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Japan needs swift action to prepare for virus '4th wave': infectious disease specialist

Hideaki Oka, a professor at Saitama Medical Center, is seen in the eastern Japan city of Kawagoe, Saitama Prefecture, on Jan. 27, 2021. (Mainichi/Shoko Washizu)

SAITAMA -- In late November 2020, Hideaki Oka, 45, professor of the infectious disease department at Saitama Medical Center in the east Japan city of Kawagoe, Saitama Prefecture, wrote on social media that a coronavirus "third wave" was imminent and that "staff at medical institutions feel pushed to their limits."

    Now it's been nearly a month since another state of emergency was issued amid a heightened spread of coronavirus infections in Japan. The Mainichi sat down with Oka, who is also an infectious disease specialist for the Japanese Association for Infectious Diseases, to discuss the situation today.

    Over the course of the conversation, he asserted that it will be necessary to assign roles for health care workers in preparation for a potential "fourth wave" of infections, and to establish a follow-up system for patients recuperating at home.

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    Mainichi Shimbun: There have been a series of cases in Japan in which the health of individuals recuperating at home with the coronavirus suddenly deteriorated and they subsequently died. A number of these individuals reportedly had no symptoms. What should be done to prevent sudden deaths when convalescing at home?

    Hideaki Oka: It's possible the reported cases weren't actually asymptomatic, and that a deterioration in their breathing was not detected as it's difficult to complain of shortness of breath. It's unreasonable in the first place for public health centers to be responsible for constantly monitoring the state of patients' issues.

    Home recuperation needs to be handled with a system that has cooperation from medical practitioners and other community doctors. Appropriately timed interventional treatment can curb the development of severe symptoms, and could be expected to decrease deaths.

    For example, local public health centers can ask community doctors to observe the status of individuals recuperating at home. Those with preexisting illnesses and others requiring close monitoring should be given pulse oximeters (to measure oxygen saturation levels in the blood), which they can use to make daily reports via Line, email or other means.

    The attending doctor would prescribe steroids to patients whose oxygen saturation levels drop below a certain number, such as under 93 or 94, following an online examination or a checkup conducted on the phone. Under this framework, public health centers would simultaneously arrange for medical institutions to accept these individuals, and hospitalize them.

    In cases where they can't be admitted, the application of steroids should start. As the individuals also need to inhale oxygen, a designated facility for administering oxygen should be set up in places like Saitama Super Arena, which could serve as waiting areas. Oxygen treatment at home is fine, too. In this way, patient deterioration can sometimes be halted after one or two days of treatment.

    MS: Can it be assumed that people recuperating at home also worry about developing severe symptoms or that they may have pneumonia?

    HO: Development of pneumonia can be determined by how many days a patient's fever has run. People with mild symptoms usually return to lower temperatures in two or three days, but fevers lasting a week can be considered pneumonia cases.

    Patients develop severe symptoms generally between 7 to 10 days after first showing symptoms. I think there are many cases where people take tests two or three days after signs of illness appear -- like a fever, coughing or a mild discomfort in the throat -- so it's a red flag if a fever continues for three or four days after a test reveals infection. Both severe and light fevers apply to this. It's not OK to wait and survey the situation just because you have a light fever.

    MS: Vaccinations will soon begin in Japan, too. What effect do you think this will have?

    HO: The vaccines are reportedly highly effective at preventing people from catching the disease or developing severe symptoms. Those who worry about having a bad case of COVID-19 should get inoculated if possible, and I'd also say that I'd like young people to cooperate in achieving herd immunity and containing infections if they don't want to keep living in the current situation.

    However, even if vaccinations do start, it's not known how long they will offer protection for. There are also questions over how many people can be vaccinated in what time frame. I believe a fourth and fifth wave will definitely come. It is reasonable to think herd immunity through vaccinations will not be attained in time for the fourth wave of infections.

    MS: What is necessary to prepare for the fourth and fifth waves?

    HO: A system for listening to the opinions of experts on the ground and countermeasures taken at an early stage are needed. The intuition of doctors in the field is the most sensitive and accurate during influenza outbreaks as well.

    As the state of emergency declaration has been issued with the main purpose of avoiding a collapse in the medical system, I think it's also necessary to decide what Japan's original definition of a "medical collapse" is. Japan has a universal health care insurance system allowing immediate access to medical services. I think there's no point in discussing medial collapse while making comparisons to the number of deaths in other countries with poor health care access.

    Now, access to health care is falling apart. I believe it's necessary to create a follow-up system for individuals recuperating at home that encompasses engagement by medical practitioners and is ready to tackle infections by assigning different roles, such as deciding which hospitals will offer acute phase care for patients with severe symptoms and which hospitals will offer backup by examining recovering patients.

    (Japanese original by Shoko Washizu, Saitama Bureau)

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