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In a major policy shift aimed at easing the burden on front-line health care workers, the Suga administration has decided to hospitalize only severe COVID-19 cases and those with an increased risk of severe illness, leaving others to recuperate at home.

Until now, patients with moderate symptoms had been admitted to hospitals, while those with asymptomatic or mild symptoms were typically asked to quarantine at hotels or at home.

But with the massive rise in new cases and the limited capacity of government-paid accommodation, the government has decided to prioritize more serious and higher-risk patients for hospitalization. Mild and asymptomatic patients will only be quarantined at government-provided accommodation when there are concerns about contagion at home.

Prime Minister Yoshihide Suga said Tuesday that under the new policy, the government would make sure that people with moderate symptoms who require oxygen or have underlying medical conditions such as diabetes would be hospitalized.

“We will free up necessary beds to make sure people with serious cases and those with a high risk of severe illness are hospitalized,” Suga said. “As the number of infected people is increasing rapidly, maintaining medical care is the biggest challenge.”

The government places COVID-19 patients into four categories: mild, moderate I, moderate II and severe.

Moderate I patients suffer from shortness of breath and show signs of pneumonia but do not need oxygen, while moderate II patients suffer from respiratory failure and need to receive oxygen. Severe illness, meanwhile, indicates the patient is suffering from severe pneumonia and needs to be admitted to an intensive care unit, as well as receive treatment such as being put on a ventilator or extracorporeal membrane oxygenation, or ECMO, machine.

The new policy was decided at a meeting of relevant ministers presided over by Suga late Monday and followed a spate of record daily infection numbers in the greater Tokyo area. That same day, 8,393 new cases were reported nationwide — nearly double the figure the previous Monday.

Suga also said the government will distribute pulse oximeters and raise remuneration for house calls for doctors to incentivize the continued monitoring of patients. Doctors were also asked to make use of online consultations.

Prime Minister Yoshihide Suga speaks at a ministerial meeting on COVID-19 medical care at the Prime Minister's Office in Tokyo on Monday. | KYODO
Prime Minister Yoshihide Suga speaks at a ministerial meeting on COVID-19 medical care at the Prime Minister’s Office in Tokyo on Monday. | KYODO

Health minister Norihisa Tamura said older people and those that have existing medical conditions but are considered less likely to suffer serious illness, who were typically hospitalized previously, would likely quarantine at home under the revised policy.

The first drug approved for mild to moderate symptoms will be proactively administered to patients age 50 or above and those with existing conditions, Suga said. The Ronapreve antibody cocktail treatment was recently authorized for use with hospitalized patients only, but quarantined patients will also be able to use the treatment.

Chief Cabinet Secretary Katsunobu Kato said Tuesday the change reflects calls from the front lines of the health care system in Tokyo and other areas, which have been witnessing a rapid increase in new cases recently.

“The rise in severe cases in people in their 40s and 50s and an increase in heat wave-triggered emergency transfers to hospital are adding to the burden on general medical treatment, with some people unable to be hospitalized and recuperating at home,” he told reporters.

The delta variant, which the U.S. Centers for Disease Control and Prevention has said is as transmissible as chickenpox, has been driving record daily infection numbers in Japan, with the nationwide figure rising above 12,000 cases recently.

“There is a risk of younger patients developing serious symptoms with the delta variant, and if new cases of infection increase quickly, patients with severe symptoms will also rise,” said Toshio Nakagawa, president of the Japan Medical Association. “Japan is facing its biggest crisis since the first wave last year.”

He added that Suga and Tamura have assured him that the government accepts the hospitalization of patients with moderate symptoms who need an oxygen inhaler where it is deemed necessary by doctors. He also urged the government to call on people to avoid all travel outside their prefecture.

The so-called basic reproduction number, which measures how transmissible a virus is, reached 1.74 in Tokyo on Saturday — its highest since May 2020 — according to Toyo Keizai data, signifying that the pandemic is far from over. A number higher than 1 indicates that the spread of the virus is accelerating, while a number below 1 shows that infections will settle down.

According to health ministry data, Japan had 5,267 beds for seriously ill COVID-19 patients as of last week, of which 1,271 were occupied — up by nearly 300 from the previous week. While the occupancy rate may seem low, patients with severe COVID-19 nonetheless require at least double the number of staff to treat them.

With more than 77% of people age 65 and above fully vaccinated, what seems to be a burgeoning trend in Tokyo is a sharp uptick in severely ill patients in their 40s and 50s. On Saturday, the capital reported a record 4,058 infections overall, of which people in those age groups accounted for nearly a quarter.

Suga has been calling on all willing people to get fully vaccinated by sometime in October and November, as the delta variant presents a higher risk of serious illness even for younger people. But as Japan's vaccine rollout has ramped up, some municipalities have seen demand outstrip supply.

Staff writer Satoshi Sugiyama contributed to the report.

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