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COVID-19 medical care in Osaka stretched to 'natural-disaster levels': hospital chief

Yukio Nishiguchi, head of Osaka City Juso Hospital in Yodogawa Ward, Osaka, is seen speaking to the Mainichi Shimbun on May 6, 2021. (Mainichi/Satoshi Hishida)

OSAKA -- Since mid-April, Osaka Prefecture's patients with serious COVID-19 symptoms have outnumbered available hospital beds for them, thereby forcing beds for patients with mild or moderate cases to be used to care for individuals in greater danger.

    Osaka City Juso Hospital in the west Japan city's Yodogawa Ward has 70 beds for moderate COVID-19 cases. Its manager, 64-year-old Yukio Nishiguchi, described the situation on the ground: "We've had cases where the disease has taken a sudden turn, and we've not been able to get people to hospitals with beds for seriously ill patients in time. I want people to understand this is a natural-disaster level situation where they can't always receive necessary treatment."

    In May 2020, the hospital became the first in the country to become a coronavirus-specialist facility with 90 beds for COVID-19 patients with moderate symptoms. By May 6, 2021, it had accepted around 1,100 coronavirus patients for treatment in about a year. When infection numbers fell in July 2020, the hospital restarted ordinary medical services, and now it runs them alongside its coronavirus outlay.

    Nishiguchi said that in the current "fourth wave" of infections in which a U.K. variant is spreading, trends around severe cases differ from before. Relatively young patients in their 30s and 40s are also seriously suffering from COVID-19, and some people's symptoms are suddenly worsening after initially improving. "A patient in their 40s who we planned to discharge the following day suddenly became much sicker, and they were moved to a ward for serious cases. Things can change so quickly, so we can't afford any complacency," Nishiguchi explained.

    He also cited the example of a patient who died; they had wanted the use of a ventilator, but their condition deteriorated so rapidly that staff weren't able to administer it in time. Nishiguchi said with a sense of regret, "Perhaps if we'd been able to get them the appropriate treatment at an early stage, the result might have been different."

    Yukio Nishiguchi, head of Osaka City Juso Hospital in Yodogawa Ward, Osaka, is seen on May 6, 2021. (Mainichi/Satoshi Hishida)

    Pressure on hospital bed availability is becoming more intense. In early April, the hospital was able to transfer to other hospitals in the evening patients who developed serious symptoms on the morning of the same day, but from mid-April shortages of beds for severe cases means it now has to sequentially choose the most serious cases to transfer.

    The hospital also has no intensive care units, and appropriate care can't be given while patients are on ventilators, meaning that its infrastructure for supplying large volumes of oxygen is given over to treating seriously ill patients who cannot be transferred to other hospitals.

    As of the morning of May 6, more than half of its currently hospitalized COVID-19 patients -- 32 of 62 people -- needed to be supplied with oxygen. Among them, seven to eight people have symptoms consistent with serious COVID-19 that mean they need large amounts of oxygen supplied, among other treatment. They are all reportedly waiting to be moved to wards for seriously ill patients.

    Additionally, the emergence of patients who have severe COVID-19 symptoms when they are hospitalized has reportedly become a hallmark of the fourth wave of infections. Nishiguchi said, "In our CT scans to evaluate how serious a patient's condition is, we're seeing some people whose lungs are already coming up completely white when they're being admitted to hospital." The rate of transfer to beds for seriously ill patients has also risen; while it was a maximum of about 15% during the third wave, it reached around 20% in April.

    During the "Golden Week" holiday between April 29 and May 5, 32 more patients were admitted to the hospital, and in the latter half of the holiday between May 3 and 5, an additional doctor was put on call -- more than during a normal holiday.

    Nishiguchi sees hard times ahead: "At the end of the third wave, patients aged 70 or older accounted for more than 70% of patients admitted. Now it's about 60%, so perhaps infections among older people are going to spread again. It seems we're still a while off from an end to this."

    He also called on people to take thorough infection prevention measures, saying, "I want people to imagine that this is like it is during a natural disaster when people want to be hospitalized but can't be, and for them to change the way they behave."

    (Japanese original by Satoshi Kondo, Osaka Science & Environment News Department)

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