New wave of infections threatens collapse of Japanese hospitals

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TOKYO –
Hospitals in Japan are increasingly refusing sick people as the country battles with coronavirus infections and its emergency medical system crashes.

In a recent case, an ambulance carrying a man suffering from fever and breathing difficulties was rejected by 80 hospitals and forced to seek hours at a hospital in downtown Tokyo to treat him. Another feverish man finally arrived at the hospital after paramedics unsuccessfully contacted 40 clinics.

The Japanese Association for Acute Medicine and the Japanese Society for Emergency Medicine say that many hospital emergency rooms refuse to treat people, including those who suffer from stroke, heart attack and external injuries.

Japan initially appeared to have brought the epidemic under control by attacking clusters of infections in specific locations, usually confined spaces such as clubs, gymnasiums and meeting places. But the spread of the virus has gone beyond this approach and most of the new cases are nowhere to be found.

The epidemic has exposed underlying weaknesses in medical care in Japan, which has long been praised for its high-quality insurance system and reasonable costs. In addition to a general reluctance to adopt social distance, experts denounce the government’s incompetence and a general shortage of protective gear and equipment that medical workers need to do their jobs.

Japan lacks hospital beds, medical personnel, and equipment. Forcing the hospitalization of anyone infected with the virus, even those with mild symptoms, has left hospitals overcrowded and understaffed.

The collapse of emergency medicine has already happened, a precursor to the general collapse of medicine, the Japanese Association of Acute Medicine and the Japanese Society of Emergency Medicine said in a joint statement. By refusing patients, hospitals are placing an excessive burden on the limited number of advanced and critical emergency centers, the groups said.

“We can no longer practice normal emergency medicine,” said Takeshi Shimazu, an emergency doctor at Osaka University.

There are not enough protective gowns, masks and face masks, which increases the risk of infection for medical workers and makes treatment of COVID-19 patients increasingly difficult, said Yoshitake Yokokura , who heads the Japan Medical Association.

In March, 931 ambulance cases were either dismissed by more than five hospitals or are traveling for 20 minutes or more to the emergency room, up from 700 in March of last year. In the first 11 days of April, that number rose to 830, said the Tokyo fire department. Department head Hiroshi Tanoue said the number of cases has increased largely because suspected cases of coronavirus have to be isolated until test results arrive.

Infections in a number of hospitals have forced medical workers to isolate themselves at home, compounding the staff shortage.

New Tokyo cases began to increase in late March, following the postponement of the year-long Tokyo Olympics. They have increased at an accelerated rate to a current total of 2,595. Most patients are still hospitalized, which pushes treatment capacity to its limits.

With about 10,000 cases and 170 deaths, the situation in Japan is not as serious as that of New York, which claimed more than 10,000 deaths, or that of Italy, with more than 21,000 deaths, according to Johns University. Hopkins.

But there is concern that the epidemic in Japan may worsen.

Doctors say they are stretched thin. As it takes a long time to diagnose COVID-19, patients who come to hospitals can inadvertently endanger those around them. On Thursday, the medical workers’ union demanded that the government pay them high-risk benefits and provide sufficient protective equipment.

Medical workers are now reusing N95 masks and making their own face shields. The big city of Osaka sought contributions from unused plastic raincoats for use as dresses of hazardous materials. Abe called on manufacturers to increase production of masks and gowns, ventilators and other supplies.

A government virus task force has warned that, in the worst-case scenario where no preventive action is taken, more than 400,000 people could die due to shortages of ventilators and other intensive care equipment.

Prime Minister Shinzo Abe said the government had secured 15,000 fans and was getting support from Sony and Toyota Motor Corp. to produce more.

Japanese hospitals also lack intensive care, with only five per 100,000 people, compared to around 30 in Germany, 35 in the United States and 12 in Italy, said Osamu Nishida, head of the Japanese Society of Critical Care Medicine.

The 10% death rate in Italy, compared to 1% in Germany, is partly due to the shortage of intensive care facilities, said Nishida. “Japan, with intensive care units not even representing half of the Italians, should soon face a deadly overrun,” he said.

Japan has limited coronavirus testing mainly due to rules requiring the hospitalization of all patients. The explosive infections prompted the Ministry of Health to relax these rules and move patients with milder symptoms to hotels to free beds for those who need more care.

Calls for social distancing have not worked well enough in crowded cities like Tokyo, experts say, with many people still going to offices in crowded trains even after Prime Minister declared the state of emergency.

Authorities fear that people will travel during the next “Golden Week” vacation in early May.

“In the medical field, we hear cries of desperation that lives that could be saved may no longer be possible,” said Abe on Friday. “I ask you once again, please refrain from going out.”

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