Coronavirus: Fears rise of collapse in healthcare as Covid-19 cases top 10,000 in Japan

TOKYO – The number of Covid-19 cases in Japan topped 10,000 on Saturday (April 18) as the country hunkered down for its first weekend under a nationwide state of emergency, haunted by the specter of a breakdown of the healthcare system.

People stayed home in many areas, heeding the call by Prime Minister Shinzo Abe on Friday, who said a blanket emergency decree was necessary to invoke a sense of urgency to prevent the spread of Covid-19 across porous city borders.

At a nationally-televised news conference, he apologized to medical front-line workers for Japan’s inability to secure enough medical equipment such as N95 masks, ventilators and personal protective equipment, which has led to fears of an institutional collapse.

Pledges of mask donations to Japan have come from overseas, including from Taiwan and Vietnam. Japanese companies have also joined the Covid-19 fight.

Carmaker Nissan is making face shields, cosmetics maker Shiseido is producing hand sanitizer, while electronics giant Sony is making ventilators. Textile maker Teijin is now making medical gowns, while beverage maker Suntory is offering hospitals free alcohol disinfectants.

This comes as the Health Ministry has asked doctors to sterilize and reuse their N95 masks amid the shortage, while the city of Osaka is collecting unused plastic raincoats to re-purpose into medical gowns.

Japan’s “cluster-based” testing approach has helped to keep a lid on group infections at one location quickly, but it has not been able to curb the spread of the disease throughout the country.

It has since relaxed testing requirements and expanded screening in a policy U-turn that is a tacit acknowledgement that its approach has been toothless against an invisible threat, given the surge in cases with no known routes of transmission.

This is one reason behind the recent surge in numbers across the country, including Tokyo which registered 181 cases on Saturday. There were 10,150 cases as of 6pm on Saturday, about twice the number nine days ago.

This means Japan is well-poised to overtake South Korea in confirmed cases in a matter of days. Its neighbor is now seeing the number of new cases taper off, having tested widely through such means as drive-through screening right from the outbreak’s onset.

On Saturday, South Korea confirmed just 18 new Covid-19 cases, bringing total infections to 10,653.

Despite signs of more aggressive polymerase chain reaction (PCR) testing, Japan is still only screening at about half its national capacity of 12,000 tests daily.

Latest figures from the Health Ministry show that as of 12pm on Saturday, the country of 125.9 million has done tests for 111,325 people, with 4,953 of them newly-tested over the preceding 24-hour period.

This is less than half the testing capacity, even though Mr Abe had said earlier this month that Japan would boost its screening capacity to 20,000 tests a day.

There are multiple reasons behind the reluctance to test more widely.

Until recently, sclerotic bureaucracy mandated that all infectious disease patients be given a hospital bed, though the lack of beds has forced a belated revision of the law to allow recovery at home or hotels.

Tests are also not readily available for everybody, done only if a doctor deems them necessary, thus making it difficult to detect Covid-19 cases that manifest in mild symptoms.

And there is the crippling manpower shortage at hospitals, which led the Japanese Association for Acute Medicine and the Japanese Society for Emergency Medicine to say in a joint statement on Tuesday (April 14): “The first sign of the collapse of medical care is the collapse of the emergency medical system, which has already happened.”

The statement noted that some hospitals were so overstretched that they have had to reject patients seeking treatment for other urgent illnesses like strokes and heart attacks.

But the unfurling crisis has led local medical associations to step up to the plate.
General practitioners in Suginami ward in Tokyo have volunteered to take test samples to reduce the burden on their colleagues at large hospitals.

Chiba prefecture has rolled out drive-through testing after the green light was given by the Health Ministry on Wednesday (April 15). More prefectures may follow suit.

“With help from regional medical associations, we will set up testing centers. If home doctors have decided testing is necessary, test samples are taken at these centers and sent to private inspection firms,” Mr Abe said on Friday. “This will lessen the burden on public health centers.”