The outbreak has highlighted underlying weaknesses in medical care in Japan, which has long been praised for its high quality insurance system and reasonable costs. Apart from a general unwillingness to embrace social distancing, experts fault government incompetence and a widespread shortage of the protective gear and equipment medical workers need to do their jobs.
Japan lacks enough hospital beds, medical workers or equipment. Forcing hospitalisation of anyone 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 overall collapse of medicine, the Japanese Association for Acute Medicine and the Japanese Society for Emergency Medicine said in a joint statement.
By turning away patients, hospitals are putting an excessive burden on the limited number of advanced and critical emergency centres, the groups said.
“We can no longer carry out normal emergency medicine,” said Takeshi Shimazu, an Osaka University emergency doctor.
There are not enough protective gowns, masks and face shields, raising risks of infection for medical workers and making treatment of COVID-19 patients increasingly difficult, said Yoshitake Yokokura, who heads the Japan Medical Association.
In March, there were 931 cases of ambulances getting rejected by more than five hospitals or driving around for 20 minutes or longer to reach an emergency room, up from 700 in March last year. In the first 11 days of April, that rose to 830, the Tokyo Fire Department said.
Department official Hiroshi Tanoue said the number of cases surged largely because suspected coronavirus cases require isolation until test results arrive.
Infections in a number of hospitals have forced medical workers to self-isolate at home, worsening staff shortages.
Tokyo’s new cases started to spike in late March, the day after the Tokyo Olympics was postponed for a year. They’ve been rising at an accelerating pace for a current total of 2595. Most patients are still hospitalised, pushing treatment capacity to its limits.
With about 10,000 cases and 170 deaths, Japan’s situation is not as dire as New York City’s which has had more than 10,000 deaths, or Italy’s, with more than 21,000 fatalities, according to Johns Hopkins University.
But there are fears Japan’s outbreak could become much worse.
Doctors say they are stretched thin. Since it takes time for COVID-19 to be diagnosed, patients who show up at hospitals can unintentionally endanger those around them. On Thursday, the medical workers’ union demanded the government pay them high-risk allowances and provide sufficient protective gear.
Japanese hospitals also lack ICUs, with only five per 100,000 people, compared to about 30 in Germany, 35 in the US and 12 in Italy, said Osamu Nishida, head of the Japanese Society of Intensive Care Medicine.
Italy’s 10 per cent mortality rate, compared to Germany’s 1 per cent, is partly due to the shortage of ICU facilities, Nishida said. “Japan, with ICUs not even half of Italy’s, is expected to face a fatality overshoot very quickly,” he said.
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