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Japan seized with anxiety over homegrown outbreak

Lack of beds and limited testing ability raise fears of nation unprepared to cope

People walk on the famous Shibuya crossing in Tokyo. Authorities have failed to determine how some of Japan's patients have contracted the coronavirus. (Photo by Shihoko Nakaoka)

TOKYO -- With the coronavirus now spreading to patients lacking direct ties to China, Japan is scrambling to strengthen screening and treatment capacity in case a full-blown crisis erupts.

A clinic near Shinjuku Station in central Tokyo has been seeing more and more patients worried they could have the new virus. So far, it has asked patients with coldlike symptoms whether they have visited Wuhan, the Chinese city at the center of the outbreak. But it could soon start asking about trips to any overseas locations.

"Even medical professionals have trouble telling whether patients have the regular flu or the new coronavirus, so we don't know what to tell people to look out for," clinic chief Rintaro Hasuike said.

"There've been more patients looking to get tested, and we don't know what to do," the head of another Tokyo clinic said.

The health ministry tells the members of the public on its website to first telephone their local support centers for overseas returnees if they suspect that they have the coronavirus. But not everyone knows about these centers.

Fears are starting to emerge that this might turn into a widespread epidemic. Four new patients were confirmed across Japan on Thursday. Authorities have failed to determine how two contracted the virus.

On Friday, a fire department employee who had helped with patient transport from the Diamond Princess cruise ship quarantined at Yokohama tested positive, despite having worn protective gear.

"Besides China, Japan is the only country where there have been infection cases of which transmission routes cannot be traced," said Nikki Shindo, a flu expert at the World Health Organization.

Those deemed possibly infected are referred to designated outpatient facilities whose names have not been disclosed to keep them from being swamped with low-risk or unrelated cases. Only then do patients undergo screening for the coronavirus, either by the National Institute of Infectious Diseases or local public health institutes.

Outside mass screenings for government-chartered flights from Wuhan or the Diamond Princess, roughly 200 patients have been screened for the coronavirus in Japan since January. Currently, only the NIID has the ability to test 200 samples at one time.

In case of a surge in patients, the Japanese government said Thursday that it will enlist private-sector facilities and universities to help with screening if necessary and will quadruple capacity at the NIID. Local institutes will also be encouraged to acquire more equipment.

It has taken nine days on average for Japan's coronavirus patients, excluding those on chartered flights and the cruise ship, to obtain diagnoses from when they first exhibited symptoms. Twelve required multiple trips to the doctor before being deemed at risk of having the virus.

The longest it took was the 22 days by a woman in Kanagawa Prefecture in her 80s who on Thursday became the first confirmed death from the coronavirus in Japan.

The longer it takes for a diagnosis, the greater the risk that patients infect those around them. But confirming cases can be tough -- especially for younger, healthier patients with only mild symptoms, much less people with no symptoms at all. Five of the roughly 760 passengers on chartered flights from Wuhan tested positive despite not having any symptoms, meaning they would have been impossible to catch through regular channels.

Treatment capacity is an issue as well. Fourteen of Japan's 47 prefectures miss their own benchmarks for the number of beds in isolation wards. Overall, there are 1,871 beds across Japan's isolation chambers -- 36 fewer than the goal. The health ministry on Sunday said coronavirus patients can stay in nonisolated facilities if no beds are available.

"If the virus spreads to the wider public, we won't be able to keep track of patients and may have to place them in shared rooms with noncoronavirus patients," said professor Hitoshi Oshitani of the Tohoku University School of Medicine.

Roughly 20 million were infected in 12 months during the H1N1 flu pandemic that began in 2009. Many hospitals were overwhelmed, delaying care for those who needed it the most.

"There are many unknowns regarding the new coronavirus, and it will be difficult to track down and isolate every infected patient," Tokyo Medical University professor Atsuo Hamada said.

"We're more likely to minimize the damage by catching and treating patients with severe symptoms early on, and the public should make even more of an effort to wash hands and cover coughs," Hamada said.

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