Inbound Ambassador

To Test or Not to Test – the COVID19 Question

WHO has strongly recommended widespread testing of COVID19 to inform what steps should be taken, but there is currently very limited testing available in Japan.

Utilizing only a fraction of Capacity

The World Health Organisation’s Tedros Adhanom Ghebreyesus has recommended the TEST-TEST-TEST tactic to deal with this worldwide pandemic, test every possible case. Yet, according to the Japan Times Japan is only utilizing a fraction (1/6) of its testing capability.

Testing Procedure Frustrating and Time Consuming

When I called the health center to ask about the testing procedure- the process was laid out as follows:
1) If you have a fever of 37.5 C for 4 days, cough and other flu symptoms, call to consult with your local doctor or clinic and tell them your symptoms. If your doctor agrees, s/he will give you a referral to a larger hospital that has the testing capability.
2) Then make an appointment at a larger hospital and get a range of tests done to rule out any other diseases or infections.
3) Finally, after all the other tests rule out other diseases, ask the doctor to test for COVID19. However, be aware, there is a chance that the doctor will not give you the COVID19 test if he does not think it is necessary.

This process to get a test is wildly inefficient. The steps create a huge financial, mental, emotional and physical drain on both the medical staff and the patients. Patients with a high fever going through this process are being required to be in waiting rooms and see multiple staff creating more chances of spreading the disease. The patient needs to rest and be quarantined at home more than any other treatment, especially if they do have COVID19, since there is no medicine available or treatment currently available unless you need a respirator.

A friend recently told me in confidence of her husband’s story of COVID19 testing in Japan. His story spans over 2 weeks of his feeling unwell, talking with medical staff and worrying. Although he didn’t have a fever, he felt desperate and compelled to lie to get a COVID19 test. But he then admitted the truth and was refused a test. Still worried, he returned to the first clinic he had visited, where they finally suspected COVID19 and the doctor persuaded the health center to give him a COVID19 test which came back negative.

This long-drawn-out process is taxing on medical staff as well as patients. Of course, it’s not a good idea to lie, but it’s understandable how people are feeling desperate in this crisis and finding very little comfort in the lack of transparency and leadership.

From February, hospitals were reportedly turning away possible COVID19 patients at the end of February, 2020 which may have led to further spread in Japan.

Drive-Thru and Phone-Booth Testing

South Korea has shown the world what world-class testing looks like. They were quick to set up a testing infrastructure that does not overly tax the patients or the medical staff or hospitals. South Korea now has the lowest death rates from the virus at only 1%. Another pandemic innovation uniquely used in South Korea is making masks and other necessary goods available only by prescription which minimizes spread due to hoarding and protects medical staff who needs masks more than the healthy general public.

Korea has also had a unique approach in not shutting services down. According to AlJareeza, Dr.Roh Kyoung-ho, National Health Insurance Service Ilsan Hospital says,

“The method of blocking off certain areas and stopping movement was what people did in the Middle Ages when they were dealing with the Black Death. It was because they didn’t know what was causing infections at the time and they didn’t know where the disease was spreading.”

South Korea has shown the world how use of technology (GPS tracking of patients), as well as widespread testing can allow businesses to stay open. The public is encouraged to maintain basic social distancing parameters while going about their daily lives. Investing in a quick and effective testing response to the COVID19 crisis may help insulate South Korea from the economic crashes other countries now face as businesses close and people lose jobs.

3 Testing Improvements to Flatten the Curve

In order to flatten the curve, Japan needs to improve public access to testing. Here are 3 key focus points that need to improve:

  • 1) Utilize more of the COVID19 testing capability of hospitals – access 5/6th of the tests by testing sooner. In the midst of this pandemic, if there is a chance the patient has COVID19, do the test before all of the other tests.
  • 2) Create more drive-thru or phone-booth or other satellite testing facilities utilizing quick testing methods such as Niigata is trying to do.
  • 3) Send the 15-minute simplified stick-type test kits to local clinics to take some of the strain off of the larger hospitals. Send the kits also to care homes, school nurses and other healthcare workers working with high-risk groups such as the elderly or people living with compromised immunity as well as known carriers (children).
  • 4) Allowing more lenient criteria to qualify for testing. Test if ANY of the symptoms such as fever, having been in an infected area, been with an infected person, or has pneumonia-type symptoms apply.
  • 5) Take out the ambiguity of testing by improving transparency of when, where and how people can get tested if certain criteria is met (see 4).

Other Supportive Measures to Flatten the Curve

  • Launch regular and frequent Public Service Announement (PSA) campaigns on social-media and TV to encourage hand-washing, social distancing, cough-etiquette as well as staying home when sick.
  • Make sure all public restrooms have soap at the sinks for the public to use.
  • Prescription for masks and alcoholic sprays, wipes, and gels to prevent hoarding and protect medical staff.
  • Encourage teleworking (working-from-home) whenever possible.
  • Flexible work-hours to avoid rush-hour crowds.
  • Offices, schools and events need to have strict rules in place to have handwashing facilities available, social distancing workspaces, airfilters for offices, frequent cleaning of surfaces and send anyone home with a cough or fever.
  • Manufacture more masks and test-kits such as the 10-minute test kit developed in Nagasaki.

Japan can turn this crisis around and become an example of efficiency, hard work, grit, and inspiration for the world in how to handle the COVID19 coronavirus. Establishing an effective, clear and transparent system of testing now can not only contain the spread but can also help restart work and culture to insulate the economy from the difficult road ahead.

Updates on the Coronavirus in Japan