TOKYO — Japan risks running out of intensive care unit space in 43 of its 47 prefectures at the peak of the coronavirus outbreak, an analysis based on government estimates shows.
Cross-referencing the share of the population expected to develop serious COVID-19 symptoms during the peak of the pandemic with data on ICU beds from medical information company Nihon Ultmarc shows only Tokyo, Okayama, Fukuoka and Okinawa prefectures with space to spare.
Japanese hospitals have cut back on ICU space in recent years, expecting demand to fall as the population ages, because elderly patients often cannot handle the physical toll that intensive treatment takes. The virus has hit this weak point in the country’s medical system.
Japan now has 5,709 ICU beds nationwide, or about five per 100,000 people — significantly fewer than in other developed countries. The U.S. has about 35 beds per 100,000 and Germany roughly 30, according to sources including the National Center for Biotechnology Information. Italy and Spain, where the virus has been particularly deadly, have around 12 and 10, respectively.
The capacity shortfall is expected to be worst in Saitama Prefecture near Tokyo, which faces an estimated 418 serious coronavirus cases at the outbreak’s peak — 80% more than its 230 ICU beds. Nearby Kanagawa Prefecture is forecast to have 40% more patients than beds.
While Tokyo is projected to have a 65-bed buffer, it could run out if cases surge too sharply or if too many beds are being used to treat patients with other conditions.
Hospitals are short not only on ICU space, but also on specialized staff. The Japanese Society of Intensive Care Medicine had certified about 1,820 critical-care doctors as of April 2019, or an average of about three for each hospital with an ICU.
But few work in such positions full-time. In the U.S. and Europe, by contrast, intensive care specialists team with health care workers in a variety of fields to improve treatment outcomes.
Osamu Nishida, chairman of the intensive care group, cites the gap in critical-care capabilities between Germany and Italy as a factor in their sharply divergent COVID-19 mortality rates — 1.1% and 11.7%, respectively, at the end of March.
“It has to be said that Japan’s intensive care system is highly vulnerable to a pandemic,” Nishida said.
The staff shortage affects hospitals’ ability to use specialized equipment. Japan has about 1,400 ECMO machines, which oxygenate blood outside the body when the lungs or heart cannot fully function, but only enough trained personnel to run 300 at a time, by one estimate.
For more effective treatment, Japan will need to consider consolidating personnel and equipment at designated hospitals set aside for coronavirus patients. With the outbreak expected to peak at different times in different locations, nationwide cooperation will be vital.