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Calls grow for more testing for coronavirus, but obstacles remain

  • April 15, 2020
  • , The Asahi Shimbun , 3:57 p.m.
  • English Press

Health experts are urgently calling for an increase in Japan’s low rate of testing for the novel coronavirus, a system hampered by outdated equipment and a shortage of testing-capable medical institutions and technicians.

 

A day before Prime Minister Shinzo Abe declared a state of emergency in seven prefectures to deal with the outbreak on April 7, he indicated that efforts would be made so up to 20,000 polymerase chain reaction (PCR) tests could be conducted daily to confirm infections.

 

However, the number of tests actually being carried out is about 7,800 a day at most, despite the health ministry’s assertion on April 10 that various institutions in Japan could conduct up to 12,000 PCR tests daily.

 

PCR tests involve adding a test reagent to a throat swab or a sample from phlegm. A special device then multiplies the DNA sequencing to determine if it matches that of the new coronavirus.

 

However, a doctor’s judgment is needed before anyone can take the PCR test because individuals with cold-like symptoms may not have enough of the virus in their body to lead to a positive confirmation.

 

Earlier, when the number of confirmed infections in Japan was low, the main focus of the testing system was on tracking those who came in contact with infected individuals.

 

The initial government policy was to hospitalize everyone who tested positive for the coronavirus. But as hospital beds were quickly occupied by COVID-19 patients, it became increasingly difficult for doctors to order more PCR tests.

 

That is one reason the average daily number of tests in March was only about 1,700.

 

The low figure, especially in comparison to testing levels in other nations, led to criticism that Japan was not doing enough to halt the spread of the coronavirus.

 

Satoshi Kutsuna, a doctor at the National Center for Global Health and Medicine, noted that the rate of positive tests has surged with the recent rapid increase in coronavirus infections around the country.

 

Kutsuna said while only about 5 percent of those who received the PCR test at the center in late March tested positive, the ratio rose to about 20 percent in early April.

 

“There is a need for more tests in areas where the disease is spreading,” he said. “The number of test facilities should be increased to confirm those who have been infected.”

 

However, Japan has a limited number of medical institutions that can conduct the PCR test, and the small number of tests has been one factor behind cluster infections at some institutions.

 

Those infections were likely caused by patients who visited the institutions while being unaware they were carrying the virus.

 

Masaya Yamato, who heads the infectious diseases center at Rinku General Medical Center in Izumisano, Osaka Prefecture, said there was a need for increased testing because some infected people were being overlooked.

 

He agreed that the shortage of medical institutions that can decide on whether a PCR test is needed is a major reason behind the still low test numbers.

 

Another problem facing Japan in the pandemic is a lack of clinical technicians who have experience handling the PCR test.

 

Although relatively simple test kits have been developed in the West, many public health institutes in Japan continue to use old equipment that require a great deal of manual operation.

 

The Japanese Association of Medical Technologists says it has about 66,000 members, or about 70 percent of all clinical technicians in Japan. However, less than 10 percent of them are capable of carrying out the PCR test.

 

An association official said it was difficult to hold training sessions now because local governments have asked their residents to refrain from going out.

 

Amid such circumstances, various efforts are being made at the local level to increase the rate, including allowing private-sector facilities to conduct the tests.

 

The Minato Ward government in Tokyo has asked a private-sector facility to conduct tests from April 13.

 

The ward had previously depended on the Tokyo Metropolitan Institute of Public Health, but the large number of tests in the crowded capital meant it often took two or three days before test results came back. In the meantime, the health of some patients worsened.

 

Ward government officials said the private test facility will produce next-day results.

 

The Tokyo Medical Association is planning to begin a new system involving six PCR centers in the capital in two weeks.

 

Local doctors who determine a patient may be infected with the coronavirus will be able to introduce the patient to a center for a test.

 

“We want to create a system in which doctors can conduct triage to determine which patients really need the test,” said Toru Kakuta, a vice chairman of the association.

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