On February 1, Mayumi, 50, felt ill and had a fever of 38 ° C. She called the health center in Toyohashi City, 283 km from Tokyo, to report symptoms and check for health. possibility of testing for Covid-19. At the other end of the line, the attendant asked if she had had contact with someone diagnosed. “Not that I know of,” Mayumi replied.
Shortly thereafter, she went to the health center, according to the instructions she received, but the examination was not authorized. “They said that due to the increase in cases, they didn’t even have a PCR [exame para detectar coronavírus] nor a flu test. They said to look for a private clinic if you wanted to be tested.
Faced with skyrocketing cases and the overload of the medical system in Japan, which has seen the third wave of infections since the end of November, people with symptoms of Covid-19 face crossroads like this: choose between paying to find out if they are infected and performing the quarantine themselves or at risk of exposing others to the virus.
Mayumi preferred to know. She went to a clinic and was seen inside the car, behind the wheel, where she measured her oxygen and temperature levels and collected her blood – the first test was negative, which l ‘released from PCR. In all, thanks to the insurance, she spent around 3,000 yen (R $ 150).
Mario, 45, preferred not to know. “I had all the symptoms, including the loss of taste,” he says. However, he decided to isolate himself and hope to recover at his home in Tokyo. “It’s a witch hunt, even among Brazilians,” reports the Brazilian, who has lived in Japan for nearly 20 years.
The case of Vietnamese student Kim, 20, was more serious. She felt very bad the morning of December 23, with a headache and a whole body. “I couldn’t sleep, but I couldn’t keep my eyes open,” recalls she, who lives in Tokyo.
The next day, Christmas Eve, it got worse: she had dizziness, a terrible sore throat and a fever of about 38.3 ° C. On the 26th, when it lost its taste and smell, he decided to ask for help. First, he went to a private clinic, where the PCR test cost 40,000 yen (R $ 2,000).
Then he decided to call a health center to report the symptoms and order the test. The system was so overloaded that she could not be answered over the phone until the morning of the 27th. At the health center, she had an x-ray, flu test and PCR – in total she paid 8,000 yen ( R $ 410). The positive diagnosis for Covid-19 came after a 15-minute wait.
She was given medication and told to go home and wait for a call from the center to see if she should stay home or check in at a hospital or hotel, where some patients with mild cases of Covid-19 are hosted to avoid spreading the virus. . As Kim shares the house with other girls, the hotel was the most likely alternative.
At night, they called and said that on the 29th, she should go to the hotel in Ikebukuro for four days of isolation. “It was an experience to spend New Years in a hotel room, alone. It was scary because I didn’t have family or close friends to help me. I felt very lonely.
Kim recovered well and returned home on Jan. 2, but the mark stuck. “My roommate, a Nepalese man, was angry when I got back from the hotel. “Why are you at home? You shouldn’t have come back, ”she told me and we fought,” she said.
Two weeks after she left the hotel, her friends didn’t want to meet her either, which she now takes for granted to maintain social isolation. “It was very sad, but now it’s okay.”
Mayumi, Mário and Kim are fictitious names. Indeed, in addition to the lack of beds and limitations for testing, there is a stigma around suspected people, symptoms and diagnosis of Covid-19 in Japan.
In the archipelago, 67% fear the social stigma of the coronavirus more than the health risks, indicated a poll by the newspaper Asahi Shimbun, carried out between November and December 2020 and published in January 2021.
Earlier this year, a young woman in her 30s was found dead in her Tokyo apartment. She was diagnosed with the virus, but was asymptomatic and therefore was treated at home. “I’m sorry I disturbed the others,” said the note she left.
Self-care at home has become a standard indication for asymptomatic patients or those with mild symptoms, which also carries risks. In December, 56 people died during treatment at home, according to the National Police Agency. In January, they were 132. On February 10, they were 7, all elderly.
This month, the Japanese government instituted a sort of “loneliness minister” to help people living in isolation, especially the elderly, who make up 28.7% of the population – the largest in the world. in proportion. On the rise, suicide is one of the main concerns of the portfolio, coordinated by Tetsushi Sakamoto, who must coordinate actions with agencies and ministries.
Between stigma, silence and loneliness, there are a number of peculiarities facing Covid-19 in Japan.
Since December, there have been several cases of people dying at home awaiting beds and even tests.
PCR tests are indicated for those undergoing screening at health centers in each city, such as recording symptoms and contacting infected people or outbreaks where confirmed contagions have occurred. Since the start of the pandemic, the country has been criticized for not having massively tested the population.
Until the end of 2020, the alternative for asymptomatic or possibly exposed people was expensive examinations at private clinics, ranging from 25 to 40,000 yen (R $ 1,270 to R $ 2,000).
Due to the high demand, private institutions have started offering exam options at lower cost. One of them offers a 1,980 yen saliva test kit, the result of which can be delivered by e-mail (express) for 9,900 yen, with a certificate in Japanese and English, for a total of 11 880 yen (R $ 607).
Detail: diagnoses confirmed in private clinics are not necessarily included in the official number of cases in the country.
Unlike the other waves crossed by the archipelago, this time, many increasingly serious cases are recorded, which overloads the medical and hospital system, public and private.
According to the Japanese agency Kyodo, until January 25, 15,000 people were waiting for beds for Covid-19. Japan has 12.98 beds per 1,000 people, the highest per capita average among developed countries, according to data from the OECD (Organization for Economic Co-operation and Development), but the majority is for mild illnesses – it there are only 5 ICU beds per 100,000 inhabitants.
Japanese organizations have been warning of the risk of collapse of the national health system for some time. “If the spread of the infection continues as it is, the collapse will be inevitable,” the Japan Hospital Association said in a statement in late December.
In Japan, all residents are required to register and contribute through taxes with public insurances, such as Kokumin kenko hoken (health insurance) or Shakai hoken (social insurance), which covers 70% of medical and hospital costs. The remaining 30% is paid by the patient directly to medical institutions. In other words, the model is public, but not entirely free like SUS, in Brazil, since most institutions are private (70%).
However, according to data from the Ministry of Health, of the 3,008 active private hospitals, 30% are able to treat patients with Covid-19.
For Kentaro Iwata, director of the Division of Infectious Diseases at Kobe University, the national health system is very good because it includes care for all. “But it also has flaws – and inefficiency is one of them. Many hospital beds are used to treat subacute and chronic illnesses, so it is impossible to use them for Covid, ”Iwata explains to Folha.
Japan approved the Pfizer vaccine and launched the vaccination campaign on Wednesday (17). “[A vacina] It can help reduce new cases, but it won’t eradicate them if it isn’t articulated with other measures. “
Portrait of Covid-19 in Japan
35,394 people were receiving treatment at home on January 20, compared to 1,096 in the same situation on November 4.
73% of public hospitals can receive patients with Covid-19
84% of hospitals with a public health plan can receive patients with Covid-19
30% of private hospitals capable of receiving patients with Covid-19
7.7 million tests have already been performed
421 thousand cases have been recorded
7300 deaths have been confirmed
10 of the 47 provinces are in a state of emergency until March 7
Source: Ministry of Health, Labor and Welfare of Japan