Coronavirus disease (COVID-19) and psychogeriatric issues in Japan

by Shinobu Kawakatsu, Professor
Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University

Key Highlights:

• The Japanese government declared a state of emergency on 7 April 2020.
• As of 26 April 2020, 348 of the 13,182 patients with COVID-19 have died in Japan.
• A worrying issue is that the psychiatric wards are being renovated and converted to temporary infection wards for treating patients with COVID-19 in some general hospitals, thereby delaying the admission of  psychogeriatric patients.
• Expanding telemedicine services to target the elderly with psychiatric disorders, including those with dementia, will be useful for preventing the spread of COVID-19 as well as in supporting these patients.

The first coronavirus disease (COVID-19) case in Japan was of a man in his 30s from Kanagawa prefecture, who returned from Wuhan, China, on 6 January and tested positive for COVID-19 on 15 January. The second case was of a man in his 40s, a traveler from Wuhan, who tested positive on 24 January in Tokyo. A staff member of the traditional Japanese-style cruising restaurant, who had come in close contact with a COVID-19 positive Chinese traveler was thought to spread the infection to the other guests and their family members during a New Year’s party held on 18 January. A mother-in-law of one of guests became the first patient who died of COVID-19 pneumonia in Japan. Another outbreak of the infection occurred on the Diamond Princess cruise ship, while returning to Yokohama on 3 February after stopping in Hong Kong as well as other ports. Thereafter, the infection spread nationwide and the Japanese government declared a state of emergency on 7 April. As of 26 April 2020, 348 of the 13,182 patients with COVID-19 have died in Japan, including 13 of 712 individuals infected on the cruise ship.

According to the data from the Ministry of Health, Labor and Welfare (MHLW), the percentage of infected people aged > 70 years is 16.5%, whereas that of deceased people aged >70 years old is 82.4%. The mortality rate of people in their 60s is 1.1%, but that of people in their 70s increased to 5.7% and that of people aged > 80 years is 9.5%, indicating high mortality rates in the elderly. It is highly recommended that young adults living in urban epidemic areas (e.g., Tokyo, Osaka, Kyoto, Nagoya, Fukuoka, etc.) not visit their grandparents to prevent the spread of infection during this period.

Although the spread of infection has been observed in 54 hospitals until 26 April, we fortunately avoided a disruption of medical care. However, supplies of personal protective equipment including masks and gowns are gradually being exhausted in most hospitals. A worrying issue is that the psychiatric wards are being renovated and converted to temporary infection wards for treating patients with COVID-19 in some general hospitals, thereby delaying the admission of psychogeriatric patients. In urban outpatient clinics, the MHLW permits the use of telemedicine; however, this is challenging in rural areas owing to lack of internet services. In 2019, in Aizuwakamatsu city of the Fukushima Prefecture, the local government and medical association collaborated with IBM to provide telemedicine services using iPads for patients with Parkinson’s disease who find it difficult to visit a doctor regularly. Expanding this service to target the elderly with psychiatric disorders, including those with dementia, will be useful for preventing the spread of COVID-19 as well as in supporting these patients.

In nursing homes, the infection prevention guidelines provided by the MHLW are strictly followed, and hence, only few cases of community transmission were reported. However, the residents of the nursing homes are not permitted to visit family members or even doctors and have to stay indoors at all time. These situations are stressful to both the residents and their family members. Hence, at such times, the internet can help in facilitating communication. The Japanese Psychogeriatric Society uploaded a message on their homepage titled "Response to Novel Coronavirus (COVID-19) Infections" for the frail elderly population, including those with dementia, and their family providers:

“It has been pointed out that older adults are more likely to get severely ill from the novel coronavirus. For older adults with dementia or mental illness, it can be quite difficult to practice preventive measures such as hand-washing and wearing masks. To reduce the risk of getting infected at home, it is important that the family members and care givers adopt these practices and prevent themselves from getting infected with the virus. In addition, people opting for care services at designated facilities may be concerned about the risk of infection. The MHLW, however, has provided detailed notes on preventing the spread of infection. At present, both care givers and care receivers are undergoing considerable stress than usual. Under this circumstance, our concern is that this stress may worsen patients’ mental symptoms. We, the Japanese Psychogeriatric Society, provide full support to our patients and their families.”

For further reading:

1. National Institute of Infectious Disease. Field Briefing: Diamond Princess COVID-19 Cases, 20 Feb Update. https://www.niid.go.jp/niid/en/2019-ncov-e/9417-covid-dp-fe-02.html

2. Ministry of Health, Labour and Welfare. About Coronavirus Disease 2019 (COVID-19) https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/newpage_00032.html

3. Nicol GE, Karp JF, Reiersen AM, 0Zorumski CF, Lenze EJ. “What Were You Before the War?” Repurposing Psychiatry During the COVID-19 Pandemic, J Clin Psychiatry 2020;81(3):20com13373

4. Japanese Psychogeriatric Society. http://184.73.219.23/rounen/index.htm

Prof. Shinobu Kawakatsu is a geriatric psychiatrist working at the Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University and became a chairman of Crisis Management Committee of Japanese Psychogeriatric Society after Great East Japan earthquake and Fukushima Daiich Nuclear Power Station Accident.