3 die at Tokyo nursing home while waiting to be hospitalized amid bed shortage

TOKYO -- Three elderly people who contracted the coronavirus passed away after waiting their turn to be hospitalized at a care facility in Tokyo amid a serious shortage of hospital beds.

There have been cases where elderly people who have a high chance of developing severe COVID-19 symptoms have been unable to be hospitalized, including three individuals whose conditions suddenly deteriorated before they passed away in hospital.

The three belonged to a Tokyo nursing home for the elderly, which saw large-scale virus clusters in January, and were put on a waiting list including 30 residents of the facility who were seeking to be hospitalized. A senior official of the nursing home described being forced to make tough decisions on hospitalization priority, while being at a loss over how to save patients with sudden condition changes.

"Do you wish for life-prolonging measures to be taken?" So asked an emergency service worker to staff at the nursing home in late January, after rushing to the facility following a sudden change in an elderly resident's condition.

"The family seeks life-prolonging measures," said staff, prompting the ambulance worker to search for hospitals on the spot. However, a hospital that could accept the individual could not be found. In addition to a limited number of hospitals that are capable of handling treatment of severe COVID-19 cases, the availability of hospital beds has also been increasingly strained due to a sudden increase in coronavirus patients.

The ambulance worker said, "There's a place with an available spot if you have no preference for life-prolonging measures." Although there is the possibility that the individual will be unable to receive full-scale treatment for COVID-19, their symptoms will only get worse if the present state continues. The nursing home staff explained the situation to the individual's family on the phone as time ticked away. Faced with a tough decision, the family asked with hesitation to prioritize sending their loved one to the hospital.

Once the preference for life-prolonging measures was withdrawn, the hospital was decided on smoothly, and the nursing home resident was moved immediately. However, they passed away in the hospital without their condition recovering.

"I strongly sensed the impact of strained hospital beds," said the senior official of the social welfare corporation that manages the nursing facility.

A serious case of cluster infections had occurred at this nursing home. On Jan. 18, numerous residents on the facility's third floor developed symptoms of fever, and eight individuals tested positive for an antigen test. When a polymerase chain reaction (PCR) test was later conducted targeting all residents, over 50 of the some 120 residents were confirmed infected by Jan. 26.

Among the infected were also individuals whose required care levels are high, including those with preexisting illnesses, and those with dementia who had the risk of wandering. The nursing home was instructed by the local public health center that "all individuals who tested positive must be hospitalized."

However, hospitals capable of accepting individuals were limited due to bed shortages, leading the nursing home to send its residents to hospitals each time vacancies arose.

As the circumstances at the nursing home required extraordinary action, an infection cluster task team was dispatched by the Ministry of Health, Labor and Welfare to take the lead in tackling the emergency situation. Preventative measures against infection have been thoroughly conducted -- which are to be kept in place until the facility's infection tally becomes zero -- by dividing the facility into zones so that infected individuals were kept on the third floor, those who came into close contact with the infected on the second, and those who tested negative on the first floor.

Amid such circumstances, the facility was having a hard time deciding on who to have hospitalized first. Only around two or three people can be moved to hospitals a day. Following continued discussion with the public health center and other parties, the nursing home decided to judge the hospitalization order while considering factors including the severity of fever and other symptoms, whether the resident has preexisting illnesses, oxygen saturation levels in the blood, and risks of individuals with dementia wandering into zones occupied by residents who are not infected with the virus.

"Many of the residents have preexisting conditions, and there was a risk of sudden changes in their conditions. However, we weren't able to have everyone hospitalized, and gave priority to those whose lives were endangered greatly. We had no choice but to conduct triage on residents of the facility," said the nursing home's senior official on the painful dilemma.

Meanwhile, checking the conditions of infected individuals who had not yet been hospitalized was another big challenge.

In order to detect sudden changes in residents, the facility had nurses and caregivers check their body temperatures and breathing conditions every three hours while being given instructions by a doctor at an affiliated hospital nearby. Despite the enforcement of such measures, three individuals, including the resident mentioned in the beginning, passed while waiting their turn to be hospitalized.

According to the nursing home, life-prolonging measures were initially desired in all three cases when asked by ambulance service workers.

Among the bereaved were those who could not view the bodies of their kin. The senior official said, "I'm terribly sorry for the residents and their families. We actually want to have everyone hospitalized as soon as possible."

The spread of infections has gradually been contained at the facility. Even then, there are still around 10 infected individuals who await hospitalization.

According to the health ministry, the number of individuals with COVID-19 who are recuperating at social welfare facilities in Japan have been increasing since last December, with the tally at 592 as of Jan. 27. Of this figure, Tokyo recorded the largest number of 219 individuals.

(Japanese original by Nobuyuki Shimada, City News Department)