TOKYO -- The growing number of coronavirus cases in Japan has brought the country's limited testing into question, with a policy designed to prevent patients with mild cases from flooding hospitals possibly undermining its ability to effectively respond to the outbreak.
Extensive testing to gauge the extent of an outbreak is viewed as crucial to formulating an effective response, and the government is facing growing calls to adjust the rules so that not all who test positive do not have to be quarantined at hospitals.
A study by researchers at Oxford University shows especially extensive screening in South Korea and Australia, with 6,148 and 4,473 tests per million people, respectively, as of March 20. Germany had conducted 2,023 tests per million as of March 15 -- 17 times more than Japan's 118 as of March 19.
Prime Minister Shinzo Abe had said Japan would ramp up its polymerase chain reaction, or PCR, testing capacity to 8,000 per day by the end of March. Yet the country now carries out fewer than 2,000 a day, with the cumulative total reaching about 54,000 on Sunday. Germany, by comparison, had already conducted 167,000 by March 15, covering a larger share of its smaller population.
A key difference lies in the two nations' handling of positive tests. In Germany, those who have COVID-19 but show no symptoms are told to isolate themselves at home.
In contrast, Japanese law requires everyone who tests positive -- even patients with mild or no symptoms -- to be admitted to hospitals, essentially quarantining them to keep the infection from spreading.
The health ministry worried that casting too wide a screening net with this policy would leave hospitals packed with coronavirus cases along with false positives, overwhelming the medical system.
The ministry said on March 1 that if hospitals become too full to accept critically ill patients, people confirmed to have the virus but who have mild symptoms will be directed to stay home. A month later, the ministry has yet to indicate whether that point has been reached, nor has it given any specific criteria for when to make the switch.
As a result, hospitals have continued admitting all coronavirus cases, and Tokyo is running low on beds at facilities certified to handle infectious disease patients.
Japan has seen relatively few coronavirus-related deaths so far, but the outbreak is gaining momentum. As more patients crop up who cannot be linked to known cases, more widespread testing will be vital to curbing the spread of the virus.
"Our key message is: test, test, test. This is a serious disease," Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, said in a mid-March news briefing.
"There's no point in checking the entire population, but [Japan] should expand its testing regime so it can check suspicious cases quickly," said Kenji Shibuya, a professor at King's College London and a senior adviser to the WHO director-general.
Some countries are adopting simpler screening methods that are quicker than the time-consuming PCR method. South Korea and the U.S. have set up drive-thru facilities to test large numbers of people efficiently.
Japan may also have lessons to learn from how hard-hit countries are handling the sudden extra burden on their health care systems.
New York City's famed Central Park has been enlisted in the battle against COVID-19, as a 68-bed field hospital with a 10-bed intensive care unit opened there Tuesday. New York state, which has seen more than 76,000 coronavirus cases and just over 1,700 deaths, aims to more than double its capacity to 140,000 beds.
The hospital ship USNS Comfort docked in Manhattan on Monday. The 1,000-bed vessel will take critically ill patients without COVID-19 infections to give hospitals more breathing room to handle the outbreak. The state has also asked retired medical professionals to join the fight.
In Europe, the U.K. military converted a London convention center into a 4,000-bed hospital in nine days as the outbreak there picks up steam. Milan has set up a field hospital at the city fairgrounds with 200 beds and a 24-hour intensive care unit.
France is easing pressure on facilities in Paris and eastern France, where the outbreak is concentrated, by using its air force and high-speed TGV trains to transport patients to other regions and neighboring countries.
Germany -- which has the world's fifth-highest number of reported cases but a markedly low death rate at just over 800 -- is using spare capacity to help out neighbors that are faring worse, accepting patients from northern Italy and France.
Additional reporting by Hisashi Tsutsui and Megumi Kito in Tokyo.