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Startup targets Japan's intensive care capacity as coronavirus hits

Online support addresses demand for specialized doctors at smaller hospitals

Japan had a shortage of trained medical specialists before the coronavirus pandemic reached its shores. Medical staff at a Tokyo hospital on April 30. (Photo by Kosaku Mimura)

TOKYO -- Japan's Covid-19 situation is speeding up the adoption of remote support systems by hospitals with understaffed intensive care units, with one medical startup pushing the trend. 

Tomoyuki Nakanishi founded T-ICU in 2016 to help hospitals boost their ICU capacity with online support from the startup's team of medical specialists. T-ICU currently works with about 19 institutions, but Nakanishi, an ICU doctor himself, said the company has been receiving more inquiries from hospitals since the novel coronavirus outbreak.

Nakanishi said there is a particular increase in demand from medium-sized hospitals that are now receiving more severely ill non-coronavirus patients who would usually go to larger hospitals. "Regional core hospitals are unable to accept non-Covid-19 patients because they are taken up by Covid-19," he said.

Japan's Covid-19 caseload has been trending down since the middle of April, but the country still has 11,724 active cases, including 294 patients who tested positive for the coronavirus on Sunday, according to Toyokeizai Online.

The Japanese Society of Intensive Care Medicine had certified about 1,820 critical-care doctors as of April 2019. This is not enough to cover all of Japan, the society admits, and most of these doctors tend to work at large-scale or university hospitals.

ICU doctors are trained to use ventilators and other life-support systems in treating severely ill patients. But while ICU remote support systems are used in the U.S. and other countries, T-ICU is the only company that provides them in Japan, according to the startup.

Toyota Regional Medical Center, in Toyota, Aichi Prefecture, is on the verge of adopting T-ICU's system, which enables remote ICU specialists to make suggestions based on patients' biometric information. The system would allow the center to receive support from doctors at a bigger and better-equipped hospital in the city.

"We do not have doctors who specialize in infectious diseases or ICU treatment," said Keita Kondo, a doctor at the center.

Medium-sized hospitals like Kondo's do not currently receive coronavirus patients but would have to if the area's larger hospitals become over-packed, which remains a threat despite the recent drop in new coronavirus cases. If that threat were to materialize, Kondo said, "we would need advice from specialized doctors."

ECMOnet offers another remote medicine service. Its medical specialists work over the phone to give advice on extracorporeal membrane oxygenation, which is what patients receive when ventilators do not work. ECMOnet was set up by the Japanese Society of Intensive Care Medicine, the Japanese Association for Acute Medicine and other groups of specialists. 

Osamu Nishida, chair of the JSICM's executive board, warned in a statement in April that a labor shortage in the country's ICUs was set to grow. While normal operations require one specialized nurse for every two ICU patients, Covid-19 requires two nurses for each patient to prevent infection. Considering demand from non-coronavirus patients, Japan "possibly has less than 1,000 beds that can host severe novel coronavirus patients," Nishida said last month.

T-ICU's Nakanishi noted the shortage of specialized ICU workers is not new and that the situation can be stabilized by adopting remote support systems. The company is in talks with about six hospitals and municipal governments, Nakanishi said.

The startup has raised 150 million yen ($1.4 million) so far from investors such as Beyond Next Ventures and SMBC Venture Capital. It also offers advice to doctors at Sunrise Hospital in Cambodia and plans to bring its service to Bangladesh later this year, although the schedule may be delayed due to the pandemic.

T-ICU's service costs about 1 million yen per month for medium-sized hospitals that typically have about six ICU beds. The company is offering its services for free until the end of June to help hospitals begin to immediately receive remote support without having to first take on cumbersome administrative processes.

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