jamanetwork.com/journals/jama/fullarticle/2763983) but it will not be of immediate practical use for you.

What do we know about people who have had the infection and now have antibody? There is some evidence that they are immune from this strain of infection. But that does not mean that they are free of carrier state. That is, you could be immune and yet still be infectious to others. We just don’t know.

Anonymous said...

Has the Doc ever stayed in a Holiday Inn Express?

Anonymous said...

You don't become China’s Associate Secretary of the Department of Health without being a loyal Communist.

Kingfish, is there a source for this interview?

Anonymous said...

Question? Shouldn't all physicians/medical personnel be tested first to see if they have the CV? Before they treat us?? I know many of them traveled over Spring Break to the hot spots---NOLA. How do we know if they aren't carriers? And do they have to reveal if tested positive?

Anonymous said...

Bitch- bitch- Bitch

Anonymous said...

The lack of across the board testing has been the biggest failure so far at both the federal and state level. It’s unfortunate they peddled a fake news attitude for so long before slowly owning up that they were spouting lies in public while dumping their stocks privately. The comments here show the damage that was done by their initial insistence that there is nothing to worry about.

Anonymous said...

"hi, i'm from china and i'm here to help you!"

right...

Anonymous said...

"Since you can't tell who is actually infected, it makes sense to screen everyone."

And then what? Someone who isn't infected today, might be tomorrow or next week.

Anonymous said...

The comments here show the damage that was done by their initial insistence that there is nothing to worry about.

What specific damage was done as evidenced by the comments here?

Anonymous said...

@10:15 Absolutely medical personnel should be regularly tested to ensure they don't pass it along to sick people unknowingly. Until the 15 minute test is widely rolled out and enough test kits are available that is not feasible though. Trump said the company was going to be shipping 50K tests per day. That is a drop in the bucket compared to the 3 million doctors and nurses working in the U.S. Maybe if they prioritize personnel working in the ER and ICU areas it could be done effectively. Personnel working with a lot of at-risk people, like nursing home employees, should also get priority.

Sho Nuff said...

Were we to use the same faulty test kits that Spain used? Or, rely on the false information that China pumped in to the information stream? The same China that produced the faulty test. If, as some so desperately want, we are a global community, the Chinese are bad faith actors. Who would have ever suspected a communist country of being deceptive, or bad faith actors? Are we to believe that China would treat the rest of the world better than it treats its own people? The problem started with, and was exacerbated by the Chinese government.

Kingfish said...

In case you didn't notice, quite a few Chinese doctors died fighting the disease. Is that sacrifice good enough for you? It was Chinese doctors who tried to get the word out about the virus and were shut down by their government. There is a difference between the doctors and the government.

So if an American physician happens to be Chinese, we shouldn't listen to what he has to say because of where he is from? I forgot, we are in Mississippi.

Anonymous said...

9:21 am Oh please do tell us how many people die driving to the courthouse a month in MS.
Oh please do tell us how many people have died of the ordinary flu in a month in MS.

You are arguing that because people die of other causes that we should cheerfully embrace a new way to have more die a year?

Sho Nuff said...

If, your comment was meant for me, Kingfish, I placed the blame firmly on the Chinese government. You mentioned the doctors that died fighting the virus, but what of those that were disappeared for daring to speak of the lies? The Chinese government can not be trusted. Being from Mississippi, which I am not originally, has nothing to do with distrust of the Chinese propaganda machine. I cannot know the extent of the doctor's personal relationship with the Chinese government, but the fact he has classmates with positions in the communist Chinese government would cause me to suspect his motives. I, also, am suspect of the fact he has not commented on the damage caused by the denial, and coverup of the Chinese government, which allowed this virus to spread to various parts of the world, causing this pandemic. Are you implying that a negative comment, about this article, makes someone racist, bigoted, xenophobic, or just something some ignorant redneck from Mississippi would say?

Anonymous said...

Why would I listen to a cardiologist about a virus? Shouldn't that be the job of a virologist? Just seems weird.

Anonymous said...

The anti-Chinese racism by some on this blog is offensive and shows nastiness in the heart of the writers and their stupidity.

Nearly all we know about the virus and the infection is due to the incredible intelligence and strength of Chinese scientists. Our test kits are based upon their knowledge.

The CDC has given guidance on the use of test kits and our governor, state health officer, and others are not following that guidance. It can be found here: https://www.cdc.gov/coronavirus/2019-ncov/downloads/priority-testing-patients.pdf

There is a nationwide shortage of swabs and viral transport media and "widespread testing" is stupid.

Those groups of young people congregating will find their own tragedy in this epidemic when 1 of 1,000 of their friends die from it.

Let's jump ahead a month or two. Say your doctor has met the virus and he won. His antibody is positive. He has a swab test which is negative. Will you be safe going to him? Maybe and maybe not.

Anonymous said...

"So if an American physician happens to be Chinese, we shouldn't listen to what he has to say because of where he is from? I forgot, we are in Mississippi."

No KF, the fact he is Chinese doesn't mean that we shouldn't listen to him, but because he went to school with some high ranking Chinese Government Official doesn't mean that we should give his opinion any more credibility either.

You are, and have been, fascinated by this guy's opinion - and you are certainly entitled to your valuation. But, that doesn't mean that we should take this cardiologist's 'recommendations' over and above those that are in the fight daily, across the state (and the nation) with epidemological training and education.

Does some of what your guru think make sense? Absolutely, but is it possible across the state? Testing at a central location for example - you think all the folks from Tippah County and Wilkenson County should cross paths with those from Tunica and Jackson Counties as they trek to Kosciusko (the geographical center of the state) or to any other "central point"?

Many other 'suggestions' from your guru make as little practical sense either. While they might be the best way to fight this virus, ignoring the practicality of them puts this cardiologist in about the same realm as listening to a lawyer or a 'philanthropist' for pandemic advice.

Zilin Wang, MD said...

It is so interesting to see in such a severe pandemic time, some people are still playing racism card. I have found the logic is fascinating: He is a Chinese = Chinese people = Chinese Communist Party = Chinese government. Chinese Communist Party is bad = all Chinese are bad. Therefore, whatever he says is bad. Some of Chinese products are bad= all Chinese products are bad. I don’t have to remind that you have used products made in China for almost 4 decades. I would like to remind you, yes, I am a Chinese but I am an American too. I have treated American patients for 21 years and helped countless patients. Yes, I am not a virologist but it doesn’t mean I don’t know anything about it. I’ve learned so much about this virus before it has come here long before anyone in Mississippi.

Better Than Ever said...

@2:07 Logical fallacy: appeal to authority. Moot point for the most past. Virus is here and now. We are not going to stop mfg & trade with China or any other nation. Nobody is going to cut us a check for expenses incurred.

Focus on keeping infection rates low. Take a shower when you get home from being out and about. Wipe your touchscreen phone down with alcohol when you get home.

Anonymous said...

We are not following the same trends as Italy or Iran. They chose not to quarantine as early as we did. This "doctor" is poorly informed.

Kingfish said...

Sho Nuff, why don't you actually read what I wrote?

" It was Chinese doctors who tried to get the word out about the virus and were shut down by their government."

Anonymous said...

I think a Chinese doctor, who is now an American citizen and has been treating patients in our country for twenty-one years is worthy of a listen and read.

Who gives a damn where he was born. During a cancer scare a few years back, I saw a doctor at St Dominick who was born in China. He was well recommended by my dermatologist and well worth the money.

I didn't give a shit if he was Chinese or Martian.





Anonymous said...

I want the test to see if I already had it. It would have been a mild case, since I have underlying issues. I stayed in bed about 4 days, 60-80% for at least 3days before and after. Hard Cough and Fever.

Anonymous said...

Better Than Ever said...

@2:07 Logical fallacy: appeal to authority


BTE has been appealing to himself as an authority from the moment he landed.

Anonymous said...

2:03 - that's a damn broad claim you are making with nothing but a link to supposedly back your claim up.

"The CDC has given guidance on the use of test kits and our governor, state health officer, and others are not following that guidance."

Your link does not tell me a damn thing about where our State Health Officer, our Governor, or others are not following 'guidance" on the use of test kits.

Please enlighten us more on your profound knowledge - or your profound political hate of our Governor - to back up this B/S statement.

Anonymous said...

What would be a threshold number of cases in a community for the department of health to issue a stay at home order for a ‘cluster community’?

Anonymous said...

4:02 - I've seen what I assume might be the same "Chinese Doctor" at St. D - Dr. Qu - who is one of the best oncologists and hemotologist in the area. Certainly intelligent and well trained. Respect him a lot for his treatment of my conditions.

BUT, I'm still not considering him to be an absolute source for medical issues outside his realm of expertise. Coming from a family that has lots of doctors and in-law doctors, I hear them constantly saying "that's not my area" when asked about medical issues in other specialties. And I also don't view his procurement and disbursement management skills as being absolute just because he is a great oncologist. I also don't kick them to the can because he is Chinese.

There are many different things at play in this post - and the fact that some are turning the comments into 'racist' issues are not the fault of the commentators, but that they are reacting to KF's introduction of his guru - championing his Chinese heritage and 'connections' (for what they are actually worth).

Appreciate his thoughts. But - don't think I'm going to weigh his opinion over and above that of the folks that are actually trained in the field, dealing with the circumstances as they exist on the ground, and are having to make the hard calls considering all factors -- regardless of their heritage, background, where they go to church, what sports team they cheer for, or any other intrinsic matters.

Sho Nuff said...

Kingfish, if I misunderstood your phrase,"shutdown by their government," I apologize. I have no ego to protect. I assumed you meant internet censorship, or media blackout. I appreciate those who were willing to sacrifice for the good of others. Where they come from is not important to me. I specifically mentioned those who were disappeared, because there are some things worse than death. I am a guest on your blog, Kingfish, and I meant in noway to treat you disrespectful. If, I have wronged you, I ask your forgiveness. Signed a humble man.

Anonymous said...

Barf

Anonymous said...

@6:02. The CDC list of priority testing was not made in a vacuum and is operational across the US. (It is also endorsed by the White House Task Force).

For those of you who are not familiar with it, here is the link available to all:

https://www.cdc.gov/coronavirus/2019-ncov/downloads/priority-testing-patients.pdf

There is a nationwide shortage of swabs and VTM (viral transport media). There are medical centers currently unable to expand testing (or even continue it) because of that. All labs and academic medical centers are running experiments (today and yesterday and tomorrow) to find acceptable alternatives to both swabs and VTM. Will saline work? How about buffered saline? We do know that the yield is less with these alternative methods and that decreases the utility of the tests.

The governor and state health officer’s strategy is now “offensive” which means “test” and isolate clusters. That is wasteful to testing and will not work. Our borders are not closed and this plan will soon fail and be wasteful. That is the rationale for the comments you (@6:02) asked for.

Anonymous said...


Social distancing just got more interesting. We have been basing our knowledge of viral spread on the assumption that this virus spreads by droplet. This is not surprising as our knowledge base for the virus is all of three months old. Not all viruses spread by droplets. Some (like the measles) spread by airborne transmission. Our recommendations on six feet of social distancing may be very incorrect. Is six feet better than 1-3 feet? Absolutely. But 20 feet or 100 feet is safer. For those of you who wish to delay getting the virus until, say, July or August, here is the emerging evidence submitted by a good group of scientists at the University of Nebraska:

https://www.medrxiv.org/content/10.1101/2020.03.23.20039446v2

Anonymous said...

Enough already. Stop being lazy and learn how to hotlink.

Sho Nuff said...

@10:08PM, do you need some help getting that cleaned up?

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