Regarding the medical care provision system for the new coronavirus, the government has decided to prioritize hospitalization for critically ill patients and those at high risk of aggravation, while for other people, based on home care and strengthening health observation. I summarized.



On the 4th, a debate was held over the government policy during the closing examination of the House of Representatives Welfare and Labor Committee.

A press conference was also held by experts.



We have summarized today's discussions on the policy and the situation at the medical site.

Minister of Health, Labor and Welfare Tamura "Need to secure a bed"

Minister of Health, Labor and Welfare Tamura said in a closing examination of the House of Representatives Health, Labor and Welfare Committee held on the 4th, "There are various patients with moderate illness, but those who are in respiratory control will not be hospitalized and will be returned to their homes. It is impossible. I am fully aware of the medical field, and I made a clear statement at the meeting between medical personnel and Prime Minister Kan yesterday. "



On top of that, "The phase has changed, and with the rapid increase in infections in April and May in Kansai, there was a problem that people who had to enter the hospital could not cope with it because they had no bed. If there is not enough room in the bed to a certain extent, it will not be possible to transport such people in a hurry, so for those who have a relatively low risk of becoming seriously ill, we have decided to take the initiative to deal with them at home. " I did.

Constitutional Democrats “Adhering to the principle of hospitalization for moderately ill patients”

The Constitutional Democratic Party has asked Minister of Health, Labor and Welfare Tamura to adhere to the principle of hospitalization for moderately ill patients, saying that they are irresponsible for the government's policy based on home care, except for critically ill patients.



The offer was made by the Deputy Representative of the Constitutional Democratic Party, Mr. Nagatsuma, who handed an urgent request to Minister of Health, Labor and Welfare Tamura.



The request points out that the government's policy of home care, except for critically ill patients, is an irresponsible response to abandoning patients, and demands that moderately ill patients also adhere to the principle of hospitalization.



In addition to urgently securing temporary medical facilities and accommodation medical facilities, it is urgent to establish a system that enables continuous oxygen administration even when medical treatment is unavoidable at home.



In response to the request, Minister Tamura said, "The phase has changed due to the spread of infection that cannot keep up with the securing of accommodation hotels," and asked for understanding.



After the offer, Mr. Nagatsuma told reporters, "The crisis is going on and we want the government to respond at full speed."

Chairman Omi "Comprehensive measures for medical care, accommodation, and home"

Shigeru Omi, chairman of the government subcommittee, told the House of Representatives Welfare and Labor Committee, "Since there is a risk that even mild or asymptomatic people will become seriously ill due to home medical treatment, medical institutions and accommodation will be provided as a system that can be immediately linked to medical care. We need three comprehensive measures: facilities and home. The debate about whether to stay at home or a medical institution simplifies the problem a little. "

Japan Medical Association "Patients judged by doctors can be hospitalized"

Regarding the government's policy that home medical treatment is the basis except for critically ill patients, Chairman Nakagawa of the Japan Medical Association should be hospitalized if the doctors in the field judge at a press conference that there is a high risk of serious illness. I showed the idea that.



Among them, Chairman Nakagawa of the Japan Medical Association said, "From medical practice nationwide,'If a person with moderate illness cannot be hospitalized, the discovery of signs of sudden change will be delayed and the number of cases will increase. There are many voices of concern, such as "Isn't it?"



On top of that, "Home visits and online medical care take longer than regular medical care, and a sudden shift to home medical care puts a heavy burden on the medical field. If the doctor in the field judges that there is a high risk of serious illness, he will be hospitalized in a timely and appropriate manner. I want the government to respond so that it can be done. "



In addition, Chairman Nakagawa said, "If the number of patients continues to increase, we will not be able to secure sufficient beds and medical staff. We strongly urge that measures to suppress the spread of infection be given top priority."

Review of Tokyo Metropolitan Government Policy Acceptance Criteria for Hospitalization

In response to the government's policy, the Tokyo Metropolitan Government is considering a review with a view to tightening the criteria for hospitalization, such as "moderate or higher," and decided concretely based on the opinions of experts. I'm going to go.



The current standard is to hospitalize "symptoms such as fever and respiratory distress are moderate or higher".



As a specific example, cases with symptoms or findings such as fever of ▽ 38 degrees or higher and ▽ oxygen saturation of less than 96% in blood are hospitalized.



The Tokyo Metropolitan Government is considering a plan to lower the standard of oxygen saturation in the blood and make it stricter regarding this hospitalization standard, and will make a concrete decision based on the opinions of the Tokyo Metropolitan experts. I am doing it.

Medical site Medical treatment transportation One after another There is a shortage of equipment and therapeutic agents

In the midst of debate over the policy, there are cases in the medical field where medical caregivers are being transported one after another and the medical system is becoming tight.

At Tokyo Rinkai Hospital in Edogawa Ward, which is close to the Olympic Games venue, we have secured 50 dedicated beds for corona patients and accept mainly moderately ill patients, but as of the 3rd, 46 people were hospitalized and almost full. It is in the state of the floor.



It means that patients who have already deteriorated to the point where oxygen administration is required when they are brought to the hospital, and patients whose blood oxygen level has deteriorated during medical treatment at home are being transported one after another.

On the day when about 10 people were hospitalized a day, the in-hospital inventory of the antiviral drug "remdesivir" to suppress the growth of the virus became insufficient.



Most of the 15 devices in the hospital, called "Nasal High Flow," which are necessary for the treatment of sending a large amount of high-concentration oxygen through the nose, were used up and were not enough, so we decided to purchase a new one.



Currently, we are closing the floors of gastroenterology and surgery to secure beds for corona patients, but we are also considering increasing the floors, and in that case, we have to close the floors of other clinical departments as well. about it.



Although we want to avoid affecting general medical care, we have to consider increasing the floor space to respond to the current spread of infection, which is a difficult situation.



Tomoyoshi Yamaguchi, director of the Department of Respiratory Medicine, said, "In many cases, pneumonia is severe and the oxygen level is worsening when transported, and I think that there are potentially many patients who have to be hospitalized even if they are receiving medical treatment at home. I think it is good for patients to be hospitalized early and administer medicines to those who need them, but the medicines, machines, and personnel are not unlimited, and there are limits. " I did.

Some hospitals restrict new hospitalizations and surgery to secure beds

Due to the rapid spread of the new corona infection in Chiba prefecture, we have decided to raise the plan to secure beds throughout the prefecture to the maximum level.



In response to this, on the 3rd, at Chiba University Hospital, a countermeasure meeting was held online with the participation of the hospital director, doctors and nurses of each clinical department.



At this hospital, the number of inpatients for the new corona was around 10 until the first half of July, but as of the 3rd, it has increased to 25, including 4 seriously ill patients.



During the meeting, a pulmonologist said, "The number of patients has increased rapidly, and we accepted three patients for two days but declined two. We need to be ready to accept them promptly." The hospital director responded, "If we do not give top priority to corona patients, we will be late, so we must limit medical care."



After that, in order to increase the number of dedicated beds that the hospital can handle immediately from the current 31 beds to 60 beds, we decided to restrict new hospitalization and surgery except in cases of high urgency.

Increasingly serious "medical pressure"

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," and "bed usage rate for the severely ill."



According to the summary of the Cabinet Secretariat, there is an item corresponding to the most serious "Stage 4" in all areas of 1 metropolitan area, 1 prefecture and 4 prefectures where an emergency declaration is issued.

Domestic infection increases pediatric patients and feels a sense of crisis

In addition, the number of children in hospitals specializing in maternal and child medical care is increasing due to the rapid spread of infections among younger generations, such as when raising children.



Aiiku Hospital in Minato-ku, Tokyo, which specializes in maternal and child medical care, also accepts hospitalization for children and pregnant women infected with the new coronavirus.



A total of 20 people were hospitalized in July, doubling the number in the previous month.



Dr. Takashi Urashima of the Department of Pediatrics, Aiiku Hospital said, "I feel the strength of the infectivity of the'Delta strain'in the 5th wave. As a result, the number of patients seems to be connected, and as a result, the number of patients is increasing at an unprecedented pace. There are some difficult aspects. "



Regarding the government's policy based on home care except for critically ill patients, "If the number of home care patients increases, the risk of domestic infection increases, so there is a risk that the number of children will increase further. However, the beds are becoming tighter. Because of the situation, I think it is an unavoidable measure to create a system that gives priority to hospitalization for critically ill patients and high-risk patients. "

Increasing number of recuperators The most serious "stage 4" in all regions

The government's "Coronavirus Infection Control Subcommittee" is an index for determining which of the four stages that indicate the infection status, and the number of medical treatment persons is 20 or more in stage 3 per 100,000 population. , Stage 4 is a guide for 30 or more people.



It corresponds to the most serious "Stage 4" in all regions where a state of emergency has been declared.

Brother and sister are infected one after another "Under one roof It is impossible to prevent infection"

As the number of recuperators increases, doctors point out the difficulty of preventing infection at home. What are the actual cases?



An 11-year-old elementary school student admitted to Aiiku Hospital in Minato-ku, Tokyo, had been confirmed to be infected with his sister and brother, and his mother said, "I was careful, but it spread in an instant. Under one roof. I don't think it's possible to prevent infection with. "



Last week, an 11-year-old elementary school girl who had been hospitalized since July 30 had a fever for four days, with her body temperature rising to nearly 40 degrees.


In the video taken by the hospital, he answered to the doctor's interview that "sometimes I have a headache and I am suffocating."



According to the girl's mother, the infection spread one after another in her family last week.



On July 27, my sister in her twenties, who attended a vocational school, had a fever and was confirmed to be infected at the hospital.


I went home once, but I was hospitalized the next day due to the adjustment of the health center because I had a strong feeling of malaise and the symptoms were relatively severe.



On the day my sister was hospitalized, my teenage brother, an office worker, had a fever.


The infection was confirmed, and two days later, the girl also had a fever and complained of a strong headache, so she was transported by ambulance.


My brother said that the health center adjusted the medical treatment destination, but it took 6 days and he entered the hotel on the 3rd.



According to the girl's mother, after finding out that her sister was infected, the family took measures to prevent the infection from spreading, such as wearing a mask in the house and spending time in each room and talking on a mobile phone when there was a need. That said, I had to share the toilet and wash basin.



The mother said, "The next day, the next day, the children became infected more and more, and it was so quick. I was really disappointed that it spread in an instant even though I was careful about hand washing and disinfection, and the infectivity was strong. I feel that it is impossible to prevent infection while recuperating under one roof. "



The mother's test was negative, but she was considered a close contact and could not go out.



I work part-time as a single mother, but because I am absent for more than a week, I have no choice but to use paid leave or withdraw my savings. It's also painful to be there. It's no longer the place to watch the Olympics. "

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