Plague Doctor

Translator: Lonelytree

San Hai City was a small state and Jiang Xing Municipal within it was even smaller. Jiang Xing Municipal sat by the coastline but its tourism was not developed. The hospital at this small city had received more than 20 similar cases since the morning of August 2nd. They all suffered from the same symptoms: fever, listlessness and coughing. Those with light symptoms were diagnosed with flu while those with more serious symptoms were disagnosed with pneumonia.

When Huang Lin, the doctor on night duty consulted a 18 year old patient named Shen Haoxuan, she heard from the patient quite plainly that he was infected by a middle-aged uncle whom he shared a bus with that morning. Instantly, alarms rang in Huang Lin’s mind. This looked like the start of an epidemic. Huang Lin immediately requested for the patient’s files of everyone who registered at the hospital that day. The middle-aged uncle whom Shen Haoxuan mentioned did exist, he was a 43 years old patient who was sent from emergency right into the medical ward at 8 am, Huang Guoxin.

Reading through Huang Guoxin’s medical history, Huang Lin’s heart sank. The preliminary diagnosis Huang Guoxin’s doctor gave him was ‘right lower lung pneumonia’. Huang Guoxin’s situation was serious, his recorded temperatures ranged around 39.2 to 41 degree. He coughed constantly and his phlegm was sticky and brown. Occasionally there was blood in his coughs, accompanied by what appeared to be decayed flesh. The lumps of flesh were temporarily identified as decayed tissues in the lungs. He was weak and sore all over his body. Clear moist rales could be heard on the back of his right lung and the chest x ray showed an irregular shadow of 6 cm x 8 cm at the bottom of his right lung. The inflammation was serious but there was no unique identifier. The patient said he had been coughing for days already but it only got serious this morning. There were a lot of phlegm and occasional blood. He came to the hospital due to fear.

Doctor Zhang, his attending doctor, instructed an inspection of the patient’s vital signs as well as his liver and kidney function. The blood test showed that there was high concentration of white blood cells. Combining that with the result from the x-ray, Doctor Zhang diagnosed the patient to be suffering from bacterial infection in the lungs. After taking the patient’s saliva and blood for bacterial culture, Huang Guoxian was immediately given drugs and cefuroxime sodium injection for infection resistance, etamsylate to stop blood boss and glucose drip. He was also given acetaminophen to help with the fever. However, a look at the patient’s temperature records chilled Huang Lin’s heart. Even with the drugs, the patient’s body temperature had not dropped, remaining above 39 degree.

“Hopefully I’m just being too sensitive.” Huang Lin then called the inpatient department to ask for Huang Guoxin’s latest update and her heart sunk right into ice. The nurse on duty told her that the patient’s coughing had gotten more serious and his consciousness was wavering… Huang Lin had a feeling this was not a normal case of pneumonia and Doctor Zhang had unfortunately given a wrong diagnosis.

Her trainee days at university informed her that 40 to 50 pneumonic patients in a day for a big city was no deal but for the population at Jiang Xin Municipal, 20 patients in a day was too many. Wang Guoxim was the first patient they registered, and the second patient with similar symptoms appeared at 3 pm but after 7 pm, patients started to pour in! She herself had treated more than 18 patients with the same symptoms already! Combine that with Shen Haoxuan’s testimony, there was only one conclusion…”This might be a contagious atypical pneumonia.”

Huang Lin shared her report with another doctor working at the emergency room, Zhao Yutao. She considered reporting this to the bigger state hospital. Their hospital was a small one, there were only 2 doctors working the emergency shift.

“An epidemic?!” Zhao Yutao, who was already in his middle age, frowned. “With the hot weather recently, it’s common for us to have an influx of patients with pneumonia. I’m sure it’s nothing serious.” Once the news reached the state hospital, no matter if it was real or not, there would be much paperwork to follow up. Zhao Yutao did not want the trouble, especially now that it was midnight. Other than that, Zhao Yutao did not like Huang Lin that much, she was a graduate from a famous university, Eastern State Medical University. From his perspective, she was inexperienced and liked to make things out of nothing. “We’ll just transfer the first patient whom you pointed out to the state hospital, stating that we do not have enough equipment to deal with his conditions,” He advised.

“Brother Zhao, this is not something that can be settled so easily.” Huang Xin insisted on her observation, “We need people from the disease control centre.” She turned to make the call to the hospital contagion management office and medical department. She reported the illness as contagious atypical pneumonia under the category B contagious diseases with signs of spreading. “The latent period for normal pneumonia should be more than five days. For this illness that we’re dealing with, there are similar early symptoms but after the high fever, the patient’s conditions will deteriorate at an alarming rate. The same is observed from another patient who is suspected to have been infected from another patient. He started to have bloody coughs only after 6 to 7 hours!”

Huang Lin stressed the severity of the situation and requested them to make the report to their superiors as well. Time was important in the early reporting of an epidemic, it was 2 hours for category A and 24 hours for category B and C contagious diseases. When category B disease showed signs of surfacing, it should be reported as though they were treating category A contagious disease. Huang Lin was worried that the medical department would delay their report. Every minute was extremely important, the earlier the steps to stop the contagion were taken, the more lives could be saved.

Thankfully the medical department reacted swiftly, they called the city disease control centre at 20: 32 on August the 2nd. When Huang Lin finished her report, she returned to her post and treated her 21st, 22nd, 23rd pneumonia patients…

When the number climbed up to the 30th case, even Zhao Yutao was panicking. So was the hospital’s contagion management office. Even the nurses could tell something had gone awry. At the same time, the city disease control centre made immediate responses regarding this public health issue. They ordered Jiang Xin hospital to quarantine the patients and upgrade the safety of the medical workers. They also sent their expert He Feng and his team over to conduct an epidemiology investigation.

“Okay, I understand.” When He Feng got the call from the centre, he was having dinner with his family, “I’ll depart now.” His wife worked at the disease control centre too so she understood his necessary absence but his seven years old daughter, Niu Niu pouted unhappily, “Daddy, can’t you go after dinner?”

“Daddy has to go to work. Stay home and accompany mommy, okay?” He Feng patted her daughter’s head. Disease control was basically a race against time. He was expected to be at any location where an epidemic was suspected, that was his job. With the night watching on, He Feng jumped into his car. His assistant Lee Wen handed him a stack of documents, it was the contagious disease reports written by Doctor Huang Lin, they detailed the patients’ medical history and their individual information. He Feng looked through the files and his heart dropped with each turn of the page….

The small town hospital did not have the device to conduct any antigen-antibody analysis, they did not even have a CT machine. Furthermore, it was only half a day, Huang Guoxin’s professional opinion was that it was too early to tell if it was a contagious disease. However, He Feng agreed with Doctor Huang Lin’s clinical assessment, this did not appear like a case of normal pneumonia.

Suddenly, Lee Wen received a phone call and he said sadly, “Leader He, the number at Jiang Xin Hospital has climbed up to more than 30 cases already.”

“Isolate the whole hospital immediately.” He Feng’s face wrinkled as he ordered quickly, “Patients who show signs of vomiting are now barred from leaving the hospital. Get the centre to send in more equipment and devices, and everyone in the hospital has to be on Grade 3 protection. This time, we might even need to apply to lockdown on…” He halted and changed the ‘entire San Hai City’ that appeared on his lips to “Jiang Xin Municipal.”

Hopefully this was just a scare, with a contagion that could only travel through close contact between patients. Hopefully… the zone of the epidemic had not spread…

The uneven small town streets were bumpy. He Feng looked out at the retreating streets and the faces of his wife and daughter flashed across his mind. ‘Niu Niu, daddy might need to stay outside for a few more days than promised before daddy can come home.’