TBS:

Hello, I'm from TBS. Japanese TV station. I'm sorry, I have three questions. First one is that, unfortunately, doctors in Wuhan passed away, even though some of them are very young. How would you analyze the reason? Second one is, it's been reported in Japan, that infection in the hospital is occurring in some places. With your experience, how do you prevent the infection in hospital? Third one is, if you have experience to cure such patients, is there any difference varying coronavirus and SARS? Thank you very much.

Du Bin:

I’ll take the first two questions and leave the last one to my colleague, Dr. Li.

As to your first question. Yes, we know that among all the non-survivors of COVID-19, that although most of them are elderly people, there are some younger deaths, including doctors and [people in the] general public.

We know that although they are not elderly—which is the well-recognized risk factor—but some of them, if not all, do have some comorbidities, or underlying diseases, such as hypertension and diabetes, which are very common even among the younger generation in China, according to the previous studies.

Moreover, as I mentioned before to the last question, that the unnecessary prolongation of the non-invasive mechanical ventilation, as well as prolonged, or long-term, high dose corticosteroids are, in my mind, the major reason of deaths in this younger generation. Because there are more harms than benefits, such as the nosocomial infection, such as the weakness, such as the barotrauma, or high hyperglycemia, et cetera.

As [for] you second question concerning the infection control within the hospital. I think the key word is “plan.” You must have a plan for hospitals in Japan. I would say you must have a plan for every suspected patient going to a fever clinic, going to the general outpatient clinic, or even inpatient department. And you must have a plan for how to detect the suspected cases according to the clinical manifestations, [according] to the laboratory tests such as lymphopenia, or according to the CT scan, as mentioned by Dr. Cao. And you must be able to perform laboratory confirmation for suspected cases. You must have a plan to isolate suspected individual cases before confirming or ruling out the diagnosis. You must have a plan to educate and train health care workers within individual hospitals to prepare themselves for the cases. And you must have a plan to prepare not only space but also supplies, such as personal protection equipment for all health care workers involved or those who may come in contact with suspected cases. Thank you.

Cao Bin:

Thank you for the question. Your third question is what is the difference between SARS-CoV and this new coronavirus? I will start with the similarities. Both SARS-CoV and the new virus belong to the coronavirus family. From the genetic sequencing analysis, we have found that the viruses are about 78% similar. When you look at the clinical features of the two diseases (SARS and COVID-19), both viruses can mainly cause pneumonia.

When we look at pneumonia, the similarity is there. They are both viral pneumonia, which means that when we look at a chest CT scan, both diseases cause ground glass opacity of both lungs. This is the similarity. When we look at the clinical features and laboratory findings, both diseases have common features, such as the normal white blood cells and, more commonly, we find lymphopenia and the increased liver enzyme, or that some of them may develop respiratory distress syndrome.

When you look at the similarities, you may find that SARS is very similar to COVID-19, but there are differences between the two viruses. And there are differences between the two diseases. First, let's look at the case fatality ratio for SARS. The case fatality ratio is round about 10%. But if you look at COVID-19, if we look at the cases outside Hubei province, the case fatality ratio is less than 1%.

When we look at the case fatality ratio in Hubei province, the number is around 3% to 4%. So, it seems that COVID-19 is less severe compared to SARS. But the bad news is that COVID-19 is easily transmitted. And when we look at the documented cases of SARS and COVID-19, we can easily find that the new virus is more “successful” compared to the SARS-CoV.

I don't know the exact number of confirmed cases in Japan, but I learned that in Korea, the case number is over three thousand. There is a rapid increase in cases in Europe, including Italy, Spain, and Germany. We can also find cases in the Middle East, such as Iran. You can find that COVID-19 is more widely distributed around the world. When we look at the pathology, and when we look at the mechanism of the disease, it seems that the SARS-Cov-2 virus can easily invade the lungs and can easily invade other organs, including the heart and liver. This new virus is a real threat to human beings. Nobody knows if the disease will spread to other areas of the world. But I believe that doctors, researchers, and scientists all over the world should work together to fight against this new disease. The war is not over. Thank you.

Xi Yanchun:

Okay, Professor Li.

Li Haichao:

Regarding the question about SARS and COVID-19, I have very deep memories of SARS, which happened 17 years ago. I worked in a hospital in the suburb of Beijing. We had totally124 beds in the hospital, and six ICU beds. In my opinion, there are some differences between COVID-19 and SARS. Now, in our ward, most of the patients are above 60 years old and some of them are above 50 years old, there are a few young people. During the SARS, in our ward there were a lot of young people, so the first characteristic of COVID-19 is that the patients are older than those with SARS. The second characteristic is that some COVID-19 patients have very severe illnesses, because they are middle age and old persons, and they have complications. They have very severe hypoxaemia and severe ARDS. A lot of them need non-invasive ventilation or mechanical ventilation for a long time. The patients have a lot of preexisting conditions, such as hypertension, coronary heart disease, diabetes, and COPD. It is also very common with disorders of electrolyte and imbalance of acid-base. There are so many problems you must face. It’s very severe. The 3rd character is [I call it] “slow”. One “slow” is that some of them have a very slow onset. They might have a mild fever or mild symptoms of respiratory tract, such as a mild cough, but 10 days later, or maybe more than two weeks later, they have exacerbations. The situation goes bad rapidly. The onset is slow, but exacerbation is quick. Another “slow” is that some patients became better, and the situation had been controlled, but they still have exertional dyspnea. When they do some exercises, saturation of oxygen decreases rapidly. They need a long time to recover. Maybe I think it's due to their old age and some comorbidities.

So it's very important to care for the patients with hypoxaemia, because you don't know when and how there could be an exacerbation. So you must keep a close eye on symptoms, saturation of oxygen, CT scan, and some other factors about the inflammation. If the situation gets worse, you must pay more attention to them. Thank you.

Xi Yanchun:

Ok, next question. The gentleman in the fourth line in the middle area, it is your turn to raise the question. Just now, you already have the mic.