As we enter the second month in a state of emergency, the COVID-19 crisis has exposed the fragility of Japan’s health care system. Its capacity has been strained to the brink of breaking down amid the surge of infections and patients with grave symptoms. The government needs to learn from the current pandemic to reassess the state of the nation’s medical services and rebuild their resiliency to crises.
Figures show that the increase in coronavirus infections nationwide is slowing — after apparently hitting a peak in mid-April — since the government declared the state of emergency a month ago. The call went out for people to maintain social distancing and stay home as much as possible, and for stores to shut down or curb their business hours. Nonetheless, experts have determined that the rate of new cases has not declined as fast as expected, and the government decided to maintain its request that social and economic activities remain curtailed through the end of May, though it left the door open to lifting the restrictions sooner if the situation is deemed to have improved.
A key reason cited in maintaining the state of emergency is fear of the medical system breaking down if COVID-19 cases were to continue increasing. Even with the recent slowdown in infections, new cases still outnumber patients recovering from the illness caused by the virus. Concern that the health care system could be overwhelmed is even greater in rural parts of the country, where the infrastructure is much more fragile.
The number of patients with serious symptoms requiring ventilators surged over the past month — although it seemingly hit a peak in late April — and those patients require intensive care for an extended period, straining the capacity of hospitals equipped to provide such care for COVID-19 patients. A study found that Japan lags far behind other advanced economies in terms of the number of hospital beds for intensive care — around seven per 100,000 population compared with 35 in the United States, 29 in Germany and 12 in Italy — and the current situation has underlined the shortage of both medical staff and equipment to cope with a pandemic like the COVID-19 outbreak.
The shortage of masks and protective gear for medical staff dealing with infectious diseases remains a serious problem. In the fight against COVID-19, more than 50 hospitals across the country have had in-house infections of doctors and nurses as well as patients. These hospitals have had to curtail their services and acceptance of new patients, putting further strain on other medical institutions in their areas.
Nearly four months after the first domestic infection was confirmed, the number of PCR tests for the new coronavirus performed remains limited. As of late April, the number of tests performed per 1,000 population stood at 1.8 — near the bottom among OECD member countries and far below the 29.7 in Italy, 25.1 in Germany and 11.7 in South Korea.
While Prime Minister Shinzo Abe said in early April that the daily test capacity would be increased to 20,000, the number of tests performed on any single day continues to be around 8,000. Given that roughly 80 percent of the people infected with the virus develop either no or only mild symptoms, the shortage of testing underscores the persistent concern that the nation has yet to grasp the entire picture of its COVID-19 infections.
A panel of infectious disease experts advising the government has acknowledged that Japan failed to beef up its system for mass testing against new viruses because it did not experience heavy fallout from epidemics in recent years such as those involving SARS and MERS.
Blame has been placed on the lack of manpower at local public health centers tasked with processing the PCR tests and the shortage of test kits as well as masks and protective gear. The staff at public health centers — whose numbers across the country have been nearly halved in the streamlining efforts since the 1990s — are reportedly overstretched in dealing with the current crisis.
Crises have a way of laying bare the vulnerabilities in a society’s basic infrastructure and functions. The COVID-19 pandemic is testing the resiliency of our nation’s health care system, and the shortcomings exposed by this crisis must be fixed promptly, both to survive the ongoing fight against this virus — which looks set to be an extended battle even after the state of emergency is lifted — and to prepare for the next crisis.
The Japan Times Editorial Board
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