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Elderly emerge as top priority in Japan's coronavirus fight

With 80% of cases never going beyond a cold, prevention focuses on at-risk groups

Keeping fit: Japan's elderly population is one of the groups seen as at greater risk of coronavirus infection.   © Reuters

TOKYO -- As Japan looks to contain the spread of the new coronavirus, protecting the elderly and other vulnerable people has become a priority for authorities.

Medical facilities around Japan now have 1,800 beds equipped for infectious diseases. There is still space left, but the ministry is scrambling to secure more.

Japan now has more than 500 cases of coronavirus infection, the bulk of which stem from a quarantined cruise ship at Yokohama that is slowly being evacuated. But a number of unexplained domestic cases pose the risk of further infections within Japan among people who have not traveled to Wuhan, the epicenter of the Chinese outbreak.

"Depending on the conditions of an outbreak, we may prioritize hospitalization of seriously ill patients and have patients with mild cases recuperate at home," a health ministry official said.

Hospitals are one front in the fight against infection spreading to high-risk groups. A survey by doctors of 138 patients in Wuhan found that 41% may have contracted the illness at medical facilities.

Japan has also reported cases of suspected infection at hospitals in Wakayama and Kanagawa prefectures, with both patients and staff testing positive.

With elderly people at especially high risk of contracting the disease, nursing homes and assisted-living facilities will also serve as front lines for prevention.

"In the event of an outbreak in a 100-person facility, you need to imagine that at least 30 people will become infected, and that a few will die," said Yoshihiro Takayama, deputy head of infectious diseases at Okinawa Chubu Hospital, located in Japan's southernmost prefecture.

Opinions are mixed on the virus's infectiousness. The World Health Organization estimates that each patient can spread the disease to 1.4 to 2.5 other people. Severe acute respiratory syndrome, or SARS, ranged from 2 to 4, while the 2009 flu pandemic had a number from 1.4 to 1.6.

But other findings place the new virus's figure much higher. One new coronavirus patient can infect around 3.8 people, estimates a study including researchers from the University of Florida and the Beijing Institute of Microbiology and Epidemiology.

The WHO estimates that symptoms end up being mild in 80% or so of cases. The fatality rate is now assessed at around 2%.

The actual percentage of deaths is assumed to be lower owing to unreported coronavirus cases. It is 0.3% to 0.6%, according to Hokkaido University medical school professor Hiroshi Nishiura.

For now, Japan's health ministry has yet to raise the alert level to trigger a more aggressive response. It has instead issued guidelines for citizens to follow before seeking a diagnosis.

Most people should suffer coldlike symptoms and a high fever for at least four days before calling a local consultation center. Seniors and the infirm should wait only two. Those feeling fatigue or having difficulty breathing should seek immediate help, according to the ministry.

The health ministry is offering doctors more discretion in when to test for the virus. Previously, such screenings were generally recommended if a patient had some link to China.

Screening capacity at national and local testing facilities has more than doubled from the initial 1,500 samples per day, thanks to added infrastructure, as well as cooperation by the private sector and universities.

Atsuo Hamada, an infectious disease specialist at Tokyo Medical University, said national authorities "should provide clearer guidelines on what steps patients with mild symptoms need to take, in order to ease public anxiety."

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