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COVID-19 front-line doctors at Tokyo hospital describe hellish working conditions

Tokyo Metropolitan Komagome Hospital is seen in this photo taken on May 11, 2021, in the capital's Bunkyo Ward. (Mainichi/Masahiro Sakai)

TOKYO -- The Mainichi Shimbun reported in May how doctors at a metropolitan government-run hospital designated for infectious disease care had been forced to work overtime far above the "death by overwork" recognition threshold (an average of 80 hours a month over multiple months) to respond to COVID-19 patients.

    Hearing testimony from medical professionals at the hospital, we shed light on the developments that led to such harsh working conditions.

    Komagome Hospital in Tokyo's Bunkyo Ward has actively engaged in caring for coronavirus patients since it accepted a Japanese national who returned from Wuhan, China, in January last year after they tested positive for the virus.

    The Mainichi Shimbun earlier reported following a freedom-of-information request with the Tokyo Metropolitan Government that a doctor at the hospital's infectious disease department worked a total of 1,180 hours of overtime over four months -- May, November, December 2020 and January this year.

    Overtime posted by the four full-time doctors at the department ranged from 169 to 327 hours in the pay period for the month of May 2020, four to 314 hours for the month of November, 93 to 282 hours for the month of December and 136 to 257 hours for the month of January 2021. Every month, at least one doctor worked more than 200 hours of overtime.

    Komagome Hospital also serves as a regional cancer center that works with medical institutions in the area and where specialized cancer treatment is available. The hospital therefore had to balance between its regular services such as accepting cancer patients whose conditions would be challenging for other hospitals and caring for COVID-19 patients. However, there was no full support system to offset the workload of the infectious disease department even after the first state of emergency was declared in spring last year.

    There was also little support from other departments even when infections were spreading, and most of the time the department's full-time doctors took care of adjusting patients' hospitalization and on-call duties. They were on call as many as 10 times a month and often worked 36 hours straight.

    A support system was only established around December last year when the third wave of infections was hitting Tokyo. Several doctors from other departments took turns and pitched in every two weeks. At that point, however, the doctors at the infectious disease department were already showing signs of depression, as well as physical and mental exhaustion. The support came too late.

    One of the reasons the hospital was reluctant to send help to the department was circumstances unique to infectious disease treatment. If doctors or nurses who come in contact with patients make a mistake when putting on or removing protective gear, it could spread the virus.

    As a measure to prevent in-hospital infections, Komagome Hospital initially intended to limit medical workers who would engage in COVID-19 treatment. Furthermore, because helping out the infectious disease department was not a job instruction but a request, few doctors or nurses proactively stepped in to support.

    The workload was most severe during times when the graph showed new infection numbers climb steeply toward the peak during periods when infections were spreading, which would later come to be called "waves" of infections.

    During those times, the hospital was receiving endless calls from the metropolitan government's task force in charge of adjusting COVID-19 patients' hospitalization slots, and the doctors were scrambling to learn the conditions of newly admitted patients referred to the hospital one after another while also providing them with treatment. The doctors weren't able to go home until midnight even on days when they were not on call.

    It took about two weeks for supporting doctors or nurses from other departments to actually be stationed at the infectious disease department, as they needed to prepare for handing their own patients over to their co-workers. The doctors recall that the waiting period was particularly tough.

    When infection numbers dropped temporarily, those doctors and nurses from other departments went back to their workplaces and came back again when infections resurged. This cycle was repeated multiple times. If some of them had remained at the infectious disease department, it could have helped reduce overtime and eased the burden on each doctor.

    COVID-19 treatment is the same as responding to a disaster, and it's not something only a certain group, such as the infectious disease department of one medical institution, can handle. Doctors and nurses were able to work tirelessly in the beginning, driven by their sense of mission, but that can only take them so far as the pandemic prolongs. The doctors asked authorities to think about how medical professionals could continue working without sacrificing their physical and mental well-being.

    (Japanese original by Natsuko Ishida, Lifestyle and Medical News Department)

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