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'Hidden' infections may be behind higher mortality rate in Japan's recent COVID wave

Staff attend to a patient in the coronavirus critical care room of Fukuoka University Hospital in Fukuoka's Jonan Ward on Jan. 17, 2023. (Mainichi/Masaaki Hirakawa) [Part of the photo has been altered]

FUKUOKA -- Amidst another wave of coronavirus infections this winter, the number of daily COVID-19 deaths in Japan has hit new records. That's despite the omicron variant's lower mortality rate. Experts and others claim that it may be due to the existence of "hidden," or unreported infections. Along with seasonal increases in stroke and heart attack patients, the situation in Japan's hospitals is becoming dire.

    When the Mainichi Shimbun visited the Trauma, Emergency and Critical Care Center at Fukuoka University Hospital on Jan. 17, an elderly patient was on a respirator in one of the beds for critically ill COVID-19 patients. Nurses wearing personal protective equipment were hurrying around. Hiroyasu Ishikura, the center's 64-year-old chief doctor, said, "Since Christmas last year, we have seen a sudden increase in the number of patients requiring hospitalization."

    The center had just increased the number of beds for coronavirus patients early this month. Despite that, as of Jan. 17, five out of seven critical care beds were filled, while the facility was treating 28 patients with moderate or mild symptoms -- in excess of the 26 beds designated for them. While the hospital acts as the last line of defense for tertiary emergency care in the Fukuoka metropolitan area, it has run out of beds and staff needed to keep up with COVID-19, and in some cases, has had to turn away patients.

    Hiroyasu Ishikura, chief doctor at the Fukuoka University Hospital's Trauma, Emergency and Critical Care Center, is pictured at the hospital in Fukuoka's Jonan Ward on Jan. 17, 2023. (Mainichi/Masanori Hirakawa)

    In contrast with the seventh wave of COVID-19, which peaked last August, this winter's wave overlaps with a seasonal increase in patients suffering from strokes and heart attacks. "Our emergency resources are already depleted. Over close to 40 years, this is the first time I've seen such a situation," Ishikura said with an agonized expression.

    As the medical system is stretched, what stands out is the number of deaths. According to daily numbers released by the health ministry, this winter's wave peaked on Jan. 6 with 246,632 new infections -- lower than the seventh wave's peak of 261,004 on Aug. 19 last year. However, the number of COVID-19 deaths hit 503 on Jan. 14, higher than the 347 reached last year on Sept. 2 at the height of the seventh wave.

    Ishikura pointed to "hidden" COVID-19 patients as a reason for the higher proportion of deaths. He believes that many people don't get tested even though they have a fever or other symptoms, or do not register their positive test results with the prefectural authorities. The lower infection numbers, then, are an effect of updated health ministry rules that allowed prefectures to simplify how they tally new COVID-19 infections, which came into effect last September.

    According to Ishikura, "The more infections, the more critical patients and deaths there are." Even for patients who make it in to hospitals that are stretched at the seams, Ishikura suspects there are many who cannot get timely care in response to their condition, and they die before getting hooked up to a respirator.

    Tetsuya Matsumoto, professor of public health at the International University of Health and Welfare Graduate School, agrees with Ishikura, saying that because it's a hassle, many people don't bother to register their results. In his view, "The current wave is only being partially grasped by the numbers, and in reality, it probably exceeds the seventh wave."

    A medical staffer enters the COVID-19 patient care center while wearing a face shield to protect from coronavirus infection at Fukuoka University Hospital, in Fukuoka's Jonan Ward on Jan. 17, 2023. (Mainichi/Masanori Hirakawa)

    Vast numbers of COVID-19 patients are burdening the health care system like never before. According the government's Fire and Disaster Management Agency, in the week ending on Jan. 15, there were for the first time more than 8,000 instances in which ambulances ran into problems delivering patients to hospitals, such as taking over 30 minutes to decide which hospital would accept them. Matsumoto said, "In some cases, elderly people with COVID who don't receive timely treatment, such as therapeutic drugs or intravenous drips, see dehydration as well as deterioration in pre-existing conditions."

    To deal with the situation, Matsumoto urges clinics concerned about outbreaks in their facility to offer remote care in order to increase the number of medical facilities able to handle coronavirus patients. He said, "To keep the economy moving, a medical system needs to be established in which those infected with the coronavirus can be readily taken in," and that through timely treatment, the number of deaths can be kept under control.

    (Japanese original by Masanori Hirakawa, Kyushu News Department, and Hiroyuki Harada, Lifestyle and Medical News Department)

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