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A lack of human resources and the delta variant could dent Japan’s highly successful track record when it comes to treating severe COVID-19 cases, doctors say.

On Friday, there were a record 2,060 patients with severe symptoms in the country, marking an all-time high for the 16th straight day. Such patients need to be admitted to intensive care units for treatment, including being put on ventilators or an extracorporeal membrane oxygenation (ECMO) machines.

Japan has around 1,400 ECMO machines, by far the most of the world. The state-of-the-art equipment is used as a last resort to remedy serious lung and heart problems by running the blood of patients with respiratory or cardiac failure through an artificial lung. It has proven to be wildly successful in treating severe cases of COVID-19.

The nonprofit Japan ECMO network says the survival rate of patients treated with the machine has stood at 66% since the start of the COVID-19 pandemic, including a rate of 81% over the past four weeks. That gives Japan the world’s best record when it comes to treating serious COVID-19 cases, the nonprofit says.

The network, which offers a 24-hour hotline for severe COVID-19 patients and in some cases helps transfer patients to facilities where ECMO machines are available, estimates that roughly 1 in 6 patients who need respirators will also require ECMO treatment. But because the resource-intensive ECMO machines are also used for organ transplant recipients or patients with severe heart and lung issues, only a maximum of around 300 machines in Japan can be used to treat COVID-19 patients, experts say.

Compounding the issue is a lack of human resources. Japan had 2,127 intensive care physicians capable of using special equipment such as ECMO machines as of April 1, according to the Japanese Society of Intensive Care Medicine. That’s only a fraction of the number in Western countries such as the U.S. and Germany.

A total of 139 COVID-19 patients nationwide were receiving ECMO treatment as of Friday, roughly double the peak of the fourth wave in late May, according to ECMO network data. Two weeks ago, the number exceeded 100 for the first time since the start of the pandemic. Friday’s number has also risen nearly fourfold from a month earlier, with no signs of abating anytime soon.

Medical equipment, including extracorporeal membrane oxygenation (ECMO) machines, sit in the intensive care unit at Chiba University Hospital in the city of Chiba on Wednesday | BLOOMBERG
Medical equipment, including extracorporeal membrane oxygenation (ECMO) machines, sit in the intensive care unit at Chiba University Hospital in the city of Chiba on Wednesday | BLOOMBERG

The situation has become so dire that Masataka Inokuchi, vice president of the Tokyo Medical Association, warned on Thursday that if the current pace of new infections continues, the health care system could soon exceed its capacity. Lives will be lost that otherwise could be saved, he added.

As the fifth wave of cases continues, Shinhiro Takeda, head of Japan ECMO network, is worried that the surge in patients with severe symptoms could overwhelm the health care system despite good treatment results so far.

Hospitals in Tokyo “are so full of patients,” Takeda told reporters Friday. “ECMO becomes necessary when it’s clear we cannot save patients even with a respirator, but the current situation is that we cannot bring them to (ECMO-equipped) hospitals.”

Another recent trend has been the decline in the average age of patients using ECMO. At the onset of the outbreak in February last year, the average age of patients using ECMO was 70, but that figure has decreased to 50 so far this month, the ECMO network said.

Yuji Fujino, the head of the Japanese Society of Respiratory Care Medicine, said Friday that his hospital in Osaka was using a total of two ECMO machines on patients in their 20s.

The share of people under 50 requiring ECMO treatment has been increasing rapidly because of the impact of the more contagious delta variant and the high vaccination rate of older people, the ECMO network said.

A worker builds a partition wall inside the intensive care unit at Chiba University Hospital. | BLOOMBERG
A worker builds a partition wall inside the intensive care unit at Chiba University Hospital. | BLOOMBERG

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