TOKYO -- Medical facilities for coronavirus patients set up by Tokyo and Osaka have struggled to attract skilled nurses as infections surge across the country, creating a major hurdle for expanding the capacity of those establishments.
The Tokyo metropolitan government on Wednesday opened a new medical center in the city of Fuchu for patients with moderate coronavirus symptoms. The plan is to eventually have 100 beds there, though only 32 can be filled right now due to staffing constraints.
The facility currently shares its 48 nurses, some of who have never cared for a coronavirus patient before, with municipal hospitals. "All these hospitals are struggling to keep up with the pandemic, so it will be difficult to send more staffers" to the Fuchu center, said a representative from the metropolitan government.
On Thursday, Tokyo posted another record of 822 COVID-19 cases, up from the previous high of 678 reported a day earlier, adding to the pressure on the medical system. The metropolitan government was forced to raise its alert regarding the strain on the medical system to the highest of four levels.
The Osaka prefectural government also launched a site for severe COVID-19 patients on Tuesday with just five of its 30 planned beds and needing around 130 nurses to run at full capacity. Unable to reach this number on its own, Osaka sought help from other local governments and Japan's Self-Defense Forces, which sent a combined 30 nurses.
Still, these reinforcements will only be available for a limited amount of time. The Osaka government on its website is offering 500,000 yen ($4,830) a month to nurses who can work at the new coronavirus center long-term -- significantly above the national average of 334,400 yen in 2019.
"We have set what we think is the appropriate figure given the experience necessary and the difficult conditions they will be working in," said a representative from the Osaka government.
"There's a shortage of nurses and people who can administer PCR tests," said a source at a staffing agency. "We've seen a 30% increase on the year in the amount of openings in related fields in April-November. Demand for testing staff and nurses has more than doubled."
There were roughly 1.5 million nurses working in Japan at the end of 2018, and the number has been on the rise. Per capita, Japan has about the same number of nurses as countries like the U.S.
But Japan also has a relatively large number of hospital beds, meaning nurses are often spread thin. The country has just 0.6 nurse per hospital bed, compared with 2.84 in the U.S. and 3.09 in the U.K., according to the Organization for Economic Cooperation and Development.
The pandemic has exacerbated the nurse shortage, since caring for severe coronavirus patients requires knowledge of ventilators and other specialized equipment. Many are also refusing to work in COVID-19 wards due to infection risks and fear of prejudice from the outside world. Intensive-care units in general require more medical staffers than nonintensive units as well.
More training and educational opportunities will be required to expand the ranks of seasoned nurses capable of caring for coronavirus patients. Japan will also need to tap licensed nurses who are not currently working, usually due to family reasons or difficult working conditions. The turnover rate for full-time nurses in fiscal 2018 came to 10.7%, according to the Japanese Nursing Association.
In order to encourage more of these inactive caregivers to return to the workforce, Japan's Health Ministry launched a new job- matching website at the end of May dedicated to medical professionals. The system allows the hiring process, including interviews, to be concluded online.
Cooperation between different municipalities will be key as well. The Health Ministry in cooperation with the Japanese Nursing Association created a formal framework in November where less-impacted areas can send nurses to hard-hit regions.
The National Governors' Association sent over 30 nurses to Okinawa in August, and 20 from 13 different prefectures to Hokkaido just this month. Several neighbors of Osaka contributed to the staffing at its coronavirus center as well. But many areas are still facing shortages, and Japan's pandemic response will require an even more flexible approach to staffing.