Benjamin So was mid-way through a 36-hour shift at a Hong Kong hospital when an elderly couple from Wuhan, China was wheeled into the isolation ward at 3 a.m. After the nurse took their vitals and nasal samples to test for the novel coronavirus, he got to work.
Inside the negative pressure chamber, So, a resident in internal medicine, asked the male patient about his symptoms, listened to his chest and reviewed an x-ray scan of his lungs. Then, he did the same with the female.
Around nine hours later, both tests came back positive. The 72-year-old man and 73-year-old woman became the ninth and tenth confirmed coronavirus cases in Hong Kong.
“I was a little shaken when I found out,” So told TIME.
After he came off shift, he sought answers from the hospital on how he should protect himself, having been in close contact with the two infected patients. The authorities said they would not provide quarantine facilities for him since he was wearing full gear during the interactions. He was even told he could come into work as normal the next day.
Frustrated, So booked himself a hotel room and decided he would isolate himself for the time being.
He may seem overcautious to some. But the 2003 SARS outbreak killed 360 hospital workers around the world and medical staff accounted for about a fifth of the 299 SARS-related deaths in Hong Kong. The coronavirus has proven to be more infectious than previously thought, and carriers of it may not show symptoms. A hospital outbreak is the biggest fear of many healthcare workers, who are not leaving anything up to chance.
There are hundreds of medical workers on the front lines of the fight against the coronavirus in Hong Kong, a semi-autonomous southern enclave separated by a border from mainland China, where the virus has killed at least 210 people and infected more than 9,700.
The virus, known as 2019-nCoV, has also spread to at least a dozen countries, but Hong Kong’s 12 confirmed cases are one of the highest outside of mainland China and the local situation threatens to worsen. As many as 95 suspected cases have been reported every day for the past week and more are expected as Hongkongers begin returning home after spending the Lunar New Year up north.
The Hong Kong government says the territory is well equipped to deal with an epidemic and that 1,400 isolation beds can be made available when necessary—a number many medical workers say is greatly exaggerated. But the public is skeptical and are calling for a full closure of the border with mainland China (the government has shut some entry points but kept others open) to reduce the chances of confirmed cases being brought into the city. In recent days, medical workers have threatened to strike until the government responds.
Many are also under intense pressure from their families to resign. “[My colleagues and I] talk about how ridiculous everything is,” So says, “about whether our life insurance will be valid if we die due to negligence on the part of the hospital.”
Cracks in the system
Joe, a resident specialist in his 30s at another medical facility, has so far only dealt with suspected coronavirus cases. (He asked to go by a pseudonym to protect his identity.) But he’s volunteered to join the so-called “dirty team,” assigned to working with confirmed cases, should they come through to his hospital, next month.
“I don’t have kids,” Joe says. “But my colleagues, a good friend of mine, has two kids. Another colleague who is also going to join the ‘dirty team’ next week, his wife is going to deliver soon.”
At a recent meeting, Joe’s boss told him: “We must not let the things that happened 17 years ago [during the SARS outbreak] happen again. No matter what, we must protect ourselves and our colleagues.”
In some ways, the coronavirus epidemic has exposed cracks in an healthcare system that many say has long been overburdened. By one estimate, Hong Kong needs thousands more doctors to bring its health services up to international standards. During flu season, bed occupancy rate at public hospitals can exceed 120%, according to a report by the city’s Hospital Authority. Patients wait on average more than three years for specialist care. The rapidly ageing population further compounds the problem—the medical needs of the elderly are at least 5.5 times that of the rest of the population.
Joe complains that the government has overlooked the “collateral damage” that’s resulted from his under-resourced department redirecting efforts to deal with suspected coronavirus cases, most of whom are from the mainland. He says emergency operations have been canceled, and certain procedures have to be put off because they can only be done in isolation wards, which are full.
“We don’t have the capacity,” he says. “We can’t deal with this tsunami.”
At another hospital, a doctor who asked to be identified as S., agreed that the lack of resources could put lives at risk.
“We don’t have enough isolation wards,” he says. “What happens is that we have to put about two or three suspected cases in one isolated cubicle. The problem is that one of them could come back testing positive.”
Experts estimate that the outbreak could reach its peak around April or May. As the figures continues to rise, being at the front lines of the outbreak has forced S. to ponder life’s toughest questions.
“Whenever I get called to see a patient [suspected to have the virus], I start thinking about life,” he says. “Should I be here? Should I be writing a will? Last night, I even left a message for my ex. I told her no matter what, I’ll always look after her, that my feelings for her have never changed.”
He adds: “We’ve been trained to deal with other people’s deaths, but we haven’t really been trained to face our own.”