With a rise in COVID-19 cases this summer having led to the deaths of patients who were isolating at home without medical support due to a lack of hospital capacity, some doctors have begun to call more aggressively for a downgrading of the disease’s classification — to one on par with influenza — to enable the prompt treatment of suspected patients without them having to go through cumbersome procedures just to get a doctor’s attention.
Given concerns that the virus would spread further if suspected COVID-19 patients with a fever or other symptoms crowded hospitals, such individuals currently have to call their home doctors or counseling centers for those with fevers to see if they’re deemed worthy of being given a PCR test.
Public health centers, which are tasked with various duties in the fight against the pandemic, are currently swamped with the processing of new cases, and in some instances it takes as long as a week before an infected patient gets clearance to receive necessary medical treatment from a designated hospital, some doctors say.
Against this background, there are increasing calls for the government to downgrade COVID-19’s classification in order to ease the burden on public health centers and potentially save more lives by speeding up treatment.
The debate on whether to downgrade the disease, which is currently classified alongside some of the most serious infectious diseases, to a less-threatening Class V disease has been gaining momentum as the government mulls its pandemic exit strategy. Health minister Norihisa Tamura signaled in July that the government would actively look into the issue, taking into account progress in the vaccine rollout, new infection figures and the number of hospital beds.
In Japan, infectious diseases are placed into one of eight classifications: Class I through Class V and three others for those that have the potential to affect the lives of people through their rapid spread — novel influenza infections, designated infectious diseases, which are identified as such by the Cabinet and require measures equivalent to Category III and above, and new infectious diseases. Class I diseases, such as Ebola, are considered the most dangerous, while Class II includes tuberculosis.
The coronavirus is currently classified as a new influenza infection, entailing some countermeasures that are on par with those for Classes I and II. It allows the government to impose strict countermeasures, such as ordering infected patients to be quarantined or admitted to designated hospitals, and restrictions on work to prevent further spread of the disease. The classification also empowers the government to ask people to refrain from unnecessary outings, a measure that is not taken even for Class I diseases.
But the classification has been putting a heavy burden on public health centers, as it means they are put in charge of contact tracing, checking up on patients isolating at home — over 100,000 during the fifth wave’s peak last month — and coordinating the hospitalization of patients. With the delta variant having driven nationwide daily new cases to a record of more than 25,000 late last month, there has also been an increase in the number of patients isolating at home who have seen their condition worsen rapidly, with some even dying from the disease.
The proposed change to a Class V disease would not mean that the coronavirus has become less threatening. Rather, the revision would allow suspected patients to get treatment at any hospital using health insurance at their own cost, rather than having all the medical fees paid at the public expense. Tens of thousands of people now isolating at home could receive treatment there from a doctor, instead of going without medical support from doctors and having to rely only on remote monitoring by health centers, as existing rules limit who can receive medical care and where.
In addition, current tough measures taken by the government and health centers would no longer be in place and restraints on social activities would be lifted.
Advocates of the change cite difficulties in accessing the health care system in a timely manner as one reason behind increased cases of serious disease or even death.
One of the most vocal proponents for the change is Dr. Kazuhiro Nagao, head of Nagao Clinic in Hyogo Prefecture. He has argued on his website that 90% of medical institutions are refusing to see patients with a fever, as they’re afraid of getting a two-week business suspension order from a public health center for causing a cluster of infections. The change would allow hospitals to promptly provide medical services to COVID-19 patients, reducing the number of severe cases and deaths, he says.
Masahiro Kami, executive director of the Medical Governance Research Institute, a Tokyo-based nongovernmental organization, says that convoluted rules specified in the infectious disease law, even on who can get a PCR test, deprive patients of the ability to promptly get medical treatment. Because the coronavirus is airborne, contact-tracing and the scouring for infection routes conducted by health centers is in effect meaningless, he said. But because it’s legally required, no changes can be made, he added.
“A general practice can do anything if a patient and a doctor reach an agreement, regardless of whether they are paying via health insurance or not,” Kami said. “But in the case of the coronavirus, rules that make it difficult to get even a PCR test until four days after the onset of symptoms are depriving patients of the right to get medical treatment.”
If it’s made a Class V disease, suspected patients would need to make copayments alongside their health insurance to take a PCR test or receive various drugs and treatments, which could be costly. The price of an “antibody cocktail,” the nation’s first approved drug for mildly and moderately ill COVID-19 cases who aren’t hospitalized, for example, has not been released publicly, but it is said to cost around ¥250,000 per dose overseas.
Many experts acknowledge that while the downgrade is something for the government to consider as it mulls its exit strategy, the change is unlikely to occur in the foreseeable future. Opponents say relaxing curbs on social activities and lifting orders on self-isolation and hospitalization might spur a new wave of infections, which could possibly lead to more severe cases or deaths.
Masakazu Uematsu, a doctor at the University of Tokyo Hospital, has said on YouTube that downgrading the classification is a “reckless” argument, considering that Class V is the weakest of the five main classifications and comes only with a requirement that doctors report the case to the authorities within seven days of diagnosis. In comparison, the positive infection of a Class IV infectious disease would require immediate reporting.
“If you don’t hospitalize patients, the elderly and others would develop serious symptoms after all and flood medical institutions,” he said.
But some doctors say that the discussions should focus on whether the change could lead to a better environment for people as a whole.
In the meantime, with the winter’s wave of infections projected to start in around late October and peak early next January, based on the previous year’s pattern, the government and municipalities should start by collectively working to increase hospital beds for COVID-19 patients, Kami added.
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