Shanghai Quarantine Diary, Part 2
From Carl Setzer, more on his exposure to the daily realities of pandemic-era Chinese medical care. Including: how to lose 40 pounds in 30 days.
This post is Part 2 in a series that Carl Setzer began yesterday. It describes his weeks of involuntary confinement at a “Covid Hospital” near Shanghai, after a positive test result.
Setzer, an American, moved to China in his early 20s and spent 16 years living and working there. He became a successful entrepreneur, founding and running China’s leading craft brewery, Great Leap. But on a business trip to Shanghai late in 2020, he ended up being detained in quarantine for many weeks.
The first installment described how and why he learned of his impending confinement. This one picks up with his adjustment to the small hospital room with three beds that would be his home through the next month.
Shanghai Quarantine Diary, Part 2
By Carl Setzer
Settling in: ‘Please lie down to prevent injury’
I began to unpack items I thought I would need, trying to organize my corner of the room in a way that could be considered efficient. I was the largest person in the room and the bed was made for someone who topped out at 100 kilograms (220 pounds) which I haven’t been since I was in the ninth grade. It was clear that I was going to have an issue with comfort.
Within 30 minutes of our arrival, nurses came in to do a wide panel of tests and bloodletting. The first was a PCR nasal swab, which was my fourth since arriving in China and the sixth that week, but it was by far the most aggressive. After the initial haze of sneezing and gagging subsided, the nurse handed me two bags with containers for urine and stool samples and told me I had to provide her with two samples of each in the next 24 hours. I was to put the bag on the floor outside the doors.
She then asked me to lie down on the bed to give a blood sample. I told her I could sit up for that, but she said that hospital policy demanded patients lie down to prevent injury. Injury?
She took about a pint of blood, the most I’ve ever given outside of blood drives. After she put a cotton ball and tape over the exit wound on the top of my hand, she told me she had to take arterial blood, a lifetime first for me. I was learning so many cool words in Chinese. She was emphatic that it was going to “hurt a lot.” She took it from my wrist (other patients would later all give it from their inner thigh). The nurse used a needle the size of which I had never seen before. She told me not to watch. I shouldn’t have watched.
The staff carried handheld translating devices. With long statements, the devices performed fine, but in short conversations or with single medical terms, some of the translations turned out hilariously wrong. One time, the nurse asked the South African how many times he had bowel movement in the previous 24 hours. The translator said: “Defecation, this happens all day long?” The staffers were all surprised I could speak Mandarin at a high enough level to translate medical terms for the other patients. When they realized that, I was asked to help translate for the South African. Eventually, the staff would wake me up and tell me to translate: not ask, just demand that I give the other patient his updates.
Following the PCR and blood tests, I was administered an electrocardiogram, which read out as normal. We were allowed a brief rest, and then I was given a pile of paperwork, various permissions and acknowledgments, and a form of consent to alert my consulate general that I was interned at this facility. Then another administrator came in and asked about insurance or direct payment. Payment is always discussed up front.
Dinner was brought at around 4:30. There was a period of inactivity until the evening temperature and pulse monitoring was administered. Lights went out at 8 p.m. That bed, for the first night, was probably the most uncomfortable place I have ever attempted to take rest. Chinese slow train hard sleepers are more comfortable. I tossed and turned and talked to my wife and various friends over messenger, and would fall asleep for 40 or so minutes at a time. The light from the exterior hallway was incredibly aggressive, and I found myself trying to sleep with a hand towel over my face. The only way this would work was if I had my conduction headphones on backwards, with the loop facing outward from my face between my eyes and nose. I felt like a character from a sci-fi TV series, but the headphones’ support arch kept the towel off my nose and eyes and helped me rest for an hour or even two sometimes.
Both of my roommates had headphones and the room stayed quiet 24 hours a day. None of us talked on the phone. The South African was a gamer, so he played video games and watched archived movies and TV shows on his laptop. The Russian actually wore the uniform pajamas they left on the beds for all of us when we first arrived. Made him look like he was in 1920s prison stripes that had been stonewashed for his comfort. He did not have a towel or appear to have any soap or a toothbrush. There was a partially consumed roll of toilet paper when we first arrived. When it ran out, I asked for more. The older woman who cleaned our room in the mornings said the hospital didn’t provide toilet paper, we had to buy it ourselves and pay to have it delivered, from the store that was in the hospital.
Food: ‘Over the 30 days, I lost about 40 pounds’
Unlimited bottled water was provided. Meals in the detention center were on a schedule. The standard breakfast offering was a box of rice porridge, a starchy thing of some sort, an egg, and a bag of pickles. Mondays, Tuesdays, and Fridays were steamed buns stuffed with some meat. Wednesday was the dreaded red bean stuffed bun. Thursday was a style of steamed bread that has no translation, a hua juan’r, basically a pillow of starch with some chives. Saturday was a shaomai, which is like a sticky rice volcano and is the closest thing Manchurians have to dim sum.
Sunday was just a slice of mantou, a bun as plain white as the suburbs in Indiana. It’s like if you made bread, let it rise a bit, and then steamed it instead of baking it. The pickles came in various forms — pickled radish slices, pickled shredded radish, pickled cucumber, pickled seaweed — but weren’t on a schedule. I think the attendant just handed out random packs with every meal. The egg was hard-boiled. Rice porridge is basically some Dickensian gruel, one of the most underwhelming ways to get calories ever invented. Six days a week they gave you a bag of hot soy milk, once a week you got a yogurt. Each breakfast was three hundred and fifty calories, two-hundred-plus from starch alone.
Lunch and dinner followed the same procedure: box of rice, two compartment boxes of a veggie, and a sauced protein thing, a bowl of soup and an egg. The only difference was that dinner came with a mandarin orange, a banana, or an apple. Apple days were awesome, but they were only once a week. Including the steamed rice and porridge, you got maybe 1,300 calories a day. Without the bulk starches, it was south of a thousand.
Over the 30 days I stayed at Jin Shan, I ate about 90 hard-boiled eggs, 25 steamed things, a chicken’s worth of poultry protein, no beef, some pork, and some processed balls of questionable source material. I lost about 40 pounds.
On days when there weren’t enough calories in the breakfast, I supplemented with some Clif Bars I had on me, but I wasn’t killing those every day because I didn’t know how long I’d be there. I drank seven to eight bottles of water a day.
Many days later, when I pushed for explanations for why I was still testing positive, the doctor explained to me that I was too fat and that I needed to eat less. When I told her that I was losing weight and my clothes were all getting looser, she laughed and said, “Well you still look very fat.” The doctor also added that I needed to relax and get more rest. When I told her about the lights being on 24 hours a day and the procedure to jolt us awake every morning at 5 a.m. for an aggressive PCR test, she just laughed and said, “It’s your own fault for being in here and you need to take responsibility for your weight problems and sleeping schedule.”
‘Nothing gets easier. It just gets normalized.’
At 5 a.m. on the second day, what would become the familiar noise of the swinging double doors woke me up. A woman in a standard uniform of head-to-toe PPE came in pushing a cart. All of the hospital staff, admin, nurses, cleaning staff, doctors, and diagnostic lab staff wore the exact same thing, white PPE coveralls with all seams secured with blue tape, leggings taped into covers for their shoes, face shield, goggles or glasses, gloves, and a mask. One out of the 10 doctors that I saw regularly had the wherewithal to write their name on their white coveralls. Everyone else was the same manifestation of a crisis worker. They also looked insulted when I tried to learn their names. There was never any connectivity between the different departments in the hospital, always the same questions from different people, but they all looked the same and that made me want to scream. For 30 days, I was addressed as “Bed Number 76.”
The woman stopped at the Russian’s bed first; he was used to this procedure and was already up and waiting. She took his pulse and tested him with PCR swabs. He choked and gagged. The nurse, like many would after her, insisted he could understand English. She told him that she was testing him for PCR viral load and that his results would be processed by the hospital. Her automated translation handheld device barked out semi-proficient English, but he protested by yelling, “Russian! Russian!” She made the adjustments and moved on to the South African, who had been awakened by the confusion.
After she finished with the South African, I asked her in Mandarin if the PCR tests would be administered every morning. She said they don’t get their specific rounds until the morning of, so if the Chinese CDC doesn’t order you a test, then you have to wait until they schedule one for you. After the morning test, there was a massive amount of anxiety that ebbed and flowed throughout the day, which only abated when the test results came back during or after dinner. The anxiety then started all over again while you waited to see whether or not you would be tested again the next morning.
The PCR test itself became so regular that I became trained to wake up 15 minutes before the doors swung open. I would sit up and the nurse would ask me to check my name written on the label of a plastic red-capped test tube. I would squint until my name became clear, “SetzerCar.” I asked them why it didn’t match my bracelet identifier, but she just said don’t worry about it. The nurse then took out two comically long and slender plastic swabs. “Swab” denotes soft plump cotton on one end, but that’s not what this was. These were swabs that were 100% plastic, with an acrylic barb on the end, with a stem that was flexible when meeting enough resistance.
Depending on the practitioner, each nurse’s technique was as identifiable as a fingerprint: it was either a gentle insertion and a full rotation clockwise and counterclockwise at the spot where the back of your throat meets your nasal passage, or it was what could only be described as a plunging of your throat via your nose by someone who was trying to both leave a mark and make a point. The more aggressive the nurse, the worse the sore throat and abrasion in my nose by the mid-afternoon, which led to the fear that I was showing symptoms, followed by a mild panic attack and ultimately the realization that the pain followed the exact same path as the PCR test swab earlier that morning.
On Day 23, my nose was so fatigued that a particularly aggressive nurse drew blood from my right nasal passage. I looked at her and she did the thing that medical professionals in China do when they cause pain: she blamed me for having a nose that bled and told me that I should drink more water. I asked her if that affected the test and she laughed as if that was a dumb question.
I wish I could say that after a certain period of time those tests got easier, but I think in situations like the one I was in, nothing gets easier. They just get normalized.
On Day 3, I was taken for a CT scan. The CT facility was in the corner of the neighboring building, so it involved getting in an ambulance. It would’ve taken less than two minutes to walk over, but the staff insisted that we take a seven-second ride. There was one other person with me, someone either Eastern European or Russian. He told me he had been there for three weeks, and the thought of a stay that long made my stomach turn. I never saw him again.
The scan itself was simple. A person said instructions over an intercom, you went in with just a t-shirt and pants, no metal. The machine told you, in Mandarin, when to hold your breath and exhale, but there were cartoons that lit up that helped people who couldn’t understand the language. After the scan, I was ushered out the back door, into an awaiting ambulance, and shuttled the comically short distance to the front door of my building. The trip felt mindlessly over-controlled and awkwardly managed, but at least I got some fresh air.
‘I know the nurse made an honest mistake, but she could have read the room.’
The bathroom had a hook and a towel rack, as well as an indentation behind the toilet that serves as a shelf. Toilet paper, soap, towels, and shampoo were not provided. You could order from the shop connected to the hospital for same-day delivery, or from Taobao or other third-party delivery systems, which delivered once a day. If your package arrived at or after 5 p.m., then you got it the next day.
Other than inside the bathroom, there was no way to have privacy in the room. The tracks for the curtain dividers were originally designed to divide two beds from one another, but the addition of a third bed meant the removal of all curtains. Phone calls were not possible unless you stood in the bathroom, but then no one else could use the bathroom.
The mandatory minimum stay for all patients is 10 days, without exception. They just tell you “8 to 10 days” to give you a sense of self-determination, as if, through good behavior, you could hasten your release.
If you test negative on Day 1, you have to stay the full 10. If you test negative during any of the first 10 days, your next test is sent to the Shanghai CDC for a confirmation; with the confirmation of a “true-certified negative,” you are cleared for release. The CDC is in charge. If you test negative for the first time on Day 9, your next test, administered on Day 10, will be sent to the CDC, and you will not get results until Day 11. The CDC can then require you to stay for an arbitrary number of tests until it is comfortable that you are “truly negative.”
This was the case with the Russian. He was negative from his Day 7 forward (my Day 3) but was not released until his Day 14. His protests were automatically translated to Chinese by the handhelds, so I wasn’t sure exactly what his questions or complaints were, but the nurses’ and doctors’ responses were simple enough. They said he wasn’t being released because he had already begun to develop antibodies and they wanted to hold him for observation a little longer.
The South African tested negative on the same day as the Russian, during his third day. I could see the light flick on in both of their eyes. Every day henceforth, they asked why they couldn’t leave earlier. “Fear of responsibility is what will keep you here and fear of responsibility will be what gets you discharged”: This was what a close friend explained to me when I needed sage words and a slap of reality. They can’t keep you forever, but they aren’t going to let you go until you aren’t a hazard. Sit tight.
No one at the hospital directly abused any of us, and the staff never purposefully tried to hurt anyone. If I had not lived in China for 16 years and had extensive and emotional experience with the Chinese medical services industry, I wouldn’t have understood as much.
The first shocking interaction that could be confused with a pointless act of cruelty I encountered happened during Day 5 of my stay, when the test results for my two roommates both came in negative (again), and, in her enthusiasm, the nurse read my results as negative also. Looking again, she immediately corrected herself without apology. When I allowed a look of devastation to appear on my face, she laughed at me, what some would call an embarrassed titter.
In all my time in China, I have mimicked and picked up social traits and cues along the way, but the one I never understood was laughing at someone in pain as an expression of embarrassment or nervousness. I know the nurse made an honest mistake, but she could have read the room.
My first 10 days felt like three weeks, and all of them were spent in the company of the Russian and South African. I had grown to resent their confidence that they were going to leave, and their pity as I kept testing positive.
They, as people, were good humans. I didn’t actually meet a bad person in that place. We all kept to ourselves and I hope that they tell stories about me, the way that I am telling stories about them. Two out of five people I didn’t ask to meet but will be connected to, in my memory, for the rest of my life.
One closing note, again with thanks to Carl Setzer for his trust in sharing this account.
In the first few paragraphs, Setzer explains his surprise at how technicians drew blood samples in the Covid hospital. Back in 2007 and 2008, when Deb Fallows and I were living in Beijing, I had a condition that required me to have twice-a-month blood tests at a local clinic. I wrote about it here.
My experiences were less dramatic versions of what Setzer describes. I didn’t have as much blood drawn each time as he did. But the technicians would say to me, as they said to Setzer, This will hurt a lot, and they were right.
Part 3 of the Covid Hospital diary is coming tomorrow.