New Corona 7th Wave Bed tightness "Exceeded the limit..." Crisis of home caregiver August 25, 11:36
"Call an ambulance if your physical condition suddenly changes
." I think that "119" is an emotional support for patients who are infected with Corona and are recuperating at home.
However, now, even if I call an ambulance, it will be difficult to carry him.
Such incidents are happening one after another.
In Tokyo, there have been cases of elderly patients dying without being transported from their homes.
Why such an anomaly?
What can be improved?
In the "7th wave", we interviewed medical sites that were cornered.
death of a man
"We weren't strong enough."
On July 29th, at the home of an elderly couple in Tokyo.
In front of the 83-year-old man who was confirmed dead, Dr. Kazuma Tashiro, the attending physician, quietly put his hands together.
The man had terminal colon cancer and was recovering at his home.
My wife called the clinic the day before,
saying, "My physical condition has deteriorated and I feel a little strange ."
When Dr. Tashiro visited him around 6:00 pm, he was in a drowsy state, and his blood oxygen level and oxygen saturation had dropped to 90%.
He was suspected of being infected with the new corona, and an antigen test was performed on the spot, and the result was "positive."
He calls 911 and asks for an ambulance.
"This is the Fire and Disaster Management Agency. Is it a fire or ambulance
?"
"I have respiratory failure with consciousness disorder due to
coronavirus
.
"
An ambulance arrived within minutes.
The doctor passed on the medical condition, etc., and headed to another patient's house call.
"I'm sorry I couldn't find the hospital."
Three hours later, around 10:00 p.m.
When I checked with the ambulance crew, the man's destination had not yet been decided.
"We have called more than 100 hospitals, but we have not been able to find a destination.
" At the same time, I told him about the future treatment policy as the attending physician.
"We don't know what will happen in the future, but we will do what we can
.
"
Oxygen was continued at home, but the next morning he stopped breathing.
Shortly after 9:00 a.m., Dr. Tashiro confirmed his death.
He was about half a day after the infection was confirmed.
"Where is the reason why you can't be hospitalized?"
Dr. Kazuma Tashiro
: “Even though the man’s cancer was in the terminal stage, he still had energy to spare and his condition was stable.
I had a positive feeling that I wanted to spend the remaining time in my own way, but suddenly that time was taken away from me.
On top of that, Dr. Tashiro strongly doubted the situation in which such a thing would occur, considering that the bed occupancy rate in Tokyo was around 50% at this time.
“In Tokyo, there should be about 50% of the hospital beds vacant, but people on the ground are indignant about why they can’t be hospitalized at all. I want you to reconsider the way hospitalization is now.”
"Empty bed" = "Can be hospitalized", but...
How should I answer Dr. Tashiro's question as he faces the man's final moments?
This month, we interviewed medical institutions in various places that accept patients with the new coronavirus.
One of them is the National Center for Global Health and Medicine Hospital in Shinjuku Ward, Tokyo.
As a special treatment hospital that provides advanced medical care, it mainly accepts "severe" and "moderate" coronavirus patients, and since the beginning of this month, about 50 of the 77 beds that have been secured are occupied. continues.
More than 60% of the hospital beds are occupied, but numerically there are about 20 vacant beds.
However, as I proceeded with the interview, I came to understand that "there are vacant beds" = "there is room in the beds" at all.
What's happening in the 'seventh wave'
In fact, during the "seventh wave" of infection, the following phenomena occurred daily, even more so than the "sixth wave".
1. We asked Dr. Atsuhito Sugiyama, the director of the hospital, what he meant
by saying, "Even if the hospital beds are vacant, it is difficult to accept them."
According to the director, the background is the ``strength of virus infection'' of the 7th wave.
At hospitals, since July, the number of cases in which medical workers such as doctors and nurses have become infected or become close contacts and unable to go to work has increased rapidly, reaching about 120 people on many days.
It takes about 1.5 to 2 times more manpower to treat corona patients than usual, but due to a series of staff unable to come to work, it is not possible to secure manpower, and even if there are vacant beds, there are not enough medical workers. This means that there is a situation where it is not possible to operate everything.
Another thing that the hospital director points out is
2, ``Once the beds are occupied, it is difficult
to get them. The value is over 80 years old.
Most of them are "moderate" patients, and there are almost no patients diagnosed as "severe", such as needing a ventilator due to pneumonia caused by the corona.
Why are so many elderly patients with less severe illness admitted to medical institutions that provide advanced medical care?
According to the director, many of the patients had fever and dehydration triggered by the corona infection, and many cases required hospitalization due to worsening chronic illnesses.
Compared to young people, the elderly tend to take longer to recover and stay in the hospital longer, which results in a situation where hospital beds are difficult to vacate.
Based on this situation, Director Sugiyama points out that it is necessary to create a system to reliably accept emergency patients who have a high degree of severity and need urgent treatment.
Dr. Atsuhito Sugiyama:
“Each medical institution has a role to play, and we need to examine the acute phase and move to the next medical institution when the symptoms improve. While the number of cases diagnosed as severe in the hospital has almost disappeared, if all beds are opened for corona patients, it will not be possible to accept truly urgent emergency patients such as cerebral infarction and myocardial infarction. It
is necessary to have a mechanism for "triage" to decide the priority in order to accept patients with a higher degree of severity after seeing the coronavirus from the same perspective as other diseases without treating only corona as a special treatment .
I think"
If a patient with another disease or injury is infected...
Interviews with other medical institutions revealed yet another challenge.
International University of Health and Welfare Narita Hospital in Narita City, Chiba Prefecture.
The interview was conducted during the Obon period.
While medical institutions around the world are closed, emergency outpatient departments are receiving requests for acceptance of patients one after another day after day. had become
According to the hospital, what has become conspicuous after the spread of the infection is the problem that "if a sick or injured patient is infected with Corona, it is difficult to find a transport destination."
At the beginning of the article, the 83-year-old man who died without being transported from his home (*Chiba Prefecture is far from Tokyo, so there is no direct relationship with this hospital). It was a case of infection with
Why is it difficult to secure hospital beds in such cases?
According to the hospital, even if the corona itself is mild, it is necessary to accept it in a corona-specific bed instead of a general bed, so if the number of infected people increases and the corona bed is tight, the number of beds that can be accepted will be limited. That's it.
"If there is no transport destination"
An elderly woman who was transported on the 11th of this month is one of those cases.
The woman was infected with Corona and was recuperating at her home, but she fell and broke her hip bone and called an ambulance.
She was taken to this hospital, 40 kilometers from her home, after being turned down by more than 20 medical facilities.
The woman had heard that ambulances and hospital beds were tight, so she hesitated at one point, saying, ``I wonder if it's okay to call an ambulance because it's this time of year,'' but when she reached her limit, she called 119.
The woman was accepted into the corona bed that had just been vacated.
Female patient:
"The ambulance team searched for a place to transport me, but I was refused when I told them that I was 'positive for corona' rather than my symptoms. I was worried about what to do if I didn't have a place to transport."
Professor Takashi Shiga, head of the emergency department at the hospital, points out that the current situation is far from normal medical care.
Head of the Emergency Department Chief Professor Takashi Shiga
"While you're in good health, you don't realize it, but once you get injured or sick, it's hard to find a hospital that will accept you. medical care is no longer possible, and the medical field has already exceeded its limits.”
After that, I spoke frankly about my current thoughts.
"It's hard to accept, and it's extremely hard to turn down a waiting patient, so both are tough."
Ambulance to transport
Ambulance services are also reaching their limits.
According to the Fire and Disaster Management Agency of the Ministry of Internal Affairs and Communications, there were 6,107 cases nationwide of "difficulty transporting" emergency patients who could not immediately decide where to accept them in the week ending on the 21st of this month.
It was the highest number in the "sixth wave", which is more than the 6,064 cases in February, more than six times the number before the spread of corona infection.
The person in charge of the Tokyo Fire Department said on the 3rd of this month as follows.
Hideaki Ogasawara, Section Chief of the Emergency Management Division
"It's been difficult to decide which medical institution to transport to, and the ambulance team has been dispatched continuously without being able to return to the fire station. In the intense heat, we wear protective clothing all over the body and respond. Although we are facing the risk of infection, we are in a very difficult situation with accumulated fatigue both physically and mentally.”
After that, when calling an ambulance, I want you to make a decision according to the symptoms.
"If there is a concentration of calls, it will be difficult to get through to the phone, and ambulances will have to come from far away, delaying the necessary relief. If you are unsure whether to call 119 or not, you can also use the fever consultation center in Tokyo. I want you to consider it."
where is the prescription
It seems that the medical field has already passed the breaking point in the big wave of the "seventh wave".
The Ministry of Health, Labor and Welfare has notified local governments that inpatients who do not need oxygen administration should switch to treatment at home or accommodation facilities, or transfer to a hospital for rehabilitation, but the high bed occupancy rate continues. I'm here.
Where is the "prescription" for promoting countermeasures against the new coronavirus while maintaining the local medical system?
We decided to interview Dr. Yoshihiro Takayama of Okinawa Prefectural Chubu Hospital, who is familiar with both "infectious disease control" and "community medical policy."
Dr. Takayama said about the current situation, as an unprecedented number of patients need medical care in the "seventh wave," the flow of cooperation between medical institutions is stagnant, and the problem of not being able to operate the hospital beds sufficiently. I'm doing it.
For the time being, Dr. Takayama mentions efforts to increase the number of patients who have recovered, such as the operation of a "hospital waiting station" that Okinawa Prefecture is working on.
"Measures in front of you"
The "hospitalization waiting station" was originally established to temporarily wait for infected people who are being adjusted for hospitalization, and emergency measures such as oxygen administration are being carried out.
In order to provide hospital beds for patients with high severity, Okinawa Prefecture is also operating as a recuperation place for inpatients whose conditions have calmed down.
On top of that, he points out that in the medium to long term, it is necessary to strengthen the system to support ``patients who do not necessarily need to be hospitalized'' outside of medical institutions.
Dr. Yoshihiro Takayama
: "By strengthening the system of 'community comprehensive care' that supports patients who do not necessarily need to be hospitalized in the community, we can preserve hospital beds and create an environment where patients who really need hospitalization can be hospitalized promptly. We can make it.”
“Re-customizing” community medicine
Dr. Takayama says that the issues that surfaced this time are actually nothing new.
“For example, even before the pandemic, patients who needed to be hospitalized could not be hospitalized due to the flu epidemic ,
and emergency refusals increased.
I think that it is necessary not only to take special measures in , but also to use the corona as a trigger to re-customize the whole community medical care.
As the population ages further in the future, one of the keys to promoting the development of communities where the elderly with illnesses and disabilities can continue to live with peace of mind is the proactive and continuous involvement of medical professionals in community healthcare. It is whether or not such a relationship becomes possible.
“For example, at various facilities for the elderly, many people in the nursing care field are supporting the in-facility treatment of COVID-19 patients. In fact, there are quite a few patients who do not need to be hospitalized just by getting involved and supporting facility care.It
is certainly ideal to be hospitalized, but from the patient's point of view, it is hospitalized and isolated. Rather, there are cases in which the movement of the body becomes worse, and in some cases it is better to stay in the facility without being hospitalized if the patient is to recover in a short period of time. Physicians from local clinics are required to support treatment at facilities.”
keep an eye on keep an eye on
Triggered by the case of a man who died at home without being able to be transported in Tokyo, I have been interviewing "Why can't I be hospitalized?"
However, looking back, I wonder if we were able to have as much interest in "the medical and nursing care system in the area where we live" until we were faced with the situation of "vacuity of hospital beds due to corona".
I feel that if I had had the level of interest and countermeasures I have taken before COVID-19, I would have been able to avoid facing the current “limits”.
In addition, new questions have arisen.
It is a fundamental question why the government could not assume the current situation based on the experience up to the "sixth wave" and take measures.
There are still many infected people in the "seventh wave", but what should the regional medical system be "now" and "future"?
What is necessary for that, and are the national and local governments taking the necessary measures?
At the very least, it is necessary for us to be proactive and keep our eyes on it.
We will continue the interview.
Reporter
Hiroshi Ichige
Joined
the Bureau in 2015 After working at the Saga Bureau and the Kamaishi Branch, he was in charge of the Ministry of Health, Labor and Welfare in the Social Affairs Department.
Social Affairs Reporter
Ayui Takahashi Joined
in 2014
and joined the social affairs department after working at the Matsuyama Bureau.
He is mainly in charge of the medical and social security fields.
Social Affairs Reporter
Atsumi Fujishima Joined
in 2013
After working at the Kochi and Kumamoto stations,
continued reporting on the novel coronavirus and child welfare in the social affairs department
Social Affairs Reporter
Tomoyo
Koizumi
Joined in 2011
After working at the Aomori Bureau and Sendai Bureau, he was in charge of the Ministry of Health, Labor and Welfare and the ruling party club in the Political Department.