With the latest flu variant engulfing Japan, hospitals are flooded not only with new patients but also former patients seeking medical certificates needed to prove full recovery to schools, employers and other institutions.

Although the health and education ministries issued a statement during the major flu outbreak in 2010 saying such documents were unnecessary, the custom remains deep-seated among schools.

To lighten the burden on both patients and hospitals, the Okinawa Prefectural Government, the area hit hardest by the flu last year, issued a statement this month calling on educational institutions not to request recovery certificates.

The prefectural government stated on its website that flu patients “are allowed to go outside if they have recovered at least five days after the disease developed and three days after a fever breaks. Hence there is no need to submit a certificate of recovery for returning” to school or work.

“We initially issued such a statement in 2011, and our stance has been widely acknowledged among medical institutions in Okinawa,” said Miyuki Yamauchi, an official of Okinawa’s department of health services. “But with the number of flu patients on the rise since last year, especially in kindergartens, we have received several inquiries and complaints from parents reporting that the institutions asked their children to submit the certificates. Thus we reissued the statement.”

In Okinawa, 33,811 people caught influenza last year, giving it the highest ratio of patients per medical institution in the nation, at 593.81.

“Usually the flu season is said to be in winter, but in Okinawa flu spreads in summer, too,” said Yamauchi. “Sometimes emergency hospitals are crowded with flu patients and issuing certificates to all of them requires a lot of effort.”

Under the School and Health Safety Act , students with flu are prohibited from attending school until five days pass from the onset of the disease and three days pass from the day the fever breaks.

The health ministry, which oversees nursery schools, stipulates in its guidelines on preventing infectious diseases that children who have recovered do not need to submit any kind of document upon returning if doctors acknowledge there is no risk of infection.

The education ministry, which oversees all schools from kindergarten on up, stipulates that children are required to get doctors’ permission to return, which some people interpret as a requirement to obtain the certificates.

“Whether to suspend students with flu from school depends on each principal’s decision, and so does the decision on whether students must hand in a certificate of recovery,” said Yohei Higuchi of the education ministry.

Tokyo Takanawa Hospital in Minato Ward is among the few hospitals that refuses to issue the certificates, noting that infection is not determined through highly sophisticated medical procedures but by a doctors’ diagnosis based on symptoms.

“We decided not to issue a certificate of recovery after the education ministry said such documents are not necessary,” said Kazuhiko Mizoi at the hospital’s general affairs division. “We explain to patients who ask for the certification that it is not needed to prove their recovery. But sometimes doctors have no choice but to issue the document because they can’t ask patients already in the examination room to go home empty-handed. It is quite troublesome for us, to be honest.”

Yuko Okuda, chief manager at Hibiya Clinic in Tokyo, said it is really troublesome that the elementary school her children attend in Shibuya Ward requires that such certificates be signed by both a doctor and the school doctor. “It’s pretty strict and time-consuming, but it cannot be helped because that is what the school requests. It might also be the current social trend.”

Konoe Kitahara, who has a child in elementary school in Edogawa Ward, said the rule probably started after recovering children who went back to school without such certificates got blamed for causing subsequent infections. “I think the certificate prevents people from pointless arguments over who spread the flu in school.”

KEYWORDS flu, children, schools, certification