"All positive people are hospitalized" Preparing for the 6th wave from Wakayama's own measures October 20, 18:42

Even in the 5th wave of the new corona, we have set a policy of "hospitalization of all people who have been confirmed to be infected", and in fact, there is only one prefecture in Japan where all people can be hospitalized.



It is Wakayama prefecture.



The fifth wave in which many people were forced to "recuperate at home" all over the country.



Of course, the situation differs depending on the size of the local government, and "hospitalization" is not the only option.



However, Wakayama Prefecture's efforts had hints to prepare for the sixth wave.



(Wakayama Broadcasting Station reporter Fumihide Makihara)

Wakayama Prefecture, which continued to raise "all hospitalization"

At the peak of the fifth wave of the new corona, in early September, the number of "home recuperators" reached more than 130,000 nationwide, and many died.



According to the Ministry of Health, Labor and Welfare, Wakayama Prefecture is the only prefecture in Japan where all infected people can be hospitalized regardless of their medical condition.



According to the government policy, hospitalization is basically for people with moderate or higher illness, except for patients who need to be hospitalized.

(Notice on August 3, 2021)



However, Wakayama Prefecture responds to sudden changes in the condition of infected people and their aggravation, and in order to prevent the spread of secondary infections such as "domestic infection", infected people We continue to have our own policy of hospitalizing everyone.



The highest number of infected people per day in Wakayama Prefecture was 90 on August 24th.



When converted to the population ratio, it was a difficult situation that exceeded the "more than 1,300 people a day" in Tokyo.



How did you survive?

Efforts to prepare for ordinary disasters in the background of securing beds

In early September, the number of new infections nationwide exceeded 20,000 per day, and medical care was tight in various places.



At that time, the number of beds for the new corona secured in Wakayama Prefecture was 570.



According to Wakayama Prefecture's calculation based on data from the Ministry of Health, Labor and Welfare, it is the number one in Japan in terms of population.



On the other hand, the total number of beds in hospitals in Wakayama Prefecture is 20th in Japan per 100,000 population (as of October 1, 2019).



In other words, Wakayama Prefecture does not originally have a large number of beds per population.

So how did you secure a corona bed in Wakayama Prefecture?



In Wakayama Prefecture, "Hidaka Hospital" in Gobo City cooperated with the expansion of corona beds from an early stage.



Initially, there were 4 corona beds, but in the 3rd wave it expanded to 48 beds and in the 5th wave it expanded to 56 beds.

56 beds are 30% of all beds in the hospital.



We asked inpatients in gastrointestinal surgery and neurosurgery to move to another floor, and made the entire hospital floor a dedicated corona ward.

"Hidaka Hospital" is also a regional disaster base hospital.



It is said that the background of the hospital's drastic response was the relationship of trust with the prefecture that it had built to prepare for the Nankai Trough giant earthquake.



In creating a medical system to prepare for the Nankai Trough giant earthquake, the prefecture played a central role in introducing the first system in Japan where local practitioners rush to disaster base hospitals in the event of a disaster.



The director of the Nursing Department of "Hidaka Hospital" said that he wanted to respond as much as possible to the policy of "all hospitalization" set out by the prefecture while communicating with the prefecture.

Kayomi Komatsu, Director of Nursing Department, Hidaka Hospital


"Discussing the creation of a medical system for the Nankai Trough, and if you consult with a shortage of nursing personnel, you will be encouraged to establish a new nursing school. I managed to shift nurses and shared my experience with other disaster base hospitals in an attempt to respond thoroughly if I accepted Corona patients. "

Thorough inspection of up to 100 contacts for each infected person

In addition to securing beds, Wakayama Prefecture has been working on a thorough PCR test called the "Wakayama method" for those who are "contacts" of infected people.



In Wakayama Prefecture, we wanted to reduce the number of infections at work and at home in the future by quickly finding and enclosing new infected people from the contacts.

The guideline for the survey of "contacts" indicated by the government is "people who met two days before the onset of symptoms".



On the other hand, in Wakayama prefecture, we have increased the number of days by one more and expanded the target to "people I met three days ago" to perform PCR tests.



Up to 100 people have been tested for one patient.

Local government dispatches public health nurses to health centers that lack manpower

Many public health nurses are needed to carry out such a thorough investigation.



Health centers have been consolidated and abolished nationwide, and their scale has been reduced.



Under such circumstances, Wakayama Prefecture has maintained and strengthened the system of health centers in preparation for the Nankai Trough giant earthquake.



As of May last year, the number of public health nurses per 100,000 population was 44.1 in Wakayama prefecture, which is 1.5 times the national average of 28.4.



However, there is still a shortage of public health nurses who can handle corona.



In Wakayama Prefecture, after the second wave, we signed an agreement to dispatch public health nurses with the municipalities in the prefecture, and created a system to have the public health nurses dispatched from the municipalities to the health centers in the prefecture where there is not enough manpower.



And in fact the agreement worked.

Health center director


"Corona is difficult to deal with because of the sudden shortage of manpower due to the outbreak of clusters. At that time, it was really encouraging for the public health nurses from the municipalities who knew the local circumstances to come to support us immediately."

As a result of these efforts, in Wakayama Prefecture, those who were found to be positive for corona were contacted by the health center by the next day and were admitted to the hospital.

Vaccination that takes advantage of the large number of clinics

In Wakayama prefecture, vaccination progressed relatively quickly.



Wakayama Prefecture has the largest number of clinics per 100,000 population at 110.8 in Japan, and by taking advantage of the large number of clinics, we promoted "individual inoculation" at clinics with family doctors. ..

Doctors who cooperated with individual vaccination


"It is our own doctors who know the patient's condition well. I think that both the hitting side and the hitting side were relieved."



"All prefectures and public hospitals are infected by hospitalization. I was watching the situation trying to suppress the situation and wanted to cooperate as a practitioner. "

"Inpatient adjustment" is done by the prefectural technical supervisor

Increase the number of beds.


Thoroughly inspect contacts.


Proceed with vaccination at an early stage.



Takako Nojiri, who is in charge of dealing with corona in Wakayama Prefecture, is a doctor and has been a health center director for nearly 20 years.



In response to this corona response, Mr. Nojiri is actually doing the work of "hospitalization adjustment" for infected people alone.



The top of the prefecture calls the key person in the hospital to request hospitalization.

"I have an elderly family member who needs long-term care, so let's be hospitalized together



."

In "hospitalization adjustment", it is said that we try to meet the needs of each patient so that it will not be allocated mechanically.



When I talked to people involved in hospitals in the prefecture, several people said, "I can't refuse the hospitalization request from Mr. Nojiri ...".

"I thought I would step on thin ice."

Even so, in the fifth wave, when the infection spread rapidly, the policy of "hospitalization for all" in Wakayama Prefecture faced a crisis.

Governor Yoshinobu Nisaka of Wakayama Prefecture


"The hospitalization rate of 100% has been pushed to the point where it is impossible. It is unavoidable, but patients who do not seem to get worse are asked to move to the hotel."

At a press conference on August 24, Governor Nisaka announced that he would prepare a hotel for lodging treatment in Wakayama City to prepare for a situation where beds would overflow.



The bed usage rate was 96.5%, the highest ever.

After that, the infection quickly subsided, and it was avoided that patients who were confirmed to be infected stayed at the hotel, but Mr. Nojiri recalled, "I thought I would step on the thin ice every day."

Takako Nojiri, Wakayama Prefecture,


"From August to September, hospitalization was adjusted every day until midnight, and I was physically close to the limit. The reality is that I was able to survive by using all my hands, such as continuing to call the hospital and increasing the number of beds by 150 in a month. "

To prepare for the "6th wave"

Wakayama Prefecture is the only prefecture in Japan that has continued to raise the flag of hospitalization, even in the "Fifth Wave," which was the biggest wave of a series of corona infections.



He points out that there may be something that can be done even in populous urban areas to prepare for the "sixth wave."

Takako Nojiri, Wakayama Prefecture


"It is true that Wakayama has a small population and has a face-to-face relationship with hospitals and public health nurses, and it is easy to share the same direction of" all hospitalization. " It is said that it is difficult to build a face-to-face relationship, so it is said that it cannot be done like Wakayama, but I do not think so. You can do it. You should prepare as much as possible from normal times and do it thoroughly without giving up. Even if the sixth wave comes, we will investigate the infected people and enclose them, and all of them will be hospitalized and treated early. By doing so, we will make the wave not to exceed the 5th wave. There is no choice but to repeat such a natural thing. "

As for the new corona measures, the situation differs depending on the size of the population of the local government, and "hospitalization" is not the only option for dealing with infected people.



However, Wakayama Prefecture's stance of working with local medical institutions and municipalities toward the goals it set itself had hints for preparing for the sixth wave.

Wakayama Broadcasting Station Reporter


Fumihide Makihara


Joined in 2004


Osaka Station After working for News Watch 9, Wakayama Station has been in operation for three years.


Continued coverage of the new corona from the first nosocomial infection case in Japan that occurred in February last year.


See also NHK Special "Pandemic Turbulent World (7)" for the full picture of "Wakayama Method".

Keywords: people, director, japan, corona, number, wave, wakayama, nurses, prefecture, nojiri, population, hospitalization, policy, persons, measures