Timeline of an Epidemic: December 1919
The disease was first identified in late December 2019. By early January, TV showed Chinese cities full of people wearing masks, and the Chinese government embarking on an ambitious building project: a 1000-bed hospital in ten days. It all seemed remote; China was a long way away.
In mid-January, it was my niece’s wedding. Four bridesmaids, four groomsmen, two flower girls, and a page boy. Hundreds of guests, and a reception at a wildlife sanctuary, with views over the distant sea and hills. A busy day!
The following week we headed to Te Anau: my brother, my sisters, my father and me. Nieces and nephews came too, so we made a good size family group.
Te Anau was full of tourists. Many were Chinese, on holiday for the Chinese New Year. Mindful of the news, we gave them a wide berth and hoped none of them were sick. Some wore masks, which seemed weird, as no-one wears face masks in New Zealand.
That week was sunny and hot; glorious weather. We climbed mountains and swam in the lake, went for bike rides and held barbeques. Looking back, I’m pleased we had that time.
January 2020: Supply Chain Concerns
I think it was the week after my holiday that Wuhan went into lockdown. We began receiving emails from colleagues in China, urgently seeking face masks. (They weren’t the only one; a supplier told me that the NZ branch of a Hong Kong bank bulk-bought thousands of facemasks. They’d packaged them up, and sent them to China.)
Our colleagues sounded genuinely desperate, so I rang all the health suppliers I know. (As I’ve worked in health supply-chain for over ten years, I know a lot of suppliers). All were utterly out of masks. Sanitiser was scarce, too.
By early February it was clear from the case numbers in Wuhan that Hubei was in trouble. I suppose it was around this time that the city was put in lockdown, although looking back, it’s hard to remember exactly when. How could they do this? we wondered. It seemed draconian.Shipping time from China to New Zealand is usually about twelve weeks. Annually, China only pauses production for one thing: Chinese New Year. This is the time when the Chinese return home; the one time in the year that families gather.
Every year, businesses build up stock to cover this production downturn. So when the lockdown hit, New Zealand storehouses were full, as everyone had stocked up for the New Year break.
Because I’m paranoid, I began counting stocks of sanitizer and asked our staff to make sure we kept our orders volumes up. Sanitizer was getting hard to find by then; supermarkets began rationing. We asked our store-people to lock down their sanitizer and masks and to ration their use.
It will all be over by tea-time
My boss thought I was taking this a bit too seriously. My workmates thought it was all going to be like Y2K. Does anyone remember Y2K? How computers were all going to break down at the turn of the millennium? And how nothing actually happened?
In three months, said one colleague, we’ll look back on this and wonder what all the fuss was about.
Meanwhile, in China, the numbers of infections grew. People began dying. Photos of crowded hospitals and exhausted medical staff.
The Chinese Government extended the New Year break. Shanghai’s port closed. Global shipping routes were affected; the cost of transport and storage increased.
Much of Chinese production had closed – this was unprecedented. It was also a significant concern, as China is key to most global supply chains. Suppliers warned of looming shortages.
Cases grew in Singapore and Korea. At this point we were seriously worried: much of New Zealand shipping passes through Singapore. Rumours circulated, so it was hard to tell what was really happening in China, and what was paranoia.
I read the Situation Report on the WHO website daily. My suppliers were worried, as stock on hand began to wear down without any signs of replenishment. And shipping was still seriously affected.
Slowly, case numbers in Wuhan began decreasing. The WHO sent a group to China. The lead doctor was impressed by the Chinese actions, describing them on Twitter as ‘unprecedented’. He doubted, too, whether any other country could repeat what China had done.
Social media pundits sneered, saying these doctors were ‘pro-China.’ They didn’t heed the message that this was a dangerous disease, with a high fatality rate, and an especially high fatality rate among medical staff.
Mid-February 2020: Am I Paranoid?
My mid-February, I started getting scared.
I’m a physiotherapist by training, with over ten years in acute medicine.
Hospital work is like nothing else, and every year it seems to get worse: more frantic, more stressful. Some days I’d be literally running from one bed to another. Patients are old and heavy and sick, and because the place is so busy, you’re under constant pressure to approve a discharge, just to free up a bed.
I also know how hard it is to work in full Protective Personal Equipment (PPE). The gowns are hot, the goggles fog up, the mask is itchy and gets in the way. Gloves sometimes tear, so mostly you double-glove. Which makes it hard to feel things; you fumble and doing even routine things take a long time. It’s always a relief to step out of an isolation room.
The WHO medical report, though, didn’t talk about isolation rooms: they talked about isolation wards. The Chinese hospitals were well stocked with ventilators; they even had ECMO machines.
NZ hospitals are lucky to have 12 ventilators. They definitely don’t have ECMOs.
It’s easy to make mistakes.
A few years ago, I had to get a sputum sample from a patient with a persistent cough. This is a sample of mucous from the lower respiratory tract. Physiotherapists help patients to clear these secretions through specific breathing techniques.
This particular patient had reported night sweats, shortness of breath and was a vet nurse. Sounds like TB, I thought. No. It can’t be. Surely the examining medical office would have picked that up.
I got the sputum sample. It came back positive for TB. I’d had a BCG vaccine ages ago, with the full-blown pustule that indicates immunity. Since then I’ve had a few Heaf tests, and they’ve all been negative. This suggests that my immunity to TB is not that fantastic.
So of course, I had to have another Heaf (which came back negative), then a chest X-Ray. I wasn’t that worried; TB isn’t a death sentence, not anymore, and my X-Ray came back clear.
I felt really stupid. I should have trusted my own judgment and worn PPE. But I’d been busy and stressed, and I’d taken short-cuts.
It’s easy to make mistakes when you’re under pressure.
March 2020: I’m going to see friends die.
My husband thought I was paranoid.
I took long walks on the beach, watched the clear green waves breaking on the white sand, and tried not to worry. The disease was miles away.
But it was coming. And as far as I could tell, the world wasn’t taking it seriously.