Hu Bijie, one of the leading infectious diseases experts from Fudan-Zhongshan Hospital talked about his past months of stationing at Shanghai Public Health Clinical Center and reflected on his career as a doctor for three decades.
Prof. Hu Bijie
On January 20, as Shanghai reported the first case of COVID-19, Shanghai Public Health Clinical Center (SPHCC) affiliated to Fudan University immediately moved to a war footing on the virus. Known as the very fortress for any widespread public health crises in Shanghai, SPHCC this time, as expected, became a designated hospital to treat all confirmed cases within the city.
As the first wave of the pandemic in Shanghai started on January 27, SPHCC also began to witness a surge in the number of COVID-19 patients. It was at this critical moment that Prof. Hu Bijie, director of the Department of Infectious Diseases at Zhongshan Hospital affiliated to Fudan University, brought a team of medical experts to aid SPHCC. As a member of the national COVID-19 expert group, Hu was charged with great responsibilities. Apart from leading medics in diagnosing, following up and treating severely ill cases around the clock, he participated in the compilation of The City of Shanghai Expert Consensus on Comprehensive Treatment of COVID-19, or Shanghai Consensus for short, an important guidebook released on March 2 for megacities across the globe to draw on the lessons Shanghai learned in COVID-19 prevention and control.
Today, the battle against COVID-19 is still on at the hospital. But with months of experience in battling the virus, everyone there was now full of confidence. “The fight against COVID-19 is a protracted war. As doctors, it is our duty to save people’s lives. To this end, we will keep working hard,” said Hu Bijie.
The news team of Fudan University Shanghai Medical College recently had an interview with Hu Bijie.
COVID-19 frontline from a doctor’s perspective
17 years ago, Hu rushed to the frontline of SARS, travelling between isolation wards in Henan, Hebei, Shanxi and other provinces. This January, on hearing that the first case of COVID-19 was diagnosed in Wuhan, Hu immediately started collecting information and studying the virus. Before he knew it, he was already leading a team and fighting the virus at SPHCC.
Q: What was it like when you first arrived at SPHCC On January 27?
Hu: We originally planned to work in rotation. The Fudan-Huashan Hospital team led by Doctor Zhang Wenhong and my team from Fudan-Zhongshan Hospital would take charge of COVID-19 patients at the hospital in turn, each for one week. But in the week we arrived, the number of new cases suddenly surged from just a few to almost twenty a day. So we instead began to station at the hospital for the following weeks.
At the beginning, I was faced with great work intensity. I got up very early in the morning and conducted research on the virus late at night. When a patient’s condition suddenly deteriorated, sometimes at midnight, I would have to show up at the hospital’s command center immediately to evaluate their condition.
The medical force dispatched to SPHCC has rich experience with pneumonia, but this novel coronavirus pneumonia is quite “sly”. Some patients started with mild symptoms and their CT scans didn’t show any serious infection, so I thought they were only having a flu or mild pneumonia. But in a few days, their conditions suddenly worsened. I knew right away that SPHCC had to increase its staffing for what might come. Due to tremendous mental pressure, I lost much sleep in the first two weeks. Fortunately, my request for more frontline staffing was soon met and we had teams of experts from various hospitals across Shanghai to help us.
The command center at SPHCC, where top physicians gather to discuss on severe cases
Q: People joked that the experts at SPHCC got into “arguments” almost every day. What were the “arguments” about?
Hu: Our “arguments” were in fact debates on therapies for COVID-19 patients. In that sense, we argued almost every day.
Things were quite intense at the beginning, and we quickly streamlined and updated many procedures to facilitate the treatment of COVID-19 patients. For example, as COVID-19 patients with a weak immune system were vulnerable to bacterial and fungal infections, I arranged sputum tests for these patients and expected the results back as soon as possible. Usually it would take 2-3 days, but considering quick changes in the conditions of COVID-19 patients, getting the results earlier meant higher chances of survival. We thus tried to accelerate the analysis of samples. The next morning after the sputum test was done, a photo of the sputum culture would be sent to a Wechat group and all experts within the group would together make a preliminary judgement and adjust medications for the patient in time.
My colleagues and the executives of the hospital were very supportive for my work. In fact, I am very grateful to my colleagues back at Zhongshan Hospital handling huge patient flows at the fever clinic while taking measures to prevent virus transmission inside the hospital. Knowing my old patients were in good hands was a weight off my shoulders.
I am also deeply touched by the kindness the hospital, Fudan University and the society have given to frontline workers. The hospital sent fresh vegetables and fruits to my apartment every week. The university introduced policies to help its doctors at affiliated hospitals. One day I used a taxi via a car-hailing app, but the driver gave me a free ride.
Doctors pose at the command center of SPHCC.
Q: You are still working at SPHCC. What has changed since you arrived? What changes do you expect in the future?
Hu: At present, the outbreak in China is under control. Though there is still a risk of imported cases, I’m in a totally different mood right now. At least I now don’t have those high mental pressure I had then. Recently, I have resumed some of my duties at Zhongshan Hospital, and my patients are looking forward to seeing me for follow-up consultations.
During these past months since we joined SPHCC, we have understood the virus better and our experience with it has helped the Shanghai Consensus gradually take shape. It is still under constant modification and improvement to ensure the best possible treatment is applied.
I have participated in online video discussions with overseas experts in the United States, Central America, Europe, Southeast Asia, South Africa, etc., as well as nationwide consultations and training sessions where I shared our findings and predictions on the disease.
Zhongshan Hospital has also released its own guidebook, Fudan Zhongshan Guidance of COVID Prevention and Control, in four foreign languages to share our experience with the rest of the world of how a large multi-department hospital can better adapt to the pandemic in terms of resource allocation, staffing, procedural adjustment and hospital administration.
Q: Amid the outbreak, the Infectious Diseases Department at Zhongshan Hospital quickly came to prominence. As the director of the department, do you think the development of infectious diseases as an academic discipline has been satisfying so far?
Hu: The Department of Infectious Diseases at Zhongshan Hospital was established after the outbreak of SARS in 2003. In 2015, the department set up its own wards and I was transferred from the Department of Respiratory Medicine to lead it.
In the past, infectious diseases departments were modeled on contagious diseases departments. However, an infectious diseases department should actually deal with infections caused by all kinds of microorganisms even if those are non-contagious diseases. The Department of Infectious Diseases at Zhongshan Hospital embraces this new perspective. Though we have now only 15 doctors at the department, it serves as an inspiration for other hospitals in China.
This pandemic has again alerted us to the fact that an infectious diseases can happen at any moment, and can hit humans quite harshly. The struggle of humans against microorganisms is far from over. It becomes more important for us to conduct research on infectious diseases and underscore the social value this discipline can deliver. In fact, many other medical disciplines, such as respiratory medicine, cardiology and surgery, are intrinsically connected to infectious diseases. Therefore, the development of these disciplines can in turn help tackle infectious diseases better.
In addition, medics of infectious diseases departments should never stop improving their skills. They must be vigilant and prepared at all times. At the same time, the improvement of hospital facilities and management, including fever clinics and wards, resource allocation and preferential policies, is also part of how we can develop the discipline.
Three rewarding decades working at the profession
In 1979, Hu was admitted to Shanghai First Medical College, which later was merged with Fudan University. After graduation, he entered the Department of Respiratory Medicine of Zhongshan Hospital, where he worked for 30 years. Five years ago, he was transferred to the Department of infectious diseases. He said that the more he studied medicine, the more fun he found there was. Being a doctor, for him, is a profession full of sense of accomplishment.
Q: Why did you choose to study medicine in university?
Hu: I was born to a family of doctors. More than 40 family members are medics. When I was in elementary school, my father began to ask me to memorize basic knowledge of anatomy, such as the number of muscles and the number of bones in the human body, and the names of common antibiotics. You can say that my formative education started with medicine.
When deciding what to study in university, initially I was going to apply for a science or engineering program, because I felt medicine was not challenging enough for me. But my father wanted me to attend Shanghai First Medical College, which was already a well-known medical college at that time. At last, I followed my father’s suggestion.
The moment I started studying medicine in a systematic way, however, I found that it was really fun to learn. There are still so many unknown areas for me to explore. During the course of exploration, I can save more lives and nothing makes me happier.
Q: In the past 30 years, was there anyone or anything that has had a profound influence on you?
Hu: My father is on the top of the list for sure. He is a dermatologist and still doing research despite his age. I learned from him the importance of independent thinking and persistence when facing difficulties.
Professor Li Xiying, my master’s degree supervisor and Professor He Lixian, my doctorate supervisor, both notable experts specializing in lung infections in China, had a great influence on me as well. I was actually the first doctor specializing in lung infections at Zhongshan Hospital with a postgraduate degree.
To some extent, my achievements today are also credited to my supervisors. They are like my family members. I used to go to Prof. Li’s place on weekends and I was treated to nice food.
Prof. He and I cycled for hours to a factory in the surburb to discuss the specifics of a brush we need for our research. I also benefited a lot from his techniques of identifying tiny focuses of infection on chest radiographs and CT images.
Q: What do you have to say to aspiring medical students and young doctors?
Hu: First of all, get to know yourself and understand why you wanted to study medicine in the first place. People have different priorities in their life and thus have different career choices. Don’t study medicine if you want to make money, because it won’t make you a lot. This profession is more about pursuing what you believe in. Studying medicine requires painstaking efforts, but one will be rewarded at last and the best reward of all is that you will be making contribution to the health of people and the betterment of society by treating patients.
What’s more, keep a positive attitude and a sense of responsibility. Working at the Department of Infectious Diseases, I have a strong sense of accomplishment. As long as we identify the pathogens, there is a high chance that patients with the same diseases will have a full recovery. When patients are happy, we feel content. In my opinion, a person’s profession and lifelong pursuit are inseparable. Looking back at the past three decades, I am in love with this profession more than ever. Many people asked me if I felt tired from being a doctor for so long. Not at all actually. A patient may have been suffering for months or even years, but as a doctor, I am able to cure them and relieve their pain. This makes me very happy.
Prof. Hu Bijie in his office
The interview has been edited for length and clarity.
Editor: Deng Jianguo, Li Yijie
