Have you ever put on Level-D protective clothing?
Various newspapers and other textbooks plainly describe wearing Level-D protective clothing against respiratory viruses. In practice, however, this is not a simple task.
It takes at least five minutes to put it on. If you try to see the patient after wearing it, it is very difficult to communicate. With the N95 respirator, a basic conversation is not easy. Physical examination is also difficult to conduct. For example, can you properly auscultate a patient while wearing such heavy personal protective equipment (PPE)? Moreover, if you are wearing this bulky PPE in the summer, the heat and stuffiness are unbearable.
|Professor Yoo Jin-hong|
When suspected of novel coronavirus infection, officially codenamed 2019-nCoV, another ordeal is awaiting you when you discuss with the community health center to discuss patient transfer over the phone. At first, it is not connected well because telephone call to the public health center is congested. Even with the connection, the voice at the other end is hard to hear. And because of wearing gloves, the keyboard touch is not comfortable. Sometimes the decision of the public health center is inconsistent with ours, resulting in disagreements or conflicts.
Doffing (taking off) the level-D protective clothing is even more difficult than donning (putting it on). Each time you take off one PPE, you will need to do hand hygiene. So doffing takes at least 10 minutes. Some patients show an aggressive attitude, making the medical personnel frustrated.
All of these are real situations. During the MERS crisis in 2015, we already experienced to know that. When a new infectious disease breaks out, the situation does not proceed normally. Standard guidelines are established and enforced, but people never act rationally. Dealing with the epidemic is a long, continuous process of hardships.
Now, let's go over the current situation.
Eventually, the third plague of the 21st century has struck the world. In December 2019, an outbreak of pneumonia of unknown origin began in Wuhan, China.
The causative pathogen was identified as a new species of coronavirus similar to SARS-CoV. It was called the Wuhan virus at the beginning but is later officially named 2019-nCoV. This virus is a positive-sense, single-stranded RNA virus belonging to the family Coronaviridae. Most coronaviruses cause only mild upper respiratory infections, but sometimes they cause fatal respiratory disease and outbreaks, as experienced in the cases of SARS-CoV or MERS-CoV. It has been warned until recently that new mutants of coronavirus can occur anytime.
The emergence of these mutants is caused by species jumping between humans and other animals. Therefore, it is likely to occur in an environment where humans and animals are in close contact. The current outbreak is also suspected of being caused by mutants from species spillover in Wuhan's wild animal market. The 2019-nCoV is rapidly spreading throughout China and around the world in a relatively short period. As of Jan. 29, 6,140 cases were confirmed in 19 countries, including Korea, of which 132 died (in China only) and had a mortality of 2.1 percent.
Like in the 2015 MERS-CoV outbreak, we are learning many lessons from this outbreak. Because epidemic is a national disaster, not only medical institutions but also governments have to be active. Hence, honesty and transparency are the two virtues that governments should have. Our country is excellent at coping with this disaster, thanks to the experiences during the 2015 MERS-CoV outbreak. Our defense system is at least more thorough and faster than it used to be.
How will the latest 2019-nCoV outbreak develop in the future, then?
Based on the precedent of the SARS epidemic, the outbreak is expected to last at least three months. And this outbreak is likely to have a higher amount of transmission than the 2015 MERS-CoV. Recently, the possibility of transmission by asymptomatic infected people has also been raised carefully, although its evidence is insufficient. Therefore, we should also prepare for the spread to communities by asymptomatic infections.
After the MERS-CoV outbreak in 2015, there was a self-tormenting expression in the medical profession society: “Patients die, hospitals die, but civil servants are praised.” However, the bad memories of the past should never be repeated.
Even now, however, cooperation between community health centers and private hospitals is not always harmonious. The government needs to be more active, not just leaving everything to the medical community. After all, the responsibility for controlling nationwide epidemics lies with the health authorities of the government.
The Korea Centers for Disease Control and Prevention (KCDC) must be the control tower of the ongoing situation in Korea, and all other central or local governmental organizations must cooperate with the KCDC.
<The writer is a professor of the Infectious Diseases Department at Bucheon St. Mary's Hospital in Gyeonggi Province. This article was originally published in the Journal of Korean Medical Science. >
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