By Isabelle Qian and David Pierson

Slumped in wheelchairs and lying on gurneys, the sickened patients crowd every nook and cranny of the emergency department at the hospital in northern China. They cram into the narrow spaces between elevator doors. They surround an idle walk-through metal detector. And they line the walls of a corridor ringing with the sounds of coughing.

China’s hospitals were already overcrowded, underfunded and inadequately staffed in the best of times. But now with COVID-19 spreading freely for the first time in China, the medical system is being pushed to its limits.

The scenes of desperation and misery at the Tianjin Medical University General Hospital, captured on one of several videos examined by The New York Times, reflects the growing crisis. Even as COVID cases rise, health workers on the front lines are also battling rampant infections within their own ranks. So many have tested positive for the virus in some hospitals that the remaining few say they are forced to do the job of five or more co-workers.

To ensure enough staff members are on the floor, some facilities have given up requiring doctors and nurses to test themselves before work. One doctor in the central city of Wuhan said her hospital’s staff had been so depleted that a neurosurgeon in her department recently had to perform two operations in one day while fighting symptoms of COVID.

“The hospital was operating on the brink,” said the physician, Dr Judy Pu, whose ward usually has 10 to 15 nurses and was down to just a pair. “About 80 to 90% of the people around me have been infected.”

China was the first country to experience the panic of COVID when it emerged from Wuhan in 2019. Then, for the past three years, the country largely suppressed the virus with a costly mix of mass testing, strict lockdowns and border closures. The government could have used the time to bolster its health system by stockpiling medicine and building more critical care units. It could have launched a major vaccination drive targeting the millions of vulnerable older adults who were reluctant to receive a jab or booster. China did little of that, however, plunging into crisis mode again like in the early days of Wuhan.

The actual scale of China’s health emergency has been difficult to gauge — in no small part because the government did away with mass testing after abruptly lifting the country’s stringent ‘zero-COVID’ measures. The country’s inadequate vaccination levels as well as the lack of herd immunity have raised fears that death tolls could reach those seen earlier in the pandemic in places like the United States, Western Europe, and, more recently, Hong Kong.

Data released by local authorities in recent days seem to confirm that the virus is running rampant, with reports from several cities and provinces of hundreds of thousands of infections recorded daily. Questions also abound about the number of COVID-related deaths China is reporting because officials only count those who die from respiratory failure directly linked to a COVID infection. Officially, seven people have died from the virus since pandemic rules were relaxed on Dec. 7, a number that belies mounting anecdotal evidence from across the country — from the crush of hearses outside a crematory in Beijing to the overflow of yellow body bags at some funeral homes.

A Shanghai hospital predicted half of Shanghai’s 25 million residents would eventually be infected and warned its staff of a “tragic battle” in the coming weeks, according to a now-deleted statement the hospital posted last week on the social media platform WeChat.

“In this tragic battle, all of Shanghai will fall, and all the staff of the hospital will be infected! Our whole families will be infected! Our patients will all be infected!” the statement read. “We have no choice, and we cannot escape.”

Manpower is stretched so thin in some hospitals that retired doctors are being asked to return to work. Physicians and nurses are reportedly being pulled from the eastern provinces of Shandong and Jiangsu to fortify medical facilities in Beijing.

Medical students who work as resident doctors and interns at hospitals have protested the deteriorating working conditions. They demanded that students be allowed to return home for winter break if they wanted to, and asked for equal pay and better protection from the virus for those who chose to work. Such students are among the lowest-paid medical workers, despite being expected to work longer hours.

Their demonstrations coincided with the death on Dec. 14 of a 23-year-old medical student who had been working at the West China Hospital of Sichuan University in the southwestern city of Chengdu. The hospital said the student suffered a heart attack, but his classmates have disputed the claim, saying he collapsed because he was overworked while infected with COVID.

The staffing crisis is expected to worsen as the winter wears on and millions of migrant workers travel home before the Lunar New Year holiday in January. Health workers are already experiencing chaos behind the scenes marked by shifting policies, physical and mental exhaustion and widespread frustration over the government’s failure to give them time to prepare for the surge of patients.

“We got no notice at all beforehand. I found out about the easing of restrictions from the news,” Pu said.

Medical staff say they could have avoided the medicine shortages that have forced some facilities to ration drugs. There also could have been more time to set up a more effective triage system to avoid overcrowding. One of the fundamental problems with China’s health system is its overreliance on hospitals for even the most basic care. Large, urban facilities like the Tianjin Medical University General Hospital, by number, account for only 0.3% of all health care providers in China, but they handled nearly one-quarter of all outpatient visits in the country last year, data from the National Health Commission show.

To ease the burden on hospital workers, the government has been working to increase the number of ‘fever clinics’ across the country. Such facilities are separate wings within hospitals or stand-alone clinics that are designated for treating patients with fevers, regardless of whether they have COVID. In the southern city of Shenzhen, officials set up fever clinics in booths that had previously been used to conduct COVID tests. In Beijing, the government said it converted empty stadiums and quarantine centres into similar facilities, raising the number of fever clinics to more than 1,000 in recent weeks.

The push to build more fever clinics highlights how quickly the government has tried to adapt to the fast-moving virus — though sometimes too quickly, some health workers say.

Adela Xu, a nurse at a cancer centre in Shanghai, said before restrictions were eased, staff and visitors needed to present negative COVID tests to enter her hospital. Then starting about a week ago, the hospital, under government orders, began constructing a fever clinic to help screen out patients who might have COVID. But by the time it opened, the facility was already rendered obsolete because the city stopped requiring COVID testing to enter the emergency room. At the same time, more and more people were becoming infected.

“Last week, about 20 out of 700 of the ER patients tested were positive,” Xu said. “Now about 100 out of 700 are positive.”

The deluge of COVID patients is not the only challenge hospitals are facing. One of the ripple effects of the outbreak has been a widespread shortage of blood for transfusions because of the shrinking pool of eligible donors.

In the southwestern city of Kunming, a blood bank said in a statement that the city was getting a fraction of the 500 donors per day it needs to keep up with demand, and that the shortage had started to affect pregnant women and patients in intensive care units.

In response to the shortages, the National Health Commission revised its 2021 rules on blood donations this month, allowing people who have recovered from COVID to donate blood after seven days instead of six months. The new guideline also lifted restrictions that had been placed on potential donors who are close contacts of COVID patients.

Some hospitals in Hebei province near Beijing are reportedly experiencing a dire shortage of ventilators, oxygen tanks and intensive care beds. In a video shot by The Associated Press, a medical worker at a hospital in Zhuozhou, a city in northern Hebei, could be heard urging a group of people to transfer a patient to a different hospital that was better equipped, saying that the facility was out of oxygen supplies.

“If you can’t even give him oxygen, how can you rescue him?” the worker said. “If you don’t want any delays, turn around and transfer him quickly!”

-New York Times