TOKYO (Reuters) - Hospitals in Nagoya city in Japan’s industrial heartland have more coronavirus patients than they can treat, forcing transfers to nearby areas and offering a glimpse of the challenges the outbreak poses for a country with a huge elderly population.

Japan has closed schools and canceled public events, which experts say has helped prevent an explosive spread of the virus. But because testing hasn’t been widespread, some medical experts say the extent of infection is understated, and a surge could yet happen.

That would put more of the country under the strain now being felt in Nagoya, and force a nationwide scramble to shift patients, many of them elderly, to hospitals in areas with capacity.

“If the numbers rise further, we won’t be able to cope, so we will either have to ask nearby prefectures to help, or tell those with lighter symptoms to stay at home,” a prefecture official in Nagoya told Reuters.

Confirmed coronavirus cases in Nagoya, the capital of Aichi prefecture, totaled 98 as of Sunday, the official said, far exceeding the city’s 27 beds at hospitals that meet conditions for patients with the highly contagious disease.

Aichi, home to Toyota Motor Corp 7203.T, is Japan's second-hardest hit prefecture, with 121 confirmed coronavirus cases so far. It has a total of 161 beds capable of handling patients with such a disease. Of those, 105 were in use as of Sunday, the official said.

Elderly people are especially vulnerable to serious effects the virus. Japan has the world’s oldest population, with more than 28% aged 65 or over.

Italy, which has Europe’s oldest population, is facing growing concerns about the ability of its strained health system to cope with a relentless increase in new cases.

“If we allow the epidemic to continue, it’s a matter of time,” said Hokkaido University professor Hiroshi Nishiura when asked if Japan could face a situation similar to Italy’s.

He added that the trajectory of the epidemic was hard to predict.

POTENTIAL SURGE

Japan has been hospitalizing all patients who test positive for the virus, even if symptoms are slight, in line with its law on infectious diseases.

But now, in some areas, patients with lighter symptoms are being asked to isolate at home.

To free up more hospital beds, patients with non-urgent surgery will likely be asked to wait, and others may be discharged earlier than is usual in Japan, experts said.

Hospitals are being asked to prepare plans for transferring patients to places that can treat them, given how the speed of the spread has varied by region, said Takuma Kato, a health ministry official.

Japan’s health ministry has issued guidelines on handling an influx of coronavirus patients based on estimates of what peak numbers might look like.

“Potentially, there will be a surge of new cases if Japan is not successful in containment, which I think will happen,” said Kenji Shibuya, director of the Institute of Population Health, King’s College, London.

“Japan is not yet at the level of what Italy is experiencing in terms of outbreak phase, but that gives us a very important lesson - we have to be prepared,” he said.

The death toll in Italy rose to 1,809 by Sunday after a 25% jump in just 24 hours. The number of cases hit 24,747.

Prime Minister Shinzo Abe has said there were 12,000 beds nationwide that could take serious virus cases and 3,000 respirators, but Shibuya said that didn’t mean there were trained medical staff to handle all of those cases.

A national action plan based on a 2012 law calls for hospitalizing severe cases and treating mild cases at home.

Parliament on Friday revised that law to allow the government to declare a state of emergency to cover the coronavirus. Abe has said conditions didn’t warrant such a declaration yet.

A shortage of cutting-edge equipment to treat the most severe cases also poses a risk, and could force tough decisions about whom to treat if cases rise fast, as in Italy.

For example, a ventilator might be in use for a 90-year-old patient while a seriously ill 30-year-old nurse went without, said Koji Wada, a member of the government advisory panel.

“So we need to discuss the ethical issues too,” Wada said.