The famous king of chanting poetry, the first-class spring literary scholar, Master Black Earth, once said: foreign countries are more chaotic, all day long, the collusion. Today the cabinet stepped down, tomorrow the prime minister was fired. After the financial crisis, and then to impeach the leader.
No one expected that the prophecies of Zhao Benshan more than 20 years ago would be fulfilled in Japan, a neighboring country.
The new Epidemic keeps recurring, and there is a shortage of hospital beds; Shinzo Abe resigned due to illness, and “Uncle Kan” took office in an emergency; the Olympic Games, which took a lot of effort to recover the economy, is still in limbo, and the fiscal deficit is the highest ever.
What has happened to this “medical powerhouse” with its numerous top hospitals and Nobel Prize winners in the new epidemic? And why is Japan so confused in the face of the new epidemic?
Medical collapse: Hundreds of patients died at Home due to inability to integrate medical resources
Japan is not a medical powerhouse or a medical powerhouse. According to statistics, the East Asian island nation is home to 8,300 hospitals and has the world’s leading number of beds per capita and the highest utilization rate of outpatient clinics.
According to the OECD in 2017, the average number of beds per 1,000 people in Japan was 13.1, twice the average (4.7).19 A Lancet report in 2016 showed that Japan also had a high outpatient utilization rate of 15.24 visits per capita in 2016, higher than the global rate of 5.42 visits per capita.
In 2018, The Lancet even ranked Japan first in Asia in its “Ranking of 195 countries and territories worldwide for quality and accessibility of healthcare”.
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Screenshot from NHK News
But another feature of Japan’s thriving healthcare sector is the high proportion of private hospitals.
According to NHK (Japan Broadcasting Association), 80 percent of Japan’s more than 8,300 hospitals are privately owned, characterized by their small size and scattered locations. Meanwhile, private hospitals account for 2/3 of Japan’s 4297 acute care hospitals.
According to Professor Toshiki Mano of Chuo University, many of the small hospitals have the name of emergency hospitals, but they are mainly in the business of treating patients with chronic and minor illnesses. In addition, in order to pursue profits, many private hospitals put their main resources and efforts on high-yield projects such as medical aesthetics and dentistry.
According to the official website of the Ministry of health and Welfare, although Japan has a large number of hospital beds, there are only 1,758 regular infectious disease beds, and these beds are concentrated in public hospitals, which account for 20% of the total.
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Source: Ministry of Health, Labour and Welfare of Japan
In addition, NHK also believes that private hospitals are generally passive in the fight against the epidemic. Last year, the Ministry of Health, Labour and Welfare conducted a survey on “willingness to treat patients with new coronary heart disease,” and only 25% of the participating hospitals said they would accept patients with new coronary heart disease, mostly public or national hospitals, while only 21% of private hospitals were positive.
A survey conducted by the Ministry of Health, Labour and Welfare in January this year found that only 23% of private hospitals in Japan are currently treating patients with new coronary arteries in their intensive care units.
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Public” and “public” corporations are different, but both are public institutions
Screenshot from NHK News
Given the dire medical situation, can The Japanese government use tough measures? According to the relevant laws, the Japanese government does not have this right. Just a few weeks ago, Japan urgently amended the Infectious Disease Control Law to allow the Japanese authorities to name and even criticize hospitals that do not meet the government’s requirements, but otherwise there are no other hard-line measures in place.
Recently, an NHK reporter followed a nursing home in a Tokyo ward that houses 18 senior citizens. However, since the beginning of the year, when one person was diagnosed with a new coronary, the number of infected people has expanded to 14, nearly all of them.
However, what’s more unfortunate is that all 14 senior citizens with neocon pneumonia have been hospitalized. One of them, an 84-year-old patient, was hospitalized in 11 hospitals without success, and the staff in charge of his care had to contact his Family, saying, “The patient has to rely on his own Life force.
The staff member complained to reporters that it is already difficult to find a bed in the area, and that beds are hard to come by even in the entire Tokyo area.
According to the Asahi Shimbun, there are currently more than 35,000 patients in Japan who have been advised to isolate themselves at home or in designated hotels. According to the survey, more than 200 patients who were not admitted to hospitals have died at home.
On April 1 last year, Professor Hiroshi Nishiura of Hokkaido University, a member of the Japanese government’s “New Coronary Pneumonia Response Team,” posted a long tweet saying that the outbreak was about to get out of control in Japan if medical resources were not integrated as soon as possible.
Less than seven months later, Toshio Nakagawa, president of the Japan Medical Association, publicly declared at a press conference on Jan. 6 that “Japanese medical care has reached the point of collapse.
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On January 13, the president of the Japan Medical Association announced that Japanese medical care had gone from collapse to destruction
(ABEMA screenshot)
A country without CDC: counting cases by “hand” and checking the flow by fax
The new crown epidemic is all about prevention and control. In addition to the medical system, Japan’s public health system is also in a difficult situation in this epidemic.
In February last year, a cruise ship “Diamond Princess” carrying patients with NCC pneumonia arrived at the Japanese port. Problems in the prevention and control of NCC in Japan have also begun to emerge.
On Feb. 18, Kentaro Iwata, an epidemiologist with experience in fighting SARS and Ebola, was shocked to discover in a 14-minute video that the entire cruise ship was in disarray and did not separate the danger zone from the safety zone.
In response, Japan’s Vice Minister of Health, Labour and Welfare tweeted a picture refuting Professor Iwata’s comments, but the picture was quickly deleted after Japanese netizens discovered that there was no separation between the so-called “isolated passage” and the “general passage”.
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Precious historical materials (screenshot from Twitter)
On February 22, another control failure was reported on the Diamond Princess: 23 passengers were sent home without being tested for new crowns. Twenty-five of the foreign passengers were diagnosed, but they had already been chartered to return home by the Time they were notified. At the press conference, the Japanese Minister of Health, Labour and Welfare apologized and thanked for this.
After the Diamond Princess incident, Kentaro Iwata said in a meeting that the root cause of Japan’s prevention and control oversight is that the country does not have its own center for disease prevention and control.
In Japan, the ministry responsible for health care is the Ministry of Health, Labour and Welfare, which has been mentioned repeatedly before. The term “Houshang” is from “Shang Shu – Da Yu Mo”: “Zhengde, utilize, Houshang, but He. It means to make people rich and abundant.
The Ministry of Health, Labour and Welfare in Japan is a hodgepodge of responsibilities that includes not only health functions but also social health insurance, drug and Food safety, employment security and assistance to the disadvantaged. Infectious disease prevention and control is only one of many operations.
In the absence of a dedicated CDC agency, Japan’s central-level department responsible for public health prevention is the National Institute of Infectious Diseases (NIID) under the Ministry of Health, Labour and Welfare. However, as a deploying agency, this institute is not comparable to a real CDC in terms of size and funding.
By one count, the CDC has 40 times the number of people on staff and a budget more than 200 times that of the NIID. Even within the Ministry of Health, Labor and Welfare, the NIID has limited power. The NIID Institute did play an important role in the Japanese epidemic, but it is difficult to make it as strong and systematic as the CDC.
In addition, the deployment of public health at the local level in Japan has been uneven. According to the Regional Health Law, the prevention and control of infectious diseases should be under the jurisdiction of locally established health centers, but health centers have a wide range of operations and also assume some hospital functions. Public health personnel are insufficient and prevention and control capabilities are weak.
According to the Asahi Shimbun, one health center in the Kansai region was even found to have no one at all who knew how to prevent and control infectious diseases, and the way to streamline it was to call patients in the office.
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Public health workers are only one of the many types of personnel at health centers.
Source: Wikipedia
Since the Diamond Princess incident, Japan’s public health system has been repeatedly questioned by Japanese citizens.
On February 17, a member of the House of Representatives asked “How does the Ministry of Health, Labour and Welfare count the number of new crowns in the country?
In response, the director of the Health Bureau of the Ministry of Health, Labour and Welfare replied that every night after 12:00 p.m., employees of the outsourcing company commissioned by the Ministry of Health, Labour and Welfare would go to the official websites of 47 prefectures to confirm the data by human eyes and then calculate the number of confirmed cases nationwide by hand. The Prime Minister, Yoshihide Suga, confirmed that “since the outbreak of the epidemic, we have been collecting data by hand calculations.
According to a follow-up interview with the Phoenix reporter, the hand-counting method is manually entered into the computer, but it is noteworthy that Japan’s new crown pneumonia case statistics system, which was developed last year, has not been used. As for the reason, there is “no comment”.
In addition to the Ministry of Health, Labor and Welfare, local health centers are also full of problems.
In the middle of last year, the Asahi Shimbun broke the story of the inefficiency of Tokyo’s health centers: when an infected patient appears, the doctor has to fax the patient’s information to the health center in the district, and the health center then manually confirms it by handwriting on the fax before reporting it and making the relevant arrangements for influenza prevention.
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Previously, a local health center refused to conduct a new crown test on a close receiver on the grounds that he could “still breathe.
Image source: Self-photographed
To date, it seems that the issue of efficiency at the health center has not been resolved: Last month, a 70-year-old patient with neonatal coronary artery disease died at home in Kanagawa Prefecture, Japan. The doctor had previously determined that he needed hospitalization and informed the authorities, but the health center failed to contact the patient, only to find out five days later that the patient had been dead for days.
The head of Kanagawa Health Center said that there are nearly 400 patients who need to be hospitalized and tracked, but they have not been contacted yet due to lack of manpower.
Fiscal collapse: Stimulus policy aborted, tax hike for citizens under huge deficit
Coronavirus (コロナ禍) is a coined word for the series of economic impacts of the new coronavirus epidemic in Japan.
In the 19th year, most Japanese media said that 2020 was the most promising year for economic recovery. However, with the epidemic, the travel industry, a vital part of Japan’s economy, has been decimated. And with the Olympics, which had been expected to be held on time, there was little leverage left to revive the economy.
In response, the Japanese government has chosen to pull the travel and restaurant industry back to life quickly by burning through money.
On April 7, 2020, the Japanese government approved a supplemental budget bill for fiscal year 2020 totaling 1,685.7 billion yen to implement the 108 trillion yen “Emergency Economic Measures for Novel Coronavirus Infections”. Of this amount, ¥167.94 billion will be used to boost the economy of travel, restaurants and other related industries.
With this large sum of money, the Ministry of Land, Infrastructure, Transport and Tourism (MLIT) has planned the “Go To Travel” campaign to subsidize domestic travel expenses of Japanese citizens. The policy was officially implemented in July last year, and the maximum subsidy was half of the cost.
In mid-September, Japan launched the “Go To Eat” campaign to stimulate food and drink consumption by giving back points (1 point for 1 yuan) and issuing food and drink coupons.
The effect of the policy was remarkable. According to one paper, the number of retrievals of Japanese tourism increased 190% compared to the same period in FY19, and the consumption index recovered rapidly from -80% to -20%.
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If a two-day trip for two people costs 80,000 yen, the government can subsidize 40,000 (about 2,400 yen)
Source: niconico screenshot
There is nothing wrong with using similar policies to stimulate the economy, and indeed, countries around the world have used such policies to revive their economies that have been hit hard by the epidemic, but the premise of such stimulation should be that the new epidemic in the country or region has been significantly contained. However, Japan is stimulating its economy at a time when the epidemic has not yet been significantly contained.
The policy has been accompanied by an increasing number of confirmed cases. A graph of the R0 (effective reproduction rate) of new cases in Japan shows this.
Since the “Go To” policy was introduced, the majority of R0 values in Japan have been above 1.0, and the epidemic has been spreading more and more.
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Source: Japan time screenshot
Toshio Nakagawa, president of the Japan Medical Association, said there is no conclusive evidence that the travel subsidy policy is directly responsible for the resurgence of the epidemic, but there is no doubt that it has a lot to do with it. Hajio Ozaki, president of the Tokyo Metropolitan Medical Association, said that the increase in travel is likely to accelerate the spread of the epidemic and hoped that the government would suspend travel subsidies. But these exhortations did not have a corresponding effect.
On November 11, Toshio Nakagawa publicly stated that a third wave of the epidemic had hit Japan. At this time, the “go to” policy was still being implemented in an orderly manner. Ten days later, NHK visited Haneda Airport in Tokyo and found that it was filled with tourists on their way out. On that day, there were 539 new infections in Tokyo and 2,398 new cases across Japan.
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The third wave of the outbreak continues to this day Photo: Yahoo Japan
How effective has the “go to” policy, which the Japanese government is pushing even though it knows the epidemic will spread, been for the economy? The answer seems to be less than satisfactory.
On February 19, the Japanese Cabinet Office released a flash report on the economic situation, stating that Japan’s real GDP will decline by 4.8% year-on-year in 2020, the first negative growth since the international financial crisis in 2008. While the economy is shrinking, the Japanese government is also suffering from the policy backlash from the early burn. According to the Wall Street Journal’s analysis, Japan’s finances will incur a deficit of upwards of 70 trillion yen in 2020.
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2020 arrears are the highest ever Photo source: Wall Street Journal
The fleece comes off the sheep’s back, and the Japanese Ministry of Finance has now come up with a remedy – a tax hike.
According to Japan’s Weekly Mail, Japan’s Ministry of Finance is planning to levy a “new crown epidemic recovery tax” to raise consumption tax from the current 10% to 15% after the end of the new crown epidemic. The 10% increase is just 19 years old. Last September, the current prime minister, Yoshihide Suga, told reporters that Japan would not need to raise the consumption tax again in the next decade.
But even if he breaks his promise to raise the tax rate again, the prognosis for Japan’s economy is not good. Many financial institutions in Asia believe that Japan will need to raise the consumption tax to at least 26% to keep the country’s finances afloat.
The past is not forgotten, the future is not forgotten
Recently, with the emergency suspension of the “go to” policy and the re-intensification of prevention and control measures, the epidemic in Japan is now on a gradual decline. In addition, since February 17, Japan has officially begun vaccinating its citizens with Pfizer’s New Crown vaccine.
According to Fuji News, Japanese Prime Minister Yoshihide Suga is considering restarting the “go to” policy again. Will Japan’s new crown epidemic slowly die down as vaccinations continue to be administered? Or will there be a fourth outbreak in the near future? Will the Tokyo Olympics be held this year? The answer is still unknown.
For our country, Japan’s performance in the New Crown epidemic is also of high reference value.
When Deng Xiaoping visited Japan in 1978, he said that one of the purposes of his visit to Japan was to find the “elixir of immortality”, a Medicine that would allow China to modernize as soon as possible. A month or so after Deng Xiaoping’s visit to Japan, the Third Plenary Session of the Eleventh Central Committee was officially held, which made the strategic decision to reform and open up the country and put forward a long-term plan for modernization.
In the era of the epidemic, we may still have the need to learn from Japan, only this time the scriptures may be different from decades ago, and this time we get more lessons learned and the thinking behind them.
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