Osaka hit hard by 4th wave of Covid, doctors warn of hospital system collapse

Up until September of last year, the Prime Minister was Shinzo Abe. PM Abe was a total asshole in many ways (he just couldn’t stop visiting Yasukuni Shrine…you know, the one with all the war criminals interred there), but his government at least gave the sense that it was doing something, anything.

After Abe stepped down (officially due to health reasons but also with a lot of corruption scandals surrounding his administration), his hand-picked, right-hand man Yoshihide Suga was elected by the ruling party, the Liberal Democratic Party (which is none of those things). Suga was a great right-hand man, but he is clearly out of his element as the leader of a country, and has barely done anything at all in his 8 months to date as PM.

Japan has not done any lockdowns; instead they have declared three or four “States of Emergency,” under which non-essential businesses were asked kindly to shut down and offered cash incentives to do so. They only recently added fines (this February), but compliance has nevertheless been pretty high (bars and restaurants remaining open and ignoring the guidelines tend to make the news). The problem is that they keep lifting the state of emergency too quickly, so infections surge and they have to start all over again. (Incidentally, there has never been a mask mandate, but mask compliance is virtually 100%. I almost never see anyone not wearing a mask.) The framework for all of this is a leftover from the Abe administration; PM Suga has not come up with anything at all.

As for the slow pace of the vaccine rollout, aside from poor logistics (they secured commitments for doses, but they never thought about how to actually get those doses from the manufacturers to Japan), one major issue is that they are insisting on doing clinical trials here in Japan rather than just using the data from trials conducted overseas. Now that they have more vaccine doses on hand, they are leaving it entirely up to municipalities to arrange the actual vaccination, but municipalities are totally unprepared for this. Towns and cities have to identify residents who qualify (by age, etc.), contact those residents and then schedule the actual vaccination. It’s a total mess…hospitals have to put up signs saying, “We do not know when vaccines will be available. Please wait to receive a letter from the city.” The central government had plenty of time to plan for all of this while they were working on approving the vaccine to begin with, but like I said at the beginning, PM Suga has done absolutely nothing while in office. The governor of Tokyo (Yuriko Koike, whom a lot of people think should be the next PM) has done more for the entire country than the goddamn prime minister has.

ETA: I am in Kobe, which is about 30 minutes west of Osaka by train. Osaka and Kobe have been hit hard by mutant variants of the virus (the UK variant and now the Indian variant), so the situation has been worse here over the past month or so than in Tokyo. Nevertheless, the fact that only 5~6,000 new cases are appearing daily nationwide is a testament to how effective masks and social distancing can be.

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Well, that’s a bright spot in the darkness.

Everyone masking up: good. And I was expecting that.
Timing bans and lifting them: ugh.

Ok this is legit alarming. I am sorry you’re having to go through this.

Same as it ever was, to quote David Byrne.

(except it was under PM Kan, not Abe)

Thanks for posting.
Good luck.
Stay safe over there.

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I have had much less of a ringside seat than @Jesse13927 has, being a relatively new immigrant and living way down in Okinawa. My understanding from the news I’ve been reading is that there actually is a significant amount of vaccine skepticism here, due to past scares around side effects for other vaccines and some apparently poor governmental responses to those fears.

In addition to the slow rollout, one of the more local frustrations with this has been that people have still been traveling domestically for national holidays, and there has even been some encouragement from the government for them to do so. Every time that happens our infection rates spike two weeks later, and we’re currently experiencing the biggest spike ever as a direct consequence of the national “golden week” holiday two weeks ago. In fact, we had actually managed to get rid of coronavirus in Okinawa at the end of April last year, only to have it come roaring back in July when they opened up and started encouraging domestic tourism. No doubt local businesses desperately need the money that the tourists are bringing in, but for those of us in non-tourist industries it kinda sucks to go from “everything’s relatively under control” to “it is nowhere near under control” and know that it was entirely foreseeable and entirely avoidable.

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In the US, I was surprised to see 20% of 12-17 yo have had at least one shot already. I’m hoping summer programs require it in as well as schools starting next year.

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Not really.

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Wait, Osaka, a city of ~2.7 million people, in May 2021 has 348 hospital beds set aside for serious Covid-19 cases?

I know the current and previous Japanese administrations are terrible, but have they been on an all-out austerity binge for the past several decades? Even the US must have better health care coverage than that.

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We are moving very fast through eligible groups.

But none of the vaccines are slated to be approved for 5-12 year olds until the fall. Substantially we’re expecting it to be after school starts.

So there’s a potential for a dangerous gap of unvaccinated in person school and anti-vaxx cluster out breaks.

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It’s actually worse than that. The 348 hospital beds is for Osaka Prefecture (the city and prefecture often get mixed up), which has a population more like 8 million.

https://www.pref.osaka.lg.jp/default.html

ETA: Where I am, in Hyogo Prefecture (Population: 5.5M) right next to Osaka, they have 124 ICU beds for serious cases.

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Wow, that is … scary. They’ve had more than a year to scale things up too. One might think that something extra had been made available by now? Apparently not.

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I don’t really know the answer for this one, but I would suspect that it’s less a shortage of ventilators and more a shortage of qualified and willing nursing staff.

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12-15 year olds should have only started this month with approval only coming earlier in May. So that 20% number may not be as bad as it looks. It is also Pfizer only right now for that age group. However it sounds like Moderna is submitting studies for approval today.

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Especially puzzling since Japan was containing the virus better than most nations early on, pre- vaccine. They were shutting down clusters and superspreading events which was the best defense at that time. Now it sounds like they’ve thrown it all away w a terrible vaccine roll out and Olympic greed

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They did very good with contact tracing and containment (not to mention masking up and social distancing) last year, but that was a different government.

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That’s understandable, though one can still wonder whether more could have been done to recruit and train the necessary personnel. I think all countries are struggling with overworked and exhausted (and severely underpaid) nursing personnel, yet that’s the worst ratio of ICU beds per capita that I’ve heard of.

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Japan has been dealing with nursing shortages for quite some time now. The government has had to make it easier for qualified foreign (mostly targeting Southeast Asia) nurses to work here, but the language barrier is still an issue.

I’ve been reading some articles about this (Japanese only I’m afraid) and they say that, although Japan has the highest number of hospital beds per capita in the OECD (13 beds per 1,000 people compared to 8 per 1,000 in the No. 2 country: Germany), Japan only has 4 ICU beds per 100,000 people. One article said that it’s not because of a nurse shortage, but because very few doctors in Japan have the specialization needed to be an ICU doctor, and most of these doctors are concentrated in a few hospitals, meaning that most hospitals are without an ICU period.

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Interesting. Makes me wonder if this is somehow related to something like relative prestige levels of various specializations within medicine (e.g. being a cardiologist or oncologist might be higher status than working in an ICU), or if it relates to pay differences. Whatever the cause, it seems rather inept on the part of the government to not have been able to alleviate this somehow.

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For context that number is 33.9 in Germany and 25.8 in the US. (Pre-pandemic numbers)

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In Japan, a lot of doctors still go the private practice, GP route. It’s a sharp contrast to the hyperspecialization seen in the west. I don’t know what it takes to be an ICU doctor, but I imagine it’s quite taxing, so that might explain part of it.

@Doctor_Faustus Thanks for the data. It makes me wonder how Japan has gotten by with so few ICU units. You sometimes see stories in the news where someone will have a medical emergency and get picked up by an ambulance, but then the ambulance will keep getting turned away by hospital after hospital because none of the hospitals are equipped to handle the medical emergency and the person will die before any hospital will take them in, but that’s not exactly a common occurrence.

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