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NCGM Fights Against COVID-19 – Lessons Learned – Public Relations Magazine for NCGM Special Feel the NCGM Issue National Center for September 2020 Global Health and Medicine Special Issue Office of Public Relations NCGM Fights against COVID-19 – Lessons Learned – Katsunobu Kato, then Minister of Health, Labour and Welfare (front row, third from the right) inspects the “Shinjuku City COVID-19 Testing Center” (April 23, 2020) Feel the NCGM Special Issue September 2020 The NCGM COVID-19 Task Force and Organization Chairman (Hospital Director) Vice Chairmen - Deputy Hospital Director - Director, Disease Control and Prevention Center - Director, Department of Emergency Medicine & Critical Care - Nursing Director - Secretary General, General Administrative Department Members of the Task Force Infection Control Team - Hospital Management and Planning Board ◎ Director, Disease Control and - Heads of departments Prevention Center - Manager, Clinical Laboratory ○ Deputy Manager, the Infection Department Control Team - Persons/individuals appointed by the Chairman Committee for the Severe and Seriously Ill Committee for the Moderately Ill Committee for the Fever Clinic Committee for the Surgical Division ◎ Director, Department of ◎ Deputy Hospital Director Emergency Medicine & (in charge of patient ◎ Director, Disease Control ◎ Deputy Hospital Director Critical Care examination/care) and Prevention Center (in charge of surgeries) ○ Head, Intensive Care ○ Administering physician ○ Chief Physician, ○ Director, Operation Department of the 5F West ward Department of Infectious Management Department ○ Head, Department of ○ Chief Physician, Division Diseases Emergency Medicine & of Preparedness and Critical Care Emerging Infections Feel the NCGM Special Issue September 2020 Table of Contents/The NCGM COVID-19 Task Force and Organization 2 Foreword 3 1. Overview of NCGM History in Response to Various Health Issues and Our Multifaceted Role 4 2. Treatment and Nursing of COVID-19 Patients and Suspected Patients 6 3. Policy Recommendations 9 4. Countermeasures against COVID-19 at Our Emergency Department 10 5. Health Checkups and Tests Conducted on Returnees on Chartered Flights from Wuhan 12 6. Cruise Ships: Diamond Princess and Costa Atlantica 14 7. Development of New Treatment: Records of Basic Research and Clinical Research 16 8. Responses to COVID-19 Outbreak in the Hospitals 19 9. COVID-19 Registry Japan (COVIREGI-JP) 20 10. International Cooperation and Joint International Research 22 11. Releasing of Academic Achievements 24 12. The Fever Clinic and the Community-Based “Shinjuku Model” System 26 13. Creation of a New Model for Recuperation in Accommodation Facilities for COVID-19 Patients with Mild or No Symptoms 28 14. In Closing: Preparing for the Second and Third Waves 30 2 Foreword Norihiro Kokudo, President National Center for Global Health and Medicine As a medical professional, I am thankful that Japan has managed to keep the COVID-19 death toll at an incredibly lower rate than those of other countries without causing a healthcare collapse during the first wave of the epidemic. We at NCGM have strived as a team to tackle this disease in the capacity of a National Center with our primary mission being infection control. Although there are no signs yet of the pandemic being brought under control and fears of the second wave rise within our nation, we have decided to put together a booklet of tasks we have accomplished as of the end of July 2020. Reflecting back on NCGM’s long history of 152 years, we have directly responded to numerous pandemics in the past, starting with the Spanish flu of 1919, SARS of 2003, swine flu of 2009, Dengue fever of 2014, the Ebola outbreaks of 2014, 2018, and 2019. We have always been fully trained and prepared for such crises as one of the four medical institutions in Japan designated for treatment of specific infectious diseases, having a total of four beds available for this treatment (which is the most out of all four institutions). Due to our efforts and preparedness, we were able to act swiftly in the midst of this pandemic, and we are thankful that there has been no nosocomial spread of COVID-19 within our staff to this point. Our tasks in responding to COVID-19 began in late January 2020 with the PCR testing of Wuhan returnees. Following this, we addressed a wide range of needs regarding COVID-19 including support for COVID cluster responses and the admission of patients from the cruise ship in Yokohama, clinical trials of new therapeutic drugs and advanced medical care for the severely ill, establishment of fever clinic and the Shinjuku City COVID-19 Testing Center, and support for the mildly ill accommodated in hotels. Since the beginning of the pandemic, we had felt an urgent need for organizational research and development to contain the spread of this unknown disease, and we launched a “Novel Coronavirus Infection Academic Advisory Board” in the beginning of February 2020. This Board covered a lot of grounds related to COVID-19, including treatment, testing, pathophysiology, and epidemiology. They also aided in the development of research protocols, coordinated with the IRB, managed and advised through the course of trials. Nearly 75 projects are underway as of the end of June 2020, and some have already been published in academic journals. Research in collaboration with other facilities and related associations are also significant, which has led to connections with the National Institute of Infectious Diseases, the University of Tokyo, Fujita Health University, the Japanese Red Cross Society, and the Japanese Association for Infectious Diseases. Expressions of gratitude to frontline healthcare workers who risk themselves in the battle against COVID-19 have been sent by the public in many ways. We at NCGM have received both monetary and in-kind contributions from numerous individuals and organizations, such as protective equipment including facemasks, food, beverages, and music concerts. We want to express our deepest gratitude. We would also like to thank all medical institutions and municipalities who have fought with us in this battle against COVID-19, especially Shinjuku City, Shinjuku City Medical Association, and major hospitals within the area. As we await for vaccines and effective drugs to come out, we must adjust to the new normal in coexisting with COVID-19. Despite the uncertainty as to when and to what extent the second and third waves will be, we at NCGM will continue to strive as a team to confront this challenging disease. August 2020 3 Feel the NCGM Special Issue September 2020 1 Overview of NCGM History in Response to Various Health Issues and Our Multifaceted Role Hajime Inoue, Former Director General, Bureau of Strategic Planning, NCGM Health issues that NCGM confronted in the past COVID-19 Japanese Embassy A/H1N1 hostage crisis in Peru swine flu Wuhan returnees Army Temporary Cruise ships Hospital SARS MERS Tokyo Army Hospital China, Vietnam Spanish flu Ebola hemorrhagic fever West Africa Ebola hemorrhagic fever Democratic Republic of the Congo Dengue fever COVID-19 Responses by NCGM The one and only medical institution capable of undertaking a multifaceted role in public health and medical treatment Providing info/advising the National and Tokyo Metropolitan Governments Clinical trials of Quarantine therapeutic drugs/development Response to of vaccine NCGM COVID clusters Functions as general hospital Care for the severely ill “Shinjuku Model” System Development of Shinjuku City COVID-19 diagnostic tests Testing Center Antibody/antigen tests Management of hotels Epidemiology accommodating the mildly ill Genome analysis Patient registry 4 Overview of NCGM History in Response to Various Health Issues and Our Multifaceted Role COVID-19 Japanese Embassy A/H1N1 hostage crisis in Peru swine flu Wuhan returnees Army Temporary Cruise ships Hospital SARS MERS Tokyo Army Hospital China, Vietnam Spanish flu Ebola hemorrhagic fever West Africa Ebola hemorrhagic fever Democratic Republic of the Congo Dengue fever Ever since the establishment of the “Army Temporary Hospital” (currently NCGM) in 1868, we have always played a pivotal role in responding to global health issues. We still have medical records preserved of numerous patients that were treated during the Spanish flu pandemic in 1918-1920, nearly 100 years ago. The accumulation of our experience within this century in confronting emerging/re-emerging infectious diseases such as SARS, H1N1 swine flu, MERS, Ebola hemorrhage fever, and dengue fever outbreaks is being put to use in our current COVID-19 response. NCGM is not only a medical institution treating patients, but a medical institution capable of undertaking a multifaceted role in public health and medical treatment. This includes providing advice to government policy-makers, conducting quarantine/responding to COVID-19 clusters, conducting clinical trials of therapeutic drugs/developing vaccines, developing diagnostic tests and conducting antigen/antibody tests, conducting epidemiological studies, performing genome analysis and creating a patient registry, and taking part in the local healthcare cooperation system as seen in the “Shinjuku Model.” 5 Feel the NCGM Special Issue September 2020 Treatment and Nursing of COVID-19 Patients and Suspected Patients Norio Ohmagari, Director, Disease Control and Prevention Center, Center Hospital, NCGM 2 Tatsuya Okamoto, Head, Intensive Care Department, Center Hospital, NCGM Tomoko Sato, Nursing Director, Center Hospital, NCGM Yuko Sugiki, Deputy Manager, the Infection Control
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