COVID-19: Why is medical system in metropolises so vulnerable?

First, overloaded hospitals.

One feature of the COVID-19 epidemic is the exponential growth of infections. Especially during the early stage of the outbreak, the surge in infections and social panic have driven a lot of people, whether they were infected or not, to seek testings and treatment in hospitals. This has caused disorder, leaving those who are critically ill unable to receive efficient and quality care. It is also a reason for its high fatality rate. Moreover, the overcrowded emergency rooms, with confirmed cases, suspected patients as well as their families, can also lead to many hospital-acquired infections (HAI).

Italy, one of the hardest-hit countries in the pandemic, has a relatively high density of physicians, counting 4 per 1,000 people, but the country still suffers a breakdown in its health care system. In the Lombardy region, the number of infections has quickly rose from 1,000 on March 2, to over 10,000 on March 14, and to over 40,000 by the end of March. As many patients with critical conditions could not be treated in time, the fatality rate in Italy is as high as 13%. By April 15, there had been 16,000 confirmed coronavirus cases in Italy, and the death toll was 21,000.

The density of physicians in the US, Japan and China was only 2.6, 2.4 and 2 per 1,000 people respectively, much lower than that in Italy.

Wuhan has 4.9 physicians per 1,000 people, while the number in the New York state is 4.6 per 1,000, both higher than their national average. However, the medical care system in both places was still overstretched by the outbreak. By April 16, 83.5% of the COVID-19 deaths in China had happened in Wuhan.

Japan's capital Tokyo has 3.3 physicians per 1,000 people, lower than the level in Wuhan and the New York State. Therefore, the Japanese government has been trying to avoid overcrowded emergency rooms as a key part of its response to COVID-19. The government advises the resident not to go to the hospital and even strictly limits testing to reduce hospitalization. Japan's measures are so far effective to reduce the number of hospital-acquired infections and lower the fatality rate as the medical resources are mostly given to those with critical conditions. By April 15, Japans' fatality rate had been around 2%. By April 10, deaths per 100,000 in Japan had been only 0.07, compared to 33.06 in Spain, 30.25 in Italy, 18.25 in France and 5.04 in the US. So far, it is fair to say that Japan has avoided collapse in the medical care system through controlling hospital visits.

However, due to the limit on testing, asymptomatic and mild cases could not be quickly identified, isolated and treated, which brings an underlying problem and casts a shadow to Japan's COVID-19 response. After the announcement of the state of emergency, Japan adjusted its strategy and started to expand testing.

Second, a drop in the number of medical staff.

A drop in the number of medical staff caused by infections also features in the pandemic outbreaks.

In the early stage of the outbreaks, the countries lacked knowledge of the coronavirus transmission, and medical staff faced a huge risk of infection due to the shortage of protective resources such as masks, protective clothing, and negative pressure wards. Those factors made testing, sampling, intubation, and other medical practices that are inherently at risk of exposure even more dangerous. As a result, the countries have seen a significant decrease in the number of medical staff caused by infections, which exacerbated the shortage of medical staff amid the outbreaks and the scramble for medical resources.

According to the information released by the World Health Organization, data reported by 52 countries showed that 22,073 medical workers had been diagnosed with COVID-19 as of April 8. The situation turned out to be even worse. As of April 15, Spain and Italy alone saw 26,672 and 15,000 medical workers infected respectively.

Apart from the risks during the treatment, the extensive isolation and infection resulted from a dinner party of trainee doctors from Keio University Hospital dealt another major blow to the already scarce medical workforce in Tokyo.

The super-transmissible coronavirus has severely threatened the safety of medical staff, weakened medical capabilities, resulting in the collapse of the medical system.

Therefore, it is critical to protect the safety of medical workers during the fight against COVID-19.