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Man dies of COVID-19 at home hours after being denied hospital bed in Japan

Masanori Nishizato, who passed away while recovering from COVID-19 at home, is seen next to his eldest daughter Yuko in this image provided by the bereaved family.

TOKYO -- Masanori Nishizato was recovering from COVID-19 at home. But in mid-August his condition took a sudden turn for the worse, and he died without ever making it to a hospital. He was 73. And his case is not the only one of its kind in Japan.

    The nationwide surge in coronavirus cases had left 96,857 people recovering at home as of Aug. 18, and the death count among this group has been rising steadily. In August in Tokyo and its neighbors Saitama, Chiba and Kanagawa prefectures, at least 21 people have died at home, compared to the four who passed away in July.

    "I don't want the government to overlook people who are on the border of life and death," Nishizato's eldest daughter Yuko, 26, told the Mainichi Shimbun.

    At about 7:30 p.m. on Aug. 13, Yuko's mobile phone rang. It was her 56-year-old mother. Her voice sounded urgent: "Your father isn't looking well." Yuko's mother and father lived together in an apartment in the city of Saitama, and she lives in a neighboring city. Over the phone, she could hear a voice, groaning and trying to form words from deep in the throat. Twenty minutes later, her mother called again: "Your father has gone."

    Yuko's mother had tested positive for the coronavirus on Aug. 4. Nishizato's positive test came through four days later. He had high blood pressure, putting him at risk of severe symptoms. Three years prior he had suffered an aortic dissection and was treated in a hospital ICU.

    The couple had planned to be vaccinated by their doctor in mid-July, but put it off because they weren't feeling well. They were infected right around the time of new inoculation appointments.

    Once the couple's infections were both confirmed, Yuko's mother made multiple calls to the public health center to have Nishizato hospitalized. According to one source, on Aug. 8 the health center told Nishizato to recover at home. A pulse oximeter for measuring blood oxygen saturation levels was delivered to their apartment on Aug. 9. From Aug. 10, Saitama Prefecture's accommodation and home recovery patient support center began daily checks on his health. Initially, his blood oxygen saturation was at 98%. All seemed well.

    When the health center called Nishizato at about 5 p.m. on Aug. 13, his oxygen saturation had deteriorated to 93%. Ministry of Health, Labor and Welfare treatment procedure guidelines state that a 93% or lower level constitutes a state of respiratory failure. If it persists, it can lead to compromised organ function, making it essential a patient be given oxygen.

    But the public health center told him to continue to stay at home. His condition deteriorated rapidly about two-and-a-half hours after the call.

    That day, about 30 minutes before Nishizato got the call from the health center, he was on the phone with Yuko. He told her in a dejected voice, "I couldn't get into hospital." He said he had no appetite, and asked her to get some jelly drinks sent to his home. She told him she'd do it. It was the last conversation father and daughter would ever have.

    After Nishizato's passing, Yuko's 32-year-old husband went to the health center to ask why his father-in-law had been left to die at home. But he was told, "We're sorry, but at that time the situation was reportedly fine." Responding to a Mainichi Shimbun request for comment, the public health center said, "The patient told us 'I'm not struggling to breath.' We did everything that we could."

    The main driver of Japan's coronavirus fifth wave has purportedly been more infectious variant strains. Dedicated COVID-19 beds are full, and more patients are recovering at home. The health ministry reported that there were 15,354 people convalescing at home in Saitama Prefecture as of Aug. 18. That is second only to Tokyo's 22,210 people. The capital region's four prefectures account for some 60% of Japan's COVID-19 home convalescents, and the numbers show no signs of falling.

    At a meeting of senior ruling Liberal Democratic Party (LDP) officials on Aug. 24, Prime Minister Yoshihide Suga emphasized the government intends to provide thorough support, stating, "We will expedite work to ensure the staff is there to guarantee people can be contacted even if they are recovering at home." But sudden changes in patient health over just one or two hours are a characteristic of COVID-19, and give us a glimpse of the limits to leaving patients to deal with the disease at home.

    Yuko left home in her teens, and in the past she and her father had clashed constantly. But when she began living alone, he would support her from afar, telling his wife to raise money for their daughter. The distance made them realize their importance to each other, and they would see each other at least once a month. He would often tell Yuko, who married this year, that he hoped to have grandchildren.

    There has been virtually no progress made on controlling the movements of the virus's current main carriers: young people. Yuko said she was worried by the photos young people were posting on social media of their barbecues, trips and other activities.

    "Even with the current state of emergency declaration, people who don't follow the rules just don't follow them," she said. "If policy itself isn't changed, people's actions won't either. I think, do their parents have to die for them to understand? I don't want there to be any more people who have to go through what I did."

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

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