The nationwide state of emergency has been extended until the end of May, but any decision on lifting restrictions on people's movements and activities will hinge on two main factors: the extent of the spread of coronavirus infections, and ensuring the medical system is capable of dealing with the outbreak. Maintaining a diagnosis and treatment system that has some leeway to accept more patients will be crucial for regaining a degree of normalcy in people's daily lives. The key to that rests on prioritizing hospitals capable of accepting patients with moderate cases of coronavirus.
A patient with a moderate case of coronavirus has difficulty breathing and must stay in hospital to receive oxygen treatment, but does not need a ventilator. This is more serious than a mild case, in which the patient has symptoms similar to a common cold and can recuperate at an accommodation facility. It appears that about 80% of coronavirus infections are mild cases, about 20% are moderate, and a small percentage are severe.
At a press conference on April 30, the Tokyo Medical Association emphasized the necessity of setting aside hospitals for coronavirus patients and concentrating on accepting patients with moderate cases. This would allow advanced medical institutions to focus on acute cases and prevent a scenario in which multiple hospitals are forced to turn away patients due to an explosive increase in moderate coronavirus cases. The central government and the Tokyo metropolitan government have floated a plan to set up a temporary medical facility for patients with moderate cases.
Establishing medical facilities able to take in patients with moderate cases of the virus has been considered an important step for some time. In a letter dated March 19, the Health, Labor and Welfare Ministry even called on prefectural governments to set up such facilities.
However, this process has not always gone smoothly in urban areas, where coronavirus infections spread quickly. The number of infections surged in Tokyo from late March through April, and authorities had their hands full as they scrambled to find enough hospital beds for patients. As a result, many hospitals ended up taking in some mild cases.
The Tokyo government even requested help from university hospitals that treat many patients suffering from serious cases of other diseases, and hospitals specializing in cancer treatment. This was because the National Center for Global Health and Medicine, a medical institution designated to treat infectious diseases, the Self-Defense Forces Central Hospital, the Tokyo Metropolitan Komagome Hospital and other hospitals were all stretched to breaking point due to the sharp increase in COVID-19 patients.
In April, preparations got underway to enable even the Cancer Institute Hospital of JFCR to accept coronavirus patients. Although the hospital has yet to take in any such patients, Director Emeritus Toshiharu Yamaguchi said: "Even if coronavirus infections spread, we can't stop looking after patients with cancer or providing other emergency medical care. We should avoid spreading out coronavirus patients among hospitals responsible for handling these other diseases."
Prefectural governments have launched so-called coordination headquarters that seek hospitals able to accept patients confirmed to have the coronavirus. However, this has not always been easy. The Osaka government quickly set up a "follow-up center" to coordinate patient distribution, but this was stretched to the limit when infection numbers spiked in April. "We called every hospital we could think of, and it was a relief when we finally found one able to help," an official of the center told The Yomiuri Shimbun.
Finding hospitals willing to accept moderate cases proved especially difficult, and not only because they greatly outnumbered severe cases. "It seems hospitals were reluctant to take in these patients because they didn't know when they would develop into severe cases," the official said. The Osaka government plans to establish a medical facility this month that will focus on treating moderate coronavirus cases.
In recent days, the number of infections has been trending downward even in major urban areas, and Aichi and Fukuoka prefectures have reported only a handful of new cases. Even so, patients can be hospitalized for two or three weeks, so medical facilities caring for them remain strained. Forecasts indicate that a second wave of infections could occur, so shoring up and improving the medical care framework is an urgent task. In regions that have fragile medical care systems in the first place, a jump in infections before preparations are made could quickly cause these systems to collapse.
Recommendations announced by a government expert panel on Monday included calls for preemptive countermeasures, such as clarifying the division of roles among hospitals.
"Estimating the harm that could be done is crucial," said International University of Health and Welfare Prof. Koji Wada, a member of the panel. "I want prefectural governments to estimate the number of patients at each level of severity, determine the number of hospital beds they can use, and consider concrete plans about what to do about any looming shortages."
Kanagawa Prefecture's approach to treating patients with moderate coronavirus symptoms offers some useful insights other prefectures could adopt.
Kanagawa was quick to set up medical facilities that prioritized treating these moderate cases. This was prompted by the outbreak of coronavirus infections that erupted on the Diamond Princess cruise ship, which docked at Yokohama Port.
"Treating moderate cases requires a lot of work, and there are many of them," said Hideaki Anan, a doctor who is in chage of the prefecture's medical crisis countermeasures and orchestrated its approach to the outbreak. "Swiftly preparing facilities capable of taking in these patients makes it possible to efficiently allocate treatment for them."
The so-called Kanagawa model is highlighted by the establishment of medical facilities that focus on treating patients with moderate cases of coronavirus infection. Initially, three such facilities were established, but this was later increased to 11. Patients with severe cases are handled by university hospitals and other advanced medical facilities.
One problem arose from the lack of clarity over where to send people suspected of having, but not yet confirmed to have, the virus. The Kanagawa Cardiovascular and Respiratory Center, a facility in Yokohama, secured 40 beds for moderate cases, but there are usually two to six suspected patients being treated there. These are pneumonia cases referred to the center before the patient undergoes a PCR test that checks for the coronavirus.
Diagnosing and treating suspected cases requires the same protective steps as positive cases, and they cannot stay in the same room as either patients that test positive or those that test negative. It currently takes one or two days for test results to come through, so the center has no option but to keep one ward with seven individual rooms set aside for patients suspected of having the virus.
"We are coping for now, but if the patient numbers increase, we'll have to keep them in another ward," said Michihiko Tajiri, head of the center.
To combat this problem, the prefectural government has set up cooperating medical facilities that will accept suspected coronavirus cases. It also plans to accelerate the PCR testing process, such as by establishing common testing areas that will be staffed by a local medical association and other entities.
Read more from The Japan News at https://japannews.yomiuri.co.jp/
