China's new workforce: COVID-19 outbreak highlights new profession, predicaments
By Tao Yuan
Sometimes called the "giant pandas" of medical workers, respiratory therapists, or RTs, were only recognized as independent professionals on the Chinese mainland this February.
When Ni Zhong chose to study respiratory therapy at West China School of Medicine 15 years ago, his dean, Dr Liang Zongan, now director of the Department of Respiratory and Critical Care Medicine at West China Hospital, lit a fire in his and his classmates' bellies.
"He told us we would be pioneers in this field," Ni recalls.
"A pie in the sky so to speak," I asked.
"More so a blueprint," he laughed.
A decade after Ni graduated from medical school, his profession is in the spotlight for its contribution to the fight against COVID-19.
Ni is one of about 140 RTs from all over China who fought the disease in Wuhan, the former epicenter in China.
"Many of the symptoms suffered by the coronavirus patients, especially the severe and critical ones, are exactly what our line of work deals with," said Ni.
"Airway management, ventilator settings, breathing treatment and so on are quite a gray area," he explained. "There's a popular saying about our job that goes – doctors can't do it all and nurses can't do it precisely."
RTs have worked as independent medical professionals for more than 70 years in the U.S., and various studies have proven their effectiveness.
According to Liang, the amount of time patients spend in the ICU is usually about 20 percent shorter under the care of RTs. He pushed for the establishment of an RT major at the West China School of Medicine in the 1990s.
There were far from enough RTs on the frontline in Wuhan. In the absence of special treatment or targeted drugs, ventilators and other types of breathing support are essential to saving lives.
"In the treatment of COVID-19 patients, good use of ventilators can save lives, while bad use of them can kill," Ni said.
"Compare the patient's lungs to a balloon. The balloon has a hole in it. The doctors' job is to locate the hole, find out what caused it, and most importantly, to patch it up. Our job as RTs is to use all kinds of breathing treatment equipment to keep the balloon inflated. It's very nuanced. Too much pressure and the hole will grow, the balloon will explode; Too little pressure, the air will leak and the balloon will deflate. The patient's lungs will fail. We RTs basically keep the patient breathing to buy doctors more time to find the cause of a disease and treat it."
Ni knows his profession is still in its infancy in China. For the past 23 years, the West China School of Medicine has been the only medical school on the Chinese mainland that offers undergraduate degree training in respiratory therapy. Currently, there are just over 1,000 RTs nationwide.
"Much of our job is similar to that of a clinical physician, with a heavier focus on certain treatments," Ni explains. "But a major difference is that we don't have a license, which is a big hindrance."
Without certification or licensing, RTs are not legally qualified to perform certain medical procedures, like tracheotomies.
"That's one of the reasons so few people go into our line of work," said Ni. "We will need a much clearer job description or professional guidelines. That's what we need to strive for."
Seemingly agree with Li, Liang pointed to the nature of past epidemics.
"If you look at all the major public health crises, especially infectious disease epidemics, it'll nearly always be an acute respiratory disease," Liang said.
"If you can't do breathing support well, it will have a big effect on society, even humanity. Speaking from this perspective, I think we need a mature respiratory therapy on par with that of Europe and the U.S."