Report on the Investigation Regarding Public Feedback Involving the Circumstances of Dr. Li Wenliang

[Source]http://m.news.cctv.com/2020/03/19/ARTIrEO6nz5wKzeVnNlyBgTM200319.shtml

On February 7, 2020, The State Supervision Commission established an investigation group to conduct an investigation into circumstances related to public feedback involving Dr. Li Wenliang. The report on the investigation is hereby released as follows:

I. Dr. Li Wenliang's basic information and the background and process of his forwarding and publishing information on WeChat

Li Wenliang is an ethnic Machu male born in October 1985, is from Jinzhou in Liaoning Province and a member of the Communist Party. He died of pneumonia caused by the novel coronavirus infection on February 7, 2020, at work. He was an ophthalmologist at the Wuhan Central Hospital prior to his death.

In December 2019, the Hubei Province Integrated Traditional Chinese and Western Medicine Hospital, the Wuhan Central Hospital Houhu Hospital area, and the Wuhan Red Cross Hospital successively admitted some patients with pneumonia from an unknown cause. On December 27, Zhang Jixian, Director of Respiratory and Critical Care Medicine Department of Hubei Integrated Traditional Chinese and Western Medicine Hospital, reported to the hospital on 3 cases of pneumonia from an unknown cause, and the hospital reported the situation to the Center for Disease Control in the Jianghan District of Wuhan. The same day, the Wuhan CDC arranged for epidemiological investigation and testing of these three patients. On December 29, Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine reported that it had discovered another 4 cases of pneumonia from unknown causes arising from the HuaNanHai Seafood Market. The Wuhan Health Commission organized a team of experts to conduct an investigation and transferred the patients to the Wuhan Jinyintan Hospital that evening. As similar cases were found in many hospitals in the city, Wuhan Health Committee issued an "Urgent Notice on Reporting on Treatment of Pneumonia from Unknown Causes" and an "Urgent Notice on the Treatment of Pneumonia from Unknow Causes" on its internal system on December 30 at 15: 10 and 18: 50 respectively, requiring good treatment of the unexplained pneumonia and to that a comprehensive search and retrospective investigation of pneumonia cases related to the HuaNanHai seafood market. These two notices were uploaded to the Internet that day at 15:22 and around 19:00 respectively.

At about 17: 30 on December 30, 2019, Dr. Li Wenliang received information sent to him by his colleagues, and at 17: 43, Dr. Li Wenliang forwarded and published text in the WeChat chat group "Wuhan University Clinical Grade 4" under the name "Li Wenliang Wuhan Ophthalmology", including "7 Cases of Sars Confirmed at HuaNanHai Seafood Market", "Isolated in the Emergency Department our hospital's Houhu area" and a picture of clinical pathogen screening results labeled with "SARS coronavirus detection"positive indication" (high degree of confidence), and an 11 second long video of a lung CT scan At 18:42, he published again in the group, "the latest information is that coronavirus infection is confirmed, and virus classification is being conducted", "don't anybody forward this, but have family and friends be on guard." At the same time, similar information also appeared in other WeChat chat groups. The two Wuhan Health Commission departmental documents that were uploaded by someone, and the information forwarded and published by Dr. Li Wenliang, brought attention and discussion.

II. Dr. Li Wenliang was spoken to and admonished by the public security organs and hospital.

On December 31, 2019 at 13:38, the Wuhan Health Commission relased the "Notice on the Current State of the Pneumonia Epidemic in Our City" saying that "27 cases have already been found", "the cases mentioned above are viral pneumonia", and saying that “as of now the investigation has not discovered clear interpersonal transmission, and has not found infected medical personnel". Several medial outlets reported this. In accordance with Wuhan's work arrangements on the prevention and control of the unexplained pneumonia epidemic, Wuhan's public security organs were to investigate and address the online transmission and release information on infectious diseases such as SARS on the basis of laws and regulations on the prevention and control of infectious diseases, public security administration, and other laws and regulations, as well as the municipal health Committee's briefings. At around 13:30 on January 3, 2020, After the Zhongnan road police station of the Wuchang branch of the Wuhan municipal public security bureau contacted Dr. Li Wenliang, Dr. Li was accompanied by co-workers to the police station. The station's Deputy Director Yang arranged for desk officer Hu to talk with Dr. Li Wenliang. After verifying through the conversation, they drafted a record on the spot. Dr. Li Wenliang expressed that the information about SARS he sent in the WeChat chat group was wrong and that he would be careful going forward, the officer talking to him drafted a written admonishment. Dr. Li Wenliang left the station at 14:30 with a copy of the written admonishment. The officer giving the talk was only policeman Hu, an auxiliary police officer, and Hu signed his own name on the admonishment as well as that of Officer Xu who was on duty that day. In reality, Xu did not participate in the conversation.

Prior to this, after the information that Dr. Li Wenliang published in the Wechat chat group was forwarded by large numbers online, the leadership of the Wuhan Central Hospital spoke with Dr. Li Wenliang. In that talk, Dr. Li Wenliang expressed that his goal in sending information that he had not confirmed, such as that about SARS, to the WeChat group was to remind his classmates in the group to take care. The hospital had Dr. Li Wenliang write out an understanding . Dr. Li Wenliang continued to work normally in his position with the hospital ophthalmology department until he took ill and was hospitalized.

III. The Onset, Treatment, and Emergency Measures for Doctor Li Wenliang's Illness

On January 10, 2020, Dr. Li Wenliang developed a fever, on January 12 he was admitted to the Wuhan Central Hospital ophthalmology ward, on January 14 he was transferred to the third respiratory and critical care area, on January 23 he was transferred to the critical care unit of the respiratory and critical care area, and on February 7, he passed away.

On December 9, 2019, Dr. Li Wenliang rotated from working in the eye clinic to the ophthalmology ward. On January 6, 2020, Dr. Li Wenlian received an 82-year-old eye patient. The patient developed fever on January 7, was then confirmed to be infected with the novel coronavirus, and died of the illness on January 23. On January 10, Dr. Li Wenliang began to have a fever and sought care in the Wuhan Central Hospital fever clinic.

On January 12, Dr. Li Wenliang was admitted to the second division of the ophthalmology department of Wuhan Central Hospital, and diagnosed on intake with acute conjunctivitis in his right eye and a lung infection. On January 14, Dr. Li Wenliang's infection worsened in both lungs and he was transferred to the third respiratory ward. A single room for isolation in the third respiratory area was arranged for Dr. Li Wenliang, with a dedicated caretaker rotation; his blood oxygen saturation, heart rate, and blood pressure were quickly monitored, and he was given respiratory support and treatment for symptoms such as antivirals, anti-infectives, phlegm reduction and stomach protections were given, and hormones and gamma globulin were used. From January 15 to 18, the attending doctor adjusted medications and treatments at appropriate times in light of Dr. Li Wenliang's condition.

On January 19, Dr. Li Wenliang had intermittent fever. In the afternoon the chief doctor of the respiratory and critical illness department and the head of the and internal coronavirus experts group checked on Dr. Li Wenliang and made treatment suggestions. That night, the hospital invited a Professor from the Huazhong University of Science and Technology's Tongji Hospital Respiratory and Critical Care Department and the head of Wuhan Coronavirus Treatment Expert Group to consult on Dr. Li Wenliang.

From January 20 to 22, Dr. Li Wenliang did not have a fever, but the shortness of breath remained quite serious. On January 15, 19, 20 and 21, hospital experts such as the team leader and deputy team leader of the hospital's expert group for coronavirus examined Dr. Li Wenliang's condition several times and gave diagnostic and treatment comments.

At about 23: 50 on January 22, Dr. Li Wenliang developed symptoms such as shortness of breath and dyspnea after going to the toilet, and his blood oxygen saturation decreased to 88%, and the symptoms eased slightly upon treatment. The attending doctor once again informed him that his condition was serious, and with his consent, he transferred Dr. Li Wenliang to the intensive care unit at 3: 30 a.m. on January 23.

Before January 27, most hospitals in Wuhan, including the Central Hospital, were not qualified or equipped for nucleic acid testing. After upgrading the facilities, the Wuhan Central Hospital began a trial of nucleic acid testing on January 27. On January 28 and January 31, the hospital conducted two nucleic acid tests on Dr. Li Wenliang; the first gave a negative result, and the second gave a positive result. On January 31, Dr. Li Wenliang was confirmed to be infected with the novel coronavirus.

From January 31 to February 3, Dr. Li Wenliang had no fever and his shortness of breath was somewhat improved, but he lacked energy and appetite. At noon on February 4, his vomiting, frequent coughing, and shortness of breath worsened, but the symptoms eased with treatment. On February 5, Dr. Li Wenliang did not have fever, but he still had wheezing and shortness of breath even in a resting state; bedside chest radiographs showed that the pneumonia was worsening in his right lung. On February 6, Dr. Li Wenliang's lung disease was serious and there was a risk of further deterioration. After consultation with the hospital's expert group, transfer to the more specialized Houhu hospital area was recommended, and after obtaining Dr. Li Wenliang and his family's consent, the attending doctor and two nurses took Dr. Li Wenliang to the hospital area at about 18: 20. At 18:55, they arrived at the Hohu area of the Wuhan Central Hospital.

At 19: 20 on February 6, Dr. Li Wenliang became delirious and his heart rate and blood pressure decreased progressively; he was immediately given an injection of epinephrine to strengthen the heart, and a vein was accessed for active rehydration to increase blood pressure. At the same time, he was intubated, invasive ventilation was used to maintain breathing, and chest compressions were continued. At 21:30 an external CPR instrument was installed to assist with sustained external cardiac compressions. CPR was continued and active drug resuscitation was given. At 22:40, The ECMO (Extracorporeal membrane oxygenation, colloquially called an 'artificial lung') that the hospital had borrowed from the Wuhan Yaxing Hospital was used to treat Dr. Li Wenliang. After coordination with the Wuhan Health Commission, experts from the Peking Union Medical College Hospital rushed to the emergency care site. At 2:58 a.m. on February 7, Dr. Li Wenliang's electrocardiogram flatlined and he was declared clinically dead. At 3:48, the hospital disclosed that Dr. Li Wenliang had died.

The doctors organizing the emergency care said that Dr. Li Wenliang was their colleague and also very young, that they didn't want to see him go and so long as there was even a sliver of hope they would not give up. At that moment they did not think of anything else, just saving him, so the emergency care took a very long time. Dr. Li Wenliang's attending doctor said that although they failed to save Dr. Li Wenliang's life, his treatment was standard, the emergency care was timely, and everyone tried their hardest. Based on the comments of experts from outside the hospital who consulted on Dr. Li Wenliang, judging from the medical records the hospital treatment was relatively standard and drugs and measures were adjusted according to the condition of the disease. The hospital solicited comments from Dr. Li Wenliang and his family on all major medical measures that were recommended and actually taken.

IV. Pension and closure following Dr. Li Wenliang's passing.

After the unfortunate passing of Dr. Li Wenliang, The Wuhan Central Hospital established a special workforce taking full responsibility for the pension and resolution of remaining matters. On the afternoon of February 7, the leaders of the central hospital visited Dr. Li Wenliang's parents, wife and children to express condolences. At the request of Dr. Li Wenliang's wife, they arranged for her and her children to recuperate in hospital.

Upon the application of the Wuhan Central Hospital, the Wuhan Municipal Bureau of Human Resources and Social Security determined that Dr. Li Wenliang was injured at work. On the basis of relevant regulations, the compensation for work-related death and funeral expenses already been released in full. The insurance company has made payment for (frontline medical personnel combatting the novel coronavirus pneumonia epidemic) to Dr. Li Wenliang's family, The Wuhan Central Hospital labor union called for employees to make donations for Dr. Li Wenliang and his family, and the Wuhan Red Cross Association received dedicated care donations that have already all been transferred to Dr. Li Wenliang's family. On March 4th, the National Health Commission and other departments issued a decision commending individuals in the national health system with advanced work on prevention and control of the novel coronavirus epidemic, with Dr. Li Wenliang among them.

V. Work Recommendations

Because the admonishment issued by the Zhongnan Road Police Station was improper and did not follow regular law enforcement procedure, the investigation group has recommended that the Supervision Organs for Wuhan in Hubei Province carry out oversight and corrections on this matter, urging the public security organs to revoke the written admonishment, pursue responsibility of relevant personnel, and promptly disclose the outcome to the public.

Investigation Group of the State Supervision Commission

03/19/2020