Temporary COVID-19 wards helpful but encounter many challenges in Japan

A temporary prefab ward set up for seriously ill COVID-19 patients in Sumiyoshi Ward, Osaka, is seen on Feb. 25. The Yomiuri Shimbun

TOKYO — A number of temporary medical care wards have been set up across Japan to accept COVID-19 patients amid the pandemic, but the challenge now is how to operate them efficiently and effectively.

The Osaka prefectural government set up a temporary prefab ward in the parking lot of Osaka General Medical Center, which is under the Osaka Prefectural Hospital Organization in Sumiyoshi Ward and has been accepting seriously ill COVID-19 patients since Dec. 15 last year.

There are a total of 30 beds, all equipped with respirators. Designed specifically for COVID-19 patients, there are no partitions between the beds, which are arranged on one floor in an effort to effectively treat multiple patients. This facility accounts for more than 10% of the 221 beds the prefecture has secured for seriously ill patients.

“I think it would have been very difficult to allocate patients without this facility,” said Rumiko Asada, who heads the prefecture’s follow-up center to coordinate hospitalization of infected patients. In Osaka Prefecture, the occupancy rate of beds for patients with serious symptoms reached about 80% in January.

The facility had a lot of problems to solve at the start. About 130 nurses were needed to fully operate the beds, and the prefectural government asked medical institutions and nursing associations for cooperation. But as of early December, it had only been able to solicit about 50 nurses, and Gov. Hirofumi Yoshimura had no choice but to ask the National Governors’ Association and the Self-Defense Forces to dispatch nurses to the prefecture.

Most of the staff at the facility were hired on temporary contracts. Therefore, turnover was high, and lot of time was needed to train them. Under these circumstances, only three beds were available when the facility opened. It was only in February when all 30 beds became available. By that time infections had begun to subside.

Learning from this experience, the Osaka prefectural government is considering the introduction of a new system, in which more than one such temporary facilities will be set up, although each smaller than the one in Sumiyoshi Ward. The prefectural government will support hospitals in their construction and operation of the facilities instead of being directly involved in the operations. The prefectural government plans to subsidize the hospitals for the initial cost of about ¥50 million per bed, and has allocated to this expense ¥1.5 billion in the budget for new fiscal year.

Prefectural governments can set up temporary hospitals based on the special measures law to cope with new strains of influenza as well as the Medical Care Law. Under the special measures law, regulations such as the Fire Service Law and the Building Standards Law do not apply, and that allows hospital operators to increase beds without hindrance.

Seven prefectures, including Hokkaido and Kanagawa, opened temporary facilities during the state of emergency in April to May last year.

Kanagawa Prefecture, for example, installed five prefab buildings on private land in Kamakura to secure 180 beds for COVID-19 patients. It commissioned Medical Corporation Okinawa Tokushukai to carry out their operation and maintenance, and the entity recruited about 110 doctors and nurses to treat more than 1,000 patients so far.

“Role-sharing between the administration and the medical corporation went well,” a prefectural government official said. “At the time of the third outbreak, however, we struggled to hire more staff to cope with the number of patients. Our task for the future is how to make an appropriate adjustment in accordance with the state of infections.”

Law revision

Some temporary facilities are struggling to accept patients to the extent that was expected.

Last year, the Nippon Foundation turned a Tokyo gymnasium intended for Paralympic events into a facility for COVID-19 patients. In addition to securing 100 partitioned beds, it set up a prefab building in a nearby parking lot to accommodate about 150 people for recuperation. The foundation offered all of this to Tokyo for free. However, the gymnasium was never used because there were a lot of problems in terms of infection control and privacy, and will be returned to its intended use for the Paralympics in April. As of Feb. 24, only about 340 people had used the prefab.

“Hotels have been satisfying the demand, and there has been little need for the temporary facility,” an official of the foundation said.

On Jan. 7, the Chiba prefectural government decided to use a former hospital ward of the Chiba Cancer Center to accept COVID-19 patients. However, it took a long time to set up, delaying the start of operations until Feb. 5, when the number of infections had passed its peak.

Before the revision, the special measures law stipulated that temporary facilities should be built in a state of emergency. However, construction takes time in terms of picking locations and securing manpower. Given this, the revised law, which came into effect on Feb. 13, includes provisions for them to be set up even before a state of emergency is declared.

To help hospitals recruit medical staff, the Health, Labor and Welfare Ministry decided in December to provide subsidies of up to ¥15,100 per hour for a doctor and ¥5,520 per hour for a nurse when hospitals dispatch them to temporary facilities.

International University of Health and Welfare Prof. Koji Wada, who specializes in public hygiene, said, “To prepare for the next epidemic, the central and local governments need to examine how each region operates temporary facilities and decide how to position them in community health care.”