July 12, 2023
Tsuyoshi Masuda
President

Japan Federation of Democratic Medical Institutions

Two months have passed since Covid-19 was downgraded to a Class 5 disease under the Infectious Diseases Control Law as of May 8. The number of outbreaks per fixed observation point continues to rise with a national average of 7.24 as of July 7. Unlike other Category 5 infectious diseases monitored at fixed points, no alert or warning levels are currently established for Covid-19. However, if considered seasonal influenza, it is currently in “epidemic” status nationwide with Okinawa at 48.39, which is an alert level. While some factors are unique to Okinawa, the virus’ strong transmission capacity and impacts of relaxed movement restrictions are seen in other prefectures as well. We therefore must conclude that the trend will most likely spread throughout the country.

As prefectures no longer coordinate hospitalization of Covid patients, each medical institution has to search for a facility capable of admitting them, which has a significant impact on their daily operations. In one prefecture, a serious ethical issue arose when a ventilator was denied to an elderly patient with respiratory failure because of the patient’s age.

Many experts expressed concern about the government’s proposal to reclassify Covid-19, pointing out that economic motives were the biggest driving force and that the move could be too hasty, but the government made the decision without disclosing related scientific studies to the public. In a statement “on reclassification of Covid-19 under Infectious Diseases Control Law” published in February this year, the Japan Federation of Democratic Medical Institutions urged the government to improve medical care programs and eliminate the situation where patients cannot be admitted to hospitals, continue to use public funds to cover medical expenses instead of forcing patients to pay them, provide financial support for medical and nursing care facilities, and thoroughly communicate risks to the public. However, the government has failed to properly respond to those demands. As a result, public wariness about infection risks has dramatically relaxed.

This has a tremendous impact on pediatric care, leading to outbreaks of several other infectious diseases, including RS and herpangina. Both hospital beds and outpatient services are beginning to tighten, especially in urban areas. As many facilities limit the number of outpatient fever cases, children with fever are unable to find a place to receive medical care.

In Asahi Shimbun’s feature article on May 24, titled, “Experts’ conflicts on Covid-19 reclassification to Category 5,” Dr. Nishiura of Kyoto University said, “The decision was made based not on scientific facts but on the atmosphere” with “major risks remaining”.

Furthermore, in an interview with Mainichi Shimbun on July 8, Dr. Nishiura noted difficulties in collecting data after the reclassification and that another peak of infection may occur in July and August. “What we can say as a social feature of the latest wave is that there are people who are consciously trying not to recognize Covid-19 as a social problem as they did before. Medical services can be tightened, and lives that could be saved may not be saved,” he said, noting that 70% of the excess cardiac deaths during the sixth wave were due to strained medical care.

We must avoid situations in which patients are unable to receive appropriate medical care because of their age orstrained medical care. We demand that the government deeply understand its responsibility to provide medical care for both general patients and Covid-19 patients and swiftly take the following measures:

1) Provide thorough instructions to ensure appropriate medical care. Limiting treatment because of patients’ age is unacceptable.

2) Inform the public of the current situation and reinforce risk communication and recommendations of necessary infection control measures, such as hand washing, ventilation, and wearing masks.

3) Promptly resume subsidies, inspection programs, and other public support that have been cut down or reduced.