Is the crash of the health system in Japan imminent or, at least at this moment, a product of bureaucratic regulation?

One is hearing a lot of comments about how Japan is on the “edge of an emergency”. Some of this is about leaders trying to get us to pay attention and follow the recommendations around protecting ourselves so they do not have to take more intrusive steps. It may be macho to shout for a “lockdown”, “shutdown,” even the extreme Dustin Hoffman movie-like “blockade with SDF troops in the streets,” of the 49.2 million people in the Greater Tokyo Region, Tokyo plus 4 adjoining provinces, but there are very real costs to millions of small and medium business owners who may not survive. Before going full Dustin Hoffman, are there other things we could be doing that are both very effective that carry a lower cost to society as a whole?

So what is the issue? Japan has more general hospital beds per 100K than any other country See below). Japan has 12,000 ICU ready beds with ventilators and at this moment only 68 total critical care patients requiring ventilators (the 60 shown in the chart below plus 8 from the Diamond Princess).  

But where Japan is short is the number of beds in legally designated “infectious disease” wards. And COVID-19 is a designated infectious disease. So what that means is that every person who tests positive for COVID-19 regardless of whether their personal symptoms are none to light must still be hospitalized in those scarce “infectious disease” wards. On that metric, we are at 50% capacity which scares a lot of people IF the “ ticking bomb” is finally going to go off. https://www.stopcovid19.jp/

Do other countries do that? Not Germany, who sends those with no and light symptoms home to self-isolate. “A key difference lies in the two nations' handling of positive tests. In Germany, those who have COVID-19 but show no symptoms are told to isolate themselves at home. In contrast, Japanese law requires everyone who tests positive -- even patients with mild or no symptoms -- to be admitted to hospitals, essentially quarantining them to keep the infection from spreading. ” https://asia.nikkei.com/Spotlight/Coronavirus/Germany-tests-coronavirus-17-times-more-than-Japan

In fact, that is the norm and Japan is inadvertently adding more burden to its health system that is not considered medically necessary elsewhere. 

So how do we fix the shortfall in infectious wards that are creating this concern among medical professionals UNDER THE CURRENT rules? Of the 1649 hospitalized patients as of the MOH’s Apr. 2 report, how many of the 852 patients classed as light (see below) could be sent home to self-isolate as Germany does it and most other countries or, if we want to be even more cautious, to newly set up isolation centers, as we did with the Diamond Princess passengers? The now-empty Olympic Village? Could 30%, 50%, all 852 patients with light to no symptoms be discharged and so reducing the burden on the hospitals by 50% in one move? Saving those valuable beds for those with a moderate condition that truly requires a hospital monitoring? What does it take to relax the laws for COVID-19 to allow for that to take place ASAP?

There is also the opportunity that appears to exist as there are over 5500 beds in infectious wards around Japan that are legally designated for TB and other specifically designated diseases. How occupied are these wards? How many of those beds already set up to deal with infectious disease controls could be quickly repurposed for COVID-19 patients? In the US, a hospital ship has arrived in New York harbor and they are moving non-COVID-19 serious patients to that ship so they can be cared for properly. Other countries are taking actions to shift non-COVID-19 patients to other hospitals so others can be used for COVID-19 patients only. Part of the issue is spreading the COVID-19 patients like peanut butter across every hospital they originally entered is putting stress across all of them instead of better balancing the actual need.

I am absolutely sure that the folks at MOH know all of this and in much greater detail than I do but they are simply not moving quickly enough to help remove some of the pressures on the Japanese health system that are being driven by bureaucratic regulations and may at least in part may not actually be real. MOHL is working very hard. Of that, I have no doubt whatsoever. But they may need to be given some signals that moving more quickly to deal with regulations that should be made more flexible to deal with the current crisis is necessary.