Plague Doctor

“Cough, cough…” The sound came from different sickrooms, echoing down the hospital corridor. The small town hospital had limited amenities. That night, Shen Haoxuan was placed inside a quarantine room which was actually just a normal room. Of the three beds, two were left empty and Shen Haoxuan occupied the only one. Needles stuck on the back of his arm. Thankfully his phone was not confiscated and the connection inside the hospital was not so bad so he could use his phone to while away some time. Shen Haoxuan typed a message and sent it to his good friend, Liu Hui, “How unlucky can I be? I got diagnosed with pneumonia and is currently quarantined. I was in a normal sickroom initially but the doctor suddenly requested for me to be moved. Not only that, even my parents have to be quarantined as well. I know it’s that uncle on the bus who infected me. Looks like I’ll have to stay in the hospital for a few days, hopefully I’ll be out of this place before the comic con ends on Saturday. Sad face.”

There was no reply from Liu Hui. Shen Haoxuan coughed heavily. The drip was attached to his arm half an hour ago but the fever showed no sign of abating and his coughing only appeared to get more serious… He checked the update that Deng Nuotong released on Wechat that morning, “Next stop Shen Shi University. Appreciate the past, look towards the future. Good luck!”

“He he, cough…” Shen Haoxuan couldn’t help but chuckle. He felt much better. Before this, he hoped for an extension of the summer holiday, but now he could not wait for the school to start. Suddenly he received a message notification on his phone, it was from his friend, Liu Hui. “This is bad. I’ve started coughing around late afternoon and now I’m burning up to 39 degrees!”

“My god, probably you’re infected as well?!”

“My mom has already given me fever medicine, do you think I still need to go to the hospital?”

Reading the replies, Shen Haoxuan felt sorry for his friend. A weight pressed down on his heart. ‘Is it because of me? Have I inadvertently harmed my friend and other innocent people who I came into contact with?’ He thought about his parents, his other friends and the crowd at the earlier con…’No, stop worrying yourself over nothing.’ Shen Haoxuan tried to comfort himself. ‘Even atypical pneumonia is not that contagious. It’s just a normal pneumonia, nothing the doctors can’t fix, I’ll probably be out of here in a few days.’

Shen Haoxuan replied, “Of course, you need to come to the hospital. This is all my fault, after we both get better, I’ll treat you to a good meal as an apology.”

…

The 30th case, 40th, 50th… Thankfully, Jiang Xin Hospital normally did not have that many inhouse patients so it had sufficient bedspace to deal with the sudden influx of pneumonia patients. However, since each patient needed to be individually isolated, it was only a matter of time until they ran out of room. That night every worker at the hospital was busy. The disease control centre had already given the order, the hospital was to be placed under lockdown. Only patients with suspected symptoms were allowed entry but everyone currently inside the hospital had to stay put.

“Aiz, Xiao Lin, you should have known something was wrong when the 10th case appeared.” Zhao Yutao changed his tune. He wore a three-ply mask and he kept finding excuses to slip away from the emergency room, to have as little contact with the patients as possible. Huang Lin ignored him. She stayed posted at the emergency room and even took her personal free time to call her university lecturers and classmates for their opinions on this issue. One of her lecturers pointed out a possibility, could it be legionella pneumonia?

Even at state hospitals, misdiagnosis of legionella pneumonia as common pneumonia was commonplace enough much less at a small town hospital. This was because it was not a common disease so general practitioners had limited knowledge of it. Furthermore, legionella pneumonia had complicated clinical symptoms and could only be detected from blood tests.

“Legionella pneumonia.” Huang Lin went online to research related journals. Everything matched except one, which was the speed of contagiousness. However, some news articles that she read online worried her. Not too ago, outbreaks of legionella pneumonia were reported at many cities across the globe. Huang Lin instantly reported this possibility to the hospital contagion management office, only then she found out the hospital had already received missives from the disease control centre in the previous month to be cautious of legionella pneumonia. However, the hospital was constantly receiving official missives so they did not give it much attention. Standard contagion control measures, like cleaning the ventilation system, were always taken.

Legionella pneumonia often festered and started inside a hospital but Huang Guoxin’s last visit to the hospital was several years ago. That meant that he was not infected at the hospital.

At 21:45, 1 hour after her report was made, the team of experts sent from the disease control centre arrived. The hospital staff, who came to welcome them, were stunned as they saw the leader, He Feng and the vice leader, Lee Wen as well as the other two members decked out in full white protective gear. They even wore a helmet-like breathing equipment, ensuring not even an inch of their skin was exposed. When Zhao Yutao saw this, he added another 2 layers of masks. Huang Lin then knew her suspicion was true. Even people from the disease control centre suspected this was legionella pneumonia, a disease that could be transmitted through the air…

After some introductions were made, He Feng’s team discussed the patients’ condition with Huang Lin as they headed towards the quarantine sickrooms. They first paid a visit to Huang Guoxin whose condition had worsened. His consciousness was slipping away and he had just hacked up a big pile of bloody phlegm. An intense stench of blood and decay permeated the room.

“None of this can be treated as normal waste.” He Feng reminded the people from the hospital contagion management office. After visiting the other patients, especially Shen Haoxuan, He Feng confirmed that they were dealing with an epidemic.

“A manga con?” Shen Haoxuan visited a manga con with more than 3000 visitors after he was infected. This knowledge chilled everyone’s heart. He Feng immediately made several calls to ensure that the centre treated this seriously. He requested a temporary lockdown on Jiang Xin Municipal. However, he knew they were already too late. Any protective measures taken so late into the epidemic would not be that effective. In fact, if not for the recent outbreak of similar disease over the globe, his requests would definitely be vetoed immediately. There was too little supportive evidence and it was so late at night.

After he concluded the disease as suspected legionella pneumonia and the attending doctor Huang Lin shared his opinion, the disease control centre and hospital staff were worried.

It was too late to draw blood for the antigen test. The human body required at least 1 or 2 weeks to come up with antigen; and the bacterial culture ordered by the hospital would take even longer to come up with the result. Thankfully, recent nucleic acid amplification testing technology provided great strides, with the identification of microorganisms shifting from their outer structure to internal DNA property, and tests moving from biological and immunization method to assessment of DNA level. PCR technology enabled a swift rudimentary testing result and proved very effective when facing a sudden public health threat. However, the small town hospital was too modest to possess a PCR lab so they would have to either ferry the sample out or ferry the devices in.

While they were on the way, He Feng had the foresight to request for the PCR equipment to be moved to Jiang Xin Hospital. Due to his superior’s concern about legionella pneumonia, his request was swiftly approved. As dawn broke, the batch of equipment finally arrived at the hospital. Accompanying them were the technical workers, who wore tight protective gear as well. After they set up the small PCR lab at the hospital, they instantly conducted 22 different kinds of respiratory illness bacterial pathogen tests for screening. Be it viral virus, flu virus, covid virus, legionella strain bacteria, or any others, they would all be identified through their DNA markers.

While they were waiting for the result, Lee Wen, who was the centre’s liaison with the local hospitals, rushed into the lab. His face under the helmet was grim.

“What’s wrong?” He Feng asked, his heart prepped for the worst.

“Doctor Huang Lin has started to cough.” Lee Wen reported, “So did the other doctor and nurses posted at the emergency room.”

He Feng frowned immediately… Doctor Huang Lin had been working for only 6 hours at the emergency room. This was much faster than normal legionella pneumonia which had an average of 36 hours latent period…

This whole hospital was now infected. The people at the PCR lab were urged to work faster. The result finally came the next morning. It was not a virus, not streptococcus, not chlamydia… The PCR result showed that it was indeed legionella pneumophilia!

Once the result was announced, He Feng, who had not slept, was quite relieved. This was because the pathogen was something that they were familiar with. Even though it spread quicker than usual, the standard control measures against legionella pneumonia should be enough to curb the spread of the disease. Even though legionella pneumophilia could be transmitted through the air, it required aerated solids to act as a transmission medium…

Just as He Feng was feeling thankful for this break, without warning, his throat felt itchy and he started to cough violently as a pressure fell over his chest. Instantly, inside the small lab, the entire room fell silent. Every lab member looked at each other dumbfounded.

“Even Grade 3 protective gear is not enough…” He Feng mumbled numbly before he exploded in a string of horrible coughs. At the same time, panic and fear hit him, almost knocking him to the ground. The contagion was strong enough to pass through grade 3 protective gear… this was not the legionella pneumophilia that they knew, it could only be a mutated form with especially strong contagious penetrability…

Most of the visitors of the manga con that Shen Haoxuan attended were probably infected. That meant the entire Jiang Xin Municipal was infected, no, the whole San Hai City was infected…