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View from the ground: Osaka doctor works after hours to check on COVID patients at home

Dr. Daigo Kasamatsu measures the blood oxygen saturation of a patient in this partially modified image taken in Osaka Prefecture, on Sept. 9, 2021. (Photo courtesy of Fast Doctor)

OSAKA -- A record high of over 18,000 COVID-19 patients were recuperating at home in Osaka Prefecture earlier this month, with many unable to be hospitalized or enter treatment facilities due to the strain on the medical system. A Mainichi Shimbun reporter observing staff at a private company providing home medical care met patients and families anxiously awaiting doctors' arrivals.

    At around 8:40 p.m. on Sept. 9, during the virus's fifth wave, a minivan stops in a residential area in Osaka Prefecture. Dr. Daigo Kasamatsu, 28, and a colleague from Tokyo-based company Fast Doctor get out and enter an apartment. When they reach the front of the patient's room, they don protective gear.

    "How are you feeling?" Kasamatsu asks. The woman, who is in her 80s, wordlessly moves her arms up and down as she lies in bed. Her daughter watches anxiously from the bedside as the doctor examines her. She has a temperature of 36.8 degrees Celsius, and 97% blood oxygen saturation. Her family expresses relief when Kasamatsu tells them her condition is not serious enough to need emergency transport.

    A video recording of the encounter was taken by medical staff, and a Mainichi Shimbun reporter watched it with the consent of the patient and her family. The woman was reportedly confirmed to have COVID-19 shortly after her first vaccination.

    Although she has dementia, the woman usually speaks smoothly. But after infection, her reactions became sluggish and she was silent more often. Kasamatsu suspected she may have had a mild stroke, and advised the family: "It doesn't have to be right now, but it might be better if she undergoes examination."

    Fast Doctor was established in 2016 and provides medical consultation services via phone, LINE and a specialized app on weeknights, weekends and holidays -- hours when general medical facilities are closed. People in urban areas including Tokyo, Kanagawa and Osaka prefectures can use it.

    In urgent cases, patients are advised to call the 119 emergency number. If symptoms are not serious, company-registered doctors give online medical examinations or home visits. In addition to the usual fees for health insurance-covered treatment, the service is also available with a transportation fee costing up to about 1,000 yen (about $9) depending on the distance.

    Dr. Daigo Kasamatsu (Photo courtesy of Daigo Kasamatsu)

    The Osaka Prefectural Government has faced a chronic medical care and emergency transport shortage amid the coronavirus pandemic, and has contracted three private companies including Fast Doctor to provide consultations and house calls to people in the prefecture recovering at home.

    The three companies gave only 63 consultations in July, but the figure jumped to 1,162 in August when the fifth wave went into in full swing. House calls comprised 621 consultations, and 207 were done online in support of emergency medical services.

    Kasamatsu works at a hospital in the city of Osaka. He signed up to Fast Doctor in May to improve his skills as an internist. On the day the Mainichi Shimbun met him, his fast doctor duties were scheduled from 8 p.m. until half past midnight, after he had finished his regular hospital work.

    Since the summer, Kasamatsu has seen more and more COVID-19 patients, including one day in August when 11 of 12 patients he saw in a nine-hour period had the coronavirus.

    "One patient's oxygen saturation level dropped to the point of requiring hospitalization, and they were saved by a device that pumped oxygen into their body. I could see the current pressure on medical care, which cannot be understood just by being in a hospital," Kasamatsu said.

    The pair left the apartment shortly past 9:40 p.m. They disposed of the used protective gear and masks in double plastic bags and carefully disinfected their hands. Medical equipment was loaded onto a minivan, which comes with a driver and, depending on the situation, a nurse. They got back in the car to head for the next house call.

    Dr. Daigo Kasamatsu examines a patient of Vietnamese nationality using gestures in this partially modified image taken in Osaka Prefecture on Sept. 9, 2021. (Photo courtesy of Fast Doctor)

    A Vietnamese man in his 20s who lives alone at the next apartment was coughing and waiting for Kasamatsu's arrival. The man had fever and cough symptoms for five days, and was subsequently confirmed to have the coronavirus. Unable to fall asleep, he contacted Fast Doctor.

    The Vietnamese man has been in Japan for about two years, and could not communicate well in Japanese. After a series of questions involving many gestures, the patient said his chest hurts when he coughs. But he had a 99% blood oxygen saturation level, and a fever of only 37.4 C. Kasamatsu prescribed him antipyretic and cough medicine.

    There have been many cases reported nationwide of coronavirus patients -- regardless of age -- suddenly going from stable to critical. Kasamatsu advised the man to request from the local public health center a pulse oximeter to measure oxygen saturation. He also reminded him to contact the public health center or Fast Doctor if his oxygen saturation dropped below 94%.

    During the car ride, Kasamatsu was asked by this reporter what patients' concerns are. He replied, "People who cannot visit medical institutions are anxious. Many ask how long symptoms will last. I want to help them get through this hardship."

    Discussions are being had over whether to lift the coronavirus state of emergency due to expire Sept. 30. Some moves toward easing behavior restrictions are emerging. But Kasamatsu said, "From a medical personnel standpoint, I hope that to prevent a sixth wave, people will withhold from taking risky actions, such as easing limits on alcohol service, for a little longer."

    (Japanese original by Hirokage Tabata, Osaka Science & Environment News Department)

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