JAAM Nationwide Survey on the response to the first wave of COVID-19 in Japan Part II: How the medical institutions overcame the first wave and how to prepare in future?

Abstract Aim To investigate and clarify the surge capacity of staff/equipment/space, and patient outcome in the first wave of COVID-19 in Japan Methods We analyzed questionnaire data from the end of May 2020 from 180 hospitals (total of 102,578 beds) with acute medical centers Results A total of 4,938 hospitalized patients with COVID-19 were confirmed Of 1,100 severe COVID-19 inpatients, 112 remained hospitalized and 138 died There were 4,852 patients presumed to be severe COVID-19 patients who were confirmed later to be not infected Twenty-seven hospitals (15% of 180 hospitals) converted their ICU to a unit for COVID-19 patients only, and 107 (59%) had to manage both severe COVID-19 patients and others in the same ICU Restriction of ICU admission was occurred in one of the former 27 hospitals and 21 of later 107 hospitals Shortage of N95 masks was the most serious concern regarding personal protective equipment (PPE) As for issues which raised ICU bed occupancy, difficulty performing or progressing rehabilitation for severe patients (42%), and the improved patients (28%), long lasting severely ill patients (36%) and unclear isolation criteria (34%) were mentioned Many acute medicine physicians assisted regional governmental agencies functioning as advisors and volunteer coordinator Conclusion The mortality rate of COVID-19 in this study was 4 5% of all hospitalized patients and 14% (approximately one in 7) severe patients The hospitals with dedicated COVID-19 ICUs accepted more patients with severe COVID-19 and had lower ICU admission restrictions, which may be helpful as a strategy in the next pandemic