TOKYO -- Japan's latest spike in coronavirus cases overwhelmed a city in central Hokkaido, prompting the northern prefecture's governor to request backup from the national government.
Defense Minister Nobuo Kishi responded Tuesday by dispatching 10 nurses from Japan's Ground Self-Defense Force to two understaffed hospitals in Asahikawa. The city endured a record number of infections that day, along with six deaths.
The crisis in Asahikawa reveals a paradox cropping up across Japan. The country is awash in hospital beds, but has precious few medical workers to staff them.
Japan fields 13 hospital beds per 1,000 people, according to data from the Organization for Economic Cooperation and Development and other sources. The Asian country easily leads its Group of Seven peers: Germany has 8 beds per 1,000 residents, while Britain and the U.S. are the lowest with about 2 per 1,000.
But Japan has only 0.19 physicians per hospital bed, says Global Health Consulting Japan, which looked at OECD data. In contrast, the U.S. fields 0.91 doctors per bed.
France and Germany have around three times more physicians per hospital bed than Japan. The number of nurses follows this trend.
And Japan's front-line medical workers are fatigued as they juggle the surging count of COVID-19 patients with the need to provide other care. At a hospital in Kanagawa Prefecture, beds set aside for severe coronavirus cases continue to operate near capacity.
Japan totaled roughly 27,000 hospital beds earmarked for coronavirus patients in mid-August, during the second wave, but the number has risen little since. The same can be said about the 3,600 beds for serious cases. Hospitals face pressure amid a third wave of cases.
"Even if the number of hospital beds is increased, provide proper administration can't be provided if there are staff shortages," said Hiroyuki Kunishima, professor at St. Marianna University School of Medicine in Kanagawa. The care for COVID-19 patients "also needs to be balanced with normal emergency medicine," Kunishima added.
The coronavirus pandemic has exposed how medical staff and facilities are not used optimally across Japan.
Medical resources are stretched thin, partly due to the many small and midsize hospitals. Japan has about 8,000 hospitals, the most among G-7 nations and well above the 6,000 in the U.S.
When it comes to the number of doctors per 1,000 people, Japan approaches the U.S. figure, though it trails Europe. But doctors in Japan are spread thin at medical centers.
This is coupled with a shortage of intensive care specialists. Some medical centers have 10 or more intensive care unit beds but only one ICU specialist.
And because 80% of the hospitals are privately run, little flexibility exists in sharing personnel among different networks.
Western nations have responded to the capacity problem through various means. Back in March, Germany sought to expand the number of ICU beds by 10,000, offering subsidies of 50,000 euros ($60,600) per bed. Sweden's government consolidated the management of empty ICU beds to facilitate the distribution of patients across municipal lines.
In the U.S., the state of Maryland has created a database to monitor empty hospital beds and hospitalizations so that it can direct patients to hospitals that correspond with the symptoms.
Japan's high rate of hospital admissions for coronavirus compared with Western countries adds to the burden on the system. About 8,000 COVID-19 patients were hospitalized as of Dec. 1 -- roughly 40% of the total active cases at the time. The U.K. has six times as many new daily cases as Japan, but only 60% more hospitalizations.
An analysis by Global Health Consulting of data on 5,801 patients at 341 Japanese hospitals with acute-care facilities between February and June found that 66% of admitted cases were mild, requiring no respiratory management.
Japan now advises hospitalization only for seriously ill COVID-19 patients and those at risk of severe illness, such as people 65 or older and those with preexisting conditions. But some municipalities admit COVID-19 cases on a preventive basis, possibly without determining whether hospitalization is necessary.
The relatively low financial hurdles to hospital admission in Japan -- thanks to a universal health insurance system -- may play a role in the high admissions rate.
Tokyo had 1,850 hospitalizations as of Tuesday, filling about 70% of the 2,640 available beds. Public health centers in the city make decisions on whether to send coronavirus cases to hospitals or have them recover at home based on factors including age, symptoms and underlying conditions.
But "if the patient complains that they're having trouble breathing, we can't handle that at the health center, so we have no choice to send them to a hospital," said a representative at one center in the capital.
"We need to have public hospitals take on more of the burden of combating infectious diseases," said Ichiro Innami, director at the Institute for Health Economics and Policy. "We need to respond more effectively with a flexible division of labor similar to other countries, such as allocating coronavirus patients based on hospitals, rather than beds, while leaving normal treatment to private hospitals."