April 11, 2020
Infections with the new coronavirus are increasing in Japan. In order to protect people's lives and health, what measures will be most effective to improve the country's healthcare system which is now approaching a crisis situation and to increase the PCR testing rates? Japanese Communist Party Secretariat Head Koike Akira, who is also a medical doctor, talked about anti-corona countermeasures in an interview with Akahata on April 11.
'Emergency declaration without compensation' cannot prevent the spread of the virus, more budget support for hospitals needed
Q: The number of infected people is rapidly increasing, and the healthcare system is on the verge of a crisis situation. What is your take on the current situation?
Koike: Prime Minister Abe declared a state of emergency and there are growing concerns among the people. The Japanese Communist Party thinks it is essential for government authorities to compensate anyone who suffers losses from a stay-at-home request associated with "the declaration". It is obvious that "the declaration without compensation" cannot prevent the spread of the new coronavirus. Therefore, the JCP will continue to press the Abe government to compensate people for loss of earnings.
The government has already implemented several support measures. All of these, however, are too small in scale to respond to the coronavirus which is said to be the most serious global crisis since the end of WWII.
Also, there is a pressing need to improve the nation's medical care system.
Tokyo has the largest number of infections. On April 10 alone, an additional 189 people were confirmed positive for the coronavirus. Currently, 1,431 people are in hospitals and 30 of them are in intensive care. Tokyo Governor Koike Yuriko said she will secure 1,700 hospital beds this week, but the situation of Tokyo's medical care capability is on the verge of overload.
Regarding the new coronavirus, 80% of infected people are said to have no symptoms or can get over it with very mild symptoms. Some cases become worse very rapidly. In order to be able to concentrate medical attention on these serious cases, "the collapse of the medical care system" must be prevented first and foremost.
Our party has been demanding that the government strengthen the country's medical care provision system.
Securing enough beds is the first step. To be ready to accept corona-infected patients, designated hospitals now keep a certain number of empty beds and receive a government subsidy of 16,190 yen a day per bed. If treating patients in acute care beds, hospitals receive a subsidy of 50,000-60,000 yen a day per bed. So, it is necessary to drastically increase the subsidy in anticipation of more patients to care for.
Hospitals have many inpatients with weak physical conditions. Accepting corona-infected patients will inevitably increase the risk of in-hospital infections. If this happens, routine practice and treatment systems could consequently break down.
In order to provide appropriate healthcare, it is necessary to categorize hospital functions. Hospitals giving intensive care for critical patients and hospitals accepting moderately-severe patients who need to be hospitalized must be separated. Then, other hospitals can focus on care to patients other than those infected with the coronavirus. Otherwise, the infection could spread. The Japan Medical Association also makes a similar suggestion.
The second step is improvements in outpatient practice specialized in handling corona-related patients. At present, 1,136 hospitals in Japan are designated to deal with outpatient care for "Japanese returnees and potential contacts". Apart from these hospitals, medical facilities should be allowed to provide "fever outpatient care" in areas separated from the normal outpatient departments. Feverish individuals should seek medical attention there first. To achieve this, the Abe government, without delay, must secure staff and prepare face masks, face shields, and other protective gear and equipment for medical professionals. The Japan Medical Association is also suggesting that municipalities set up official outpatient consultation centers.
In order to maintain a designated number of empty beds, patients who have mild symptoms even if found to have positive PCR test results should be transferred to hotels or other accommodations. This is a necessary measure in terms of securing hospital beds for patients who have moderate and severe symptoms, and this must be done very carefully because sometimes conditions worsen very quickly. Special support is of course necessary for housebound patients.
Financial support is essential to secure empty beds. In fear of in-hospital infections, people now hesitate to go to see a doctor. Accordingly, many medical institutions are experiencing financial difficulties. However, the government in a draft supplementary budget allocated 149 billion yen as a package of "urgent comprehensive support subsidies for new coronavirus infections". What the Abe government is saying is this: with this 149 billion yen, beds, testing equipment, respirators, and every necessary item to respond to potential patients must be prepared. Even after spending for preparing face masks and developing effective drugs are taken into account, the amount needed will be at least 800 billion yen.
The U.S. Trump administration has enacted a two trillion-dollar (about 220 trillion yen) emergency coronavirus budget. Under this budget, 100 billion dollars (about 11 trillion yen) will be used as urgent financial support for medical institutions and 16 billion dollars (about 1.76 trillion yen) as funding for medical equipment. Similarly, the Japanese government should increase its budget for anti-corona efforts.
Furthermore, home care for people with coronavirus who show mild or no symptoms has become an issue. Concerns over how to establish a network between medical practitioners in communities and how to protect home helpers from infections are increasing. So, it is also necessary without delay to take measures focusing on home care of COVID-19 patients, including publishing state guidelines and support programs regarding health management and care providers.
Doctors and other medical workers in Japan have very high skills and a strong sense of social responsibility. All they need to do their job is sufficient financial assistance.
Improve PCR testing system to test people in need without delay
Q: What do you think of the issue of the slow rollout of PCR tests?
Koike: Between February and March, the number of people who consulted government-set “call centers for Japanese returnees and potential contacts” stood at 313,475. Of them, 16,730 or 5.3% visited “outpatient services for returnees and potential contacts”. Furthermore, the number of those who successfully had PCR tests was only 12,595 (4%). In Tokyo, the percentage was 2.3%. Even if people who have symptoms seek to take a PCR test based on a doctor’s diagnosis, their request will be rejected. This is reality.
This situation has been mainly caused by the current system which allows people with alleged exposure to COVID-19 to take PCR tests only at hospitals dealing with “Japanese returnees and potential contacts” in principle. In order to visit such facilities, these people basically need to contact “call centers” to be confirmed as being infected. In this context, call centers effectively play a role as a bottleneck.
When the virus outbreak occurred, with the PCR testing capacity insufficient, the number of virus tests carried out was limited. At present, the PCR tests are covered by the public health insurance program and the capacity has improved to test more than 10,000 people per day. However, the initial decision to limit the number of people to be tested through double- and triple-checking remains unchanged.
The reason for this is, as also pointed out by the government expert panel on COVID-19, public health centers where the call centers for the PCR testing were set up are overloaded. Public health centers are tasked to deal with various health issues, including tuberculosis and food poisoning, and cannot focus only on the coronavirus. However, due to the government downsizing policy, they became shorthanded and are overwhelmed by a constant stream of phone calls seeking a PCR test.
In addition, the PCR test method itself is problematic. Under the current method, swabs are taken from inside the mouth of a test subject, which often cause airborne droplets to be dispersed due to coughing and sneezing. Medical workers have to put on a face mask, a goggle, and other protective gear to carry out the test. Hospitals need to sanitize the room every time after a test. So, medical facilities have to limit the number of PCR requests approved.
In contrast to Japan, other countries run the diagnostic test for a large number of people. Germany and South Korea employ a “drive-through” PCR test to prevent medical workers from being exposed to the virus as much as possible. Japan’s Health Ministry recently announced its plan to improve the PCR testing system and is considering introducing the drive-through test. It should waste no time in implementing this plan.
As I mentioned above, as the swab method entails an infection risk, people who just fear becoming infected should not be allowed to take a PCR test. On the other hand, over-reliance on the tests should be prevented because they sometime provide false-negative results. Yet, it is necessary to enable people with potential exposure to COVID-19 to take a test immediately if they are ordered by a doctor to be tested.
PM Abe has been insisting that the government will increase the PCR test capacity to 20,000 per day. The point is not the capacity. Even now, although Japan has a capacity of more than 10,000 per day, the actual number of tests carried out per day is only 3,000-5,000. There is a gap between the capacity and reality. This is the point. Limiting the number of tests would hamper the detection of virus hot spots, and this is very dangerous.
Nobel Prize-winning stem cell biologist Yamanaka Shinya proposed, “If people are unaware of being infected with COVID-19, they will increase a risk of secondary infections. It is necessary to improve the system so that people in need of a PCR test can take the test safety without delay.”
The government should change its policy limiting the number of tests and start carrying out the tests on a massive scale.
In addition, it is necessary to introduce blood-based antibody tests as early as possible. A recently-released test kit uses a drop of blood sample taken from a fingertip and the results come out in approximately fifteen minutes. This test method is easy to use and involves little infection risks. This kit is said to be sufficiently reliable in determining whether a person had contracted the coronavirus. So, it can work for epidemiologic research to check to see, for example, how widely the virus spread in communities.
Gov’t should allocate far larger budget to vaccine development by regarding it as national project
Q: How about the development of vaccine?
Koike: A vaccine will play a decisive role in containing the epidemic. However, the amount of money the Abe government plans to spend in this regard is insufficient. The government-proposed supplementary budget plan allocates 10 billion yen to support vaccine development projects and 21.6 billion yen for international R&D projects.
The U.S. government in February passed a budget of 330 billion yen for research and development of a coronavirus vaccine. The size of the budget is far larger than Japan’s budget allocation.
Japan’s major pharmaceutical makers are reluctant to fully commit to coronavirus vaccine development because vaccine sales will decline once the epidemic is over. The Abe government should regard the vaccine development as a national project and provide sufficient financial support for it just like governments in other countries.
Gov’t should drastically review policy of streamlining public health centers which puts threats on people’s lives
Q: What do you think of the government’s health policy as a whole?
Koike: In the recently-published emergency economic package, the government wrote that it will strengthen public health centers while showing no remorse in regard to its own policy of downsizing these facilities. Former Osaka City Mayor Hashimoto Toru, who is notorious for having closed down many public health centers in the city, called for a review in the current policy to slash the number of health centers. This remark is hypocritical to the extreme.
The government should be blamed for decreasing the number of public health centers nationwide from 850 in 1990 to 472 in 2019 as well as for cutting medical staff. The government needs to reflect on the fact that the merger and closure of these facilities put people’s lives in danger. It has to immediately start working to increase the number of facilities protecting and caring for the public health.
The government in September 2019 published a list of 424 public hospitals to choose a merger or closure. The government in its vision for community health care intents to slash the number of hospital beds for acute stage patients by 200,000 or 30% by the end of March 2026. JCP Policy Commission Chair Tamura Tomoko on March 27 in a House of Councilors Budget Committee meeting proposed that the government suspend the bed reduction plan until at least the current coronavirus pandemic comes under control. Health Minister Kato Katsunobu flatly turned down Tamura’s proposal by saying that it is a matter of course for the government to consider long-term policies along with short-time measures.
While calling on hospitals to secure a sufficient number of beds for COVID-19 patients, the government at the same time intends to push forward with the bed reduction plan. This is unacceptable.
The government has decreased the number of public hospitals. It has repeatedly cut state remunerations for medical facilities which pushed hospitals to make utmost efforts to keep all beds occupied in order to make ends meet. The coronavirus crisis has highlighted the fact that the maladministration has made hospitals vulnerable to being unable to handle a health emergency.
The current crisis points to the need of drastically reviewing the way the country and the government have been run. We need to make great efforts so that Japanese politics will be transformed for the better after the coronavirus pandemic ends.
