A recent surge in the admission of COVID-19 patients to intensive care units at hospitals across Japan is complicating the provision of care to other seriously ill patients, some of which are not receiving the medical attention they need.
Over the past few days the numbers of new daily COVID-19 cases appear to have been decreasing, with a near one-month low of 2,764 new cases reported Monday, according to a Kyodo News tally.
But the number of critically ill COVID-19 patients are still on the rise, with a record 1,017 cases recorded Monday, the health ministry has said.
The central government offers a variety of subsidies aimed at increasing the number of intensive care beds available to novel coronavirus patients. Those funds are used to set up partition walls and negative pressure rooms inside the ICU, for example, to prevent transmission of the virus to other areas of the unit where people with other diseases are treated.
But increasing ICU capacity for COVID-19 patients comes at the expense of cutting ICU capacity for other patients suffering from common medical conditions such as heart attacks, and has far-reaching repercussions on traditional health care.
“If the ICUs were expanded (for novel coronavirus patients), we would not be able to accept as many serious noncoronavirus patients suffering from myocardial infarction, for example, as we do now,” said Dr. Kentaro Iwata, head of the infectious diseases department at Kobe University Hospital in Hyogo Prefecture, on Jan. 13. “That means those people would be left to die of myocardial infarction at home. So we are being forced to make an ultimate choice based on which would lead to less misery.”
Kobe University Hospital, which provides second-line hospital care for COVID-19 patients in Hyogo Prefecture, takes in patients when first-line hospitals in the city have no more room to accept them.
The university hospital is just one such facility facing such difficult choices. Hospitals in other parts of Japan, including Chiba Prefecture, are increasingly facing the heavy burden of dealing with severe COVID-19 cases.
Dr. Koutaro Yokote, director-general of Chiba University Hospital, says treating seriously ill COVID-19 patients often requires the attention and involvement of emergency and intensive care physicians, which is leading to a terrible trade-off with intensive care provision for patients suffering from common but critical ailments.
Complicating the effort is the fact that patients with severe COVID-19 require at least double the number of staff required to treat those who are seriously ill with other medical issues.
“As a result, we are starting to see cases where coronavirus patients and other emergency patients are not accepted at any hospitals, with the ambulances bounced around between facilities, and we’re nearing a situation where we will not be able to save lives that could normally be saved,” Yokote said in a statement sent to The Japan Times.
Japan has an intensive care capacity of about 17,000 beds. But because of the need to treat all emergency cases, the number of beds available for seriously ill COVID-19 patients was limited to 3,600 as of last week, according to health ministry data.
Many local governments have been publicly calling on medical facilities to increase the number of beds they make available for severe COVID-19 cases, but hospitals have been struggling to increase ICU capacity as separating part of the ICU for COVID-19 patients, amid worries over nosocomial (hospital-acquired) infection, is not easy.
Some local governments, including Kanagawa Prefecture, have taken advantage of the government subsidy to create makeshift prefabricated wards and boost the number of hospital beds for seriously ill COVID-19 patients.
Up until late October, all novel coronavirus patients were hospitalized. But since late October, due to the surge in new cases, only those age 65 or older, those with respiratory syndromes or other moderate and severe symptoms and pregnant women have been eligible for hospitalization, leaving those who are asymptomatic or who have mild symptoms to recuperate in hotels or at home.
Tokyo, which to date has seen the worst numbers of cases anywhere in the country, has gone even further, having patients under age 70 with no underlying conditions sent to hotels that are contracted out and repurposed by the capital as ad hoc medical facilities. Tokyo alone has more than 5,500 people on the waiting list for hospitalization or medical care within hotels, metropolitan government data shows.
Hospitals are already overwhelmed with COVID-19 patients to the extent that accepting admissions of other seriously ill patients is becoming a problem. In Nagoya in recent days, a man in his 60s and a woman in her 70s, neither infected with the novel coronavirus, both suffered from cardiac arrest in ambulances as paramedics struggled to find hospitals that would accept them.
“Right now, the beds for seriously ill patients are full and Hyogo Prefecture does not have much room to take new serious cases,” said Iwata of Kobe University Hospital.
“That you cannot go to a hospital, even if you develop a life-threatening illness, should be unthinkable in a country like Japan that has a national health insurance program,” he added. “But this is the reality.”
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