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With the government’s policy shifting toward limiting hospitalizations of COVID-19 patients amid rising numbers of daily infections, public health centers — in charge of monitoring patients at home — are increasingly worried about whether they will be able to detect if a patient’s condition is deteriorating quickly.

Public health centers are in charge of judging the nature of a patient’s symptoms, which will determine whether they will be hospitalized or not. Based on their condition, patients are categorized as severe, moderate I (who have difficulty breathing and have signs of pneumonia), moderate II (who can’t breathe sufficiently on their own), mild or asymptomatic.

The centers will also arrange for them to stay at local government-designated accommodation if they are unable to stay at their residence and conduct follow-up checks on those recuperating at home.

“At present, about half of the patients are in their 20s and 30s, most of them with mild symptoms,” said an official at a public health center in the city of Chiba. “But even if the percentage of elderly patients is low, if the number of positive cases increase, the number of elderly patients — some of which have underlying conditions — will rise.

“We don’t expect the number of patients to drop — on the contrary, the situation will only worsen,” the official said. “If that occurs, for people whose condition worsens suddenly while at home, they may not be able to get the care they need in time.”

According to the Chiba Prefectural Government, the occupancy rate of hospital beds for COVID-19 patients in the prefecture had reached 56% on Tuesday, up from 47.5% on July 28, while 3,831 people were recuperating at home.

In a major policy shift Monday, the government decided to hospitalize only severe and high-risk COVID-19 patients and have the remainder recuperate at home, a move that is facing criticism from ruling and opposition parties. The move is likely to put more strain on the already overwhelmed public health centers, as well as giving them greater responsibility for what could be life or death matters for patients.

“Public health centers won’t be able to (make the judgment call),” said Osaka Gov. Hirofumi Yoshimura on Monday, adding that doctors should increase house calls to determine how patients are doing.

Between January and June, 84 COVID-19 patients died at home, public broadcaster NHK reported Tuesday.

The workload of public health centers has already been increasing since July, when daily cases started to rise, especially in major cities such as Tokyo.

“The situation has been dire since the beginning of the week” starting July 25, said an official at one of Tokyo’s public health centers who asked for its ward or city not to be disclosed.

When a patient tests positive, health center officials talk with them for two hours on the phone to check their condition, get information on possible close contacts and discuss recuperation options, the official said. Afterwards, accommodation is arranged, as are deliveries of meals and frequent follow-up checks on the patient’s condition.

“We get support from other departments and part-time workers, but as the numbers continue to grow… there are limitations,” the Tokyo health center official said. “Arranging spaces in hospitals is already becoming a problem.”

On Wednesday, nationwide cases topped 14,000, the highest figure ever, due partly to the spread of the highly transmissible delta variant.

On Tuesday, the number of patients requiring hospitalization nationwide was 86,144, up from 42,267 from the same day the week before, according to the health ministry.

In Tokyo, 14,019 people were recuperating at home, while 8,417 people were waiting for hospital beds or spaces in designated hotels.

Health minister Norihisa Tamura said Tuesday that the government is ready to offer support for public health centers, including beefing up staffing levels.

The expectation is that, with the vaccine rollout, daily cases will eventually decline, easing the burden on hospitals and public health centers. As of Wednesday, 29.84% of people had received two doses of a vaccine.

“For the effects of vaccinations, we will need to wait much longer,” the Chiba public health center official said.

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