INTERNATIONAL - A Tokyo hospital treating coronavirus patients issued guidance last week to its doctors and nurses: only one surgical mask per staff will be allocated each day due to a supply shortage.
The notice, which was posted on the walls of the hospital’s general ward on Feb. 28, said that it only had enough in stock to last for another month so staff should use the same mask throughout the day.
“This is not how surgical masks should be used. But it is an emergency measure,” the notice said.
The shortage of basic medical equipment is being felt across the country, with some doctors and nurses having to use gauze as a temporary measure to get through, according to local medical associations. A few hospitals and clinics are weighing closing temporarily to avoid the risk of coronavirus potentially spreading among its patients.
The shortages emerging at some frontline hospitals in Japan is reminiscent of the situation in China, especially in the epicenter of Hubei province, after the epidemic first erupted in late January.
While Japan’s situation is unlikely to become as severe as China, skepticism over Tokyo’s handing of the virus threat has been growing with the government seemingly on the back foot despite having weeks to prepare as the outbreak spread in neighboring South Korea.
As of Friday, Japan has over 1,000 official cases including those from the Diamond Princess, a cruise ship authorities quarantined for weeks in Yokohama harbor amid a virus outbreak on board. But experts believe that the number of undetected cases could be far higher.
With 28% of its population above 65 years old, a robust health-care system is vital as the country braces for an outbreak that’s already sickened almost 100,000 globally and killed over 3,300.
“With the oldest population on earth, you also have the largest percentage of your people falling into the highest risk categories for severe illness on earth due to COVID-19.” said Laurie Garrett, an American global health writer, referring to the name of the disease caused by the pathogen. “Japan will have a great challenge, given its aging population.”
Public Criticism
Prime Minister Shinzo Abe’s administration has come under public criticism for its slow response to the virus outbreak. The cabinet will decide next week to ban reselling of masks including on e-commerce platforms, the Nikkei reported Thursday.
It has also come under scrutiny from experts who say the country’s limited testing capacity points to a possible wider infection in Japan. On the northern island of Hokkaido, as many as 940 -- more than 10 times the official figure --may have been infected as of late last month, according to a study by Hiroshi Nishiura of Hokkaido University.
Despite the threat, hospitals in Tokyo, Chiba, Kanagawa, Okayama, and two other prefectures are lacking basic medical supplies, according to local branches of the Japanese Medical and Dental Practitioners Association.
In Kyoto, almost 90% of hospitals don’t have enough supply of masks, according to a survey conducted by the association.
While there are no imminent cases of hospitals and clinics need to shut down because of lack of supplies, an official at the Tokyo Medical Practitioners Association said that some may need to consider a temporary closure as the last resort unless shortages improve.
A passerby wearing a protective face mask, following an outbreak of the coronavirus, walks past an electronic board showing the graphs of the recent movements of Japan's Nikkei share average outside a brokerage in Tokyo
The situation runs the risk of entering a vicious cycle and intensifying fear among the local population, said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.
“If the government fails to figure out a way to accommodate the unusually high demand, the health-care system could be overwhelmed and that could cause problems in a further spread of the virus, and in panic.”
Not Enough
Highlighting the risks medical workers face, a doctor at a hospital in Sagamiharay, west of Tokyo, tested positive for the virus, a local official said Friday. The physician had been in contact with a person who was later confirmed with the virus, he said.
The country’s medical association has requested the government to secure masks, sanitizers and other equipment for hospitals.
Yoshitake Yokokura, the association head, told a press conference Wednesday he’s also asked for government help in securing medical staff after closures of schools nationwide from this week put a strain on its workforce, especially on working mothers.
Responding to the shortage of masks hitting hospitals, the health ministry said on its official Twitter account that it was taking measures to prioritize allocating supplies to hospitals dealing with infectious diseases.
Securing supplies, however, will not be easy even for the government. Manufacturers of surgical masks say they cannot keep up with the surge in demand.
“We’ve been turning down many orders,” said a spokesman at Yokoisada, a maker of the brand Nippon Mask, which has been ramping up production in the Philippines and China to serve its mainly Japanese clients. “We cannot keep up.”
The government said last week it would directly buy masks from manufacturers and ship them to Hokkaido, where it has declared a state of emergency due to the surge in cases. That is making hospitals in other regions worry.
“The government is now putting its priority to Hokkaido. But we’re hearing from doctors here that Chiba also needs to be prioritized,” said Keiko Yoshikawa, general director of the local medical association. The prefecture currently has 16 confirmed cases.
To be sure, Japan is not alone in the predicament. As the virus accelerates its spread globally, health-care systems in developed countries like the U.S. and within Europe are also facing severe strain. In the U.S., widespread reports of faulty test kits and a lack of supplies is putting pressure on U.S. President Donald Trump’s administration.
“Even the best health-care systems have gaps,” said Paul Ananth Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection. “All across the world, health-care systems are straining with the demands on resources. Unless there are fundamental changes in the way in which health-care systems are prioritized globally, this is not surprising at all.”
Demoralized
At the frontline hospital in Tokyo where masks have been limited to one per day, a doctor says he’s no longer wearing masks at all on concerns that re-using them could be more dangerous for himself and patients.
In China, hundreds of doctors, nurses and other medical workers were infected because they worked with patients without adequate protection.
The situation at another hospital which has an infectious disease ward in Kanagawa prefecture, outside Tokyo, is more dire.
A doctor who declined to be identified as she was not authorized to speak publicly said the shortage of masks has become more acute from this week and instructions were given to all nurses that only one mask will be issued for three shifts, unless they were in contact with patients suspected of having the coronavirus.
Those working in hospitals face the highest risk of being infected, so the shortage of medical supplies is demoralizing, she said.