[Recommendations for avoiding medical strain: A comparative analysis of regional responses in Hyogo Prefecture during the eighth wave of COVID-19].

Abstract

Objectives　During the eighth wave of COVID-19 in Hyogo Prefecture (October 1, 2022-February 28, 2023), the overwhelming transmissibility of the virus caused a significant strain on the healthcare system. This study focused on Amagasaki Health Center, Akashi Health Center, Sumoto Health Center (island region), and Asago Health Center (rural region) and their unique responses. The difference between the calculated "required number of critical care beds" (based on hospitalization recommendations) and the number of secured hospital beds was used as a measure of bed capacity strain, while the number of incidents involving difficulty in emergency transport was used as an indicator of a strain on emergency medical services. The aim of this study was to propose strategies to avoid medical system overload during future infectious disease pandemics based on the responses of each health center and regional healthcare system.Methods　Each fire department provided information on incidents involving difficulties with emergency transport. The "required number of critical care beds" was defined as the cumulative daily number of hospitalization recommendations(minus the number of patients who had exceeded the standard 10-day hospitalization period outlined in the guidelines). In the Amagasaki and Akashi Health Center jurisdictions, the number of patients hospitalized daily based on recommendations was recorded. These data were used to evaluate the validity of the calculated required number of critical care beds and assess the effectiveness of back end support operations.Results　Within the Amagasaki Health Center jurisdiction, where a consistent approach was adopted to hospitalize patients at designated medical institutions (from recommendation to discharge), the required number of critical care beds peaked significantly beyond the number of secured hospital beds. This peak coincided with a surge in COVID-19 emergency transport difficulties. In contrast, the Akashi Health Center jurisdiction, with back end support beds, partially mitigated bed-capacity strain and emergency transport difficulties. The Sumoto Health Center's jurisdiction minimized a healthcare strain by prioritizing the continuation of its regular medical care system. In the Asago Health Center jurisdiction, approximately half of the hospital beds were in psychiatric hospitals. Patients in these facilities could continue treatment therein, allowing the region to avoid significant healthcare constraints.Conclusion　Increasing the number of secure hospital beds alone is insufficient for preventing regional healthcare strains in SARS-type pandemics, such as COVID-19. Operating back end support systems and enabling self-contained treatment in facilities, such as care homes for older adults and psychiatric hospitals, are effective measures for avoiding this strain.