In early 2020, in the Chinese city of Wuhan, Dr. Li Wenliang lay in a hospital bed with a debilitating fever. He was no ordinary patient, and even then — before Covid had its name — he feared that this was no ordinary ailment.

Dr. Li was widely regarded in China as a heroic truth-teller. He had been punished by the authorities for trying to warn others about the virus, and then, in a terrible turn, had become severely sickened by it. Weeks later, he would become China’s most famous fatality of the emerging pandemic. He was 34.

His death set off an outpouring of grief and anger on a scale and intensity rarely seen in China. More than two years later, Dr. Li remains a galvanizing figure, a symbol of frustration with the government’s suppression of independent voices. His profile on the Chinese social media site, Weibo, regularly receives hundreds of comments a week, and has become a place where people pay tribute and share their personal stories.

A government investigation into the circumstances around Dr. Li’s death concluded in a report that the Wuhan Central Hospital had spared no effort to try to save him. But a more complete picture of his medical care and his treatment by the authorities has remained elusive.

The New York Times’s Visual Investigations team has now filled in some of these gaps with an exclusive interview with one of Dr. Li’s colleagues. He provided a firsthand account of Dr. Li’s final hours, describing the resuscitation measures that were used and discussed. We are referring to him only as Dr. B because he is afraid of reprisals from the Chinese government. The Times talked to Dr. B via video, and verified his identity with public information.

The Times also obtained and examined internal memos from Wuhan Central Hospital and Dr. Li’s medical records, some of which backed up Dr. B’s account. The medical records have been verified by experts and contain details that match publicly available information. Eight U.S.-based Chinese medical experts, who have experience treating Covid patients or have practiced in Chinese hospitals, reviewed the medical records for The Times.

We found no evidence his medical care was compromised. But these documents, along with Dr. B’s account and experts’ analysis, reveal important new details about his illness and treatment.

Taken together they show how Dr. Li spent his last 39 days going up against a deadly virus — and navigating government attempts to censor him.

An Acute Illness

In early 2020, the virus was spreading rapidly in Wuhan, the city in China where the pandemic first took hold. Dr. Li checked into the hospital on Jan. 12 with a fever, a lung infection and other symptoms. According to several of the doctors who reviewed his medical records for The Times, by the third day, Dr. Li was seriously ill and required oxygen support.

“He was infected with an early variant of the virus, so the illness started acutely, its course was life threatening and it developed very fast,” said Dr. Wu Yuanfei, a virologist at UMass Chan Medical School in Worcester, Massachusetts.

The experts said that based on the records, the treatment Dr. Li received, in general, followed the norms of that time for managing the symptoms of coronavirus patients.

A little over a week into Dr. Li’s hospital stay, his doctors wrote that he was struggling mentally and diagnosed him as being in a depressive state, a detail that has not been reported. The record did not attribute his emotional condition to any specific factors, but noted that Dr. Li had lost his appetite and couldn’t sleep at night.

He was kept in an isolation ward, allowed to communicate with his family only by video chat. He had just weeks earlier been disciplined by the police for warning friends in a private group on WeChat, a Chinese social media service, about the new virus that was spreading through the city. His employer, Wuhan Central Hospital where he worked as an eye doctor, had made him write a letter of apology, the content of which was obtained by The Times.

Despite the official warnings, on Jan. 27, 2020, Dr. Li gave an anonymous interview to a prominent Chinese newspaper, describing how he had been reprimanded for trying to raise the alarm. Eventually, he revealed his identity on social media, and instantly became a folk hero. From his hospital bed, he took more interviews and said he hoped to recover soon to join medical workers fighting the outbreak.

Deterioration and Attempts at Resuscitation

But on Feb. 5, Dr. Li’s condition deteriorated severely — his pneumonia grew worse, his breathing became extremely labored.

That afternoon, Dr. Li’s doctors ordered several tests of his lungs and heart, his medical records show. According to Dr. Yuan Jin, a pulmonary and critical care doctor at Good Samaritan Medical Center in Brockton, Massachusetts, these exams suggest that Li Wenliang’s medical team was responding to a worsened condition.

By the morning of Feb. 6, doctors wrote in the progress notes that Dr. Li was at risk of multiple organ failure. Several physicians we spoke to said that Dr. Li’s condition was so serious that his medical team should have at this point, or before it, considered intubating him and placed him on a ventilator — a higher level of oxygen support.

The records indicate that Dr. Li had earlier been given oxygen through a nasal tube and then an additional oxygen mask. His medical team also tried to use a noninvasive ventilator on Jan. 19, but wrote that “the patient could not tolerate.”

It is unclear why Dr. Li was not intubated. Some doctors are more reluctant to intubate young patients; sometimes the patients themselves refuse it. To this day, there is no consensus on when invasive ventilators should be used on Covid-19 patients.

On Feb. 6, Dr. Li went into cardiac arrest at around 7:20 p.m. Though his daily progress note did not explicitly say that his heart stopped, it recorded that the medical team started performing CPR — a procedure that is applied in such an emergency. They intubated him at that point, a common practice during resuscitation. The note said his pupils were not responding to light.

According to the medical records, doctors tried to revive Dr. Li for over seven and a half hours, but his heart never restarted.

The government investigation said doctors placed Dr. Li on extracorporeal membrane oxygenation. Also known as ECMO, it is a last resort, invasive treatment involving a machine that siphons blood out of the patient, runs it through an oxygenator and pumps it back into the body.

According to Dr. B, who arrived at Dr. Li’s intensive care ward around 9 p.m., about two hours after Dr. Li entered cardiac arrest, the hospital’s leadership pushed the medical team to use ECMO because it wanted to show the public that no effort had been spared.

But several doctors in the room argued that by that point it was too late for it to have been of any use, an assessment that six physicians we talked to agreed with. Dr. B also said putting Dr. Li on ECMO, given its invasive nature, would have been an “insult to his body.”

Dr. B left the room around midnight. He said ECMO had not been used because an instrument to perform the procedure was not available. It is unclear whether it was ultimately used after he left.

There is also no indication in the doctors’ orders from that night that the procedure was ever administered.

But for some reason, the daily progress notes say ECMO was used. It was the only discrepancy of this kind found in the medical records.

The Death of Dr. Li

That night, conflicting messages about Dr. Li’s condition — some released by state media outlets, then deleted — generated confusion. At 10:40 p.m., a state-run publication, Life Times, said that he had died at 9:30 p.m.

It was nearly 4 a.m. the next morning, Feb. 7, when the hospital finally announced Dr. Li’s death. It said he died at 2:58 a.m. The government’s investigation cited an electrocardiography performed at this time that showed he had flatlined.

Our investigation found that among the records was an echocardiogram report around 9:10 p.m. the previous evening that showed that his heart had stopped beating.

“I think Dr. Li Wenliang had already died by the time I saw him around 9 p.m. on Feb. 6,” Dr. B said. He added: “The normal process at this point would have been to pronounce him dead.”

“They dragged their feet for so long over the announcement. It’s like the hospital really did not treat us as human beings,” he said. For Dr. B, going public with his version of events was an attempt to get his story out and honor Dr. Li’s legacy.

The Times made multiple attempts to contact Dr. Li’s medical team, but none agreed to answer questions. The press office of Wuhan Central Hospital told The Times that it was not accepting interviews from international media outlets. China’s National Supervisory Commission, the country’s top disciplinary body investigating Dr. Li’s death, did not respond to requests for comment. The Chinese Embassy in Washington, D.C. did not respond to requests for comment.

The post How a Chinese Doctor Who Warned of Covid-19 Spent His Final Days appeared first on New York Times.

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