In one recent case, an ambulance carrying a man with a fever and difficulty breathing was rejected by 80 hospitals and forced to search for hours for a hospital in downtown Tokyo that would treat him. Another feverish man finally reached a hospital after paramedics unsuccessfully contacted 40 clinics.
Japan initially seemed to have controlled the outbreak by going after clusters of infections in specific places, usually enclosed spaces such as clubs, gyms and meeting venues. But the spread of virus outpaced this approach and most new cases are untraceable.
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 hospitalization 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 centers, 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 2,595. Most patients are still hospitalized, 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.
Medical workers are now reusing N95 masks and making their own face shields. The major city of Osaka has sought contributions of unused plastic raincoats for use as hazmat gowns. Abe has appealed to manufacturers to step up production of masks and gowns, ventilators and other supplies.
A government virus task force has warned that, in a worst-case scenario where no preventive measures were taken, more than 400,000 could die due to shortages of ventilators and other intensive care equipment.
Prime Minister Shinzo Abe has said the government has secured 15,000 ventilators and is getting support of Sony and Toyota Motor Corp. to produce more.
Japanese hospitals also lack ICUs, with only five per 100,000 people, compared to about 30 in Germany, 35 in the U.S. and 12 in Italy, said Osamu Nishida, head of the Japanese Society of Intensive Care Medicine.
Italy’s 10% mortality rate, compared to Germany’s 1%, 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.
Japan has been limiting testing for the coronavirus mainly because of rules requiring any patients to be hospitalized. Surging infections have prompted the Health Ministry to loosen those rules and move patients with milder symptoms to hotels to free up beds for those requiring more care.
Calls for social distancing have not worked well enough in crowded cities like Tokyo, experts say, with many people still commuting to offices in crowded trains even after the prime minister declared a state of emergency.
Officials fear people may travel during the upcoming “golden week” holiday in early May.
“From the medical field, we are hearing cries of desperation that lives that can be saved may no longer be possible," Abe said Friday. "I ask you all again, please refrain from going out.”
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