New cases are soaring, hospital beds are filling up and the coronavirus outbreak in Japan continues to worsen, but the intended impact of Prime Minister Yoshihide Suga’s controversial attempt to alleviate pressure on the country’s health care system has yet to materialize.
Suga announced earlier this month that, in principle, more COVID-19 patients with mild or in some cases moderate symptoms will be asked to recover at home to streamline the hospitalization of those with severely ill symptoms or pre-existing conditions.
The major policy shift sparked a sizable backlash from experts, the media and Suga’s own political party for circumventing the central government’s infectious disease advisers. And it triggered fears among the public that, if the condition of a patient isolating at home suddenly worsens, medical personnel won’t be able to reach them in time.
But, for all the criticism and controversy, the very hospitals meant to be relieved by the policy shift have seen little improvement.
“The situation on the ground has barely changed,” said Tadateru Takayama, director of Itabashi Hospital’s Department of General Medicine.
Itabashi Hospital — Nihon University’s teaching hospital located in Tokyo’s Itabashi Ward — has six beds for COVID-19 patients in need of intensive care. Another 50 beds are for all other virus patients, including those suffering from mild or moderate symptoms, those suspected of infection but awaiting test results and outgoing patients who are recovering from severe symptoms but no longer need intensive treatment.
All six of the beds for severely ill patients have been almost continuously occupied for the past two weeks, Takayama said.
“As soon as one patient is discharged, another is admitted,” he said. “What hospitals need right now is a better system for outgoing patients who need to isolate in a temporary facility or be sent home to quarantine.”
While the fifth wave of the pandemic began in Japan as a viral rebound in Tokyo and its surrounding prefectures, in recent weeks the country has seen a nationwide, record-breaking surge in daily cases, severely ill patients, hospital occupancy and infected patients isolating in their homes.
In response to Suga’s announcement earlier this month, critics pointed out that patients with mild COVID-19 can worsen suddenly and unexpectedly, and the shift could make it logistically difficult for infected people to receive treatment.
Not only that, a reduction in patients with mild and moderate illness doesn’t necessarily mean a hospital can take in more severely ill patients, owing to differences in the equipment, facilities and specialist staff needed to provide treatment, which can include artificial ventilation and lung oxygenation.
The day after Suga’s remarks triggered concerns that only severely ill patients or those with pre-existing conditions would be hospitalized, health minister Norihisa Tamura hastily clarified that “everyone who needs to be hospitalized will be hospitalized.”
But hospitals had already been under heavy strain for weeks by the time of the abrupt policy shift.
“The reality is that not everyone who needs to be hospitalized is promptly admitted, if at all,” Takayama said.
Now, as the outbreak spreads nationwide, the country’s health care system is increasingly inundated with patients in various conditions, and the overflow is causing problems too.
Since the second half of 2020, larger cities have sent mild or asymptomatic patients to empty hotels repurposed as temporary quarantine facilities. However, staff shortages limit the number they can admit, and more patients are being asked to isolate at home, where they risk transmitting the virus to those they live with.
Just in the past week, several prefectures have seen the number of patients isolating at home surge to unprecedented levels.
Experts are concerned that public health centers — which act as intermediaries between infected people seeking treatment and hospitals accepting coronavirus patients — will be overwhelmed if the trend continues.
The central government’s Fire and Disaster Management Agency said last week that between Aug. 2 and 8 there were 2,897 reports of first responders facing difficulty in finding a medical facility willing to take in a patient. Of those cases, 1,387 — or 48% — were individuals thought to be infected with COVID-19, which is the first time the agency has seen more than a thousand such cases.
Since late July, there have been growing reports of infected individuals in Tokyo who died while isolating at home, or were forced to find treatment outside the capital after they couldn’t find a hospital that was willing or able to take them in. Seven people have died while quarantining since the fifth wave of the pandemic abruptly began to escalate in late July.
“I know people isolating at home right now must feel a great deal of concern,” Suga said during a news conference Tuesday evening.
Suga pledged to open more quarantine facilities, raise subsidies for nurses providing at-home treatment to virus patients and hasten the distribution to hospitals and quarantine facilities of a COVID-19 “antibody cocktail” that is “highly effective in reducing the risk of developing severe symptoms.”
The prime minister also announced Tuesday that the country’s state of emergency will be expanded from six prefectures to 13, and extended from the end of August until Sept. 12.
But pandemic fatigue, the waning impact of voluntary measures and an increasingly dysfunctional health care system are casting doubt upon the effectiveness of the country’s response in stemming the current wave of infections.
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