The BMJ
理事 久住英二
【インタビュー】How Japan survived covid-19 2022/3/31
「 It was not an easy process for the public to get vaccinated, however. Because responsibility for vaccinating fell to each municipal government, the vaccination schedule was erratic across the country. Residents were required to secure a vaccination inoculation ticket number online, and then wait for a voucher and another form to arrive by post.
Working with patients in all age groups at three clinics across Tokyo—as well as foreign residents in Japan—Eiji Kusumi says that the multiple hurdles of online reservation, language barrier (the website was in Japanese only), and the lack of IT skills among all populations “worked well for the government,” in the sense that there were only a small number of vaccines available at the time. “Later, it made citizens feel that they are ignored by the government, especially the younger people, since they were not able to get vaccinated anytime soon,” says Kusumi.
The Tokyo Olympics arrived in July 2021, and so did the delta variant. Once again, there were not enough beds in Tokyo’s hospitals. “Public hospitals were not accepting covid patients. Funds were given to the National Health Organisation and the Japan Community Healthcare Organisation, but they were not accepting covid-19 patients,” says Kusumi.
His disappointment with the two medical bodies can be best understood in the way in which GPs like him were able to test patients but unable to admit them. “One of my patients, who was in his 50s, died in his home, while we were trying to secure a hospital bed for him with the local health office of Shinjuku,” says Kusumi, adding that since only younger people were seeking online consultations, there is a high possibility that many older people died in their homes without having seen any doctor.
During the early days of the delta variant, Tokyo governor Yuriko Koike blamed the city’s adult entertainment industry for the rapid transmission. “This pushed people working late at night in these businesses to avoid vaccination, as a show of resistance, for being blamed as the enemy of the public,” says Kusumi.
Kusumi says he often dreamt of patients not finding beds. “The biggest stress was the powerlessness. Fortunately, none of my staff quit, because I was always telling them that we were doing the right thing: testing patients, providing online consultations, and doing the best we could.”
“Positive PCR [polymerase chain reaction] tests exceeded 60% at my clinics—that was 12 times more covid patients than the government data. But since only severely ill people were being sent to the hospital, such data were not recorded,” says Kusumi, adding that the 30 doctors across his three clinics were mostly consulting patients online and could only prescribe medication to control the symptoms.」
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「 しかし、一般市民が予防接種を受けるのは簡単なことではなかった。予防接種の実施は各自治体に委ねられていたため、全国的に接種スケジュールが不規則だったのだ。住民の方は、インターネットで接種券番号を確保し、接種券と別の用紙が郵送されてくるのを待つ必要がありました。
都内3カ所のクリニックで幅広い年齢層の患者や在日外国人と接した久住英二は、オンライン予約、言語の壁（ウェブサイトは日本語のみ）、ITスキルの欠如という複数のハードルが、当時はワクチンの数が少なかったという意味で「政府にとって好都合」だったと語る。「その後、特に若い人たちがいつまでたっても予防接種を受けられないので、市民が政府に無視されていると感じるようになりました」と久住は言う。
2021年7月、東京オリンピックが到来し、デルタの変種も登場した。再び、東京の病院のベッドが足りなくなった。「公立病院はCOVID-19患者を受け入れていなかった。国民健康保険団体連合会、地域医療機能推進機構に資金が回されましたが、COVID-19の患者を受け入れてくれませんでした」と久住は言う。
久住が2つの医療機関に失望したのは、彼のような開業医が患者を検査することはできても、入院させることができなかったという点から理解できる。「新宿の保健所に病床を確保してもらっている間に、50代の患者さんが自宅で亡くなってしまったんです」と久住は言う。
デルタ変種の初期には、東京都の小池百合子知事が、急速な感染の原因を都内の風俗業に求めた。「これにより、これらの業種で深夜に働く人々は、国民の敵として責められることへの抵抗として、ワクチン接種を避けるようになった」と久住は言う。
久住は、患者がベッドを見つけられない夢をよく見たという。「最大のストレスは、無力感だった。幸いなことに、スタッフは誰も辞めませんでした。患者を検査し、オンラインで相談し、できる限りのことをするのが正しいのだと、いつも言い聞かせていたからです」。
"私のクリニックではPCR（ポリメラーゼ連鎖反応）陽性率が60％を超えており、これは政府のデータの12倍ものCOVID-19患者がいることになります。しかし、重症者しか病院に連れて行かないので、そのようなデータは記録されませんでした」と久住は言う。また、3つのクリニックにいる30人の医師は、ほとんどオンラインで患者の相談に乗り、症状を抑えるための薬を処方することしかできなかったという。」
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