IT to Contain COVID-19: Insights from the the University of Chicago’s Nakamura Yūsuke

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Japan has lifted its state of emergency in response to the COVID-19 pandemic, with the exception of four prefectures including Tokyo, but over the past few months the government response to the crisis has been called slow and insufficient. With a second or even a third wave of the pandemic anticipated, what should the government do to deal with the peril of this disease? This is the question we posed to Nakamura Yūsuke, a former special advisor to the cabinet, leading researcher on genome medicine, and professor emeritus at the University of Chicago.

Nakamura Yūsuke

Physician. Professor emeritus at the University of Chicago and the University of Tokyo. Former special advisor to the cabinet and director of the Cabinet Office’s Medical Innovation Promotion Office. Held a number of academic posts, including associate professor at the University of Utah and professor at the University of Tokyo’s Institute of Medical Science, before becoming a professor in the University of Chicago’s School of Medicine in 2012. I 2018 returned to Japan, where he is currently director of the Cancer Precision Medical Center and the Cabinet Office’s Cross-Ministerial Strategic Innovation Promotion Program. One of the world’s leading medical genome researchers and a promoter of the use of artificial intelligence at hospitals.

No Clear Command Tower for COVID-19 Response

“The biggest problem in Japan is that the ‘control tower’—the people responsible for the COVID-19 response—is not clear,” says Nakamura Yūsuke, a physician and genomic medicine specialist. “This isn’t limited to this recent crisis. In other cases as well, Japan has lacked an adequate long-term vision for building organizations. Japan is the only country in the world to have the minister in charge of economic matters also handle the response to COVID-19. It was a member of the government’s crisis-response team of experts, Professor Nishiura Hiroshi of Hokkaidō University, who announced the estimate of deaths from COVID-19 if proper precautions were not taken; that information should have been conveyed by a top government official to emphasize the message of the importance of saving lives.”

According to Nakamura, the absence of a control tower to coordinate the response was clearly revealed in the meandering policy toward polymerase chain reaction testing. In his April 6 press conference, Prime Minister Abe Shinzō announced the goal of conducting 20,000 PCR tests a day, but the details of the plan were not indicated, and ultimately responsibility was thrown to local governments and the medical practitioners. Even today, the number of tests being carried out is inadequate, as Professor Nakamura explains.

“One major reason why PCR tests have not increased is that the government put the cart before the horse with its original policy—trying to avoid a collapse of the medical system by limiting tests to persons with serious symptoms. This made the number of infected seem smaller. It was also a mistake to adopt the policy of targeting clusters despite the increasing number of persons with community-acquired infections whose infection routes cannot be traced.”

As Nakamura notes, the official explanation is that the number of PCR tests have not increased because of the difficulty of collecting samples and of conducting the test itself. But all that it takes to collect samples is a drive-through method, like South Korea has implemented, or to administer tests to outpatients with a fever then disclosing the test results to doctors and medical clinics. Impatient with the slow government response, the Tokyo Medical Association is aiming to set up dozens of PCR testing centers within Tokyo, serving as a model case for the country.

The testing is said to be difficult to perform unless a person is a clinical laboratory technician, but if robots are used that problem can be easily resolved, as Nakamura points out.

“Certainly, the staff administering the test and handling the samples may risk infection up to the point where RNA is extracted, so caution must be exercised. However, all of the subsequent processes can be done automatically using robots. The RNA itself is not infectious, so that work can be automated. The world will laugh at the excuse that such work is hard to perform by hand.”

PCR tests are actually being performed in France by robots that were manufactured in Chiba Prefecture. In other G7 countries, anywhere from 15,000 to 33,000 tests have been conducted per 1 million people, and other countries are also focusing resources on widespread testing. But Japan is not even in the top 100 countries in this regard. When it comes to this area, Japan is very much a “developing country.”

“Since Japan is not testing everyone who requests a PCR test, it is not possible until much later to determine the extent to which the virus has spread throughout the country,” notes Nakamura. And the need for accurate tracking may become more urgent in the future: “The National Institute of Infectious Diseases announced recently that the virus that is spreading now is a potentially more infectious European strain of SARS CoV-2.”

A demonstration PCR test conducted in Itabashi, Tokyo, on April 28, 2020. (© Jiji)
A demonstration PCR test conducted in Itabashi, Tokyo, on April 28, 2020. (© Jiji)

Has Japan Become a “Developing Nation” for Medicine?

There have been concerns about securing a steady supply of the reagents used for PCR testing, since they are imported, but Nakamura states that there is no need for worry.

“The reagents are made in Europe, where there are far more COVID-19 patients than in Japan, so some have warned about potential import restrictions on these vital supplies, making it impossible to provide testing for everyone. However, a company in the United States confirmed to me that there is no problem whatsoever.” In other words, if the Japanese government is serious about increasing PCR testing, it is certainly possible to achieve a level of testing on par with Europe and the United States.

The country faces no technical limitations when it comes to testing, explains the doctor. “Japan is certainly not lagging behind other countries technically. If robot and information technology is used, the implementation rate for PCR testing can be increased dramatically.”

Nakamura points out that the policies of the Japanese government have lacked awareness of the use of IT to deal with the crisis. “A few days ago, I saw a report on how the paper-based report on COVID-19 patients was finally digitized. This seems an example of how Japan is losing its status as an advanced country. In South Korea, drive-through PCR tests have become common, while in Taiwan, informational apps are available so that everyone can purchase masks equally. The Japanese government is spending over 46 billion yen to distribute two masks to every household, but many households have yet to receive them. Our neighbors are far ahead of us in terms of their policies.”

IT as a Source of Solutions

Nakamura—who was appointed the program director of the Cabinet Office’s Strategic Innovation Promotion Program in 2018, and is involved in helping hospitals to employ artificial intelligence—is confident that using IT to deal with the COVID-19 crisis will be a way for Japan to solve the problems it faces.

One problem he notes is the sudden change in some patients from mild to severe symptoms, even leading to death, as well as the issue of how to alleviate the fears of patients with milder symptoms who are quarantined at home or in hotels and other facilities. Nakamura suggests the creation of a system that would allow such patients to use a smartphone or tablet computer to send reports on their own temperature and other vital signs three times a day to medical staff.

“In the United States, smartwatches with an electrocardiogram function have already been approved as medical devices. If the breathing rate and pulse are measured three times a day and a warning sent to medical staff when an abnormality occurs, it’s possible to securely monitor patients waiting at home or in hotels and respond swiftly to a sudden change in their condition. This would also solve the problem of nursing staff not being on hand in the middle of the night at such hotels.”

He also suggests the use of robots, since patients with mild conditions waiting in hotel rooms are must avoid contact with others as much as possible. “Disposable plates and dishes can be brought to the patient by robots. The collection of towels and sheets can also be automated, with an alarm to indicate the collection time and a special container in which the patient can place those items.”

The humanoid robot Pepper makes its appearance on April 30, 2020, at a facility for COVID-19 patients who are asymptomatic or have mild symptoms located in Hachiōji, Tokyo. The device behind it is a cleaning robot. (© Kyodo)
The humanoid robot Pepper makes its appearance on April 30, 2020, at a facility for COVID-19 patients who are asymptomatic or have mild symptoms located in Hachiōji, Tokyo. The device behind it is a cleaning robot. (© Kyodo)

Although Japan has outstanding human resources and is technologically advanced, the government has been lagging behind other countries when it comes to making effective use of those resources. One can only hope that Japan will draw on the knowledge of experts advocating the introduction of robots and AI to deal with the COVID-19 crisis to set patients’ minds at ease and to reduce the strain on medical staff if a second, or even a third, wave of the pandemic arrives.

(Originally written in Japanese. Banner photo: A medical staff member at the Intensive Care Unit for COVID-19 patients at St. Marianna Medical University Hospital in Kawasaki, Kanagawa Prefecture, on May 4, 2020. © Reuters/Aflo.) 

Health medicine IT coronavirus COVID-19 pandemic