＜prologue＞
I started a blog called “The Baby Boomer Generation’s Miscellaneous Blog”（Dankai-sedai no garakutatyou:団塊世代の我楽多（がらくた）帳） in July 2018, about a year before I fully retired. More than six years have passed since then, and the number of articles has increased considerably.
So, in order to make them accessible to people who don’t understand Japanese, I decided to translate my past articles into English and publish them.
It may sound a bit exaggerated, but I would like to make this my life’s work.
It should be noted that haiku and waka （Japanese short fixed form poems） are quite difficult to translate into English, so some parts are written in Japanese.
If you are interested in haiku or waka and would like to know more, please read introductory or specialized books on haiku or waka written in English.
I also write many articles about the Japanese language. I would be happy if these inspire more people to want to learn Japanese.
my blog’s URL:団塊世代の我楽多（がらくた）帳 | 団塊世代が雑学や面白い話を発信しています
my X’s URL:団塊世代の我楽多帳（@historia49) on X
Over the past month or two, there have been daily television reports of the “crisis of a medical system collapse” due to COVID-19, with grief-stricken appeals being made by Omi, chairman of the government’s COVID-19 Infection Control Subcommittee, as well as the presidents of the Japan Medical Association and the Tokyo Medical Association.
However, what I find puzzling is that we don’t hear any talk of a “medical system collapse” in Europe and the United States, where the number of COVID-19 infections and deaths is orders of magnitude higher than in Japan and the third wave of the virus is serious. Why is that?
I would like to consider this question today.
1. What is a medical system collapse?
“Medical collapse” is a slang term developed based on the argument that a stable and continuous medical care system cannot be maintained due to factors such as excessive societal demands for medical safety, excessive expectations for medical care, declining physician morale due to policies to contain medical costs, an increase in defensive medicine, and worsening hospital management.
In 2020, in countries where the novel coronavirus pneumonia infection spread rapidly, the term “medical collapse” came to be used to describe the state in which medical personnel and medical equipment were in short supply and serious cases could not be treated.
2. Why is Japan at risk of a medical collapse?
In France, with a population of 67.06 million, about half that of Japan, more than 2.47 million people have been infected and the total number of deaths has exceeded 60,000.
In the United States, with a population of 328.24 million, more than 17.84 million people have been infected and the total number of deaths has exceeded 317,000.
Although the number of infections in Japan has been increasing recently, the cumulative total remains at approximately 200,000 infections and 3,000 deaths, two orders of magnitude lower than in the United States.
(1) Shortage of Infectious Disease Beds
Japan has a high number of hospital beds per capita compared to other countries. Japan’s hospital bed ratio per 1,000 people was 13.1 (2017), significantly higher than the OECD average of 4.7.
However, at the start of the COVID-19 pandemic, there were only 2,000 infectious disease beds nationwide. This is because, apart from the Spanish flu, Japan had never before been hit by a nationwide, large-scale infectious disease like COVID-19.
Learning from the lessons learned from the first wave, the national and prefectural governments have requested cooperation from medical institutions in providing hospital beds and are gradually increasing the number of hospital beds dedicated to COVID-19 infections.
However, the number of “planned available hospital beds” for COVID-19 patients has barely increased from approximately 27,000 in mid-August, and the “planned available hospital beds” for severely ill patients has remained stable at approximately 3,600.
(2) Shortage of medical staff
For ordinary hospitals that are not designated infectious disease hospitals, accepting patients with COVID-19 pneumonia is a significant hurdle.
This is because they require infectious disease specialists and trained medical staff, and they must also pay close attention to hospital-acquired infection control measures.
The number of doctors per bed in Japan is one-fifth that of the United States and one-third that of Germany and France. The same trend applies to nurses.
In Europe and the United States, large hospitals with ample staffing are able to respond flexibly to situations, but in Japan, there is a chronic shortage of staff doctors.
(3) Becoming a COVID-19 Specialty Hospital Will Cause Hospital Management to Collapse
Osaka Municipal Juso Municipal Hospital was the first in Japan to become a COVID-19 specialized hospital. It was established to prevent a medical system collapse, but now it appears the hospital is crying out for help.
The reason for this is that by specializing in COVID-19, revenue from other medical departments has decreased. Eliminating obstetrics and gynecology would eliminate revenue from childbirth, and eliminating outpatient care, emergency care, hospitalization, and surgery would halve revenue and result in a deficit.
In response to this, the only direct support the national government has received is a tripling of medical fees for COVID-19 patients, and there has been minimal support from local governments, meaning hospitals are unable to survive.
As a result, doctors and nurses at Juso Municipal Hospital have been quitting one after another. The workload is intense, the pay is inadequate, and even if you continue working out of a sense of mission, after six months your body begins to give out and your mental health takes a turn for the worse.
Conversely, private hospitals that have refused to accept COVID-19 patients are seeing an increase in patients, leading to a “polarization of hospitals.”
3. Measures to Address Japan’s Medical Collapse
(1) Support from Staff at Small and Medium-Sized Hospitals and Clinics with Available Capacity
A system should be established to allow staff from small and medium-sized hospitals and clinics with available capacity to support designated infectious disease hospitals as patients stop coming due to fear of COVID-19 infection.
Naturally, financial support for the cooperating medical staff and small and medium-sized hospitals and clinics is essential.
(2) Maintaining Empty Hospital Beds Even After the Current COVID-19 Pandemic Ends
Even after the current wave of infection subsides, it is necessary to maintain empty hospital beds and medical staff by not admitting patients with other illnesses in preparation for future waves.
In this case, too, financial compensation will be necessary for hospitals to keep empty hospital beds, which are a valuable source of income.
(3) Establishing a System for Sharing Medical Resources Between Prefectures
As Komeito Secretary-General Ishii proposed on an NHK program on November 29, establishing a system for accepting patients across prefectures and a system for sharing medical resources between prefectures would also be effective.
Osaka Prefecture’s acceptance of nurses dispatched from the Kansai Regional Association is a pioneering example.
(4) Improving working conditions for hospital doctors
Japan is currently experiencing a chronic shortage of hospital physicians. This is due to poor working conditions, including long overtime hours, as well as lower salaries compared to private practice physicians.
(5) Training of Expert Specialists Capable of Operating Advanced and Specialized Medical Equipment, Such as ECMO (Extracellular Oxygen Membrane Oxygen Oxygen Reaction)
It is necessary to train expert specialists capable of operating advanced and specialized medical equipment, such as ECMO (Extracellular Oxygen Membrane Oxygen Oxygen Reaction) machines, an artificial lung used to treat severely ill COVID-19 patients.
Currently, there are approximately 1,400 ECMO machines in Japan, the most in the world. However, even with the availability of ECMO machines, there are still few doctors with the specialized skills to operate them. Furthermore, since only a few machines are distributed across each hospital, opportunities to use them are limited, making it difficult for doctors to improve their proficiency, and they appear to be underutilized.
4. Response in Europe and the United States
(1) Europe
Germany has just under 70% of the number of hospital beds per capita in Japan. However, because hospitals are considered “public” and the government retains command and control, they were able to convert general hospital beds into dedicated COVID-19 beds within a matter of weeks.
Specifically, one clinic in each city, town, or village was designated a “COVID-19 specialty clinic,” and one “COVID-19 specialty hospital” was established in each regional area.
As a result of this united effort by medical professionals in the fight against COVID-19, the medical system did not collapse, even though the number of infections was significantly higher than in Japan.
By the way, in Germany, with a population of 83.13 million, a total of over 1.51 million people have been infected, and the total number of deaths has exceeded 26,000.
In other European countries, hospitals are mostly run by local governments, allowing for flexible operation.
(2) United States
However, in the United States, the rapid increase in COVID-19 infections, with daily infections exceeding 100,000, is straining the medical system and appears to be on the brink of a “medical collapse.”
UW Health University Hospital (affiliated with the University of Wisconsin) in Madison is reportedly calling on primary care physicians and general practitioners to cooperate and treat critically ill patients.