The Japanese government has indicated it is planning to restrict COVID-19 hospitalizations in areas with spiking case numbers. The policy shift is apparently due to fears that hospital bed numbers will come under severe pressure.
Under the restrictions, COVID-19 cases with moderate symptoms judged unlikely to worsen severely will be turned away from hospitals. Even patients now in hospital with breathing problems will, based on their doctor’s judgement, be asked to go home to recover unless they need an oxygen mask or otherwise require on-site treatment. The stated aim of all this is to free up beds for the very ill, but there are serious problems with the plan.
In Japan, local health care centers perform coronavirus tests and find beds for people they judge need hospitalization. However, it is no easy task for these centers to determine whether infected people should stay home or go into hospital, on top of ascertaining the severity of patients’ symptoms and whether they have any underlying health problems. There are apparently already health care centers so overwhelmed that they don’t have enough time or staff to properly grasp people’s conditions.
Determining the risk of severe symptoms in individual cases, and of a case spike, have been left up to local governments. This has led the National Governors’ Association to call on the central government to provide a set of standards for judging these factors.
One distinct feature of COVID-19 cases is that symptoms can shift suddenly and severely. During Japan’s fourth infection wave earlier this year, one at-home patient after another succumbed to the disease in Osaka Prefecture and other parts of the country. A system to identify these suddenly worsening cases is thus essential. Although the government plans to respond to the issue with regular doctors’ visits and online checks for homebound patients, there are no prospects on the horizon that enough staff can be found to put this into practice.
Even if the hospital occupancy rate declines under the new policy, Japan will still be in a difficult situation. COVID-19 patients could be left out in the cold unless the medical system is expanded. The government has said that new medications will be introduced to prevent severe COVID-19 symptoms, but they are administered by intravenous drip, making them difficult to use at home.
Experts had long warned that the coronavirus’s more transmissible variants could cause a case spike in Japan, but the government responded too slowly. The government did not even ask for the opinion of the Ministry of Health, Labor and Welfare’s expert committee before shifting policy on hospital admissions.
Prime Minister Yoshihide Suga has repeatedly stated, “It’s my job to protect the health, lives, safety and peace of mind of the Japanese people.” However, he has made no move to correct his reliance on vaccines as a pandemic panacea and his subsequently over-optimistic outlook. His failure to expand the health care system has come back to bite him, and the whole country.
The first thing the government ought to do is admit that the medical system is under real pressure. It must then explain thoroughly to the people why it has adopted the restricted hospitalizations policy, and what problems need to be solved. If it does not, it will never gain the people’s understanding.