Relatives of COVID-19 death question Japan’s home recovery policy

Yoshihiko Takeuchi, who ran a small restaurant on the island of Okinawa, only told a few friends that he had the coronavirus. Because he did not answer phone calls from public health officials for three days, police came to his home and found him dead in his bed.

He was among hundreds of people who have died while under “jitaku ryoyo” or a policy of having some COVID-19 patients “picked up at home”.

In many countries, people with the virus are staying at home to isolate and recover, but critics say that in Japan, a country with one of the most affordable and accessible healthcare systems, people were denied hospital care, and the policy amounted to “jitaku hochi” or “abandonment at home”.

Takeuchi’s sister and the daughter of another man who died at the COVID-19 home have created an online support group for the grieving relatives of these victims.

Japan has seen the number of cases drop dramatically over the past two months and the government has established a roadmap to improve its response to the pandemic. A plan adopted on November 12 aims to have beds that can accommodate up to 37,000 patients nationwide by the end of November, up from 28,000.

That compares with more than 231,000 coronavirus patients requiring hospitalization at the end of August, according to government data. Many had to recover at home.

Prime Minister Fumio Kishida also pledged that health workers would regularly visit homes with COVID-19 patients with mild symptoms.

Public anger over inadequate treatment in the country with the world’s highest number of beds per capita is a factor behind these changes. Kishida’s predecessor, Yoshihide Suga, stepped down after just a year in office, mainly due to widespread dissatisfaction with the government’s response to the pandemic.

Speaking up takes courage in a conformist society like Japan, and class actions are rare. But Kaori Takada, Takeuchi’s sister, and others in her group believe their loved ones have been denied the medical treatment they deserve.

“I had to raise my voice,” she said.

She’s not sure what to do. Thousands of people follow the group’s Twitter account and others have told similar painful stories.

Takada, who lives in Osaka and runs a small nursery in his house, was Takeuchi’s only remaining relative. They spoke on the phone just before he was diagnosed, but he didn’t tell her he was sick at home alone. Given the widespread phobias in Japan about COVID-19, he did not want the news to be released.

Takada said he was a sweet and much loved man.

Kaori Takada poses for a photo at her home in Matsubara, south of Osaka, western Japan on November 16, 2021.

“We come together, try to heal, share how people have been treated so cruelly and maybe we help each other take that first step forward,” she said in a phone interview. .

Japan’s local public health offices, responsible for organizing care for COVID-19 patients, have struggled to find hospitals that would admit them. In some cases, ambulances have been moved from hospital to hospital.

A few makeshift facilities provided care and supplemental oxygen, but calls for the creation of large field hospitals have gone unheeded.

In New York, for example, hospitals were quickly converted, adding thousands of additional beds and intensive care units for patients infected with the virus. A Navy medical vessel and other facilities have been turned into makeshift hospitals. At the height of the epidemic in April 2020, there were more than 1,600 new hospitalizations per day across the city.

In August of this year, when infections in Japan increased with the spread of the delta variant, Japanese hospital systems were quickly declared to be “stretched”, even though there were far fewer cases of COVID-19 than there were. in the United States, Europe and other Asian countries. and the countries of South America. In early September, more than 134,000 people were sick with the virus at home, according to records from the Ministry of Health.

About 18,000 Japanese have died from causes related to COVID-19 in a population of 126 million. No one knows exactly how many have died at the home, although the National Police Agency, which tracks the deaths, said 951 people have died at the home since March 2020, including 250 in August 2021 alone.

Shigeru Omi, one of the government’s top coronavirus advisers and head of the Japan Community Health Care Organization, or JCHO, urged the government to set up emergency field hospitals, especially to avoid deaths due to “jitaku ryoyo”.

The Japanese healthcare system is dominated by small private hospitals and clinics, and few inpatient facilities are equipped to treat infectious diseases. Many beds are occupied by psychiatric patients, the chronically ill and the elderly, and there are relatively few doctors, intensive care specialists and nurses.

This photo provided by family shows Yoshihiko Takeuchi, right, posing for a photo with her friend Kayoko Kitatani, who visited her restaurant in Naha on the islands of Okinawa, southern Japan, in 2015.

This photo provided by family shows Yoshihiko Takeuchi, right, posing for a photo with her friend Kayoko Kitatani, who visited her restaurant in Naha on the islands of Okinawa, southern Japan, in 2015.

In some places, local authorities arranged for these hospitals to accept patients who were no longer contagious and were recovering from serious illness after being treated in larger hospitals. But overall, the number of cases far exceeded the number of beds available for intensive care.

JCHO operates 57 of Japan’s largest hospitals. All of them are heavily subsidized by taxpayers’ money. The health ministry said it was providing up to 100,000 yen ($ 900) per bed for COVID-19 patients.

In October, JCHO said it had prepared 972 beds nationwide for patients with the virus, less than 7% of its more than 14,000 total beds, although in August it had temporarily made room for approximately 1,800 patients.

JCHO declined to comment on Kishida’s call to provide thousands of additional beds.

Dr Takanori Yamamoto, an intensive care physician at Nagoya University, believes that hospital care needs to be restructured to focus on critically ill patients in designated facilities, instead of distributing them to small hospitals that each have adequate facilities. ‘a handful of intensive care beds.

Resources were mismanaged, including widespread hospitalizations of people who did not need them, he said. Public health units are designed for research and are not suited to be “gatekeepers” for delivering COVID-19 care, he added.

The problems run deep into a decades-old system, and Yamamoto fears that even if Japan does overcome this pandemic, it will not be prepared for the next one.

“No other country has turned away such patients, even countries that have had many more cases. The idea that doctors can’t see patients should be out of the question. If you are a doctor, you have to take care of the sick, ”Yamamoto said.

“Japan did nothing. There was no leadership, ”he said.

It’s time to act now, before another wave of coronavirus infections strikes, said Dr Kenji Shibuya, research director at the Tokyo Foundation for Policy Research, an independent think tank.

“They didn’t act before, even though they knew it was going to happen,” said Shibuya, who has experience in Britain. “It is a lack of commitment, a lack of will, a lack of passion to effect change in times of crisis,” he said.

Last August, Yuko Nishizato, co-founder of Takada’s group, pleaded with hospitals for her 73-year-old father to be admitted. But he died after testing positive for COVID-19 without ever receiving any treatment other than fever medication.

Phone records show he repeatedly called the local public health center until his death. It breaks his heart to know that he only got recordings.

“I wanted him to live to see his grandchildren. I wanted him to see me as more adult, ”said Nishizato. “There are so many who have suffered in the same way, and I don’t understand why. ”

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