Japan's healthcare system in a state of emergency as Covid-19 cases soar
TOKYO – In the trail of the Tokyo 2020 Games, the Olympic motto of “Faster, higher and stronger” could have described the state of Covid-19 infections in Japan’s capital. Every day marks a new record high infection number as the more potent Delta variant quickly outpaces other strains. Nationwide, daily cases hit 20,000 for the first time last Friday (Aug 13).
The country recorded 19,955 cases on Tuesday (Aug 17) as the number of patients in intensive care or on life support rose to another new peak of 1,646.
Prime Minister Yoshihide Suga, who has drawn criticism for his government’s handling of the pandemic, admitted at a news conference on Tuesday that the ferocity of the spread of Covid-19, driven by the Delta variant, has been “completely unexpected”.
With Japan’s healthcare system on the brink of collapse, government hospitals are only admitting severe cases of Covid-19 infections – defined as those suffering from serious pneumonia or needing a ventilator to breathe.
Under this system of home isolation, the Suga administration is distributing pulse oximeters and asking doctors to make use of online consultations.
Those with oxygen levels above 96 per cent are deemed mild, those between 96 per cent and 93 per cent are considered moderate I, those below 93 per cent are classified as moderate II and those needing intensive care are rated as severe.
Since mid-August, more than 20,000 Covid-19 patients in Tokyo have been told to stay at home and monitor their blood oxygen levels. The number is more than eight times that of a month ago and double what it was at the beginning of August.
Ms Takano (not her real name), who is in her 40s, recounted her attempt two weeks ago to call an ambulance for her husband, whose blood oxygen levels had dropped to 94 per cent and who was feeling breathless.
“I was told by the public health centre that now they can dispatch ambulances only for cases with blood oxygen levels below 90 per cent, and that if I wanted medical attention for him I would have to find medical help on my own,” she said. Public health centres are municipal health centres that coordinate hospitalisations.
The next day, her husband’s oximeter reading dropped to 90 per cent, but when the ambulance arrived, his oxygen level had gone back up to 94 per cent.
“The medics said they had to follow the public health centre guidelines and couldn’t take him to the hospital,” she said.
She eventually managed to get a house call from a doctor, who arranged for an oxygen concentrator to be delivered to their home.
Dr Kazuma Tashiro, director of Hinata Home Care Clinic, said that he has been getting more such calls from Covid-19 patients than he can handle.
“Patients who show mild symptoms may suddenly turn severe, but this doesn’t mean that they can be hospitalised immediately. So, this is where we are needed. But considering the time needed to travel to the patient’s home, change into our personal protective equipment, examine the patient and do the necessary follow-up procedures, one doctor can attend to at most only five patients a day. At full strength, my clinic can attend to only 20 or 25 Covid-19 patients a day,” said Dr Tashiro, adding that he gets about 50 calls a day on average.
“And we still have other patients to treat.”
In another case, a man in his 30s living on his own had been recuperating at home for a week when his blood oxygen levels dropped suddenly to below 70 per cent. He was able to call for an ambulance, but had to wait inside the vehicle for six hours while the paramedics searched for an available hospital bed for him.
Dr Yutaka Ueki, assistant director of the Tokyo Medical and Dental University, said: “It is now not uncommon for Covid-19 patients to be made to wait hours inside an ambulance before a hospital that can accept them is located.”
It is not just hospital beds, but also ambulances that are in short supply.
According to the Fire and Disaster Management Agency, in the week beginning Aug 9, a record 3,361 calls for an ambulance could not be attended to throughout Japan, including cases not related to Covid-19. More than half of these were in Tokyo.
As patients are advised not to step out of their homes, some municipalities arrange for the delivery of food supplies, as well as a handbook on what to do when in self-isolation such as how to ventilate the room and prevent household transmissions.
A resident in Shinagawa ward who recovered from Covid-19 a month ago said he received three boxes of food supplies, including bottled mineral water, canned food, pasta, instant noodles, pre-packaged food, jelly, biscuits and snacks such as popcorn.
The man in his 30s told The Straits Times: “When I was really ill, I had a temperature of nearly 39 deg C and was too weak to even open the boxes. Looking at the items now, I would probably only be able to eat the jelly. But it’s helpful to get such food supplies. I’m grateful.”
Healthcare experts note that with the more infectious Delta variant – which makes up between 80 and 90 per cent of all cases in Tokyo – the policy of home isolation may result in more infections within families.
According to the Tokyo Disaster Prevention Information website, in the last week of July, over 60 per cent of infections were from household transmissions.
In Osaka last Friday, Governor Hirofumi Yoshimura announced that the prefecture would shift towards hotel isolation for hospital patients who are deemed to be in a stable condition, to make more beds available for severe cases.
Speaking to the press, Governor Yoshimura said that the move was also to prevent the development of severe cases as doctors and nurses would be on site at the hotels to attend to patients.
As of Aug 17, more than 8,700 patients were under home recuperation and 2,450 isolated at hotels in Osaka. In Tokyo, the numbers tally over 22,000 and 1,600 patients respectively.
The prefecture is also developing an online database that will allow the speedy dispatch of ambulances and allocation of beds to patients.
Osaka’s move reflects the lesson learnt from the death of 19 patients who were in isolation at home between March and May this year. One of them, whose condition suddenly turned severe, had spent nearly 47 hours waiting in an ambulance before getting medical attention.
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