Correspondence Address:
Fang Bai
The First Affiliated Hospital of Hainan Medical University, Haikou 570102, China
China
Jihao Wang
The First Affiliated Hospital of Hainan Medical University, Haikou 570102, China
China
Zhenqiang Zhao
Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, China
China

Full Text



In August 2022, Sanya, a tourist resort in of Hainan Province, China, experienced a COVID-19 outbreak of SARS-CoV-2 Omicron variant BA 5.1.3. The sudden and rapid surge in the daily tally of new infections overwhelmed the municipal healthcare system, necessitating the construction of makeshift hospitals as a quick and effective solution to the crisis by coverting existing hotels in Sanya into makeshift hospitals. Apart from COVID-19, patients in the cabins have comorbidities. Therefore, it is necessary to equip the cabins with a medical team capable of managing a broad spectrum of illnesses[1]. The First Affiliated Hospital of Hainan Medical University and the National Emergency Medical Rescue Team (Hainan) dispatched medical teams with expertise in fighting the epidemic and are experienced in emergency medicine, critical care, respiratory medicine, gynecology, pediatrics, geriatrics, surgery, and other disciplines.

According to Diagnosis and Treatment Protocol for COVID-19 (Trial Version 9)[2], the team formulated the diagnosis and treatment standard applied in the hotel cabin hospitals, and actively carried out standardized and homogeneous diagnosis and treatment[3]. In particular, for the special population in the cabin, such as children, pregnant women, the elderly, and those with comobidities, the medics would make a close observation every morning and offer timely intervention when necessary. For high-risk patients with worsening conditions, the team worked out a referral standard and mechanism to ensure that critically ill patients were transferred to designated hospitals and received proper treatment in time. In addition, according to the newly released Hainan Province Recommendations on Traditional Chinese Medicine Prevention for COVID-19 (Trial Version 3)[4], the integrated treatment mode of combining traditional Chinese medicine and western medicine was applied with special Chinese medicine decoction being distributed to patients in the hotel cabins every day.

The key to turning hotels into makeshift hospitals lies in the infection control, which requires a rapid and reasonable transformation incorperating the basic original structure of the hotels, basically realizing the partitioning management of three zones (contamination zone, semi-contamination zone, and clean zone) and two passages (staff passage and patient passage)[5],[6]. Besides, Sanya makeshift hospitals within hotels were designed with professional groups of specialized physicians from infection department and experienced medical staff who were then assigned to every entrance of the cabin passage and the potentially contaminated area of the exit passage to ensure that the team members were checked by professional personnel when entering and leaving the cabins. When wearing protective suits, the medical staff were checked whether the operation process was up to standard, whether there was any incorrect wearing and possible exposure. By doing so, it was to ensure that the protection of each person in the cabin meets the requirements of infection prevention and control. The procedures for removing protective suits should also be strictly followed when medical workers pass through buffer zones, potentially contaminated areas and clean areas. The staff on duty of the hospital infection specialized group should guide and assist the medical staff to remove protective suits in the potentially contaminated area, ensuring the operating standard while reducing exposure opportunities.

The makeshift hospital professional staff of infection and control should conduct hierarchical and classified training and assessment for staff at all levels in the hotel cabins. The medical staff working in the cabins should practise wearing and taking off protective clothing in the hotel room every day, the process of which would be recorded and then sent to the hospital professional staff for review. Only after passing the assessment can they enter the cabins for work. In order to avoid incorrect operation in personal protection of personnel with no knowledge of infection protection(security, cleaning and hotel staff, etc.), regular and repeated training should be conducted through a combination of on-site teaching, key points illustrating and repeatedly demonstrating and highlighting three main necessary aspects including personal protective skills (wearing and taking off the protective suits, hand hygiene, etc.), key points of infection control for working in polluted areas, and environmental disinfection etc.

Most patients in the hotel cabin hospitals lived in a single room or a room for two. Compared with the environment of the ordinary cabin hospitals, the hotel ones were featured by narrower space, more closed surroundings, less communication with people, and greater psychological pressure. In addition, separation from family and the lack of awareness of novel coronavirus pneumonia and its disease development were more likely to cause mental and psychological problems such as emotional instability, anxiety, fear, depression or insomnia. Mental health workers and volunteers were working to carry out psychological assessment, psychological support and education with free psychological counseling services offered by a 24-hour psychological service hotline. The medical staff on duty have been providing health education every day to explain the knowledge related to COVID-19, eliminate the wrong recognition of the disease, and reduce the psychological burden of patients. Moreover, they have organized patients to participate in activities and exercises, such as calisthenics, Baduanjin (Eight silken movements), to cheer up patients’ mood, strengthen their physique and if necessary, extend anti-anxiety treatment and other medications for people in need.

During the anti-epidemic period, medical staff have been engaged in the work of high-risk, high-intensity and high pressure. Therefore, they might also suffer from different degrees of psychological problems such as sleep disorder, poor diet and anxiety due to a monotonous routine of “travelling back and forth between home and hotel” every day[7]. To ensure a healthy state of mind of medical staff, we have organized many psychological lectures and sharing sessions as well as hot-lines with psychological counseling experts for one-on-one online communication.

During the epidemic prevention and control in Wuhan and Shanghai, a large number of volunteers inside and outside the cabins played an important role[8],[9]. Likewise, Sanya hotel cabins also witnessed an indispensable part that those volunteers play in. The patients in the hotel cabins were scattered in different rooms on different floors, which increased the difficulty of treatment, nursing and life support. Therefore, we recruited one volunteer from each floor of the hotel makeshift hospitals, who was then appointed as “floor leader”, to assist the medical staff to complete part of the work. In principle, the age of the volunteers in the cabins is 18-55 years old and they mainly assist the medical team in collecting data, distributing materials, delivering meals and medicines, cleaning up garbage, maintaining order and reporting patients’ feedback, etc. At the same time, they could also help medical staff in health education and psychological counseling, which was conducive to the management and operation of the hotel cabin hospitals. Each volunteer would be given a certificate of honor and a letter of appreciation to acknowledge their dedication when they left the cabins.

Converting hotels as makeshift hospitals was Hainan government’s first attempt against the background that the number of beds in general urban areas could not meet the rapid growth of infected cases. Sanya is home to rich hotel resources that were immediately put into use after a reasonable renovation, making a common issue of “blank period” and “people lining up for beds” occured in the original cabin hospitals a rare scene.

In the context of the normalization of the epidemic situation and the advocation of One Health perspective, it is advisable to consider coverting hotels into makeshift hospitals as a prompt public health response, considering that hotels are featured by certain advantages, such as good environment, independent rooms and beds that can not only protect patients’ privacy, but also ensure low viral load in public areas, facilitating patients’ recovery. This study provides a valuable reference in rapid conversion of hotels in Sanya, expecting to inspire people to mobilize every possible resource by converting them into temporary makeshift hospitals in wartime.

Disclaimer

The authors contributed to this article in their personal capacity. The views expressed are their own and do not necessarily represent the view of the institutions they are affiliated with.

Conflict of interest statement

The authors declare that there is no conflict of interest.

Funding

This work was supported by the Hainan Province Clinical Medical Center and Academician Workstation in Hainan Province, Hainan Province Science and Technology Special Fund (ZDYF2021SHFZ238, ZDKJ2021038), National Natural Science Foundation of China (81860347,81871611).

Authors’ contributions

Wang JH, Zhao ZQ, Bai F, Chen H and Cheng SW discussed the framework of the article. Cheng SW, Chen XN and Yuan W was responsible for manuscript writing. Lin SB, Xie H, Guo YX, Huang H, Chen J contributed to the critical revision of the article. Wang JH and Cheng SW reviewed and edited the content of the whole paper.

References