Japanese medical workers fear worst as coronavirus cases increase

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She is the primary nurse at a Saitama prefecture hospital and witnesses the pressure on an intensive care unit that treats seriously ill coronavirus patients.

“It is difficult because we think the patient is improving, but they will suddenly deteriorate,” she said.

The sharp increase prompted Prime Minister Shinzo Abe to extend the state of emergency in seven prefectures across the country. On Friday, he also pledged to supply medical equipment such as surgical masks, gowns and face shields to hospitals facing acute equipment shortages within a week.

Earlier this week, a team of government experts warned that Japan could have more than 400,000 coronavirus-related deaths if measures such as social isolation were not taken.

But most of the deaths, they warned, could result from a lack of fans.

The shortage of medical supplies became apparent this week when the mayor of Osaka, Ichiro Matsui, urged people to donate unused raincoats for health workers to use as personal protective equipment after being forced to wear trash bags.

Experts say medical shortages combined with relatively low test rates and Japan’s lack of telework arrangements threaten to create a potentially explosive spike in some cases.

Hospital clusters

While Japan was fighting the virus, clusters of infection are also forming in hospitals.

On April 12, 87 new cases of coronavirus were confirmed among doctors, nurses and patients hospitalized in a hospital in the Nakano district of Tokyo, according to the Tokyo metropolitan government. The increase in hospital clusters is of particular concern, due to the potential for additional community transmission.

“It is very important to keep tests away from clinics and hospitals,” said Kenji Shibuya, director of the Institute for Population Health at King’s College London and former head of health policy at the World Health Organization. (WHO).

“The lack of testing in Japan has led to widespread community infection. Hospital workers are not prepared because they do not know the patient’s infection status. “

Protective medical personnel organize an exercise for a coronavirus outbreak in a hospital February 7, 2020 in Tottori, Japan.

In Yokohama, paramedics Sho Hayakawa have seen a steady increase in the number of coronavirus patients in his hospital in recent weeks. As a father, he is afraid of bringing the virus home to his wife and toddler. “I worry about getting it, but I’m very careful,” he said.

Tokyo and Osaka have started to transfer hotels with mild symptoms of coronavirus to hotels to ease pressure on hospitals, and more prefectures are expected to follow suit soon. Hayakawa hopes that similar measures will be implemented in Yokohama.

Anesthesiologist Mio Shin said that after her colleague had to self-quarantine because he was working with a doctor at another hospital suspected of having a coronavirus, she took on the workload.

“Many doctors work shifts in different hospitals, so I had the impression that overcrowded clinics across Japan temporarily lost staff members as they involuntarily came into contact with people who did not know that ‘They had a coronavirus,’ said Shin.

She said that as more medical workers are needed to care for patients with coronavirus, there will be fewer people to take care of everything from cancer treatment and infertility to heart surgery and maternity care.

“I think people in Japan may not have realized how these absences will affect not only coronavirus treatments, but also everything from infertility and cancer treatments, as other medical workers are necessary to care for patients with coronavirus, “said Shin.

Cluster approach under review

Since Japan recorded its first cases of coronavirus in February, officials have focused on controlling infection clusters rather than the widespread tests seen in countries such as neighboring South Korea.

Japan only tested 90,000 people, compared to more than 513,000 in South Korea, which has 51 million inhabitants, compared to 126 million in Japan.

Experts suspect that the infection rate may already be much higher than official statistics reveal.

Japan’s approach to testing aims to identify patients in need of urgent medical care to avoid overwhelming hospitals. The country has the capacity to perform up to 12,000 tests a day, but in reality between 6,000 and 7,000, according to a spokesman for the Ministry of Health.

On Wednesday, the Tokyo Metropolitan Medical Association announced that it would establish up to 20 new test sites. Eiji Kusumi, a doctor specializing in infectious diseases, said he had already registered to administer them. “Once the tests are available for people with milder symptoms, we will likely see more cases of coronavirus,” he said.

The government has repeatedly stressed confidence in its testing strategy.

“We continue to focus on the Cluster approach because we do not yet see an overshoot in the coronavirus cases,” said a spokesperson for the Ministry of Health.

However, in some cases, Japan has not been able to trace the cause of the infection. When Tokyo recorded 197 new cases of coronavirus last Saturday in its second highest day jump, for example, authorities could not trace the source of 77% of the cases, according to the Tokyo metropolitan government.

“In big cities, it is very difficult to contain and track (infection) clusters because there will be different routes of transmission,” said Shibuya, the former WHO official.

To contain the clusters, health workers should interview people who test positive to find out how they got infected. However, since the coronavirus can survive on surfaces such as doorknobs and light switches, it is often difficult to determine how people got the virus, said Shibuya.

The focus on confining clusters worked in the early stages, when the infection rate was still low and localized, but as health systems are under increasing pressure, there is an urgent need to reassess this strategy, a- he added.

Need to move public messaging

Takayuki Miyazawa, a virologist at Kyoto University, said that to contain the virus, the government must be honest with people about what life will be like in the foreseeable future: in particular, a lot of social distancing and working remotely.

“Politicians give people too much hope and tell them to endure the state of emergency until May 6, when it should be lifted,” said Miyazawa. “So people think it will all be over by May 6, but they don’t understand the reality – that we have to keep guard against the virus. “

Head nurse Kajiwara said her hospital set up an intensive care unit dedicated to patients with coronavirus in early April, but with only six beds – half of which are occupied – Kajiwara fears that she will soon be overwhelmed.

Nationally, Japan has only seven intensive care beds per 100,000 people, compared to 35 per 100,000 in the United States, according to the Japanese Society of Intensive Care.

There is also concern about equipment shortages. According to information provided by the country’s Society of Respiratory Medicine, there are only 22,000 respirators for a population of over 126 million. At the end of February, 40% were in service.

Kajiwara said his team was doing everything they could to care for the patients, knowing that some would not and that they too were at risk of infection.

“I want to keep hope,” she said. “All of this experience made me think that we live so comfortably in Japan and take a lot for granted. I think people realize what they need and what is really important to them now. “

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