【Aging, safety net and fiscal crisis in Japan】No.221: The COVID-19 PCR test system is not well established

Criticism of public health centers is on the rise as people are still unable to get quick access to PCR tests for COVID-19. A public health center is a public institution that is responsible for various health issues, including infectious diseases and food safety, and has long played an important role in terms of being an infrastructure that ensures people's safety and security. Although there were 845 centers in 1995, as a result of the consolidation of the organization based on the enforcement of the revised law in 1997, the number decreased to 469 in 2020 (Figure 1). As such, COVID-19 has come at a time when public health professionals have been scaled down.

With regard to the specific case of COVID-19, the public health center is responsible for deciding whether or not to carry out a PCR test when a suspected patient is reported by a doctor. The problem is that even if a doctor believes that a PCR test is necessary based on a patient's symptoms, they are sometimes refused by the public health center. According to the guidelines, those with a slight fever of 37.5 ° or higher but no other symptoms are advised to recuperate at home. However, in some cases this has resulted in sudden death. Some public health center directors, who are medical doctors, confess that they are reluctant to approve PCR tests because "there is a lack of beds and medical disruption occurs when there are a lot of positive cases found at once." In such cases, public anxiety and dissatisfaction would only increase.

Therefore, on April 6 2020, Prime Minister Abe committed to increasing the number of PCR tests per day to 20,000, and created a mechanism for medical institutions to directly request PCR tests from private inspection institutions without going through public health centers. However, by the end of April, the number of PCR tests per day had not even reached 10,000. Although it has been pointed out that there is a shortage of specialists in PCR testing, the government's COVID-19 Countermeasures Advisory Committee has not been able to explain the real reason for the delay in the development of a PCR system.

Figure 1 Number of public health centers

(Source: Japan Association of Public Health Center Directors)