Assessment of Critical Care Surge Capacity During the COVID-19 Pandemic in Japan.

Japan has the highest proportion of older adults worldwide but has fewer critical care beds than most high-income countries. Although the COVID-19 infection rate in Japan is low compared with Europe and the United States, by the end of 2020, several infected people died in ambulances because they could not find hospitals to accept them. Our study aimed to examine the Japanese healthcare system's capacity to accommodate critically ill COVID-19 patients during the pandemic. We created a model to estimate bed and staff capacity at 3 levels of pandemic response (conventional, contingency, and crisis), as defined by the US National Academy of Medicine, and the function of Japan's healthcare system at each level. We then compared our estimates of the number of COVID-19 patients requiring intensive care at peak times with the national health system capacity using expert panel data. Our findings suggest that Japan's healthcare system currently can accommodate only a limited number of critically ill COVID-19 patients. It could accommodate the surge of pandemic demands by converting nonintensive care unit beds to critical care beds and using nonintensive care unit staff for critical care. However, bed and staff capacity should not be expanded uniformly, so that the limited number of physicians and nurses are allocated efficiently and so staffing does not become the bottleneck of the expansion. Training and deploying physicians and nurses to provide immediate intensive care is essential. The key is to introduce and implement the concept and mechanism of tiered staffing in the Japanese healthcare system. More importantly, most intensive care facilities in Japanese hospitals are small-scaled and thinly distributed in each region. The government needs to introduce an efficient system for smooth dispatching of medical personnel among hospitals regardless of their founding institutions.

Violence against doctors in Iraq during the time of COVID-19.

OBJECTIVES: This study assessed patterns in reported violence against doctors working in 11 Baghdad hospitals providing care for patients with COVID-19 and explored characteristics of hospital violence and its impact on health workers. METHODS: Questionnaires were completed by 505 hospital doctors (38.6% male, 64.4% female) working in 11 Baghdad hospitals. No personal or identifying information was obtained. FINDINGS: Of 505 doctors, 446 (87.3%) had experienced hospital violence in the previous 6 months. Doctors reported that patients were responsible for 95 (21.3%) instances of violence, patient family or relatives for 322 (72.4%), police or military personnel for 19 (4.3%), and other sources for 9 (2%). The proportion of violent events reported did not differ between male and female doctors, although characteristics varied. There were 415 of the 505 doctors who reported that violence had increased since the beginning of the pandemic, and many felt the situation would only get worse. COVID-19 has heightened tensions in an already violent health workplace, further increasing risks to patients and health providers. INTERPRETATION: During the COVID-19 epidemic in Iraq an already violent hospital environment in Baghdad has only worsened. The physical and emotional toll on health workers is high which further threatens patient care and hospital productivity. While more security measures can be taken, reducing health workplace violence requires other measures such as improved communication, and addressing issues of patient care.