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.

中文翻译：

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日本 COVID-19 大流行期间重症监护人证激增能力的评估


日本是全世界老年人比例最高的国家，但重症监护床位比大多数高收入国家少。尽管与欧洲和美国相比，日本的 COVID-19 感染率较低，但到 2020 年底，有几名感染者因找不到医院接收而死在救护车上。我们的研究旨在检查日本医疗保健系统在大流行期间容纳危重 COVID-19 患者的能力。我们创建了一个模型来估计美国国家医学院定义的大流行应对 3 个级别（常规、应急和危机）的床位和工作人员容量，以及日本医疗保健系统在每个级别的功能。然后，我们使用专家小组数据将我们对高峰时段需要重症监护的 COVID-19 患者人数的估计与国家卫生系统的能力进行了比较。我们的研究结果表明，日本的医疗保健系统目前只能容纳有限数量的 COVID-19 危重患者。它可以通过将非重症监护病房床位转换为重症监护病床并使用非重症监护病房工作人员进行重症监护来适应大流行需求的激增。然而，床位和工作人员的容量不应该一成不变地扩大，这样才能有效地分配有限数量的医生和护士，这样人员配备就不会成为扩张的瓶颈。培训和部署医生和护士以提供即时重症监护至关重要。关键是在日本的医疗保健系统中引入和实施分层人员配置的概念和机制。更重要的是，日本医院的大多数重症监护设施规模较小，分布在每个地区。 政府需要引入一个有效的系统，以便在医院之间顺利派遣医务人员，无论其成立机构如何。