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Online consultations a lifeline for Japan's COVID-19 patients recovering at home

Kazue Ota, director of medical corporation Heiikukai, is seen using a smartphone for an online consultation with a COVID-19 patient recuperating at home, in this partially modified image provided by Heiikukai.

TOKYO -- Amid a sudden rise in COVID-19 patients recuperating at home, online examinations are supporting them with efficient prescription issuance and temporary care for individuals who cannot be hospitalized.

    Online medical services have been prescribing medicine to mild COVID-19 patients who lack access to health care, as well as supporting patients classified as having "moderate symptoms II" who require oxygen administration but cannot be hospitalized in certain regions due to severe bed shortages.

    In mid-August, Kazue Ota, director of medical corporation Heiikukai, received an online examination request from an ambulance crew member. Heiikukai is entrusted with online consultations for COVID-19 patients recuperating at home in Tokyo's Setagaya Ward. It involved a man in his 50s with no underlying conditions. He had been recovering at home with mild symptoms, but called an ambulance when his health deteriorated. His oxygen saturation level was 84% when paramedics arrived, under the 93% standard for the "moderate symptoms II" category requiring hospitalization.

    Each ambulance has a limited number of oxygen tanks, and the man was supplied with oxygen while being transferred in a total of three vehicles. During this time, ambulance crew could not find a hospital to accept him, nor could they stop administering him with oxygen.

    Eventually they turned to Ota. She did an online examination and arranged to have an oxygen concentrator delivered to the patient's home for administration there. The man returned home, and his oxygen saturation level temporarily improved. Two days later his symptoms reportedly worsened again, but this time he was successfully admitted to a hospital the same day.

    According to Heiikukai, until early July, patients with mild symptoms accounted for a majority of online examination requests, but in mid-August "moderate symptoms II" patients requiring oxygen administration comprised nearly one-third of all requests. Strain on hospital beds has meant two to three days are now required for hospitalization. As a result, many have had to return home as they couldn't be admitted to a hospital despite calling an ambulance.

    Online medical examinations have been a way to cover patient care before hospitalization by securing them oxygen and medicine supplies. But Ota stressed that oxygen administration is symptomatic pain-relief treatment, and that patients should actually be hospitalized, saying, "These patients are under extremely tough conditions, and (treating them online) is far from the ideal."

    Shinagawa Medical Association director Kazuhiro Miura is seen starting up online patient consultation software at Miura Hospital in Tokyo's Shinagawa Ward on Aug. 13, 2021. (Mainichi/Yuki Nakagawa)

    Online examinations are also a great support system for patients with mild symptoms who cannot go to hospital. On Aug. 10 a Setagaya Ward resident in her 40s tested positive along with her husband and all three of their young children. Although her case was mild, she was fatigued throughout her body and couldn't get out of bed for five days since developing symptoms.

    On Aug. 19, she had pain in her face and a runny nose, and Heiikukai saw her online. Antibiotics arrived at her home on the same day. Her husband, who has a preexisting condition, suffered from a high fever and vomiting, while her grade school-age child had a cough. Following online consultation, they were each prescribed medicine matching their symptoms. The woman said, "There were times I was worried as my symptoms went on, but I was relieved after receiving medicine when struggling."

    The national government has also stepped up support for online medical examinations of patients recuperating at home, with the Ministry of Health, Labor and Welfare raising remuneration for such consultations. Medical examination fees for initial consultations were doubled from 2,140 yen (about $19) to 4,640 yen (about $42), while repeat appointment fees increased to 3,230 yen (about $29) -- around four times the original 730-yen (about $7) fee.

    Medical associations as a whole have also moved internally to promote online examinations. The Tokyo Medical Association is arranging a system for online examinations of residents in all areas of the capital recuperating at home. It plans to create an online waiting room that several patients can enter, and establish a system directly connecting doctors and patients.

    The Shinagawa Medical Association heralded the implementation of a similar system. Association director Kazuhiro Miura said, "It will reduce public health centers' work finding doctors available for consultation, and doctors can also save time needed to visit homes and can do examinations during times between other work."

    (Japanese original by Yuki Nakagawa, Lifestyle and Medical News Department)

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