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Japan's health care system teeters on the brink as coronavirus takes a toll on hospitals

by Tomohiro Osaki

Staff writer

At a university hospital in central Tokyo where emergency physician Akina Haiden works, the surge in COVID-19 patients is taking a toll like at many hospitals across the nation.

Supplies of protective equipment — such as N95 masks and isolation gowns for medical workers — are running threateningly low, said Haiden, causing her and others to reuse masks intended for single use.

“I’m wondering when one of us (will) die,” she said.

Nearly all nonemergency surgeries have been postponed at the hospital for now, she added, amid high demand for intensive care units (ICUs).

“I’m not saying the general public shouldn’t be able to get (masks), but I really believe health care personnel and all other essential employees should have priority,” she explained. “If that doesn’t happen, we aren’t going to have a lot of medical professionals left to take care of patients.”

As the COVID-19 pandemic continues to rage throughout Japan, a growing number of hospitals facing a dearth of protective equipment for medical staff have been pushed to the brink of dysfunction. As well as having to postpone elective surgeries, some have had to reject new patients.

Experts say the nation is tipping toward a full-fledged “collapse” of its medical system, stressing the need for measures such as boosting testing capacity, building field hospitals and making more active use of disaster-response professionals.

“We feel that the collapse of the emergency care system is already here,” said the Japanese Association for Acute Medicine in a statement issued earlier this month.

The unraveling of emergency care capabilities is an area where the overwhelmed state of the nation’s health care system is particularly evident.

Worried about nosocomial (or hospital-acquired) infections, many medical facilities are now balking at admitting those feared to be infected with the new coronavirus that causes COVID-19.

The result has been fever-struck patients in ambulances getting denied admittance repeatedly. Between April 1 and 25, the number of such cases where emergency patients were rejected by at least five different hospitals, or had to wait for more than 20 minutes to be accepted, nearly quadrupled in Tokyo from a year earlier to 1,919, according to a public health office at the Tokyo Metropolitan Government.

This has, in turn, forced critical care centers to bear the brunt of the influx of COVID-19 patients, significantly reducing their ability to treat severely sick and injured patients not infected with the virus that causes the respiratory disease.

Osaka General Medical Center, one of 42 institutions in the country designated by the health ministry as a “high-level” critical care center, has been cutting back on the number of critically ill patients it admits since mid-April.

The hospital, which is accepting COVID-19 patients, resorted to limiting other admissions in order to consolidate its manpower and hospital beds, in the hope of offering better treatment to those infected with the novel pathogen, said Kazuomi Nose, a secretariat official with the center.

“It was a tough call,” he said.

Since patients with the new coronavirus are walking in as emergency outpatients, hospital rooms normally reserved for those with other serious conditions or injuries now go to them, Nose said. Because of the infection risks, those rooms need to be designated as strictly off-limits to non-COVID patients, the official added.

“Reduced access for those patients is unavoidable,” he said.

Keenly aware of the situation, the health ministry recommended earlier this month that patients with mild symptoms and those who are asymptomatic be sent to recuperate in hotel facilities or at home — a sudden departure from its previous policy of having everyone hospitalized.

In the hope of securing more beds, the ministry has also rolled out incentive schemes that offer hospitals double the amount of money they would usually receive for taking in critically ill COVID-19 patients who require artificial respirators or extracorporeal membrane oxygenation (ECMO). At the same time, the government is encouraging doctors to perform examinations online to minimize the risks of hospital staff getting infected.

Experts, however, say bolder measures are necessary to forestall the disintegration of the nation’s health care system.

In a statement submitted to the Tokyo Medical Association earlier this month, a group of doctors argued that more PCR testing was needed to detect and isolate as many carriers as possible — before they inadvertently spread the virus in their homes or places of work.

In what the doctors say was a nod to the proposal, the association later announced plans to launch a new PCR testing system in Tokyo that could bypass the usual rigmarole associated with public health centers.

“To my way of thinking, it’s clear that the low volume of testing has led to the spread of infections in Japan,” said Okinawa-based doctor Yasuharu Tokuda, one of the chief petitioners. “Our strategy is based on the idea that unless infections are curbed, we cannot avoid the collapse of our medical system.”

Tokuda has suggested that playgrounds at Tokyo schools, which are largely closed at the moment, be converted into testing sites, provided they are thoroughly disinfected.

As far as manpower goes, disaster medical assistance teams (DMATs) — teams of medical professionals trained for disaster response under a state-led initiative — and the Self-Defense Forces should be mobilized to conduct testing, he said.

Although DMATs are technically not infectious diseases specialists, Tokuda said they are the personnel with the highest degree of readiness in the nation, and fully capable of collecting samples safely if properly supervised by infection control experts.

The Japanese Nursing Association is calling on retired nurses to rejoin the workforce, to help fill the manpower shortage caused by the pandemic.

To prevent hospital bed demand from exceeding capacity, some experts say Japan should emulate other developed countries in setting up field hospitals — in particular by repurposing venues built for the Tokyo Olympics. Tokuda argues that aside from hotels, newly constructed condominiums dotting the Olympics Village in Tokyo’s Harumi seafront district could also be used to take in those with mild symptoms.

Overseas, such makeshift hospitals have already been set up in exhibition centers, sports stadiums and parks.

East London’s ExCeL exhibition center, for example, has been transformed into the NHS Nightingale hospital, with space for 4,000 beds. In Madrid, there is a plan to create what has been touted as Europe’s biggest field hospital by fitting a convention center with 5,500 beds.

But Osamu Kunii, who heads the Strategy Investment and Impact division for the nonprofit Global Fund to Fight AIDS, Tuberculosis and Malaria, said hotel facilities provide more desirable accommodations for coronavirus patients than field hospitals. If precedent is anything to go by, such field hospitals could wind up being underutilized, with some having served fewer patients than initial estimates suggested, he said.

That said, the government should nonetheless prepare for the worst-case scenario, which might necessitate these impromptu hospitals being built, Kunii said.

“They should at least start making preparations for such facilities in terms of budget and logistics, so that they can be on standby and immediately work toward setting them up should an explosive rise in cases force them to do so,” he said.

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