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How did Tokyo's Sumida Ward achieve zero COVID deaths in August, keep hospital beds open?

Tokyo Metropolitan Bokutoh Hospital is seen in Sumida Ward, Tokyo, on March 5, 2021. (Mainichi/Hayato Matsui)

TOKYO -- Despite rapid infection increases in the capital amid the coronavirus fifth wave, Sumida Ward recorded no COVID-19 deaths or serious cases in August. No coronavirus patients have had to wait for hospitalization since mid-August, either.

    How was the ward able to do this amid the pressure on many areas' medical systems? A Mainichi Shimbun reporter investigated the "Sumida model" approach to securing hospital beds.

    At a weekly online meeting attended by the ward's public health center, medical association and hospitals in fall 2020, a representative for the local Tokyo Metropolitan Bokutoh Hospital -- a designated medical institution for infectious diseases with beds for COVID-19 patients -- raised a concern: "We want to free up beds for patients who have recovered from their symptoms and are less infectious, but we can't find anywhere to transfer them."

    In response, Itaru Nishizuka, director of the Sumida Ward Public Health Center, proposed that private hospitals, which had not accepted COVID-19 patients, establish "recovering patient beds" unique to the ward to take them. The ward office decided to provide subsidies of up to 10 million yen (about $91,000) per bed. But it still wasn't easy to dispel the medical field's anxiety, nor were the measures simple to achieve.

    The ward persistently negotiated with private hospitals to treat less infectious patients by furnishing them with scientific data. They also tried to alleviate hospitals' anxiety by informing them that medical personnel assigned to recovering patients could use relatively simple equipment, such as masks and gloves. After about two months of persuasion, the initiative got underway in late January, during the third infections wave. The number of patients being prepped for hospitalization, which had been 37, soon dropped to zero.

    Nishizuka said, "There is no place to accept recovering patients, and it was deadlocked. It's a government's responsibility to solve the problem." Currently, 56 beds across 10 institutions including private hospitals are designated for recovering patients. Because ambulances are not available to transfer patients from Bokutoh Hospital, the ward government provides vehicles to avoid putting a strain on the hospital's COVID-19-designated beds.

    Sumida Ward started fifth-wave preparations early. While vaccinations for elderly people had been progressing, Nishizuka began taking measures under the expectation the next wave would bring more young COVID-19 patients, and that there was a need to secure hospital beds for moderate cases and strengthen their response to patients recovering at home.

    The ward requested cooperation from each hospital. Hospitals that had been providing only back-up support, such as beds for recovering patients, expressed intent to prepare beds for COVID-19 patients, and it was eventually decided that 34 beds would be reserved for moderate cases and two for severe cases.

    In addition, the ward has a unique "suspected case beds" system that temporarily accepts people suspected to have the coronavirus. Of the 81 such beds, 33 are operated for emergency COVID cases under a maximum subsidy of 1 million yen (about $9,100) per bed.

    Of these, seven are "prenatal beds" earmarked for infected pregnant women and children. The provision came about in response to a case in Chiba Prefecture in August, when a baby born prematurely at home died because hospitals wouldn't accept the expectant mother, who had COVID-19.

    Sumida Ward has also established a medical system centered on its public health center; it manages health observation and prescription deliveries in cooperation with the local medical association and pharmacists' association. The ward's vaccination rate is one of the country's highest; preliminary figures state that 62.3% of residents had completed their second round of vaccinations as of Sept. 4. The nationwide rate is just under 50%.

    Nishizuka explained the background to the results: "What is particular about Sumida Ward is that it supports the east Tokyo region's medical services with Bokutoh Hospital playing the central role. Sandwiched as we are between the Sumida and Arakawa rivers gives us a disaster preparedness mindset, and we have been consistent in building face-to-face relationships with private medical institutions and local medical associations."

    Yuji Inokuchi, president of the All Japan Hospital Association, said, "What we need is to build a medical system matching each regions' characteristics. For this to happen, government leadership and cooperation among hospitals is essential."

    (Japanese original by Shunsuke Kamiashi, Lifestyle and Medical News Department)

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