Earlier this week, British medical journal The Lancet published a brief correspondence from two Chinese medical aid workers who said they were currently fighting the coronavirus outbreak in Wuhan. The letter, which describes extreme and intolerable working conditions inside the isolation wards, was suddenly retracted today, under what can only be described as highly suspicious circumstances.
The correspondence, titled “Chinese medical staff request international medical assistance in fighting against COVID-19,” was published in Lancet Global Health on Monday and was authored by Yingchun Zeng from the Third Affiliated Hospital of Guangzhou Medical Hospital and Yan Zhen from Sun Yet-sen Memorial Hospital in Guangzhou, China.
The Lancet retracted this letter earlier today, February 26. It remains online, but the letter is now watermarked with several instances of the word “RETRACTED,” which appears in a red, all-caps typeset. The Lancet provided a painfully brief explanation for why it chose to pull the correspondence:
On Feb 26, 2020, we were informed by the authors of this Correspondence that the account described therein was not a first-hand account, as the authors had claimed, and that they wished to withdraw the piece. We have therefore taken the decision to retract this Correspondence.
That the authors of the letter fabricated their accounts or based them on the accounts of others who had first-hand knowledge is certainly a possibility. More plausible is that Chinese authorities interfered in this case, compelling the authors to demand that their letter be taken down—though we have not seen any direct evidence to support this possibility.
The contents of the letter are disturbing. In the correspondence, both Zeng and Zhen claimed to have worked in the Wuhan isolation wards, performing a number of duties, from providing oxygen to patients, monitoring ECG readings, providing basic nursing care, among many other tasks.
“The conditions and environment here in Wuhan are more difficult and extreme than we could ever have imagined,” they wrote.
I've never seen an article like this in the Lancet. It's not a study, it's a cry for help.
— Balaji S. Srinivasan (@balajis) February 26, 2020
Zeng and Zhen described a severe shortage of protective equipment in Wuhan, citing insufficient access to face masks, face shields, googles, gowns, and gloves. Hands are being washed so often, they say, that nurses are developing “painful rashes,” and respirators are worn for extended periods, resulting in pressure ulcers on foreheads and ears. Many nurses have mouths covered in blisters, they said, and some are experiencing fainting episodes on account of hypoglycaemia (low blood glucose) and hypoxia (inadequate oxygen), according to the letter.
Owing to the length time it takes to put on protective clothing (including four layers of gloves), Zeng and Zhen claim that nurses avoid food and drink for up to two hours before their shifts.
These conditions, they authors say, are taking a psychological toll.
“While we are professional nurses, we are also human. Like everyone else, we feel helplessness, anxiety, and fear,” they wrote. “Experienced nurses occasionally find the time to comfort colleagues and try to relieve our anxiety. But even experienced nurses may also cry, possibly because we do not know how long we need to stay here and we are the highest-risk group for COVID-19 infection.”
Indeed, this risk is very real. More than 3,000 medical staff in China have been infected with COVID-19 thus far, and nine have succumbed to the virus, according to China’s National Health Commission. Some 14,000 medical aid workers from across China have come to Wuhan in support of local teams, according to the letter, but “we need much more help,” wrote Zeng and Zhen, who are now “asking nurses and medical staff from countries around the world to come to China now, to help us in this battle.”
Gizmodo asked Lancet Global Health about this situation and why the journal chose to retract the paper. Their response largely echoed the one already posted online.
“Questions regarding the validity of this correspondence were brought to our attention by a number of readers,” wrote a Lancet media spokesperson to Gizmodo in an email. “In addition, we received a direct communication from the authors of this correspondence… stating that the account they described was not first-hand, as they had originally claimed in the correspondence, and that they wished to withdraw the piece. Following due process according to the COPE retraction guidelines, we determined that it was our duty to retract this correspondence.”
To which the spokesperson added: “Every piece of original research published across The Lancet Group is subject to peer-review. However, we also publish a range of additional content, including correspondence, which is not. In these instances, we take the perspectives provided by authors on trust.”
Wanted to post actual text of retraction note as it's not necessarily Lancet GH saying it was not a first-hand account; rather journal is conveying what the authors newly conveyed yesterday. Link: https://t.co/XCCrZh5BeC
One has to wonder if the authors were pressured to recant.
— Chelsea Polis (@cbpolis) February 27, 2020
The Lancet clearly had no choice but to retract the paper, given that the authors themselves admitted to an impropriety. What’s more, and as Reuters reports, “a medical team sent by Guangdong province to help in Wuhan posted an online statement to a newspaper saying the two were not part of the team and their description of conditions was not accurate.”
We can’t help but wonder, however, if Zeng and Zhen were compelled by Chinese authorities, possibly under threat of imprisonment, to issue a bogus claim to The Lancet. We’ll likely never know, though Gizmodo did reach out to the authors of the retracted paper for comment (we did not receive a response by the time of publication). Quite ominously, Zhen did not show up at work today, reports Reuters.
There is, of course, the larger issue of the working conditions in Wuhan and the overall accuracy of the now-retracted letter. Claims made by the authors are consistent with those reported elsewhere, including around inadequate equipment, bleeding ulcers, and exhausted nurses. Other reports describe female medical staff being forced to shave their heads and medical staff having to wear diapers because they can’t go to the bathroom, among many other hardships. So yeah, the situation for nurses in Wuhan is clearly not great, regardless of whether the Lancet letter is an honest account.
At the same time, China has already shown its hand as this crisis continues to unfold, attempting to control the flow of information and stamp out any criticisms of the government’s handling of the the outbreak. This is all very unfortunate, as we cannot believe official statements from the government that currently has the most experience fighting this virus. An atmosphere of distrust is certainly something we don’t need during this critical time.