Eyewitness: Shanghai Life in the Shadow of COVID-19

Aude Lecrubier

March 09, 2020

SHANGHAI — Dr Nathanael Goldman is a paediatrician from Belgium who has been working in Shanghai, China for many years, where he consults for the private medical group Parkway Pantai Ltd.

Dr Nathanael Goldman

Isolated from his family, having left Brussels several weeks ago, he agreed to share with Medscape's French Edition  his experiences of the COVID-19 epidemic, and expresses concerns over the delay in Europe in limiting the spread of the virus.

What happened at the beginning of the outbreak?

"News of the epidemic came at the start of January via social media, when we learned of the arrest of Dr Li Wenliang [he died on 7th February from Covid-19], who had shared on WeChat the existence of SARS cases in Wuhan.

"Life continued as normal after that, while we heard more and more worrying news about the situation in Wuhan.

"Events progressed 3 weeks later when, on the eve of Chinese New Year, the city of Wuhan, as well as several others in the province of Hubei, were cut-off from the rest of China.

"When I wanted to go back to the airport after New Year’s eve to return from Jiangxi province to Shanghai, the bus connection was stopped. It seemed that travel in China would become quickly more difficult and we risked finding ourselves stuck far from home.

"Lots of people travelling via Wuhan or those who had left the city for New Year were stranded far from home, sometimes in difficult conditions, particularly for those still in Wuhan.

"Since returning from the Chinese New Year holidays on 28th January, I have not worked one day to monitor the flow of patients to designated hospitals for suspected cases. Our clinic was quickly closed and only reopened on 3rd March.

"Some of my colleagues in other clinics in the same group have continued to work at a slow pace in centres that were authorised to stay open. Last month, a large number of businesses put their employees in technical unemployment, or assigned them to home working.

"We have all received the instruction to stay at home as much as possible, and temperatures are taken at the entrance of all public places and residences. Entrances and exits are ticketed.

"At the beginning of February, a 14-day home quarantine was imposed on everyone who returned to Shanghai from elsewhere in China or from abroad. A tracking system, including via mobile telephone, was put in place to ensure that no one breaks the rules.

"In terms of care … fever or signs of respiratory infection have to be managed by government designated clinics. It certainly complicates life for those who want simply to avoid the public system and its long queues, as well as the infectious risk incurred by waiting."

Have you thought of returning to Europe?

"For many expatriates, the question of going home often comes up. We don’t know how long it will take to control the epidemic. International flights are becoming rarer, initially for economic reasons, as the airlines lost money on empty flights, then due to the risk of infection.

"The measure to close the schools was announced during the Chinese New Year holidays, initially until 17th February, then until 2nd March, and then for an indeterminate period, with widespread online education.

"Consequently, many among us have decided to stay but to send our families back home. Locking yourself in quickly becomes uncomfortable, particularly for young children. For example, the parks are closed and there’s hardly anything else to do but play at home. My wife left for Brussels with our youngest, who really needs physical activity every day. Several days at home is okay, but here we’re talking about a month.

"Also, my employer asked me to stay, in case the authorities give us the green light to reopen the clinic and also due to the uncertainties in terms of flight connections and the need for quarantine on returning.

"It has allowed me to read the information published on Covid-19, to produce several videos and to interact on social media, either to respond to questions from non-professionals or to defend the importance of preparing regions of the world not yet affected by the virus – an idea that was, until very recently, little shared by my colleagues, who saw Covid-19 as a bad form of influenza affecting certainly the most fragile but also only a minority of people."

What is the mood like in Shanghai?

"Until around mid-February, there were practically no cars on the road; only buses, often empty, were running, which made cycling very pleasant. I had the opportunity to see the Bund [the quay of old Shanghai, which stretches for more than 1.6 km along the Huangpu River], which is usually crowded, completely empty of visitors.

"The streets are coming back to life, the pedestrians having returned, but we are far from having the usual crowds in Shanghai. Lots of restaurants and shops remain closed. It’s likely that a large part of their personnel have not yet been able to return to Shanghai and that it is also necessary to be in good hygiene, which requires a number of administrative steps.

"As time passes, the pressure mounts for the economy to restart and for people to be able to pay their rent and eat. There are laws to ensure that people are paid, so they are put on technical unemployment, but the rules have their limits: the money must come from somewhere.

"For my part, the clinic has reopened but I don’t have any patients today."
 

Have you experienced shortages?

"Yes, alcohol solutions, masks … At the beginning, pharmacies were robbed. Guards were placed in front of the entrances and masks were issued only by order of the local community administration, after passports and other documents were presented. Similarly, paracetamol was only available on prescription.

"In terms of access to food, the food shops in Shanghai stayed open and well stocked, and we can easily go into town to do the shopping."

The epidemic is slowing down in China and its actions have been praised by the World Health Organisation. What do you think?

"The measures taken by China to combat the epidemic are, in many people’s opinion, extraordinary and, in fact, have simply not been implemented in recent history.

"In Wuhan, people have not been able to leave their home for some time, with the police and army guaranteeing that the instructions are followed.

"The figures show a decline in the epidemic throughout the country and it seems to justify, in retrospect, the extreme, historic measures, which are based on what is known about reducing the transmission of an infection in the population. In reality, for a month now, the economy of China has practically ground to a halt and only began to restart over the last 10 days.

"Many were surprised by the brutal implementation of these measures to halt transport, on-site education and industry. There is no real discussion in civil society in China when a decision has to be made, unlike in our Western societies.

"In the case of this epidemic, it seems obvious to me that it is precisely this authoritarian approach that allowed the series of measures that led to the control of the epidemic to be put in place so quickly.

"Of course, it is an experience without comparison and no independent audit of the numbers has been presented."

Are these kinds of drastic measures possible in Europe?

"Seeing the difficulties of controlling this epidemic in China, I recently suggested in one of my videos that our Western democracies start to prepare, precisely because there is no executive power that can alone decide to establish new rules affecting the whole of society, as we saw in China.

"It is probably not foreseeable that we could go so far in terms of quarantine measures due to, among other things, the respect for individual rights and an independent press.

"It seems to me that it takes time to prepare and we will have more chance of being effective by starting early. And yet, a worrying situation in Italy had to be seen before some countries started to prepare."

How can you explain the delay in taking measures?

"It is with seeing the first deaths locally that we have really started to worry. But the deaths represent the tip of a giant iceberg of infected people who are significantly less symptomatic. Complications are seen in a small minority of people and therefore it requires statistically enough people to be infected in the population to start seeing this minority.

"The illness has an incubation period estimated at between 2 and 14 days, perhaps even 27 days according to certain sources. This is the first time lag. For the illness to develop a complication takes 8 to 10 days, which is a second time lag.

"In other words, the serious cases in a population are very probably the sign that the virus has already been in circulation. Taking things in hand at this stage does not make things easier. Hence the need for early preparation.

"I feel it is imperative that those responsible for public health who have the attention of our governments are convinced that this epidemic represents an important logistical challenge, notably for our healthcare systems, which are still saturated with the seasonal influenza epidemic.

"After my experience of these last weeks, in view of the reports in the press of several of these specialists as well as many of my European colleagues, I doubt that this epidemic is currently being taken with all the seriousness that it deserves."

No conflicts of interest or funding declared.

Translated and adapted from Medscape's French Edition. Find the latest COVID-19 news in Medscape's Coronavirus Resource Centre.   

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