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As Japan coronavirus cases climb, pressure to secure medical equipment, staff rises

The monitor for a ventilator affixed to the back of a wheelchair used by House of Councillors member Yasuhiko Funago of the Reiwa Shinsengumi party is seen in this file photo taken in Matsudo, Chiba Prefecture, on Sept. 22, 2019. (Mainichi/Shinnosuke Kyan)

TOKYO -- Confirmed infections from the novel coronavirus in Japan stand at around 3,000 cases, with an explosive rise yet to have taken place. But recent weeks have seen increasing numbers coming from large cities where much of the population is gathered.

If the number of cases continues to rise, Japan could find itself facing tough questions on where to place limited medical resources -- as already seen in Italy and Spain, whose medical systems have virtually collapsed, pressuring doctors to prioritize treatment of people with a higher chance of surviving.

Kaori Muto, a professor in medical sociology at the University of Tokyo and a member of the government's panel of experts on coronavirus countermeasures commented, "It's extremely harsh to leave the decision as to who gets priority (for ventilators) up to doctors alone. We should be prepared both emotionally and with the facts now."

On March 30, five volunteers at a bio- and medical ethics research group comprising doctors, nurses, and ethicists compiled opinions on how to distribute ventilators. Their report says that an explosive rise in coronavirus cases, "would be a state of affairs in which triage concepts employed in medical treatment during times of disaster would be applicable."

The report suggests that it may become admissible for ventilators to be removed from patients with a low chance of survival and reallocated to those more likely to survive. It continues to say that this approach should be taken not just with ventilators, but also with other equipment, hospital beds and other provisions including medical workers.

At a plenary session of the House of Councillors on April 3, Prime Minister Shinzo Abe stated that 62 of the approximately 3,500 coronavirus patients across Japan needed ventilators and other equipment due to their severe symptoms as of April 1. He said the government has secured more than 8,000 ventilators in preparation for an increase in the number of patients.

However, there remain risks of an exponential rise in patients causing health services to collapse, which would result in a desperate shortage of equipment and people to administer treatment.

Among these treatments is extracorporeal membrane oxygenation (ECMO), an advanced form of life support that takes on the role of the heart and lungs, and which is reserved for critical patients. While ventilators help patients who can't breathe take air into their lungs, ECMO equipment connects to the bloodstream to remove deoxygenated venous blood and then pump oxygenated blood back into the body. By doing so, it can preserve patients' life functions.

Figures current to March 30 compiled by the Japanese Society of Intensive Care Medicine and other bodies show that among 40 patients infected with the novel coronavirus who received treatment by ECMO, 19 had recovered to the point that they were no longer on the machines.

But across the whole of Japan there are only around 1,400 ECMO devices available -- less than 10% of the number of ventilators Japan has. According to Dr. Shinhiro Takeda, who represents a network that provides advice on treatments using artificial heart and lung equipment, excluding the ECMO machines in regular use, it's expected that the available stock could be used to treat between 500 and 700 people. It may also become necessary for them to be used at medical facilities whose staff are not familiar with the equipment.

While the Japanese Society of Intensive Care Medicine's report on the fundamental points of caution when using ECMO advises against using the technology on people with terminal cancer or those aged between 65 and 70 or over, Takeda said, "At present, doctors are utilizing the equipment while making comprehensive decisions with regard to factors including age and underlying health issues."

The government has revealed plans to support the increased production of ECMO machines. But the management of the equipment requires several medical workers to be on hand around the clock, and a certain level of knowledge and experience is required.

Dr. Norio Omagari, who works at the Center Hospital of the National Center for Global Health and Medicine and has treated patients with severe coronavirus symptoms, said, "Machines are just machines after all; it's the people that bring a treatment team together. We need to discuss whether there are enough staff members to support the operation of the machines, as well as where to acquire workers if the staffing level is not sufficient."

(Japanese original by Sooryeon Kim and Eri Misono, Lifestyle and Medical News Department, and Yusuke Kaite, Political News Department)

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