Where Empty Hospitals Reject Coronavirus Patients
WHY YOU SHOULD CARE
Because the virus has revealed structural problems in Japan’s health care system.
By Leo Lewis, Kana Inagaki and Robin Harding
Dr. Fumiue Harada thought his job was done when he sent a dehydrated 81-year-old patient to the local hospital. Then a colleague called: The patient’s CT scan showed a risk of COVID-19. He needed to be transferred to a specialized hospital immediately.
So began Harada’s marathon search for a hospital willing to accept a suspected case of coronavirus. “It took seven hours, but I eventually found a hospital that would take him 40 kilometers away,” says Harada, who runs a primary care clinic in the east of Tokyo.
Patients have been turned away from dozens of hospitals, even though Japan, with fewer than 15,000 cases, has relatively few COVID-19 patients. It also has more hospital beds per head than any other country in the world: twice as many as France and almost five times as many as the United States.
From their point of view, if they take coronavirus patients they risk infections within the hospital.
Motohiro Sato, health economist, Hitotsubashi University
Japan has drawn close to the limit of its health capacity in recent weeks, forcing it to declare a state of emergency. The coronavirus outbreak has exposed long-standing structural problems caused by bureaucratic inflexibility and a plethora of small hospitals.
“We have a lot of beds, but a limited number equipped for critical care,” said Shigeru Omi, one of the doctors leading Japan’s fight against coronavirus, in a recent interview with the Financial Times.
Japan has approximately 6,000 intensive care beds, about the same number a head as the United Kingdom, but only a quarter of the U.S.
Health care in Japan is funded by universal public insurance but delivered largely by the private sector, says Motohiro Sato, a health economist at Hitotsubashi University in Tokyo. Many hospitals grew out of successful medical practices and have 100 to 200 beds, compared with 800 to 1,000 in a large university hospital.
These smaller hospitals do not have the resources to run an intensive care unit or maintain negative pressure rooms for infectious diseases. What’s more, accepting COVID-19 patients puts everything else they do in jeopardy. As a result, many hospitals refuse to treat them.
“You can offer them high compensation, but you can’t make them take corona patients,” says Sato. “From their point of view, if they take coronavirus patients they risk infections within the hospital.”
When Japanese hospitals treat a coronavirus patient, they can disinfect the ward and carry on almost immediately. But a COVID-19 infection caught in a hospital means 14 days of quarantine for medical staff during which it cannot accept new patients or emergency visits.
“There could be a risk that the hospital would collapse, so it takes a certain amount of courage to cooperate in taking care of coronavirus patients,” says Dr. Mitsuyoshi Urashima, a professor of molecular epidemiology at Jikei University School of Medicine. In a book published in 2013, Urashima warned about the vulnerability of Japan’s medical system to a pandemic.
The Jikei University Hospital treated passengers from the Diamond Princess cruise ship in February, but after suffering an in-hospital infection in April, it was forced to close to new patients. According to the Japanese Nursing Association, there have been infections inside 54 facilities across the country.
The other bureaucratic factor is the categorization of COVID-19 as a disease requiring compulsory hospitalization. In the early days of the outbreak, Japan’s infectious disease beds filled up with barely symptomatic patients. To be released, they needed two negative tests, so they sometimes occupied those beds for more than a month.
The owner of one of Japan’s largest hospital chains, who asked not to be named, says that coronavirus patients do not use any of his capacity of 5,000 beds because the beds are not classed as infectious disease ones. Many are empty because people are postponing nonessential treatment during the pandemic.
Dr. Hiroki Ohashi, who offers special morning hours at his clinic in Kawasaki for patients with COVID-19 symptoms, says: “The big hospitals nearby were getting drained, having to deal with a spike in the number of coronavirus patients that require hospitalization and those visiting with coronavirus-like symptoms.”
The moment of peak absurdity came a few weeks ago, says Ohashi, when the National Cancer Center began taking coronavirus patients. But, he says, the situation in the Tokyo area has begun to improve: “The peak was probably one or two weeks ago.”
Since then, Japan’s big cities have started renting out hotels to quarantine patients with light symptoms, relieving the pressure on hospitals, while the number of institutions accepting COVID-19 patients has increased.
“Another possibility is to allow more online treatment,” says Sato.
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