《人物周刊专访【#卫健委高级别专家组成员杜斌#】》中英文20200327

«VIP Weekly» Exclusively Interviewed with Mr.Du Bin, Director of Medical ICU , Peking Union Medical College Hospital

VIP Weekly: During treating and curing COVID-19 in Wuhan, many intensive-care doctors will mention Du Bin, director of  Medical ICU, Peking Union Medical College Hospital. We asked a critical-case specialist: what kind of person is Du Bin? The answer is: A pure doctor. Du Bin is a member of the high-level expert group of National Health Commission of PRC, and national expert group on the medical treatment of COVID-19, which is the most important role that a doctor can play in this epidemic disease. He thinks he has done his best, but the core of dealing with violent infectious diseases is prevention and control, not treatment. “The most important decision is not to determine a person’s life and death, but to determine a group of people’s lives and deaths.” At noon on March 11th, Mr.Du received our exclusive interview. Judging from his report, we don’t think the epidemic situation is going to be out of control.

Mr. Du: I felt devastated in January. Some patients falled to the ground when they just arrived to the hospital.

VIP Weekly: You felt devastated in January. Besides complicated disease, was there any other reason?

Mr. Du:  In fact, there was another reason at that time, there were a lot of patients outside the hospital. At that time when you went to Wuchang Hospital, there were as much as five to six hundred fever clinic patients every day. There was a period that Tongji Hospital issued 400 limited outpatient registration number. Only one hour there was no more left. Some patients falled to the ground when they came, and were immediately treated by  cardio-pulmonary resuscitation(CPR).How could that work? No, their lives couldn’t be saved at all. The presence of those patients outside the hospitals meant the medical treatment might be delayed.

VIP Weekly: What is the work of High-Level Expert Group?

Mr. Du: I arrived in Wuhan at noon of 18^th. The Health Administration showed me 45 patient cases in the afternoon, but in the evening I was told that there will be some different issues for me. The next day a High-Level Expert Group came, the one with academician Zhong Nan-shan. I didn’t know why they put me in that Group. As I understand,  the so-called High-Level Expert Group is to investigate what the epidemic situation is like, make a general judgment and then report to the leadership in Beijing on the 20th. So we spent a day on the 19th, to listen to the report of the epidemic situation presented by the province and city, and then went to Wuhan CDC and Jinyintan Hospital. On the 20^th morning, we first reported to the State Council, and in the afternoon I attended the teleconference of the Joint Prevention and Control Mechanism of the State Council. The participants were not all from health section, and some are from public security, traffic and so on. Two leading officials from Hubei Province also attended. Frankly speaking, from their report, they did not feel the matter was out of control.

VIP Weekly:  I saw another High-Level Expert Group member, Yuan Guo-yong, in an interview saying that Zhong Nan-shan had kept asking whether there were more patient cases.

Mr. Du: Exactly. The two-level institutions provided the patient numbers which were different from each other, or some numbers were not so confirmed. For example, we asked if there were medical staffs to be infected. This is important not because of the number of the infected medical staffs, but because this phenomenon did exist or not. If it existed, it means people will infect each other. My understanding is, in fact when Zhong Nan-shan and Yuan Guo-yong came, they already knew there were cases of disease spreading due to family gathering in Shenzhen, they wanted to confirm Wuhan actually had such cases too.

VIP Weekly: What’s the itinerary after the Beijing report?

Mr.Du: At the end of the meeting on the 20th, I was given another assignment, refering to that WHO was going to hold a video conference and Geneva was going to be on web connection with Beijing to discuss the epidemic situation. It was said the conference was very important to help WHO to decide whether it was an international public health emergency. On the morning of 21st I was given another notice that the meeting had been rescheduled to the evening of the 22nd, which was one day later. I was impatient. I said I didn’t want to stay here, I wanted to go to Wuhan, I didn’t like meeting. Later the leader agreed, I packed things and returned to Wuhan. I was in the ward to communicate with the patient ,” We are still getting slowly to know this disease. ”

VIP Weekly: On January 22nd you started your rounds at Jinyintan Hospital. Was there any deeply impressive patient?

Mr. Du: Frankly, I don’t remember. It took me a few days to get to know the characteristics of the disease, although they would explain to me at that time, but it was different from my own feelings. At that time, my first feeling was everyone had the same illness condition, more or less. This was a bit like Y2014 Kunshan explosion, where we received burnt patients , among them 186 were hospitalized. Third-degree burn area was about 95% on average. Every patient was more or less the same. Regularly we took care of patients in ICU. I saw this person had heart failure, that person had kidney failure, the third person had diabetes, the fourth person had pneumonia, and so on. They were not the same. However in the ICU of Jinyintan Hospital, all patients had the same disease. After seeing them, I had no deep impression on some partcular patient, because all mixed together in my mind.

VIP Weekly: What were their symptoms?

Mr. Du:  They all had respiratory failure, but the severity of respiratory failure varied. Some were non-invasive, others were invasive; some had kidney failure, others did not; some had shock, others did not. It was later that we had gradually got a little clearer understanding on this disease.

VIP Weekly: How did your knowledge gradually build up?

Mr.Du: Definitely I had to watch the patient every day, to see the disease situation changes. I spent more than ten days in Jinyintan Hospital, then I went to different hospitals. So far, we still slowly come to know the disease. Frankly at the initail stage, I felt a little helpless. Only from the point of view of the patients and their illness situations, I really had no idea. We saw, for example, that for a significant number of patients, even if on ventilator, it was still very difficult to correct low oxygen saturation problem; for another example, some patients had persistent carbon dioxide retention problem, which is difficult to regulate by adjusting the ventilator. I remember very clearly that, at the first few days I went to see a patient. His blood gas test showed carbon dioxide was xxx, which was so low that it could not be measured, as there were no numbers. I adjusted all the morning beside the bed, and when I came out at noon, the carbon dioxide showed more than 115. Finally I got the number, but it exceeded the upper limit of the measurement. I felt very upset, as I did not know what I was doing, what was the effect of my work?

VIP Weekly: With the change of understanding on the disease, how does the change affect the medical treatment in the epidemic situation? Did you make any mistakes?

Mr. Du: When I got into the ward, I gradually came to know these diseases. In addition to respiratory failure, we first started to realize the kidney problem, which was discovered in the first 10 days. But I admitted that the heart problem was actually not discovered until very late. For example the myocardial damage, someone mentioned to me whether there was such problem, when I hadn’t realized it and even said “you were wrong”. If I accepted such idea, I might have realized the problem earlier and communicated more with others. This was a typical mistake. It is normal as everyone will make mistakes.

VIP Weekly: You felt devastated in January. Was there any other reason besides the complexity of the disease?

Mr. Du: In fact, there was another reason at that time, that is, there were a lot of patients outside the hospital. At that time if you went to Wuchang Hospital, you would see that hospital had five or six hundred fever clinic patients every day. There was a time that Tongji Hospital issued limited outpatient number, 400, and in one hour all the number was distributed without any doubt. Looking back, as long as ICU of Jinyintan Hospital had one vacant, there would always be patient coming to use it, perhaps more than one patient. In fact for infectious disease, the most important thing is not treatment, but prevention and control. You do whatever to reduce the number of patients, then treat the remaining patients. If you didn’t know how many patients were outside the hospitals, this meant you didn’ t know either how many severe patients existed. Some patients falled to the ground when they came, and were immediately treated by cardio-pulmonary resuscitation. How could that work? No, their lives couldn’t be saved at all. The presence of those patients outside the hospitals meant the medical treatment might be delayed.

VIP Weekly: What were you worried about then?

Mr. Du: In fact, two things happened which we were least willing to see. One had happened before I came, that is, hospitals became new virus-spreading points. Another was that the family had become a contagious place. People came to the hospital to get medical treatment, not to get sick; you hoped him/her to quarantine at home in order not to infect others, but things turned out not to be like that. When I came, the hospital was paralyzed, and it had no way to fulfil its mission. Conversely it became a place to spread the virus. Of course, I only cared about medical treatment. I was not responsible for prevention and control, as this was not my professional scope. I might not be able to propose better measures. But from the spreading of this virus, it was said to breakout from Huanan Seafood Market, then to the hospitals, and then to the community. I think this may not be right. “You don’t want intubation, I’ ll intubate for you”.

VIP Weekly: As a member of the Expert Group, what treatment advices did you give?

Mr. Du: Initially there was not any holistic medical treatment opinion, but more for each individual patient. In fact at the beginning of this period of time, I was still a little devastated. Usually after the adjustment of medical treatment, the patients will get better or improved. But whatever you did for those patients, it finally did not work. We all came to realize that the initial treatment must be questionable, so that the patients had not got better. Consequently, later we reached a consensus that those patients might be short of oxygen for quite a long time before treatment. So when we were in the Jinyintan Hospital and Pulmonary Hospital rounds, we would discuss with the doctor, and advised not to wait but quickly intubate for the patients. Even though, some patients had cardiac arrest when they were intubated, which meant the intubation was too late, without any doubt. So then we reached a relative consensus that we should be more positive to try earlier tracheal intubation. Thus, later thanks to earlier tracheal intubation, it was relatively easier to maintain the patients’ lives.

VIP Weekly: Did you self manually incubate patients?

Mr.Du: Yes, I did.

VIP Weekly: Why did an expert as your high level have to do tracheal intubation manually by yourself?

Mr. Du: Why couldn’t I intubate? Why must other people without me incubate? I know very well how to intubate! I intubated patients not in Jinyintan Hospital. The first intubation I did was when PUMCH took over the ICU of Zhongfa Branch of Tongji Hospital, and I was appointed as ward director. I was there the day when they started receiving COVID-19 patients. My previous experience told me the most flustered thing was when you first started receiving COVID-19 patients because everyone was not familiar with the disease. When I was there, if a patient came up for tracheal intubation, I would surely conduct the first tracheal intubation by myself, at the same time I told the doctors I could do and should do this. If you didn’t do it yourself, how could you let others do? This was my idea. It was nothing special. Even if there were a lot of doctors in this team who could do intubation, and maybe a lot of them were more proficient than me, but I had to conduct the first tracheal intubation. (Note: Tracheal intubation is a high-risk operation that sprays patients’secretions, blood or produces droplets or aerosols, increasing the risk of coronavirus infections. )

VIP Weekly: I heard that you are the most carelessly protected doctor in whole Wuhan City?

Mr. Du: If I was not infected, that meant I was not necessarily wrong. They said I didn’t wear goggles when I was in the ward, I only wore face screen, and I chose only one of the two protections. They said “Du Bin, why have you got only the goggles or only the face screen?”This was because I never believed there were virus in this room that would quickly enter your eyes. But I told them, “Have you seen me taking the goggles off when I am facing a patient? Never. I don’t do this when I was facing a patient. I’ m not a fool.”The most important thing was mask and hand washing. Nothing else was so important. But when you did high-risk operations, it was another story.

VIP Weekly: Later the hospitals were noticed to increase the rate of intubation, how do you understand?

Mr. Du: First, the need for intubation is not evaluated by the rate of intubation. At that time we said to increase the rate of intubation, not to say that you had to achieve a proportion, not to say every ward should have intubation. This was because we found that some medical staffs in the ward did not recognize the harm of delayed intubation, and that non-invasive respiration might cause the harm of respiratory droplet transmission. They said“intubation cannot be employed”. This was not correct. How could a doctor see the patient’s condition get worse and worse and the doctor had the treatment measures but did not use? If you didn’t want to intubate, I would intubate by myself and give you an example. The psychology of fear, as everyone knows, is normal. But if you keep talking about fear, it’s not correct.

VIP Weekly: At the beginning of the epidemic, many people did not receive adequate medical treatment. But recently we notice that, with  the state financial support, there are some treatments that use the most extreme means to keep patients alive. In normal times, the patient’s family and doctor may choose whether to stop the treatment, rather than continue to use the extreme treatment to support patient’s life.

Mr. Du: Actually, you’re right. This is the case with some critically and severe patients. You do save his/her life, but later he/she becomes a plant man/woman, and requires constant input from family and society. From earthquakes to burns, until now it has no solution. At ordinary times we talk about our judgment with patient’s family members, then the family members will make a choice whether they accept it or not. It’s an ethical question, a medical ethical question, and I can’ t give you a good answer for the time being.

VIP Weekly: One of the doctors I interviewed had 11 critically and severe patients at his hand, and he was desperately trying to maintain their lives every day, but he estimated 90% of them were hard to live. What about this?

Mr. Du: I don’t know, but it’s one thing we have to think about. Japan, for example, found that burnt victims had a particularly high suicide rate a year later, and they were difficult to return to the society. Their lives are maintained now, but what will happen later? This is more complicated.

VIP Weekly: A few days ago, at the State Council’s first English news conference on epidemic prevention and control, when sharing China’s anti-epidemic experience, why did you quote the sentence in 《Pestilence》 ——” All this has nothing to do with heroism. The only magic weapon is integrity “?

Mr. Du: Just that morning a classmate of mine sent me this words when I was worried there was nothing to say. It was quite appropriate for the occasion. So I cited it.

VIP Weekly: Is that really what you think—-the only weapon is integrity?

Mr. Du: Of course. You choose such a career. You have honor, you also have responsibility. If you’re a war correspondent, you go where there is a battle, because it’s your job. If you’re a captain of a plane, you earn so much a year. But if the plane has an accident, you should be the last to leave. This is your responsibility. So is the doctor. At this point, if you the doctor don’t go the risky hospital, who can replace you? It’s the doctor’s responsibility.

VIP Weekly: What is the doctor’s responsibility?

Mr. Du: Finish your work, cure the patients and save their lives. It is not appropriate that a medical expert comes but does not enter the ward. Entering the ward is not something noble, but is what we should do.

VIP Weekly: Have you done your best?

Mr.Du: Certainly I have. But I can’t say all my judgments are right, because it is impossible.

VIP Weekly: Can you tell now what mistakes you have made?

Mr.Du: I can’t say until now I’ ve realized all the mistakes. But I know I  have surely made some mistakes, which is normal.

VIP Weekly: When were you under highest pressure?

Mr. Du: There was really no highest pressure. Frankly speaking, because the most important decision was not made by us. We did it before to work on a diagnosis and treatment scheme, for example a scheme for bird flu or something. The most important decision is not to decide a person’s life and death, but to decide many people’s lives and deaths. The role of the executive department is really the most important, as it determines the lives and deaths of many people, for example to carry out home quarantine, to build mobile cabin hospitals(FangCang hospital), which influences far more than one or two persons.