Sep. 25, 2009 (The Yomiuri Shimbun) -- A Yomiuri Shimbun survey has found that 13 prefectural governments plan to triage patients suffering from the new H1N1 strain of influenza when the flu pandemic peaks in their areas.
According to the survey, 26 other prefectures are considering triage, through which they would call on major hospitals to treat influenza patients who develop serious symptoms and require hospitalization, and for local clinics to handle patients with minor symptoms. Four prefectural governments said they planned to ask flu patients with minor symptoms to refrain from visiting medical institutions.
The survey shows that different prefectural governments are likely to respond in different ways at the peak of the pandemic, as the situation likely will vary in each case.
The Health, Labor and Welfare Ministry had asked prefectural governments to consider developing systems that will allow influenza patients with severe symptoms to receive appropriate treatment when the flu pandemic reaches its peak. The Yomiuri survey aimed to determine how the 47 prefectures had responded to the government's request as of Friday.
Among the 13 prefectures planning to triage influenza patients, the Miyagi prefectural government intends to distribute a list of medical institutions capable of accepting flu patients with serious symptoms to such places as fire stations, health care centers and clinics.
"We'll list [medical institutions] that can accept pregnant patients, children and patients who are receiving dialysis, all of whom are at a higher risk of developing serious symptoms, and urge patients with mild symptoms not to go to [the listed institutions] for treatment," an official of the Miyagi prefectural government said.
The Miyazaki prefectural government said it had established a system in which clinics would introduce main hospitals to patients deemed to need hospitalization.
Meanwhile, the Kanagawa prefectural government said it had set up a forum where health care centers, organizations of medical professionals and other related parties would discuss how to triage patients.
In Okinawa Prefecture, the pandemic peaked in August, and that prefecture's measures could help other areas plan their responses.
In Naha, where triage was not employed, about 200 patients with fevers flocked to hospital emergency rooms on Aug. 16, a day after the nation's first death from the H1N1 virus was confirmed in Okinawa Prefecture.
However, Okinawa city used women's associations and other groups to advise patients with mild symptoms to go to clinics. As a result, no major confusion was reported at main hospitals.
Among eight prefectures that said they would not implement triage or had not considered it, the Saitama prefectural government said triaging patients would be difficult and therefore it would ask medical institutions to consider coordinating operations on an area basis. The government of Hokkaido said it would consider triage if it was necessary.
The four prefectures planning to ask influenza patients with minor symptoms to refrain from seeing doctors at hospitals are Yamanashi, Nagano, Hiroshima and Kumamoto. In the survey, 23 other prefectural governments said they were considering such measures, but many voiced concern, saying administrative authorities would be seen as imposing restrictions on people's access to medical care.
"Early diagnosis and treatment is needed to prevent patients from developing serious symptoms, and it is essential for medical institutions to divvy up their responsibilities," said Koichiro Kudo, director of the Disease Control and Prevention Center at the International Medical Center of Japan. "Governments need to take the initiative in establishing systems that will enable regional medical coordination as early as possible."
