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Tokyo Gov. Yuriko Koike announced Thursday that the metropolitan government will prioritize the hospitalization of severely ill or high-risk COVID-19 patients, reflecting the central government’s controversial policy shift from earlier this week.

On Monday, Prime Minister Yoshihide Suga said those with moderate symptoms will now in principle be asked to isolate themselves at home.

The central government’s major policy change was met with swift opposition from the public, major media outlets and Suga’s own political party due to concerns that moderately ill patients can worsen suddenly and unexpectedly, and that the shift could make it logistically difficult for infected people to receive treatment.

“The purpose of these revisions is to better utilize the limited resources we have to contain this outbreak,” Koike told reporters.

Tokyo saw a record-breaking 5,042 cases Thursday. The metropolitan government’s advisers predicted the same day that, if new cases continue to emerge at the current rate, Tokyo could see a weekly rolling average of 6,129 cases on Aug. 11 and 10,909 a week later — meaning 1 in every 1,000 Tokyo residents would be infected.

So far in August, eight people with COVID-19 have died while isolating at home in Tokyo, according to the metropolitan government. Between January and June, 84 COVID-19 patients died at home nationwide, public broadcaster NHK reported Tuesday.

Prefectural governments are creating their own approaches based on the central government’s new policy. Osaka Gov. Hirofumi Yoshimura said Tuesday that the prefecture will continue to hospitalize mild and moderate COVID-19 patients.

Crowds on the streets of Tokyo's Harajuku district on Saturday | REUTERS
Crowds on the streets of Tokyo’s Harajuku district on Saturday | REUTERS

Based on their condition, patients are categorized as severe, moderate II (who can’t breathe sufficiently on their own), moderate I (who have difficulty breathing and have signs of pneumonia), mild or asymptomatic.

While some people who test positive for COVID-19 are hospitalized, others are sent to a temporary quarantine facility — repurposed hotels — or asked to isolate at home. The shift in policy announced this week aims to divert moderate patients away from hospitals and toward the other two options in an attempt to procure more space for those with severe symptoms.

Experts are concerned that public health centers — which act as intermediaries between infected people seeking treatment and hospitals accepting coronavirus patients — will be inundated with demands for treatment.

Not only that, a reduction in moderate and mild patients doesn’t necessarily mean a hospital can take in more severely ill patients, owing to differences in equipment, facilities and the amount of staff trained in providing treatments such as artificial ventilation and lung oxygenation.

“For all the criticism and opposition, the policy shift was probably inevitable, albeit long overdue,” said Junko Yamaguchi, deputy director of Itabashi Hospital’s Division of Emergency and Critical Care Medicine.

“It’s undeniable that we’re running out of hospital beds,” Yamaguchi said. “That said, mild patients can suddenly become worse and, without providing better logistical support to public health centers, sending pulse oximeters to households could spread fear and confusion.”

The metropolitan government plans to distribute pulse oximeters to people who test positive but are not experiencing symptoms that require hospital treatment. The devices had been delivered to infected individuals awaiting hospitalization or admission to a temporary housing facility, but now they will also be delivered to individuals asked to isolate at home.

The streets in Tokyo's Akiharaba district on Wednesday | AFP-JIJI
The streets in Tokyo’s Akiharaba district on Wednesday | AFP-JIJI

The delta variant — which is thought to be twice as contagious as the original strain of the coronavirus — is estimated to make up 90% of new cases in the Kanto region, the health ministry’s advisory board said Wednesday.

As of Thursday morning, about 3,400 of the capital’s 5,967 hospital beds dedicated to COVID-19 were occupied, and more than 14,700 individuals were isolating at their homes after testing positive. Both figures are records for the city.

The virus is spreading fastest and most broadly among people in their 20s and 30s, but those in their 40s and 50s account for the biggest slice of hospitalized patients at 44%.

On Thursday, experts advising the Tokyo Metropolitan Government said infections among older people are beginning to increase, and warned of a delayed uptick in infections among older residents, for whom COVID-19 is far more often life-threatening.

“The virus is spreading to a degree we’ve never seen before,” said Norio Ohmagari, director of the Disease Control and Prevention Center at the National Center for Global Health and Medicine and a top adviser to the Tokyo Metropolitan Government.

The virus is spreading rapidly in other parts of the country as well.

The central government announced Thursday evening that quasi-emergency measures active in five prefectures will be expanded from Sunday through Aug. 31 to eight more. The list now includes Fukushima, Ibaraki, Tochigi, Gunma, Shizuoka, Aichi, Shiga, Kumamoto, Hokkaido, Ishikawa, Hyogo, Kyoto and Fukuoka.

On Thursday, Fukuoka requested that the government declare a state of emergency in the prefecture.

In late July, the state of emergency active in Tokyo and Okinawa Prefecture until Aug. 22 was extended until the end of August and expanded to Kanagawa, Chiba, Saitama and Osaka prefectures.

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