Japan's local hospitals fear lack of supplies and staff may overwhelm health care systems

Takao Shimanuki, who heads Nihonkai General Hospital in Sakata, Yamagata Prefecture, feels it’s only a matter of time before his hospital will max out its ability to accept COVID-19 patients.

“If the number of patients increases at the current pace, beds allocated (for coronavirus patients) will eventually be full,” he said.

Yamagata Prefecture has cared for a total of 60 COVID-19 patients, as of April 18, since the first case was confirmed at the end of March. Located in the northern part of the prefecture, Nihonkai General Hospital is designated to treat patients with infectious diseases.

As patient numbers have increased, the hospital expanded the number of beds set aside for COVID-19 patients to 54, including those in the intensive care unit (ICU). At present, it is caring for six COVID-19 patients.

However, the situation is getting worse by the day. Medical masks and surgical scrubs are expected to run out as soon as the end of this month. As there is only one facility that can conduct testing in the prefecture, the hospital purchased a testing device on its own — only to be told that it won’t be delivered for three months.

Through cooperation with other hospitals in neighboring cities, the hospital has decided to only accept patients with severe symptoms from April 13.

“The number of patients is small compared to large cities but the possibility of a collapse in the medical system is not someone else’s problem,” Shimanuki said. “We are the main health care provider and if we max out (on our capacity to accept patients) it will have a profound effect.”

Like Yamagata, prefectures in rural areas are worried that their hospitals will reach their capacities sooner rather than later as they have fewer doctors and nurses available compared to metropolitan areas.

In Toyama Prefecture one of the large-scale hospitals suffered from a nosocomial infection, with more than 20 patients and nurses testing positive and another 200 forced to self-quarantine at home.

A recent Kyodo survey also highlighted the struggles that many local municipalities are facing. A Nara Prefecture official said treating coronavirus patients would put a strain on local hospitals, according to the survey.

Individuals who have been tested will be occupying beds until results come back, meaning it won’t be possible to accept new patients during that time, the official said in the survey.

Hospital staff also need to prepare medical supplies, as well as depressurized rooms where patients will be treated.

“Treating coronavirus patients will be a significant burden to hospitals compared with normal patients” since they require more staff and supplies, the official said.

Other prefectures are also voicing similar sentiments in the survey. A Wakayama Prefecture official said doctors at hospitals treating COVID-19 outpatients are becoming exhausted. In Nagasaki Prefecture, there aren’t many doctors specialized in respiratory diseases.

To tackle the issue, some municipalities have offered subsidies for medical facilities. Hospitals in Aomori Prefecture that purchased respirators are eligible for prefectural subsidies, while Kyoto Prefecture is offering funds for hospitals to purchase medical supplies to prevent the virus from infecting others.

Sources said Wednesday that Aichi Prefecture, which had 195 patients as of Tuesday, was considering offering ¥1 million per patient for hospitals that accepted COVID-19 patients, hoping the money would be used to improve working conditions for health care workers.

According to the source, Aichi, in cooperation with smaller municipalities, is considering offering a higher amount for patients with severe symptoms, such as ¥2 million for those treated with respirators or were admitted to ICUs and ¥3 million for patients treated with cutting-edge extracorporeal membrane oxygenation machines that are used to remedy serious lung and heart problems.

Concerned about the possibility of an exponential rise in the number of patients, the health ministry has launched a task force specifically to support hospitals in rural areas, discussing necessary measures with prefectural governments.

Key topics under discussion include when to discharge patients with mild or no symptoms, and the dispatch of officials to coordinate the acceptance of patients among prefectures if their number rises.

“If the number of patients rises exponentially in areas where there are only a few hospitals and medical staff, it will have a significant effect on the local medical system,” said a hospital official in one of the prefectures. “We, in local areas, are the ones who need to be on alert.”