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Prime Minister Yoshihide Suga on Monday unveiled a revised policy for treating COVID-19 patients, reclassifying who would be admitted to hospital, following an unprecedented surge in cases that has seen national daily case numbers exceed 10,000.

However, the public was upset by the shift, as it gave the impression that only patients experiencing severe symptoms that require intensive care could be hospitalized, while those classified as having moderate symptoms would be forced to stay at home even if they had pneumonia and needed oxygen.

The government later clarified that most patients with moderate symptoms will be admitted to hospitals, as even some ruling party lawmakers demanded the guidelines be scrapped. Still, the administration’s inability to get its message across to the public and its failure to notify lawmakers and public health experts in advance generated confusion, frustration and apprehension.

Here is an explanation of what happened, what the policy change means and how it will be implemented.

What was the hospitalization policy before the announcement?

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 have respiratory failure and need to receive oxygen. Severe illness, meanwhile, indicates the patient has severe pneumonia and needs to be admitted to an intensive care unit and receive treatment such as being put on a ventilator or extracorporeal membrane oxygenation machine.

Until the policy shift, in general a broader range of patients were admitted to hospital, including those who were considered to have a high risk of becoming severely ill. Asymptomatic patients and those who had mild symptoms — a cough and a high fever but no signs of pneumonia or difficulty breathing — were sent to hotels, and they were only allowed to quarantine at home under extenuating circumstances.

Prime Minister Yoshihide Suga attends a news conference on the response to the COVID-19 pandemic, in Tokyo on July 30. | REUTERS
Prime Minister Yoshihide Suga attends a news conference on the response to the COVID-19 pandemic, in Tokyo on July 30. | REUTERS

What prompted the changes?

The central government said there were a variety of factors that led to the policy shift. The more contagious delta variant is driving a dramatic increase in the number of new cases, while the number of severely ill patients — mostly those in their 40s and 50s, an age group that has not been vaccinated to the same extent as those age 65 or older — has begun to trend upward. In addition, hospitals are also under increasing strain from factors not related to COVID-19, such as heatstroke.

To cope with the difficult circumstances, the government is hoping to allocate resources to patients with severe symptoms and thereby create enough capacity that patients whose conditions worsen can immediately go to hospital. The worst-case scenario the government hopes to avoid is that patients requiring immediate medical attention cannot be seen by doctors because hospital beds have been filled up.

What are the changes?

The phrases the prime minister used to describe who will be hospitalized were ambiguous: He said the government would ensure that it secures the necessary hospital beds so that “severely ill patients and those who are at high risk of becoming severely ill” can be admitted to hospital.

“Other patients,” he added, would stay at home and only be sent to hospital if their condition takes a turn for the worse.

To enable monitoring of stay-at-home patients, he said pulse oximeters would be distributed to them, and doctors in their districts could call on them at their house or see them online. Patients who recuperate at hotels would be limited to those who could transmit the virus to family members.

Why was there a backlash against it?

Suga’s equivocal remarks on hospitalization standards immediately caused confusion, especially over whether moderate patients would be admitted to hospital.

His phrase “severely ill patients and those who are at high risk of becoming severely ill” conveyed an impression that moderate patients would be forced to stay at home, since hospital beds are stretched thin. He did not explicitly state when, where and how the policy would be implemented.

Although as early as Tuesday one senior administration official had insisted, “No one has said moderate patients can’t be hospitalized,” the administration’s failure to make this point clear at an early stage amplified fear among the public.

Additionally, the Suga administration neglected to engage in prior consensus building with ruling party lawmakers and public health experts, including the government’s top medical adviser on COVID-19, Shigeru Omi. After getting angry calls from constituents, both opposition and ruling party members demanded the government retract the change.

Prime Minister Yoshihide Suga attends a news conference with Shigeru Omi, the government's top coronavirus disease adviser, in Tokyo on July 30. | REUTERS
Prime Minister Yoshihide Suga attends a news conference with Shigeru Omi, the government’s top coronavirus disease adviser, in Tokyo on July 30. | REUTERS

What steps did the government take to clarify the policy shift?

By Tuesday afternoon, Suga had changed course and explained that “severely ill patients and those who are at high risk of becoming severely ill, including those with pre-existing conditions such as diabetes, and moderate patients who require oxygen inhalation” will be hospitalized regardless of symptoms.

Health minister Norihisa Tamura on Thursday affirmed that moderate patients will “in principle” be treated at hospitals, while Suga said patients “who have a high risk of developing severe symptoms even if they don’t need oxygen inhalation” will be hospitalized.

However, the government has maintained its policy on treatment at hotels due to capacity problems.

The health ministry has noted that the guideline is for “areas where the number of infected is surging rapidly, such as Tokyo,” and is not a blanket nationwide advisory.

How will the policy be implemented?

It will be up to individual prefectures to decide how to follow the new guidelines.

Tokyo Gov. Yuriko Koike announced Thursday that the metropolitan government will prioritize the hospitalization of severely ill or high-risk COVID-19 patients following the shift. Meanwhile, Osaka Gov. Hirofumi Yoshimura said Wednesday that the prefecture would not adhere to the revised policy and will in general continue to admit patients who are not in a severe condition.

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