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Japanese medical institutions struggle to cope with coronavirus chaos

In this Feb. 6, 2020 file photo, an employee at the Tokyo Metropolitan Komagome Hospital in the capital's Bunkyo Ward is seen setting up signs asking those who have symptoms such as a fever and coughs to use a different entrance. (Mainichi/Go Kumagai)

TOKYO -- A growing number of people are consulting with medical institutions in Japan over their concerns that they may have been infected with the coronavirus or developed symptoms of pneumonia caused by the virus.

This is apparently because it is difficult to distinguish pneumonia caused by the coronavirus from common colds due to their similar symptoms. Moreover, only those linked to China's Hubei province, ground zero of the outbreak, are in principle subject to virus tests by the Health, Labor and Welfare Ministry, fueling concerns.

The Japanese government is developing a simple checkup kit for coronavirus infections, but it is expected to take a considerable amount of time before the method can be put into practical use.

As experts have hinted at the possibility of in-hospital transmission, chaos over the outbreak could deepen if the number of those infected with the virus is to further increase.

The Okinawa Chubu Hospital in Uruma in Japan's southernmost prefecture is receiving requests from several local residents for virus inspections every day. It goes something like, "I walked past a Chinese person at a shopping center. Can I get a checkup?"

Yoshihiro Takayama, a physician at the institution specializing in infectious diseases, appears puzzled by such requests. "There's no need for examinations as long as they show no symptoms," he said.

Noting that there is a possibility that the number of patients will further increase in Japan, Takayama added, "The elderly and people who have chronic diseases tend to develop serious symptoms. We've begun efforts such as prescribing more medicine."

A call center the health ministry set up at the end of January receives approximately 1,000 inquiries a day. Many callers complain that they developed a fever and a sore throat several days after going to a crowded place. However, there has not been a confirmed case of infection from those who have no connection to Hubei province.

Hitoshi Oshitani, virology professor at Tohoku University, is calling on the public not to panic.

"In cases of an epidemic, a situation must be avoided where people with mild symptoms rush to major hospitals preventing patients with serious conditions from being looked after. I'd like people to act calmly," he said.

The health ministry currently offers checks for infections to those who had traveled to Hubei or lived there within 14 days before they developed symptoms, such as a fever of at least 37.5 degrees Celsius or respiratory problems, or had close contact with someone who did. People who have developed a fever or respiratory symptoms and had close contact with infected people, as well as those who need to be hospitalized for a fever and respiratory problems regardless of their travel history to Hubei, are also subject to checkups.

The government announced on Feb. 12, however, that it will flexibly conduct examinations on those who do not meet these conditions in light of the current situation where the number of infections is growing.

Some hospitals are beginning preparations to accept patients infected with the coronavirus. The Tokyo Metropolitan Komagome Hospital in the capital's Bunkyo Ward has put up a sign at its entrance for outpatients, urging those suspected of having been infected with the virus to move to a reception area for specialized examination rooms to prevent in-hospital infections.

There are reports of suspected transmission in hospitals. A paper published by the Journal of the American Medical Association says 57 out of 138 infected patients, or 41%, admitted to the Zhongnan Hospital of Wuhan University contracted the virus within the institution. Experts point out that the initial symptoms of pneumonia caused by the virus could have been difficult to distinguish from those of other illnesses, and the hospital might have failed to take adequate preventive measures.

A patient who was hospitalized for stomach problems later tested positive for the virus. As the patient was not initially thought to have contracted the virus, they are believed to have transmitted it to more than 10 medical staffers at the institution.

It turned out on Feb. 12 that a Japanese quarantine officer who was engaged in work aboard the Diamond Princess cruise ship at anchor off Yokohama, south of Tokyo, had contracted the virus. The officer measured passengers' body temperatures and collected questionnaires about their health conditions from the night of Feb. 3 when the ship arrived at Yokohama to the following night. In accordance with the World Health Organization guidelines, the officer wore a long-sleeved gown, disposable gloves and a surgical mask and disinfected their hands and fingers while on duty.

The health ministry says this was the first case of a quarantine officer contracting the virus. Thorough preventive measures are needed for quarantine officers who have close contact with infected people or those suspected of having the virus, and a ministry official said, "We've been taking necessary preventive measures, but we'll review the practices and take more thorough steps."

It is essential for medical institutions to be fully prepared to treat patients and those who have developed symptoms on top of preventive measures at ports and airports.

The government intends to designate at least one outpatient institution in each of some 340 medical care zones across the country as facilities where people who have come back from Hubei and who have had close contact with infected people are examined and treated. Moreover, the government will allow patients who tested positive for the virus to be hospitalized at regular hospitals as long as single rooms can be secured for them.

Yet, not all medical institutions can admit infected individuals.

Prevention of in-hospital transmission also poses a challenge. Satoshi Kamayachi, an executive board member of the Japan Medical Association, told a recent news conference that such infections "must be prevented by all means." He then urged people who suspect they have contracted the virus to consult public health centers or medical institutions before undergoing checkups.

(Japanese original by Eri Misono, Yuki Ogawa, Sooryeon Kim and Go Kumagai, Lifestyle and Medical News Department)

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