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

Third, a serious shortage of hospital beds.

Since the outbreaks, the countries have experienced a shortage of medical supplies such as face masks, protective clothing, disinfectant, test kits, ventilators, extracorporeal membrane oxygenation machines, and especially, hospital beds. COVID-19 patients are required to be treated under quarantine to curb the spread of the super-transmissible coronavirus, and severe cases should be treated in intensive care units (ICUs), but general hospitals have been in serious shortage of beds.

There are up to 13.1 hospital beds per 1,000 people in Japan, the highest in the world. For Tokyo, a city with a total of 128,000 hospital beds, the figure is 9.3. Even so, it already saw a severe shortage of hospital beds.

In contrast to Tokyo, for every 1,000 people, Italy has a high number of doctors but only 3.2 beds, the US has only 2.8 beds, and New York has only 2.6, even lower than the national average. Obviously, inadequate hospital beds have become a bottleneck that restricts medical institutions from receiving patients and hinders timely treatment.

The figure of China is 4.3, a quarter of that of Japan but higher than that of the US and Italy. Wuhan, in particular, has 95,000 beds, or 8.6 beds per 1,000 people, almost as high as that of Tokyo, but it still suffered from a serious shortage of hospital beds in the early stage of the outbreak.

In fact, the problem is that not all hospital beds are qualified for receiving COVID-19 patients for isolation, and the scramble for medical resources has made the bed shortage even prominent.

Wuhan rush-built the Huoshenshan Hospital and the Leishenshan Hospital for severe cases under national support. The two hospitals with high isolation levels are equipped with specialized treatment equipment, and 1,000 beds and 1,600 beds, respectively. The city also converted stadiums into 16 temporary treatment centers, and quickly provided 13,000 beds with antibacterial and epidemic prevention levels up to those of first-class hospitals in China. The move channeled mild cases, helped to concentrate high-end medical resources on severe cases, and alleviated the pressure.

The experience of Wuhan—building Huoshenshan, Leishenshan and temporary treatment centers to address bed shortage—is worthy of reference and learning for the world.

Japan now requires some confirmed patients to stay at home for quarantine due to insufficient beds, which is actually an extremely dangerous practice. First, it puts the family members of the patients at risk, and may lead to infections in clusters within the families. Second, patients cannot get effective and professional treatment, and without timely update on health conditions, they may not be able to receive swift referral for treatment when the conditions deteriorate.

Therefore, Tokyo is now transforming hotels and convention and exhibition facilities into isolation wards for patients with mild symptoms, in an effort to channel mild cases and relieve the pressure on hospitals. A more serious problem in Tokyo is the shortage of ICUs. Japan has merely five ICU beds per 100,000 people, and there is a huge gap compared with the 35 in the US, 30 in Germany, 12 in France, 12 in Italy, and 10 in Spain. Tokyo has only 764 ICU beds, or only 5.5 per 100,000 people. To provide enough beds for severe cases is a key for Tokyo to avoid a potential collapse of the medical system.

The countries have adopted a variety of measures to address bed shortage in affected areas, with the US even sending naval hospital ships to assist. In late March, US President Donald Trump sent USNS Mercy and USNS Comfort hospital ships to Los Angeles and New York, respectively, offering them mobile hospitals on the sea with 1,000 high-class beds each. Though the beds are not necessarily suitable for COVID-19 patients, the hospital ships can alleviate the pressure on general hospitals in beds and leave them more space for treating COVID-19 patients by accepting a large number of patients with common diseases.

The emergency importation of a "hospital" has also become a new option. Struggling with a desperate shortage of beds amid the outbreak, South Korea imported an entire "Huoshenshan Hospital in slabs" from the Broad Group in China. The prefabricated stainless steel slabs made up negative pressure isolation wards in South Korea. Equipped with fresh air systems and ozone technologies, the wards have the highest level of protection against cross infection. The first phase of the project took only two days locally before the wards were put into use.