What will happen to the number of infected people such as Tokyo? Strengthening the health center system New Corona

What will happen to the number of infected people such as Tokyo? Reinforcement of health center system New corona July 11th 0:19

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In the first wave of the spread of the new coronavirus in Japan, the burden was concentrated and the labor shortage became a major issue at the public health center. There were a number of cases where the call center could not be reached and it took time to collect and transport the samples, resulting in a delay in the test. Now that the number of infected people is rapidly increasing in Tokyo and elsewhere, how are public health centers trying to strengthen their systems?

Health center now

This time we interviewed the Kita Ward Public Health Center in Tokyo. On the 9th, more than 200 new cases were confirmed in Tokyo, and 6 cases were confirmed in Kita Ward. Staff were busy answering phone calls and securing medical institutions to receive them.

At the Kita Ward Public Health Center, in March when the infection spread, only 5 public health nurses and doctors were required to carry out multiple tasks such as telephone consultation, determining whether to carry out PCR test, and securing the patient's hospital. I was responsible for this. The work was so concentrated that strengthening the system became an urgent issue.

Arranged so that more than 20 staff members can get support from other departments of the ward office and public health center as needed. We decided to entrust some of the tasks that the public health nurse was responsible for, such as transporting samples for PCR tests.

Furthermore, support from the university is now the most powerful force. Currently, we are requesting Teikyo University, which has a campus near Kita Ward, to help analyze the data of infected people.

A dedicated room is set up in the public health center where four graduate students and faculty members studying public health enter data such as patient outbreak reports every day. We analyze how old people are, and how long it takes on average from the time a patient develops the disease to the PCR test. In addition to being an important resource for understanding the current situation and considering measures at public health centers, it also reduces the burden on public health nurses.

Mariko Inoue, Associate Professor of Teikyo University School of Public Health said, "I think the staff at the public health center is too busy with patients to handle statistical analysis. If we visualize the current situation with data, it will be useful. ".

However, Hideo Maeda, the director of the public health center, feels, "Is this system really sufficient when there is a big second wave in the future?"

Maeda said, "I think we have managed to improve the system within what we can do now, but depending on the size of the second wave, I am worried that more human resources will be needed."

One of the reasons for this is that it is difficult to expand the number of "public health nurses" who are at the core of our work.

It is said that a public health nurse with specialized knowledge and experience of infectious diseases is indispensable for core tasks such as interviewing patients to identify concentrated contacts and investigation to identify the infection route.

In Kita Ward, there are currently 9 public health nurses, including new staff members. Although it is relatively substantial among the local governments nationwide, it is not easy to expand it further.

Maeda said, “Infected people are starting to increase in the ward, and we are nervous in the field. We do not have a public health nurse with knowledge and experience of infectious diseases because we want any local government. Is the biggest challenge.”

The biggest challenge "Securing public health nurses"

"Securing public health nurses" is said to be the biggest issue facing public health centers.

In order to know the current situation, we interviewed the Japan Nursing Association, which introduces human resources for public health nurses and nurses to local governments.

From April to June, the association was flooded with more than 1,600 job offers from local governments and medical institutions across the country.

Approximately 50,000 people, including public health nurses and nurses who were leaving their jobs, were requested to return to work, and by the end of last month, approximately 1,000 had returned to the scene, but only 138 public health nurses remained.

"Nurse Plaza" of the Tokyo Nursing Association, which deals with the practice of referral work. Since April, 15 public health nurses and nurses have been assigned to work at 6 public health centers in Tokyo, such as a call center, which provides consultation for people with onset.

Hiroko Sato, Director of Nurse Plaza in Tokyo, said, “Since each local government regularly hires personnel at public health centers, we have rarely been recruited to us. The work of public health centers is tight. The fact that they are doing it has been transmitted to us."

Securing difficult public health nurses. It has been said for over 10 years that the work is concentrated and the burden is increasing at public health centers.

According to a survey conducted by the Japan Nursing Association on the public health nurses who work for local governments in 2010 with more than 18,000 people, about 71% of the respondents answered that they could not evaluate or review the business because they were busy with their daily work. 67% of respondents answered that the cases and tasks they deal with are complicated and difficult.

The number of public health nurses working in local governments, such as public health centers, has increased little by little, increasing by more than 10% from 10 years ago, but it has been pointed out that they are still not catching up with the expansion of work.

Kumiko Kamada, Executive Director of the Japan Nursing Association, said, "I have to point out that somewhere in the municipality there was a lack of control over infectious diseases, which could be called the basis of the public health center. It has become.”

Professional personnel Why are you missing?

According to experts, public health nurses who are in charge of the field of infectious diseases are unable to secure sufficient human resources for two main reasons.

<Reason 1 Centralization of
public health centers > One is the consolidation of public health centers due to administrative reform such as the Great Heisei merger. There were 852 health centers nationwide in 1992, but in April this year it was almost halved to 469.

For example, in Tokyo's 23 wards, there were 4 public health centers in Setagaya Ward and Ota Ward in 1997, respectively, and in Osaka City, the public health centers in 24 wards of the city were integrated in 2000, It became a place.

It has been pointed out that along with this, the number of personnel involved in the work of infectious diseases has decreased.

<Reason 2 Business is complicated and diversified> The
other is that the work required of public health centers has diversified with the times.

In the 1945's, public health centers mainly deal with infectious diseases such as tuberculosis, but after the 1940's, new health and social problems such as declining birthrate and aging, lifestyle-related diseases, and suicide problems will arise.

The number of fields at the public health center that should be addressed other than infectious diseases, such as support for elderly people and persons with disabilities who need nursing care, as well as support for abuse, has increased significantly.

According to a survey conducted by the Japan Nursing Association two years ago, when asked which public health nurses working in public administration such as public health centers and health centers are involved in many tasks, "Mother and child health" was the most common at 46.5%, followed by "lifestyle habits" “Disease prevention” was 35.9%, while “Health crisis management including infectious disease control” was 12.3%.

Experts and others have pointed out that given the limited budget of local governments, the priority for dealing with infectious diseases became a low priority, resulting in a decrease in the number of public health nurses with experience and knowledge.

Don't miss the lessons of the new influenza

The need to strengthen the health center system was strongly pointed out 11 years ago even after the outbreak of the new influenza.

In June 2010, a panel of experts examining the measures of the new influenza country compiled a report including recommendations to the country.

Among these, as “strengthening the system related to infectious disease risk management”, “it is necessary to further strengthen the response at the time of occurrence, and to significantly strengthen the organization such as public health centers of local governments and personnel system and develop human resources Need to proceed.”

In response to this report, the Ministry of Health, Labor and Welfare says that it is proceeding with a review of measures against infectious diseases, but some experts say that the measures and human resource development leading to drastic improvement were not sufficient. I am.

Expert "Hurry up the system"

Professor Toshiyuki Ojima of Hamamatsu University School of Medicine, who is familiar with the actual situation of public health centers, said that the number of public health nurses responsible for infectious diseases is small. "There is no opportunity for public health nurses to be involved in infectious diseases compared to the past, and the number of people who can respond to them is small, so this time there was a situation where a new virus occurred and the health center punctured."

In addition, "It was pointed out that the same problem as this time will occur with the new strain of influenza and that the public health center should be strengthened, but I think that it did not reach the point of expanding the number of personnel and securing the budget. I can say that I forgot."

Now that the infection is spreading again, the required measures are: "Each local government should maintain the support system that was established during the first wave. In addition, the information system that connects medical institutions and public health centers using IT has begun to operate. It is important to have it function properly and to have an inspection system so that not only health centers but also family doctors can perform PCR tests.”

And as a long-term measure, he said, "It is necessary to make use of the lessons learned this time to build a solid personnel system and organization so that it will not cause a new type of influenza."