Regarding the medical care provision system for the new coronavirus, the government announced on the 2nd that hospitalization will be focused on critically ill patients and those at high risk of becoming severely ill, and that other people will be treated at home.
What will change from the past based on home medical treatment?
And what are the challenges of home care?
What will change from the past?
According to the new coronavirus medical treatment guide published by the Ministry of Health, Labor and Welfare, the patient's symptoms are classified into four stages, "mild", "moderate 1", "moderate 2", and "severe". It also shows the policy of.
▼ Mild cases have no evidence of pneumonia, and many people recover spontaneously, but the condition may progress rapidly, so those who are at risk of becoming severe are eligible for hospitalization.
▼ Moderate 1 is for people with dyspnea or pneumonia, who are hospitalized and carefully followed up.
▼ Moderate 2 is a person whose blood oxygen saturation is 93% or less or who needs oxygen administration, and will consider transferring to a medical institution that can provide advanced medical care.
▼ Severe cases are those who enter the intensive care unit or need a respirator, and consider using an artificial cardiopulmonary device = ECMO depending on the medical condition.
This time, the government will review the response to hospitalization in areas where the number of infected people is increasing rapidly.
According to the Ministry of Health, Labor and Welfare, until now, ▽ people with moderate or higher illness were hospitalized in principle, ▽ people with mild or asymptomatic treatment were treated at accommodation facilities in principle, and ▽ only those who were unavoidably unable to receive medical treatment due to mild or asymptomatic treatment. Was used as home medical treatment.
In the future, ▽ hospitalization will be targeted at ▼ severely ill patients and ▼ people with a particularly high risk of aggravation, and ▽ other people may spread the infection at home, such as in the same room or bedroom where they eat with their families. Except in some cases, we basically ask for medical treatment at home.
How to decide "people with a particularly high risk of aggravation" is left to the prefecture.
The country has set a new policy because of the rapid spread of infection and the tightness of beds.
The Ministry of Health, Labor and Welfare wants to secure an empty bed by limiting the number of people to be hospitalized to severely ill patients, and to establish a system that allows them to be hospitalized promptly even if their condition suddenly changes during medical treatment at their home or accommodation facility.
"Medical system is tight" in the background "Declaration" Stage 4 in 6 prefectures
So how far is the sickbed tight?
The government's "Coronavirus Infection Control Subcommittee" provides indicators to determine which of the four stages of infection status is in.
Of these, there are three items for "medical pressure": ▼ "bed usage rate" ▼ "hospitalization rate" ▼ "bed usage rate for critically ill people".
According to the summary of the Cabinet Secretariat, among the six prefectures that have been declared a state of emergency as of the 1st, there is an item corresponding to the most serious "Stage 4" in all of them.
[Bed usage rate]
First of all, the degree of medical pressure. As a guide, the bed usage rate is 20% or more for stage 3 and 50% or more for stage 4.
The usage rate of the entire bed was
▼ 49% in Tokyo
,
▼
57% in Saitama
,
▼
53% in Chiba
,
▼
52% in Kanagawa
,
▼
36% in Osaka
,
▼
73% in Okinawa. I am.
[Hospitalization rate] The
"hospitalization rate" is the percentage of all medical care recipients who have been hospitalized.
As the number of patients with the new coronavirus increases, the number of patients who should be hospitalized but cannot be hospitalized and receive medical treatment at home or institution increases. Therefore, the lower the "hospitalization rate", the more patients cannot be accepted. It is increasing, that is, medical care may be tight.
The standard hospitalization rate is 40% or less for stage 3 and 25% or less for stage 4.
Hospitalization rate is
▼ 13% in Tokyo
▼ Not applicable in Saitama prefecture,
▼ 14% in Chiba prefecture,
▼ Not applicable in Kanagawa prefecture,
▼ 16% in Osaka prefecture,
▼ 19% in Okinawa prefecture.
[Severely ill person's bed usage rate] The
standard for the severely ill person's bed usage rate is 20% or more in stage 3 and 50% or more in stage 4.
The bed usage rate for the severely ill is
▼ 70% in Tokyo
,
▼
32% in Saitama
,
▼ 32% in
Chiba
,
▼
37% in Kanagawa
,
▼
19% in Osaka,
▼ 86% in Okinawa. It has become.
3 days of home recuperation ... Family infected one after another
People who have experienced medical treatment at home are raising anxiety.
A 60-year-old care helper woman living with her husband and two sons in Tokyo was infected with the new coronavirus last month by the entire family living together.
The infection of the eldest son of a 30-year-old office worker was found on the 19th of last month, and three days later, the husband became ill, and the infection was confirmed after that.
Around the same time, the woman and her 29-year-old second son also tested positive for the PCR.
The eldest son, who was first found to be infected, was treated at a hotel, but it took time to make adjustments, and after confirming the infection, he spent three days at home, so the woman thought that the infection had spread at home during this time. increase.
The woman said, "I kept my eldest son in a private room so that he wouldn't touch it, but it was difficult to prevent the infection because the toilets were shared, and it spread in a blink of an eye. I didn't feel like living while I was taking care of myself at home. "
On top of that, except for critically ill patients and those who are at high risk of becoming severely ill, the policy based on home medical treatment is "Medical care is tight and there may be only one way, but to prevent domestic infections. It will be difficult and the infection will spread more and more. "
Miyako's follow-up center
A woman in her 40s living in Tokyo was confirmed to be infected with the new coronavirus on the 30th of last month, four days ago, when her eldest daughter was a high school student.
The next day, the health center contacted me, and after investigating the behavior history, the health center explained that I would take over to the follow-up center in Tokyo.
The follow-up center in Tokyo is a contact point for medical consultations and health observations, and the woman called the center because her eldest daughter's fever rose to the 39-degree range, but she said that she could not connect because there were a series of inquiries. is.
The eldest daughter continues to receive medical treatment at home.
The woman said, "I had my daughter take medicine and food, and I could only cool the fever for the time being. I'm not a seriously ill person, so I can't enter the hotel or hospital, so I can't enter the hospital, so at home. I was worried about what to do if I had to do it. My daughter's symptoms are calm now, but when I hear that only people who are at high risk of becoming severe can be hospitalized, I am worried and uneasy. I feel that there was more I could do before the infection spread. "
Infected people who died at home January-June 84 people nationwide
The Ministry of Health, Labor and Welfare uses a system that aggregates information on people infected with the new coronavirus from local governments and medical institutions nationwide, and aggregates cases where the place of death is registered as "home."
According to this, 84 of the people who were reported infected during the six months from January to the end of June died at home nationwide.
By age, ▼ 1 in 20s, ▼ 3 in 30s, ▼ 1 in 40s, ▼ 7 in 50s, ▼ 11 in 60s, ▼ 24 in 70s, ▼ 36 in 80s There was one person, ▼ unknown age.
Apart from this, in Osaka Prefecture, the medical system was in a critical state, and in the "fourth wave" of infection from March to June, patients who died without receiving medical care at home or accommodation facilities. Has announced that there were 19 people.
By age, there were 2 people in their 30s, 3 people in their 50s, 6 people in their 60s, 3 people in their 70s, and 5 people in their 80s, and even the younger generation died.
Health center "Home medical treatment is very strict"
Regarding the government's policy of taking home care as a basis, the director of a health center in Tokyo says, "It is very difficult for the health center to respond in detail when it comes to home care."
Hideo Maeda, director of the Kita Ward Public Health Center in Tokyo, said, "In the situation where people complain of dyspnea for moderate or higher illness, they should be treated in the hospital. However, it is very difficult for the public health center to contact you several times a day or watch over 24 hours a day, so it is very difficult to respond in detail. I think that will cause anxiety. "
On top of that, he said, "If you continue to have severe moderate illness, you may not be able to be hospitalized even if you look for it all over Tokyo. Basically, if you do not reduce the number of positive people, medical care in Tokyo will collapse. Mild people I would like you to take measures such as using the accommodation medical facilities that Tokyo is using for people with a certain risk, or setting up temporary medical facilities to observe their health. "
Expert "Sudden deterioration of symptoms is a challenge"
Regarding the government's policy based on home medical treatment, Professor Koji Wada of the International University of Health and Welfare, a member of the expert meeting of the Ministry of Health, Labor and Welfare, said, "Some people infected with the new coronavirus feel that they have difficulty breathing. It is known that there are a certain number of people who develop pneumonia without it and their symptoms worsen rapidly. The challenge is to find out who is ill at home and quickly connect to medical care. " ..
On top of that, "If you are hospitalized, it is clear who will be responsible for management, such as your doctor, but in the case of home medical treatment, it may not be clearly decided. If you are a younger generation, it is thought that there is no family doctor. It is also necessary to establish a medical system in the community, such as having the clinic follow up on the health condition, "he emphasized the need to establish a medical system that supports people who are being treated at home.
In addition, Professor Wada commented on the current infection situation, saying, "In Japan, the risk of infection is the highest in a year and a half since the spread of corona. Especially when medical care is tight, you may not be able to receive the medical care you expect even if you get infected. To protect yourself and your family, reduce the chances of meeting and contacting people. I have to get it. "