Jared Diamond, author of Guns, Germs, and Steel, said the COVID-19 pandemic will be remembered as “the first global crisis” in human history. On the other hand, each country’s experience and knowledge in responding to the pandemic are fragmented and scattered. Due to COVID-19, borders have been blocked and exchanges have been cut off.
The image of COVID-19 outside the country stuck in our minds remains in fragmentary scenes in early 2020, such as large-scale temporary hospital beds installed in gyms and burials of the dead at once.
During the COVID-19 pandemic, all communities suffered the pain of loss and fell into a pit of failure, big or small. No society has found a perfect answer. The same is true of South Korea, which is evaluated for its excellent quarantine performance. The best we can do in the face of the huge event of a pandemic is to faithfully and fiercely gather each other’s experiences, worries, reflections and reflections.
In the face of the common opponent of COVID-19, what did each society value and what path did they take?
Looking back on the memories of the pandemic is not simply to prepare for the next infectious disease crisis. It is to lay the foundation for a better society to overcome disasters.
A white light car entered the parking lot of an eight-story apartment building showing signs of age. The text written in orange on the outside of the car is ‘Ominami Family Clinic’. On that day, the doctor Hideaki Miyachi, director of home visit treatment, Keiko Takahashi, a nurse, and Kaori Yoshino, an office worker, sitting in the driver’s seat, talked for a while in the car while looking at the chart of the patient they were about to meet.
Doctors and nurses wearing face shields over masks got out of the car and went up to the third floor of the apartment. When nurse Takahashi rang the doorbell, an elderly woman welcomed the visiting treatment team. She is only 89 years old, and 90 years old in Korean age, Mr. H. Mr. H lives alone in this apartment consisting of one room, a small living room and a kitchen. On one wall of the well-groomed house, there were pictures of family members and contact information of relatives written in large letters to be seen clearly.
While Takahashi was checking blood pressure and body temperature, the doctor, Director Miyachi, spoke. “Have you stopped coughing now? Are you having any discomfort these days? How about your appetite?” Mr. H said in an excited voice that he was even more grateful for the many guests today. “Appetite is fine. My knee hurts a bit, but I can’t walk.” Director Miyachi dictated his blood pressure, body temperature, and questionnaire in a notebook.
As if familiar with Mr. Takahashi, he found a notebook with the word ‘Contact’ and opened it. It is a notebook in which the daughter of Mr. H, who lives apart, and the visiting treatment team exchange messages. After checking the memo left by her daughter, Takahashi wrote a message on the back page. H has been receiving treatment at the Ominami Family Clinic since October 2017. Even after the outbreak of COVID-19 in 2020, the visiting medical team who visits this place twice a month has never stopped. “August 31. As always, you were examined. I was prescribed eye drops. Thank you for letting me know about the short-term admission schedule. The next visit is on September 14th and 29th. Thank you for the sudden interview (for allowing me).” Sudden coverage refers to reporters and photographers who came from Korea.
Of course, quarantine indicators such as the number of confirmed cases or the number of deaths cannot be the absolute criteria for determining the success or failure of a response to COVID-19. It is also true that the COVID-19 statistics announced by the Japanese government are under the suspicion of being underestimated. ). However, it is worth paying attention to the efforts made in Japan, a super-aged society, where nearly 30% of the total population is over 65, to protect the elderly who are at high risk of COVID-19 and nursing facilities for the elderly.
“Visiting treatment”, the center of Japan’s quarantine
In Japan, the legal status leading the prevention of COVID-19 is not the central government, but the prefectures (corresponding to Korea’s metropolitan governments). Although each local government has the advantage of being able to respond according to the local situation, as in Korea, which has a central government (Prime Minister), a central government (Ministry of Health and Welfare), and a central government (Disease Management Agency) system, it has not been able to achieve consistent quarantine. It was the medical institutions rooted in the community that filled the gap in the government.
At the center of it is ‘visiting treatment’. In Japan, where visiting medical care was institutionalized in 1986, it has been expanding in earnest since 2006. In the background, there was a realistic consideration of the need to reduce the welfare budget that is increasing in the age of super-aging. This is because the cost of the government subsidy is reduced when an elderly person resides in their own home and receives ‘visiting care’, ‘visiting nursing’ and ‘visiting care’ services rather than entering a nursing facility.
The method in which doctors and nurses visit patients’ homes and visits to nursing homes directly played a role in maintaining access to medical care for the vulnerable, although not perfect during the COVID-19 pandemic. It was also a device to prevent social isolation. This is different from Korea, where patients whose condition worsened during self-isolation or who were blocked from hospital treatment due to fever symptoms were blocked from receiving medical treatment other than waiting for a bed. Visiting treatment may be a clue to exploring the issue of ‘care for the elderly’, which has emerged on the agenda in the post-corona era.
In Japan, too, many people died without receiving timely treatment due to a shortage of hospital beds and medical staff. The group infection that occurred in nursing homes and the damage caused by it also remains a deep pain. There were also a number of hospitals that provided formal visiting treatment for the sole purpose of profit. The hosting of the Tokyo Olympics further frustrated the exhausted front-line quarantine workers and medical staff. This article doesn’t cover solid success stories or better models. What
August 31st, Musashimurayama City, Tokyo
Ominami Family Clinic
Musashimurayama City, located in the northwest of Tokyo, is a small town with a population of about 70,000. Although it is located in Tokyo, it is an area where railroads and national roads do not pass, and there is a quiet atmosphere. The primary medical institution, the Ominami Family Clinic (hereinafter referred to as the Ominami Clinic), a local clinic, opened in 1985. The slogan was ‘a clinic that can receive treatment from babies to the elderly’. In the morning, he sees the outpatient treatment of patients who visit the clinic, and in the afternoon he visits the clinic. The number of visits is about 150 per month. On the afternoon of August 31, a total of six people including Mr. H visited the house for examination.
In Musashimurayama City, it was August 2021 when nine local lawmakers joined together to form a ‘Corona 19 Home Care Support Project’. When the number of new confirmed cases per day increased to 20,000 in one month during the fifth epidemic, the Japanese government changed the guidelines to ‘home care’ for those who were diagnosed with Corona 19 who were not serious enough to be hospitalized (home care is for Korea) It is a concept similar to the at-home treatment of
In central Tokyo, where the epidemic was more severe, deaths occurred during home care. Residents’ anxiety was growing. Ominami Clinic Director Hideaki Miyachi said, “This background brought our local clinics (clinics) together.” The ‘home care treatment project’ had two main roles. The first is to receive a referral from a public health center, classify the severity of COVID-19 patients, and then determine whether hospitalization is necessary. Patients who are judged to require hospitalization will be referred to Musashimurayama Center Hospital. The second is a health monitoring project for confirmed patients who are receiving home care. In Korea, local lawmakers voluntarily took over the role of the hospital bed assignment team of the Joongsubon (Ministry of Health and Welfare) and telephone monitoring for home therapists.
Director Miyachi explained the goal of this project with four keywords. “The first is ‘Byungjin Linkage’. Here, sick is a hospital and Jin is a clinic. It is a ‘collaboration’ between our local clinic and the central hospital (Mumashimurayama Center Hospital) in response to COVID-19 medical care. The second is ‘reducing the work of public health centers’. During the Corona 19 epidemic, the public health center was almost on the verge of collapse, and the local lawmakers wanted to share it at 10 o’clock. The third is ‘regional integrity’. It means to make the most of the medical resources in Musashimurayama City to treat COVID-19 patients and prevent other medical functions from being paralyzed. The last keyword was the reassurance of local residents.”
In the midst of an infectious disease crisis, what was the background that led the local lawmakers to protect the village, not even a large hospital? Was there even a network that connected local legislators in the first place? Director Miyachi paused for a moment, then tilted his head and said. “All nine clinics are places where we first met during the COVID-19 pandemic. There are 27 clinics in Musashimurayama City, and it turns out that all the clinics participating in this project have one thing in common: they pursue ‘comprehensive medical care’.” Comprehensive medical care means that not only individual medical care, but also various aspects that determine a patient’s health, such as lifestyle, eating habits, home environment, and family relationships, are taken into consideration. This includes visiting visits.
Even during the COVID-19 pandemic, regular visits twice a month were continued. A patient with a fever suspected of being infected with COVID-19 was visited by medical staff wearing protective clothing. When the condition of a confirmed COVID-19 patient who was undergoing home care suddenly deteriorated, he went on an unscheduled temporary visit. Among the patients receiving treatment, the proportion of elderly people with dementia was high, and basic hygiene rules such as wearing a mask were often not observed. Were there any difficulties in continuing visits during the pandemic? Kayo Kawahara, head of the nursing department at Ominami Clinic, answered somewhat unexpectedly. She said, “It’s actually not that hard to do this in a protective suit. At the home we visited, we sometimes meet critically ill patients that are beyond the scope of treatment we can provide. It was very difficult when there were no beds in the hospital, so we couldn’t arrange admission or an ambulance to take the patient to the hospital.”
August 30 afternoon, Tachikawa City, Tokyo
Tachikawa Mutual Hospital
2 pm Seminar room on the 2nd floor of Tachikawa Mutual Hospital. A meeting was in progress, in which Vice President Hideki Yamada and other officials from Tachikawa Mutual Hospital gathered, the president of the local medical association, and representatives of residents. Tachikawa public health center staff and fire department paramedics were connected through an online conference program called ‘Zoom’. Tachikawa Mutual Hospital is a place that has obtained the qualification as a ‘regional medical support hospital’ by the Japanese government.
The theme of the day was ‘Status of Corona Response and Tasks at the Head Office (Tachikawa Hospital)’. An official from Tachikawa Mutual Hospital said that the 50 beds dedicated to COVID-19 were almost full, and asked for understanding about the situation in which the 119 ambulance sent the patients who came on board. In the summer of 2022, Japan was struggling to overcome the turning point of the 7th wave. The curve of the number of confirmed cases, which soared to 250,000, the largest in mid-August, had been broken, but at the end of August, there were still about 150,000 confirmed cases per day. The number of ambulance denials increased from 34 in June to 108 in July.
Tachikawa Mutual Hospital is a general hospital (secondary medical institution) with 280 beds. We have been seeing patients with COVID-19 since the beginning of the epidemic. All patients with mild, moderate, and severe symptoms are treated except for the most severe patients who need to be equipped with Ekmo equipment. Unlike Korea, where public hospitals were emptied and dedicated to COVID-19 patients, Japanese private hospitals have mostly participated in the treatment of COVID-19 patients if they have adequate facilities (more than 200 beds). Tachikawa Mutual Hospital was one of them.
Things have improved a lot now, but participating in the treatment of a new infectious disease in early 2020 was precarious. When it became known that a COVID-19 patient was hospitalized, other patients stopped visiting. Hospital staff were told to refrain from attending the child’s daycare center. At the request of the Tokyo Metropolitan Government, 42 hospital beds were prepared for COVID-19, but the budget and supplies were insufficient. There were not enough protective suits and N95 masks, so I had to cut the plastic and make my own gown. South Korean medical organizations such as Green Hospital and the Association of Social Medical Institutions (Sairen), which have been interacting with the Japanese Minuiryun, also sent quarantine items. Then there was talk that the hospital might go bankrupt.
At that time, TV Asahi was looking for a hospital to see COVID-19 patients. Hideki Yamada, vice president of Tachikawa Sangho Hospital, raised his hand when other hospitals were saving themselves for fear that the number of patients would decrease further when there were rumors of a confirmed case of COVID-19. Vice President Yamada appeared on the broadcast and appealed as follows. “Our hospital and staff are doing their best to overcome the infectious disease crisis. However, you (patients) do not visit the hospital, so you are in a state of complete deficit. You must come.” Despite these appeals, the patients did not return for a while, but with the broadcast, the Tokyo Metropolitan Government’s subsidy increased significantly.
Tachikawa Mutual Hospital was also introduced to Korean media ahead of the Tokyo Olympics last year. An anti-Olympic poster posted on a hospital window became a hot topic on social media and spread to Korea. The message on the poster was, “Medical care is limited, stop the Olympics!” Vice President Yamada remembered the spring and summer of last year, when the 4th and 5th trends continued, as an extreme situation. The number of confirmed COVID-19 cases was much smaller than the current 7th wave, but at the time, the delta mutation, which had a higher lethality than Omicron, was leading the epidemic. The situation in Osaka was particularly serious. In April and May of 2021, the fourth epidemic period, there were 19 confirmed cases of COVID-19 in Osaka and 24 in Hyogo Prefecture near Osaka, who died at home. As a critically ill patient exploded, Hyogo Prefecture even set guidelines that people over the age of 85 should not ride an ambulance.
The Japanese government has introduced a policy to encourage medical institutions to actively visit medical institutions in the face of great damage in the Osaka area. Originally, if you went to visit medical treatment (basically twice a month), you could receive 57,760 yen (about 570,000 won) as a fee. In July 2021, the Japanese government added 9,500 yen (about 95,000 won) to the basic price under the name of ‘special corona addition’, and from September, the added amount was raised to 28,500 yen (about 280,000 won).
Deputy Director Yamada said that active visits to medical treatment helped protect the elderly and reduce the number of deaths, but at the same time pointed to the dark side. In caring for the elderly, ‘visiting medical care’ and ‘visiting care’ in which helpers, who are Korean caregivers, support their lives, are intertwined.
“Actually, the people who are at high risk of infection because they have close contact with patients are the caregivers who give them baths and help with household chores. There was no financial compensation or support for them. So, medical staff come, but caregivers who feel the risk of Corona 19 stop visiting and are unable to receive care.
Single-person and two-person households have been created. Even though these houses cost a lot of money to send doctors and nurses to visit them, their condition worsened. Without the caregiver, I couldn’t eat properly, became dehydrated, and my life was ruined.”
August 30 morning, Tachikawa City, Tokyo
Shisei Home Aoringo
Shisei Home Aoringo is an elderly care facility located about 2 km from Tachikawa Mutual Hospital. The medical foundation ‘Konsaenghoe’, to which Tachikawa Mutual Hospital belongs, visits this place for medical treatment. A doctor who visits a nursing facility for the elderly is called a ‘successful doctor’. Even in Korea, each nursing home makes a contract with a nearby medical institution to designate a compulsory doctor and to manage the health of the elderly, but in most cases, it is only at a formal level. Even that didn’t work properly during the COVID-19 pandemic. This is because in Korea, the out-of-court doctors stopped visiting the nursing facilities where the cohort was isolated due to the group infection.
On August 30, Shisei Home Aoringo (hereafter Shisei Home) was the first to visit the doctor, Rieko Nakanishi, a family medicine specialist. Shisei Home, which occupies a seven-story building, houses 129 seniors. The living spaces for the elderly are on the 3rd to 6th floors. Each floor is further divided into four zones: E (East), W (West), S (South) and N (North). 10-11 people live in one area. All have private rooms. There is a living room in the center, and there are private rooms around it. Each area has a designated doctor, but the area in charge of Mr. Nakanishi was 4S (S on the 4th floor).
At 10 am, Mr. Nakanishi, who took the medical records of the inmates from the nurse’s office, came up to the 4th floor. Nurses working at Shisei Home accompanied them. When entering the 4S area, helpers (caregivers) pushed the wheelchairs carrying the residents out. There was a long line in front of Mr. Nakanishi. He especially carefully examined the whole body of one of his grandmothers. D is 91 years old. D, who is suffering from colorectal cancer, has been receiving medical treatment at his home for a long time, and recently entered Shisei Home.
Vice President Yamada of Tachikawa Mutual Hospital, who visited Shisei Home to help with the coverage of 〈EPN〉, said that if it is divided into upper, middle and lower levels, this is ‘higher’ compared to the overall level of nursing facilities in Japan. Although the structure of nursing facilities in Japan is changing to single rooms, it is still not uncommon to have rooms for 3 or 4 people. Above all, it is said that the purpose of the establishment in 1912 is well maintained, and nurses, caregivers, and staff take care of the residents with sincerity. On the other hand, it is popular because of its low cost. Usually you have to wait 2-3 years. For this reason, the opportunity to enter is mainly given to the elderly who are in serious condition and need special care because it is difficult to work alone. When receiving the maximum support from the government, the monthly fee for Shisei Home is 167,000 yen (about 1.65 million won), which the resident must pay. Vice President Yamada said, “Wealthy elderly people do not have to wait for these facilities. You pay an expensive fee and immediately enter a high-end facility. On the other hand, the best way for ordinary people is to enter a place like Shisei Home. However, as seats are not readily available, most ordinary Japanese elderly have no choice but to receive home medical care (visiting treatment and home care).”
During the pandemic, nursing facilities in Japan also suffered greatly from the COVID-19 mass infection. Due to the 7th outbreak in the summer of 2022, in the third week of August, the number of group infections in facilities for the elderly reached 736. The atmosphere of Shisei Home I visited that day was very stable, so I guessed it was a place that was one step away from the Corona 19 madness, but it turned out that it was not. Vice President Yamada said that the 4E and 4N areas on the 4th floor are being quarantined due to COVID-19.
In front of Area 4E, there was a sign ‘Green Zone’. An employee put on a protective suit and face shield in front of the entrance to Area 4E, then went inside with several towels. A ‘green zone’ refers to an area with close contacts. Deputy Director Yamada explained that the facility staff in charge of Area 4E contracted COVID-19 and designated the area as a ‘Green Zone’. A ‘red zone’ where there are confirmed COVID-19 patients and a ‘yellow zone’ where there are suspected COVID-19 patients.
As of the summer of 2021, Japan has a policy of so-called ‘zoning’ in case of an outbreak of COVID-19 in a nursing facility. If one or two confirmed cases of COVID-19 are found, they are removed from the facility and sent to the hospital, but if the scale is larger than that, the area is closed and only patients in need of hospitalization are sent to the hospital. The ‘zoning’ area is isolated from the outside, but you can live relatively freely within it.
Vice President Yamada said that even in quarantine areas where there are confirmed cases of COVID-19, regular visits by the commissioned doctor twice a month do not stop. He puts on a protective suit and goes in and sees the patients. Still, there was no doctor who refused to come into contact with a confirmed person and expose them to the risk of infection. Vice President Yamada replied: “Whether there is a confirmed case of COVID-19, influenza, or an earthquake, we have to go unconditionally. It’s a regular visit.” Even among Japanese medical professionals, opinions are divided as to whether the visit of the outsourced doctor at the nursing facility where the cluster infection occurred was effective. Some experts believe that it has been helpful to some extent, while others evaluate that the role of out-of-court doctors who do not have expertise in treating infectious diseases is limited in a situation where the number of confirmed cases is increasing.
12:15 noon. Nakanishi, who returned to the nurse’s office after visiting the doctor, was talking on the phone with the family of 93-year-old M. This grandfather was not a resident of the 4S area in charge of Mr. Nakanishi, but he lost consciousness while taking a bath the day before, and he made a temporary visit. His grandfather, suffering from emphysema, was originally a poor resident. Ms. Nakanishi and the care manager (social worker) took turns talking with the family and discussing whether to be transferred to a hospital or to die at a facility. Visits to nursing homes are prohibited due to COVID-19, but family visits are permitted before death. However, his grandfather’s family said he was quarantined due to COVID-19. Nakanishi-san, who was holding the receiver, closed her eyes tightly.
Mr. Nakanishi has been in charge of visiting Shisei Home since February 2020. During the COVID-19 pandemic, I visited this place four times a month on a set day of the week. Fortunately, Corona 19 did not circulate in the area he was assigned to, so he never treated Corona 19 patients, but there were frequent cases of fever patients suspected of Corona 19, and when that happened, he wore a protective suit. Has anything changed in the two and a half years of the chaotic time of the pandemic? Mr. Nakanishi smiled embarrassedly saying it was an embarrassing question. And after a while he replied: “What I do here has not changed.”
[세계의 코로나 대응, 현장을 가다]
1. Japan
– Japan’s effort and reflection to save its neighbors www.EPN.co.kr/48618
– Establishment of community care through team medical care www.EPN.co.kr/48619
2. Sweden
– What was different about Sweden’s Corona strategy? www.EPN.co.kr/48670
– Why did Sweden open schools www.EPN.co.kr/48671
– “You must not forget that you are living life” www.EPN.co.kr/48672
– A way of coordinating life between work, childcare, and family www.EPN.co.kr/48673
3.UK
– How the UK is coping with disaster inequality www.EPN.co.kr/48728
– “Pandemic has exposed and amplified inequality” www.EPN.co.kr/48729
– 500m along the River Thames, a wall filled with red hearts www.EPN.co.kr/48777
– The gap filled by the independent scientific advisory group www.EPN.co.kr/48779
– “The media should invest in professional knowledge” www.EPN.co.kr/48771
© EPN