Experts Offer Advice on Coronavirus Countermeasures

Society Health

The Stop Infectious Diseases 2020 Strategic Council advises the government to muster the budget and human resources needed for a Japanese version of the US Centers for Disease Control and Prevention and to roll out mobile medical units, among other key measures.

Just Like a Natural Disaster

In the mid-February, the Stop Infectious Diseases 2020 Strategic Council—an organization made up of experts on infectious diseases, chaired by Kaku Mitsuo, specially appointed professor at Tōhoku Medical and Pharmaceutical University—issued urgent recommendations to people in Japan regarding the lifestyle habits they should seek to acquire to reduce the risk of infection. The Council has followed up on this with advice on policies that the government should implement from here on out as it faces the serious risk of the spread of infectious diseases.

Based on the view that the spread of novel coronavirus is a “natural disaster that has struck Japan,” the Council advises the government to take the following measures to confront the likely future spread of infectious diseases.

1.  Rethinking Healthcare Systems and Processes

It had been said that the source of novel coronavirus was a wildlife market in Wuhan, China, but this has not been definitively confirmed. There is a possibility that the virus could break out again to spread around the world in the future. It is important for people in Japan to be aware that an infectious disease can occur at any place and time.

Japan needs to put in place a crisis-management system for infectious diseases that includes not just epidemiologists, but specialists from a wide range of other fields as well, including informatics and immunology, thereby creating a structure for advising the government.

The CDC, the US Centers for Disease Control and Prevention, is staffed by around 11,000 personnel and has an annual budget equal to over ¥800 billion. This body handles a wide range of tasks from gathering information explaining situations to the public to implementing quarantines. The scale of the organization sharply contrasts with Japan’s National Institute of Infectious Diseases, which has only around 300 staff members and an annual budget of roughly ¥8 billion. Japan needs to create a new organization with greater facilities and human resources, modeled on the CDC, in order to coordinate crisis-management efforts regarding infectious diseases.

2. A Revamped Inspection and Quarantine System

COVID-19 infections have spread in Japan with no clear identification of the source and route of infection, due to the inability to identify those who have contracted the virus but do not exhibit symptoms. Countering this requires the expansion of medical facilities able to identify infected persons.

Even when the technology and facilities are available to diagnose new infections, unless there is a framework for this to be covered by insurance, the medical authorities will have to cover the cost of the diagnosis. They will also need to maintain stocks of the diagnosis kits and devices that determine whether a person is infected, and create the necessary systems for dispatching needed personnel.

3. Mobile Medical Units for Normal and Emergency Use

Medical examinations of suspected carriers of the coronavirus are conducted in many cases in small, prefabricated structures placed at hospital perimeters to avoid infecting other patients.

Mobile medical units can be separated from a hospital, thereby reducing the risk of the virus spreading to other parts of it. It is easy to clearly demarcate a “red zone” where the virus might be and safe “green zones” so that the treatment of regular outpatients and the treatment of patients infected with the disease can each continue to be carried out.

Mobile medical units can be equipped with x-ray equipment and computed tomography scanners so that the main hospital facilities will not be exposed to the virus. They can also be used at normal times as mobile medical units and then moved to the site of an outbreak at times of emergency.

4. Systems for Emergency Prescriptions and Information Management

The current healthcare management system in Japan relies on tools like the “medicine notebook” (okusuri techō), a physical record of the drugs prescribed to the patient who carries it, but the haphazard use of these tools can make it difficult to evaluate the risk of polypharmacy (concurrent administration of multiple medicines that can lead to harmful side-effects) and to determine standards for prioritizing or discontinuing the use of certain prescribed medicines. At times of disasters, managing medicines becomes even more difficult, which can lead to disaster-related deaths resulting from the worsening of chronic conditions.

In the current COVID-19 crisis as well, a major task is to ensure that elderly persons without cold symptoms and those with underlying illnesses will not come into contact with the likely infected people who have come to the same medical clinic or hospital.

In this connection, it would be advisable to replace the medicine notebook with a digital system to manage healthcare information so that patients could be tracked and prescriptions issued, even remotely, using their “My Number” card.

In addition, at times of disasters or disease outbreaks, short-term prescriptions of effective drugs (enough for around seven days) could be distributed in advance. In this way, even if a person were quarantined because of an infectious disease, it would still be possible to receive needed medication.

Kaku Mitsuo (left), a specially appointed professor at Tōhoku Medical and Pharmaceutical University and chairman of the Stop Infectious Diseases 2020 Strategic Council, along with other experts at a Tokyo event hosted by the Council to present advice to the government on measures to counter infectious diseases (February 27, 2020).
Kaku Mitsuo (left), a specially appointed professor at Tōhoku Medical and Pharmaceutical University and chairman of the Stop Infectious Diseases 2020 Strategic Council, along with other experts at a Tokyo event hosted by the Council to present advice to the government on measures to counter infectious diseases (February 27, 2020).

5. Infectious Disease Plans and Telecommuting

Policies to deal with infectious diseases should aim to bolster national resilience, just as disaster-related policies do. This means working to achieve a strong and flexible country that can protect the lives and property of its citizens based on an awareness of disaster prevention and mitigation.

Business continuity planning in the corporate sector aims to minimize the damage to a company or other organization from a natural disaster, terrorist attack, or other emergency, enabling the entity to continue operations and recover from whatever damage took place. All sorts of organization—not just companies—need to implement continuity plans for infectious diseases as well as natural disasters, in order to prepare for such situations as the current COVID-19 outbreak.

Moreover, the increase in telecommuting that has arisen during the current outbreak should continue as a trend among workers, rather than a temporary stopgap measure. Such working from home can play a vital role in the future in the case of the next outbreak of a contagious disease or a natural disaster.

6. The Importance of Disinfection Effort

One effective way to prevent the spread of disease is to disinfect areas where many people gather. However, this policy is not being thoroughly implemented due to the cost involved and a lack of necessary personnel. In the case of the Diamond Princess cruise ship, which had many infected passengers, it proved to be quite difficult to maintain hygienic conditions on board.

Hospitals in the United States use ultraviolet sterilization robots that move about the facilities to help prevent infection. Since there is a limit to the ability to clean areas by hand, active use is being made of such robots that emit UV rays capable of killing even bacteria resistant to drugs.

The use of long-lasting disinfectant at schools has also been shown to be a way to greatly reduce the risk of influenza infection among children without requiring frequent reapplication. It is important to be aware of methods and products that use the latest technologies to disinfect spaces.

7. Following the Seven Urgent Tips

On February 10, the Council recommended that people in Japan take precautions in seven areas of everyday life to avoid infection, including the need to “maintain a proper level of concern.” The details of their recommendations can be found in our article, “Experts Offer Seven Urgent Tips for Avoiding Novel Coronavirus.”

(Originally published in Japanese. Banner photo: A mobile medical unit scheduled to be used for medical examinations at the Aichi/Gifu World Rally Championship in November 2020. © Nikkan Kogyo Shimbun/Kyodo News Images.)

Health disease infectious disease medical care virus coronavirus COVID-19