ASOURCE Times

The government's response that continued to turn behind

The number of people infected with COVID-19 began to decrease, and we were finally in a lull. The decrease in the number of deaths in Japan compared to developed countries is due solely to the cooperation of the people, such as responding to deaths in the medical field, the activities of cluster countermeasure groups, and refraining from going out. The health center, which was criticized as a "bottleneck" in the PCR test, was at the forefront of preventing the spread of infection by continuing to observe the health of a large number of close contacts. However, we have not succeeded in suppressing COVID-19, and thanks to the efforts of the field and the cooperation of the people, we have managed to overcome the outbreak of infection, and we must not forget this.

Another possible cause of the low death toll in Japan is the treatment in the ICU. For example, in the United States, 90% of patients who enter the ICU with a ventilator have died. On the other hand, in Japan, ICU specialists are excited when 80% survive. Since the medical insurance system is different between the United States and Japan, it is not possible to make a general comparison, but based on the data that 90% of patients die in the United States, treatment is provided within the scope of insurance, whereas Japanese doctors treat all patients. We will do our best to help the remaining 20% of patients who were supposed to die. Similar efforts should have been made for this COVID-19 patient.

On the other hand, the government's response continued to fall behind. Information has been received that the incidence of viral pneumonia of unknown cause has increased in Wuhan, China since around November last year, and the first person infected with COVID-19 in Japan was confirmed in mid-January this year. Originally, at this point, the national government would take the lead in taking precautions, such as preparing beds for infectious diseases, allocating personnel, and securing PPE (Personal Protective Equipment) and respirators. Each municipality should have prepared for it by assuming a policy and showing it. However, the government held an expert meeting in mid-February, about a month later, and finally came up with urgent measures such as strengthening the PCR testing system.

Even so, the shortage of hospital beds for infected people continued, and the Japan Medical Association announced the "Medical Crisis Situation Declaration" on April 1, requesting the public to manage their own health, take measures to prevent the spread of infection, and take appropriate medical examinations. Did. At the same time, he urged the government to issue a state of emergency based on the Law on Special Measures for New Influenza, etc., and the government finally issued a state of emergency on April 8, a week later.

The lessons of the past are not used

Looking at the response of neighboring countries, Taiwan has been successful in its swift waterfront operations, with only a few dead. In addition to promptly preparing and thoroughly implementing PCR tests in South Korea, infections were suppressed by thorough tracking using smartphone apps. Taiwan experienced the SARS epidemic in 2003 and South Korea experienced the MERS epidemic in 2015, and the lessons learned at that time were used.

In Japan as well, based on the experience of influenza pandemics caused by A (H1N1) pdm09 from 2009 to 2010, the government's "New Influenza Countermeasures Action Plan" was revised in September 2011, and in April 2013, "New Influenza Countermeasures Action Plan" was revised. The Law on Special Measures for New Influenza, etc. has been enforced. Apart from this, for example, in Tokyo, the "Tokyo Metropolitan New Influenza Countermeasures Action Plan" was formulated in 2008. This divides the city into 10 blocks in order to respond to the outbreak of new influenza, and for each block, health centers, wards, cities, towns and villages, infectious disease designated medical institutions, infectious disease medical care cooperation medical institutions, medical associations, pharmacist associations, dental associations, etc. We have set up a council consisting of two groups to formulate a regional medical care plan for each block, raise awareness about measures against new influenza, and conduct training on how to respond to new influenza outbreaks. Fortunately, the virulence of the influenza virus that caused the pandemic was relatively low at this time, so despite the fact that more than 20 million people were infected, more than 200 people died, and the damage in Japan is extremely light. It was suppressed.

However, the council did not work with COVID-19 this time. It is presumed that this is because the members of the council were repeatedly replaced within a few years after the pandemic of the new influenza, and the transfer of the significance and purpose of the council became ambiguous. Since these lessons learned 11 years ago were not utilized, not only the PCR testing system but also the securing of beds for infectious diseases was delayed. Especially in Tokyo, due to the shortage of beds from the end of March to the latter half of April, medical care was on the verge of collapse. The medical field, which was hit by the surprise of COVID-19, had no choice but to fight with a round waist.

Establishing a system over a wide area

Currently, the development of therapeutic drugs and vaccines is in progress, but we believe that it will take several years before a new safe and inexpensive drug that is clinically effective for COVID-19 appears. However, unlike Japan's response this time, it is not possible to survive forever just by surpassing the situation and struggling with medical professionals. Because it will be a long fight.

Considering the possibility that the second wave will hit from this autumn to next spring, we must use our imagination to prepare on the assumption that the wave will be several times larger than the first wave. In addition to expanding the system for performing PCR tests quickly and in large quantities, we have set up a specialized hospital specializing in COVID-19, but without consulting COVID-19, diseases such as cancer, circulatory system, and digestive system. It is necessary to divide the roles of medical institutions in advance, such as deciding the hospital that corresponds to the disease. It is also important to have an outpatient clinic system in place. In the unlikely event that the influenza pandemic and the second or third wave overlap, the confusion of outpatient care can be unimaginable.

Local governments will play a central role in these measures. However, the spread of this infection has made it clear that one administrative district cannot do it. A system that transcends municipalities and, in some cases, prefectural areas is required. And the country is required to devote a budget to the system development.

Unlike the SARS virus, which is the same coronavirus, the causative virus of COVID-19 secretly enters the human body, remains asymptomatic for a long time, and spreads the infection. Like the human immunodeficiency virus (HIV) and the human papillomavirus (HPV), I find it a nasty virus. I see the catchphrase "with corona", but never allow it to coexist with a virus. Medical professionals, researchers, the public, and the government must all remember the feelings of "versus corona" and "against corona" and continue to fight until the end.