On the frontline, healthcare professionals (HCPs) are tirelessly working to save the millions of lives against coronavirus. With a sense of mission, they are working selfishly at the risk of their own lives. For the past week, the number of COVID-19 cases has grown more rapidly in Japan, incurring more concerns and anxiety. Last week the Japanese government declared a state of emergency for several major cities of concern, including Tokyo, in the attempt to flatten the outbreak curve. Will Tokyo or Japan be heading down the track of New York?
Japan has a universal healthcare system, allowing easy access to healthcare, and a large number of hospital beds per population, compared with other western countries. However, it is a different story when it comes to intensive care unit (ICU) beds. The number of ICU beds is around 4 per 100,000 persons, which is a lot less compared to US and Europe, where 7 to 24 ICU beds are available per 100,000 persons (1). Taking the shortage of manpower and other resources into consideration, the actual number of ICU beds available for severe patients with COVID-19 could probably be less than half of the total ICU beds currently existing. If the number of cases continue to increase, like what we saw last week, the number of severe cases requiring ICU management would also increase. This would overwhelm the secondary or tertiary hospitals, possibly leading to collapse of healthcare here in Tokyo.
On the underside of HCPs fighting against coronavirus in the forefront, pharmaceutical companies are endeavoring to find vaccines and treatment for COVID-19 quickly. It will not be overnight discovery, rather a long battle, at least several months for this crisis. They have been exploring their own platform or chemical library to identify or repurpose their medicines to potentially treat COVID-19. A few examples of such medicines include antiviral agents to reduce viral infection, multiplication or viral loads, such as RNA polymerase inhibitors and immunosuppressive agents to reduce severity (lower excessive inflammatory responses) for patients with ARDS (Acute Respiratory Disease Syndrome) due to the coronavirus, such as IL-6 inhibitors.
The Japanese government has requested (and is supporting) Fujifilm Toyama Chemical Co. Ltd. to produce increased mass of favipiravir (AviganTM) to cater for 2 million people with COVID-19 for emergency use. Favipiravir was approved in 2014 in Japan for the treatment of novel or re-emerging pandemic influenza virus with an approval condition, in which the medicine is produced only by the request of the Minister of Health, Labour and Welfare (MHLW). Up until now, there seems to be only 2 clinical studies in Wuhan and Shenzhen, China, which are possibly suggestive of favipiravir’s effectiveness against COVID-19. Yet, as of today, April 13th, the study paper in Shenzhen was temporarily removed (2), while the Wuhan study was not yet published in a peer-reviewed article (only published in MedRxiv), where the primary outcome, clinical recovery rate of day 7, did not differ between 2 arms (favipiravir vs arbidol) in the version revised on April 9th (3).
On April 10th, one of the datasets on remdesivir was published in the New England Journal of Medicine. It was from compassionate use of remdesivir for severe COVID-19 patients in US, Europe or Canada and Japan. The result was not definite, but it certainly shows a hopeful sign that it may work against COVID-19 (4).
This is an uncertain time with an unpredictable ending as we go through this first hand. It does take time, and our journey to fight against coronavirus has just started, especially in Japan where the infection peak has not yet passed. We do not yet know exactly when or how this eventually ends and how heavy it takes its toll on us. Yet, we are certainly and quickly discovering and learning much more about SARS-CoV-2 and COVID-19 over the past 4 months, evolving to better handle the situations around this crisis. We are surely progressing one step at a time, closer to an end. When things look dark, there is always a silver lining. There is a hope on the other hand. Always one step at a time.
(1) Shime N. Clinical and investigative critical care medicine in Japan. Intensive Care Med. 2016；42（3）：453-5.
(2) Cai Q, et al. Experimental Treatment with Favipiravir for COVID-19:An Open Label Control Study. Engeneering. 2020 Mar 18.
(3) Chen C, et al. Favipiravir versus Arbidol for COVID-19: A Randomized Clinical Trial. medRxiv.2020 Mar 17.
(4) Grein J, et al. Compassionate Use of Remdesivir for Patients with Severe Covid-19. N Engl J Med. 2020 Apr 10.doi:10.1056/NEJMoa2007016.