In preparation for the simultaneous spread of the novel coronavirus and influenza, the Health, Labor and Welfare Ministry plans to change the consultation and examination process for people suspected of being infected with the coronavirus by the end of October.
Currently, health centers and other consultation facilities refer suspected cases to specialist outpatient clinics. Going forward, people will be urged to first consult with a primary care doctor in their community before being tested.
The aim is to increase the number of facilities that can receive coronavirus patients so that specialist facilities can focus on treating severe cases. However, challenges such as a lack of preparation remain to be solved.
"We don't know if we can cope if the number of patients increases," said Hiroji Okawa, director of the Okawa Children and Family Clinic, in Ota Ward, Tokyo. "If in-hospital infections occurred, the affected facility may have to close its business immediately."
With deep roots in the local community, Okawa's clinic has many regular patients. During flu season, 30 to 40 people visit the clinic every day. The clinic has set up a private consultation room for suspected coronavirus cases, but Okawa said it is difficult to distinguish between coronavirus and influenza cases because the symptoms for both are similar.
According to Okawa, there is also a chronic shortage of N95 masks, which are essential for medical examinations. "Overcoming the shortage of protective equipment is indispensable for accepting more patients. We also need to have a system in place that will allow health centers to take responsibility for finding facilities for patients who test positive," he said.
Under the new system, people suspected of being infected with the coronavirus should first call their local medical institution for advice. If the medical institution is unable to conduct testing, the patient will be referred to another medical institution that can. If the test is positive, the health center will arrange for hospitalization and medical treatment.
Until recently, only those who were determined to be in need of medical attention after contacting a public health center or other consultation service were referred to specialist clinics and the list of such hospitals have not been publically disclosed.
This was to prevent people from rushing to such facilities and overwhelming them, but instead, consultation centers have been flooded with inquiries, causing a vicious circle in which congestion has occurred, which has in turn prevented people from accessing tests.
The shift to the new scheme is aimed at reducing the burden on public health centers by increasing the number of facilities that can deal with suspected cases, and also creating an environment in which specialist hospitals can focus on treating seriously ill patients. However, the burden on family doctors will inevitably increase as they need to create dedicated areas for patients who may be infected to prevent in-clinic infections.
The health ministry has proposed such ideas as several clinics follow a rotating schedule, and conducting treatment and examinations outdoors. The ministry has called for a system to be in place by the end of October that is tailored to local conditions, but it remains to be seen whether the transition can be made quickly.
The ministry has asked local governments to consider publicizing the names of medical facilities that can handle coronavirus cases so that people who think they are affected can receive consultations or medical treatment smoothly.
This month, the Kochi prefectural government set up a system to allow about 100 medical institutions to conduct tests. However, a clinic on the list reportedly saw a 20% drop in visitor numbers compared to the previous month after the names were disclosed.
"This will make it difficult to run a business," a doctor at the clinic said.
Meanwhile, the Mitaka city government in Tokyo is not disclosing the names of medical institutions.
"The only way to get through this is to share information within the medical community and avoid inconveniencing patients," a member of the city's medical association said.
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