China’s Hospitals Releasing Coronavirus Patients Before They Fully Recover

February 21, 2020 Updated: February 27, 2020
FONT BFONT SText size

She was still on oxygen support when the doctor declared she was ready to go home.

The patient (name omitted for safety reasons), a 56-year-old woman from coronavirus epicenter Wuhan City, couldn’t stop coughing. Too much fluid was filling up her lungs because of the viral infection, causing chest pains and making it hard for her to breathe.

“Her limbs were so weak that she would fall when going to the restroom. She couldn’t walk out of her room,” her daughter, Zhang, wrote in a social media post pleading for public attention.

Despite that, her nucleic test results—the official diagnostic test for the coronavirus—came back negative, and to hospital staff, that was enough reason to discharge her. On Feb. 16, they stopped her treatments, apart from some cough medicine, according to Zhang. Four days later, they dispatched a car, and she was on her way.

Many cases have been reported of patients being discharged before recovering, and the worry is that—although the virus tests are negative—they may in fact still be infected and spreading the disease. Chinese health authorities have warned that some tests may be inaccurate and the government has shifted case count methods two times in the past two weeks, calling into question the authority of the data and efforts to contain the virus.

“The government said they will ‘hospitalize anyone who should be hospitalized,’” Zhang said, citing the slogan from a recent COVID-19 outbreak control campaign in Hubei Province, where Wuhan is the capital, to locate all coronavirus patients.

“You may have admitted them, but then you discharge those who haven’t recovered.”

By then, her mother had stayed in Wuhan’s Zhongnan Hospital for 25 days.

“Will these people carry the virus with them? What if they spread it out further?” Zhang told The Epoch Times, noting that her mother’s CT scans have shown “clear fibrosis in the infected spot” and pleural thickening—that is, lung infection.

Zhang said that a lot of patients were similarly discharged, casting doubt over the reliability of official infection figures. At least a few of them got reinfected, according to Zhang.

There are “a lot of half-truths in the recovery data,” she said.

When reached by phone, a doctor on duty at Zhongnan Hospital didn’t directly respond to questions about the criteria for discharging patients, but said that it was dependent on individual circumstances. The in-patient department couldn’t be reached for comment.

China’s National Health Commission advises hospitals to release patients or transfer them to the appropriate department for other disease if all of the following conditions are met: their temperature has returned to normal over a period of more than three days, the patient has shown a clear improvement in respiratory symptoms, there’s a significant reduction in lung inflammation, and their respiratory swab samples have tested negative to the virus twice, over the period of two or more days.

Cases Going Under the Radar

The Chinese National Health Commission has warned that negative nucleic acid test results do not necessarily warrant the patient to be virus-free. A variety of factors, such as quality of samples and the timing and handling of them, could have an impact and lead to possible false-negative results.

Chinese officials, media reports, and studies have also noted cases where patients had the virus despite being discharged from the hospital or initially testing negative to the disease.

Guangzhou No.8 People’s Hospital recently found that 13 of their discharged patients—roughly 14 percent—tested positive again in later check-ups, according to a Feb. 25 press briefing.

A 20-year-old woman from Wuhan initially tested negative to the virus on Jan. 26, but a follow-up test on Jan. 28 returned positive. She tested negative again for two subsequent tests on Feb. 5 and Feb. 8 respectively, according to a case study published in the Journal of the American Medical Association on Feb. 21.

All five of her relatives became sick with the virus after meeting with her. But as of Feb. 11, the woman did not exhibit any typical signs of infection, such as fever, gastrointestinal symptoms, cough, or sore throat, suggesting that she might be an asymptomatic carrier.

On Feb. 19, a patient considered to have recovered from coronavirus in Chengdu, the capital of southwestern Sichuan Province, was hospitalized again upon testing positive for the virus, according to local news outlet Red Star News. The person left the hospital on Feb. 10 and since then has stayed at home under self-quarantine.

Lei Xuezhong, vice director of infectious disease center at West China Hospital and an expert assisting with outbreak control in Sichuan, told the outlet that the case demonstrated a need for stricter lab testing standards. Health workers will increase the frequency of diagnostic tests from two to three to increase accuracy, he said.

When asked if the patient had a relapse of the disease, Lei dismissed such a possibility, saying it was likely a result of a small amount of remaining virus manifesting in the body, and thus should not cause public panic.

A patient surnamed Tang in Hunan, located south of Hubei, left the hospital on Feb. 4 after testing negative to the virus, according to local media. CT scans found small shadows in her lung area. Three days later, she was hospitalized again after complaining of low fever and dry coughs. Her lung infections had gotten worse. She tested positive on her fourth test, on Feb. 9.

In Jingzhou, Hubei, the first patient declared to have recovered was recently hospitalized, according to Caijing, a Beijing-based Chinese magazine. The patient had two negative test results prior to his discharge.

The first two coronavirus cases in Ontario, Canada, a couple in their 50s, also found traces of the virus from testing of nasal and throat swabs even after having recovered, Ontario health officials said on Feb. 13.

Seven Australians evacuated from the Diamond Princess cruise on a flight to Darwin, Australia, who initially tested negative before boarding, later returned positive tests upon a second health screening conducted after reaching Australia on Feb. 21.

wuhan woman lion
A Chinese woman wears a protective mask as she walks in the street in Beijing, China, on Feb. 20, 2020. (Kevin Frayer/Getty Images)

Confusion Over Official Data

A lack of consistency in how infections are counted in China has resulted in growing mistrust in official data on the outbreak. The government of Hubei has shifted the case count methods twice over the past two weeks, in response to guideline changes issued by China’s top health authority.

The changes drew confusion on Feb. 20, when Wuhan City reported 615 new confirmed cases—hundreds more than the provincial total of 349. The officials said that the higher Wuhan numbers arose because the National Health Commission advised the province to no longer account for the numbers of patients who showed lung infections in CT scans (also known as “clinically diagnosed patients”), and only include those who tested positive in nucleic tests.

Hubei said that in applying this methodology revision, it subtracted 279 cases from the total tally as those cases were of clinically diagnosed patients.

The change in the counting method was a reversal of the previous guideline. When the previous guideline took effect on Feb. 12, it led to a ten-fold rise in the case tally to 14,840, with over 13,300 of them being clinically diagnosed patients

However, on Friday Hubei’s health commission announced that they would add back the 279 cases it subtracted the day before, saying it was a mistake to remove cases that were already counted. It added those who made removed the cases would be held responsible.

Nowhere to Turn

Zhongnan Hospital, the largest hospital in Wuhan, has recently built extra capacity to take in virus patients.

On Feb. 19, one day before Zhang’s mother was discharged, the hospital added another 2,000 beds for coronavirus patients. It has for several consecutive days had more beds than patients, according to a Feb. 22 report from China News Service, the second-largest state-owned Chinese news agency.

Before Zhang’s mother was released, the doctor suggested that she self-quarantine at home and avoid close contact with family members. But Zhang said this was hardly realistic in their tiny two-room apartment—shared by the family of three.

CHINA-HEALTH-VIRUS
Medical personnel walking among patients with mild symptoms of the COVID-19 coronavirus resting at night in the temporary hospital set up in a sports stadium in Wuhan, in China’s central Hubei province, on Feb. 18, 2020. (STR/AFP via Getty Images)

Her case remains in limbo. The makeshift hospitals, known as fangcang, which take in suspected patients and those with light symptoms, have refused to admit her, saying that her condition was too severe. The neighborhood committee that’s in charge of arranging hospitalization of residents said they couldn’t do anything because the hospital was not within their jurisdiction. Nor did the hospital in their district of Qiaokou have any additional capacity.

The city’s health commission similarly turned them away, because they did not have oversight over provincial hospitals like Zhongnan, Zhang said.

The Epoch Times has spoken with families of patients who jumped to their deaths from buildings after being denied treatment. Zhang said she also knew of at least four or five infected locals who attempted suicide in sheer desperation.

“Of course, the medical resources are limited, but you can’t only pursue a recovery rate and ignore patients’ needs,” Zhang wrote in a now-deleted post.

Follow Eva on Twitter: @EvaSailEast