Japan’s virus policy under question
Isolation at home denies sick health care, critics say
TOKYO — Yoshihiko Takeuchi, who ran a small restaurant on the island of Okinawa, told only a few friends he had the coronavirus. When he didn’t answer phone calls from public health workers for three days, police went to his home and found him dead in his bed.
He was among hundreds of people who have died while subject to “jitaku ryoyo,” or a policy of having some COVID-19 patients “recuperate at home.”
In many countries, those with the virus stay home to isolate and recover, but critics say that in Japan, a country with one of the most affordable and accessible health care systems, people have been denied hospital care, and the policy amounted to “jitaku hochi,” or “abandonment at home.”
Takeuchi’s sister and a daughter of another man who died at home of COVID-19 have started an online support group for grieving relatives of such victims.
Japan has seen caseloads fall in the past two months, and the government has made a road map to improve its response. A plan adopted Nov. 12 aims to have beds for up to 37,000 patients nationwide by the end of November, up from 28,000.
That compares with more than 231,000 coronavirus patients needing hospitalization in late August, according to government data. Many had to recuperate at home.
Prime Minister Fumio Kishida also promised to have health care workers routinely visit COVID19 patients with mild symptoms at home.
Public anger over inadequate treatment in the country with the world’s largest number of beds per capita is a factor driving such changes. Kishida’s predecessor, Yoshihide Suga, resigned after only a year in office, mainly because of widespread dissatisfaction with the government’s pandemic response.
Speaking up takes courage in a conformist society like Japan, and class action lawsuits are rare. But Kaori Takada, Takeuchi’s sister, and others in her group believe their loved ones were denied the medical care they deserved.
“I had to raise my voice,” she said.
She is not sure what she will do. Thousands are following the group’s Twitter account and others have come forward with similar painful stories.
Takada, who lives in Osaka and runs a small nursery in her home, was Takeuchi’s only remaining relative. They spoke on the phone right before he was diagnosed, but he did not tell her he was sick alone at home. Given widespread phobias in Japan about COVID-19, he didn’t want word to get out.
Takada said he was a gentle man and much loved.
“We are coming together, trying to heal, sharing how people have been treated so cruelly, and perhaps helping each other take that first step forward,” she said in a telephone interview.
Japan’s local public health bureaus, responsible for arranging for the care of COVID-19 patients, struggled to find hospitals that would admit them. In some cases, ambulances were shunted from one hospital to the next.
A few makeshift facilities provided treatment and supplemental oxygen, but calls to set up big field hospitals went unheeded.
In August, when infections in Japan surged with the spread of the delta variant, the country’s hospital systems were quickly declared “stretched thin,” even though it has had far fewer COVID-19 cases than the U.S., Europe, and some other Asian and South American countries. In early September, more than 134,000 people were sick with the virus at home, according to Health Ministry records.
About 18,000 Japanese have died of COVID-19-related deaths in a population of 126 million. No one knows exactly how many died at home, though the National Police Agency, which tracks deaths, said 951 people have died at home since March 2020, with 250 of them in August 2021 alone.
Dr. Takanori Yamamoto, a critical care physician at Nagoya University, believes hospital care needs to be restructured to focus on seriously ill patients in designated facilities, instead of spreading them across small hospitals that each have a handful of ICU beds.
Resources were improperly managed, including widespread hospitalizations of people who didn’t need it, he said. Public health bureaus are designed for research and are ill-suited to be “gatekeepers” for doling out COVID-19 care, he added.
The problems are deeply rooted in a decades-old system, and Yamamoto worries that even if Japan manages to ride out this pandemic, it will be unprepared for the next one.
“No other nation turned away patients like this, even countries that had far more cases. The idea of doctors not seeing patients should be out of the question. If you are a doctor, you have to take care of the sick,” Yamamoto said.