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Japan care facility creates indoor hospital section after huge virus cluster found

The room designated for changing into protective gear inside the Hokuso Ikusei-en welfare facility is seen in this photo taken on April 17, 2020. Due to shortages of protective gowns, staff members instead wear trash bags, and a nurse is seen taping up visible gaps between gloves and clothing to prevent viral transmission. (Mainichi/Asako Kuroda)

TOKYO -- In late March, a welfare home caring for disabled people in Tonosho, Chiba Prefecture east of Tokyo, became host to a novel coronavirus cluster infection that was the largest recorded in a facility of its type in this country.

In a Japan first, the facility has been turned into a "hospital" through cooperation between the local government and private sector firms. At an interview with the headquarters for support measures established within the facility, Mainichi Shimbun reporters saw staff members and others working flat out to support the residents despite shortages of protective gear and other essential equipment. Thanks to their efforts, residents at Hokuso Ikusei-en facility are reportedly on their way to recovery.

Hokuso Ikusei-en was established by the Chiba Prefecture city of Funabashi and run by the social welfare corporation Sazanka-kai based in the same city. It's home to a total of 70 people aged from their 20s to 80s, some of whom have intellectual disabilities. On March 27, 15 of the residents were reported to be presenting fever symptoms. The prefectural government publicly announced the case as a cluster infection on March 28 based on the results of coronavirus tests.

Eventually, total infections from the cluster rose to 118 people. Among them were 51 of the 70 residents, over 70% of them, 40 of its 67 staff members, and family members of those under its care, making it Japan's largest recorded group infection from a welfare facility.

On March 30, several doctors including infectious disease specialists from the National Institute of Infectious Diseases gathered at the facility. Around that time, people who tested positive for the coronavirus were to be hospitalized whether they showed symptoms or not. But there were no facilities with the capacity to accept all of the home's infected people. A decision was made immediately to transfer the handful of residents with severe symptoms elsewhere, and care for the rest at Hokuso Ikusei-en -- essentially turning the care home into a hospital.

Based on requests from the Chiba prefectural government, a system was introduced in which several doctors take turns to do a round visit of the residents twice a day, and two nurses look after the residents overnight.

To prevent the coronavirus spreading further, the facility's interior is now split into "zones" based on the risk of infection. The residential area, which is prone to virus transmission, is labelled the "red zone," and entry is prohibited to all but the on-site medical team and facility staff wearing protective gear.

The headquarters for support measures is located in the facility's gym, which has been disinfected and is designated the "clean zone." The hallway that connects the residential area with the gym, and the room designated for changing into protective gear, are together classed as the "semi-clean zone." Staff members move around on a separate route to ensure that those who have come into close contact with infected people do not enter the "clean zone."

The Mainichi Shimbun's reporters were allowed to conduct interviews only in areas of the clean zone or semi-clean zone that were at least two meters from the changing room, and they followed instructions given by the headquarters for support measures, including wearing masks throughout the visit. They were put on their guard when a staff member pointed to an area on the floor marked with duct tape and said firmly, "Please do not go beyond this point."

The facility began to see a shortage of equipment necessary to prevent viral transmission when coming into contact with infected residents. Among the items in short supply are nonwoven gowns, goggles, and high-performance medical masks used by staff entering the red zone.

In place of protective gowns, staff members have since April 15 been wearing trash bags they fasten around their bodies using tape. Nurses in the changing room who were about to enter the red zone were heard exchanging words such as, "Watch out for heat stroke, it's humid and hot," and, "It's best to change clothes regularly."

A male facility staff member wearing a trash bag emerged from the red zone drenched in sweat. At the zone's exit, a nurse helped him take off his bag and gloves, while keeping extra caution to avoid virus particles becoming attached to the body, as part of a countermeasure against secondary infection. After all the equipment had been removed about three minutes later, the staff member's expression seemed to relax a bit.

Currently, excluding those in administrative positions, only seven facility staff members directly care for residents, according to Hokuso Ikusei-en's deputy director. The facility is having to cope with labor shortages by taking on staff dispatched from other social welfare corporation Sazan-kai facilities and from the Funabashi city government. Previously twelve people did daytime weekday shifts, but now only five workers can be secured even with the help of the municipal government and other bodies. Staff members are also required to keep on taking turns doing night duty.

The deputy director commented, "We are not quite able to get around to bathing the residents, which requires a number of staff members to do so, and this is an inconvenience caused to our residents. Our staff members are also working hard, and being pushing to their limits mentally."

(Japanese original by Asako Kuroda, Lifestyle and Medical News Department, and Asako Kamihigashi, Integrated Digital News Center)

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