White tents are set up at the entrance of Kawakita General Hospital in Tokyo’s Suginami Ward on April 16. (Hiroyuki Yamamoto)

In early March, phones started ringing off the hook at a hospital in a residential area of Tokyo’s Suginami Ward.

They were all requests from public health centers to accept patients suspected of being infected with the new coronavirus.

It was well beyond the scope of the hospital's capabilities, as it has only 331 beds and is not designed to admit patients with infectious diseases.

Stunned medical staff suddenly found themselves thrust into the vortex of the coronavirus pandemic.

“We are simply a base hospital serving local communities,” said Takahiro Okai, 57, an assistant director of Kawakita General Hospital. “I don’t know how long we can survive and keep fulfilling our new role. We are in an uncharted territory, and it’s scary.”

TENTS IN THE GROUNDS

In early February, the hospital started seeing outpatients who had returned from overseas or had close contact with a COVID-19 patient. The individuals were referred to Kawakita hospital by public health centers.

At the time, doctors tended to one or two patients each day.

But the situation drastically changed, and very quickly, in March.

Staff came under ever-increasing requests from public health centers to accept patients suspected of being infected with the deadly virus.

Callers became desperate, too, asking hospital staff, “Is it impossible already?” or “Would you do us an immense favor and take an extra patient please?”

Elsewhere in the capital, the number of COVID-19 cases began skyrocketing.

By March 28, all beds at designated medical institutions for specified infectious diseases were full.

Newly diagnosed COVID-19 patients had nowhere to go.

Alarmed at the direction the health crisis was taking, the Kawakita hospital set up 38 beds on one of its floors for COVID-19 patients. It also started accepting people with severe symptoms whose health condition was rapidly deteriorating.

On March 31, a doctor-in-training at the hospital tested positive for the virus, prompting 17 other trainees to stay home. The hospital temporarily stopped accepting general emergency patients.

On April 15, staff set up spacious white tents on the hospital's premises.

From April 17, all visitors were required to have their body temperature checked before entering the hospital. Anybody with a high fever will be shunted to one of the tents so nurses can ask about symptoms.

Anyone suspected to be infected with the coronavirus will be referred to a doctor in an outpatient clinic set up inside the hospital exclusively for COVID-19 patients.

Currently, 14 people who are either infected or suspected to be infected with the coronavirus have been admitted to the hospital.

“We need to continue to take in patients for as long as possible,” a staff member said.

MORAL OBLIGATION

What Okai fears most is a potential in-hospital infection cluster.

Recent reports on coronavirus group clusters at Eiju General Hospital in Taito Ward and Nakano Egota Hospital in Nakano Ward have confirmed the physician's fear.

“Frankly speaking, it is hitting too close to home,” he said.

At Kawakita, staff have repeatedly practiced putting on and taking off protective gear such as masks, gloves and gowns, as a preventive measure. They also carefully established procedures so virus carriers and non-carriers do not come into contact inside the hospital.

“Our facility is not specialized to deal with infectious diseases, so it’s even harder for us,” Okai said.

Many front-line health workers in Tokyo said they have reached breaking point.

Already overwhelmed, they found themselves in even deeper water after the Tokyo metropolitan government’s latest guideline released in early April decreed that COVID-19 patients with mild symptoms will be treated at hotels, instead of hospitals, from now on.

“The collapse of the medical care system is about to begin. That’s what I thought,” said a respiratory medicine doctor who works at a general hospital in the capital on hearing the news.

“Hospitals that are only capable to see patients with mild symptoms have now no choice but to make beds available to take in those with severe symptoms,” the doctor said.

“The situation has the potential to lead to a devastating inferno,” the doctor said.

The outpatient division at the hospital where the doctor works is already stretched beyond capacity with patients brought in by ambulance, those with a referral from another medical institution and walk-ins.

“Staff have been so preoccupied with handling these patients that they are not able to give sufficient attention to non-coronavirus patients," the doctor said. "The hospital has lost its function as a local base hospital.”

Since April, the doctor has been administering polymerase chain reaction (PCR) tests and treating in-hospital COVID-19 patients.

The doctor can operate an artificial ventilator, and is thus in a position to care for patients most in need.

Although at high risk of getting infected, the doctor receives only one fresh face mask per day. The doctor has no idea when the hospital will exhaust its stock.

“It’s just unthinkable that we wear the same mask all day under ordinary circumstances," the doctor said. "I am horrified that we are unable to practice basic precautionary measures that we learned.”

The doctor has a 2-year-old child at home.

To ensure the child doesn't become infected, the doctor goes straight to the bathroom on coming home, undresses and washes the dirty clothes before putting on clean ones.

The doctor keeps the bag at the door, and has instructed the child to keep out of hallways and the entrance to prevent possible contact with the virus.

The hospital stopped receiving outpatients other than those suspected to have COVID-19 from early April.

The hospital is still not fully equipped to handle COVID-19 patients with severe symptoms. Yet, it has admitted several COVID-19 patients because all other hospitals were full.

“We are doing things beyond our capacity," the doctor said. "We are just driven by a sense of morality.”

(This article was written by Chiaki Ogihara, Hajimu Takeda and Midori Iki.)