Monday, 6 April 2020

Prevention measures adopted by public health nurses regarding COVID-19: Case-related and general population level approach


Kyoko Yoshioka-Maeda
National Institute of Public Health, Japan

Chikako Honda & Riho Iwasaki Motegi
University of Tokyo, Japan

email: yoshioka.k.aa@niph.go.jp

Introduction

The spread of coronavirus disease (COVID-19), that first emerged in Wuhan City, Hubei Province of China in December 2019, is accelerating worldwide. The World Health Organization (WHO) on January 30, 2020 declared the outbreak a public health emergency of international concern (WHO, 2020a). As of March 31, 2020, the total number of confirmed cases in Japan was 1953, and total deaths were 56; the figures currently remain at low levels (WHO, 2020b). Japan has an excellent infection control and surveillance system for communicable diseases. Each prefecture and designated city or core city has established a public health center that works as a headquarter in controlling communicable diseases including COVID-19 through community containment. Most of the public health nurses (PHNs) have worked as public servants in local government (Ministry of Health, Labour and Welfare, 2018), and are playing a critical role in supporting COVID-19 patients and community-dwelling people. This study aims to focus on two levels of prevention and control measures adopted by PHNs regarding COVID-19 in Japan: case-related and general population level community containment.

Case-related population-level approach
Early detection and containment of coronavirus clusters would be effective in ending the epidemic. To prevent one cluster from developing another cluster, PHNs conduct contact investigation for each new COVID-19 patient to identify people who have come in close contact with him/her. PHNs care for these people and monitor their health condition for 14 days to confirm whether there are any new COVID-19 patients in the cluster.

PHNs identify vacant beds for admission of COVID-19 patients in each community and coordinate for his/her admission to the hospital. To prevent infection of the staff that transfers COVID-19 patients to designated hospitals, PHNs have prepared personal protection equipment for the staff members and go together with them to the hospital. Through collaborating with the staff of public health centers, PHNs register daily new cases of COVID-19 with the National Epidemiological Surveillance of Infectious Diseases (NESID), which is the national infection disease surveillance system for centralizing data management. PHNs also prepare press releases regarding new COVID-19 cases. These are basic approaches adopted by PHNs to support patients with communicable diseases, especially tuberculosis (TB) (Ishikawa & Ahiko, 2014). They are now applying these skills and measures to COVID-19 patients.

With the increase in number of COVID-19 patients, public health centers are facing labor shortage. Collaborating with faculty members of universities, graduate school students, part-time or retired PHNs, and part-time registered nurses, the chief of PHNs try to secure adequate human resources to respond to increasing care needs. 

General population level approach
The national government formulated the ‘‘Basic Policies for Novel Coronavirus Disease Control’’ on February 25, 2020 (Ministry of Health, Labour, and Welfare, 2020a). The three main objectives of countermeasures to prevent the spread of infection are: (1) stop the epidemic in its early stages and minimize its scale, (2) decrease the incidence of severe cases, and (3) lessen the impact on society and economy. The government has requested people in each community to avoid gathering in groups in poorly ventilated areas, to avoid places where people gather closely together, and to avoid making contact with unspecified people (Japan Ministry of Health, Welfare, and Labour, 2020b).

In addition, PHNs have created public relations material to prevent infection and spread of COVID-19 by enhancing awareness of the importance of washing hands, cough etiquette, refraining from going out when having coronavirus symptoms, and wearing masks when need to go out through public service announcements, cable television, and websites. Furthermore, for PHNs, eliminating and preventing discrimination regarding COVID-19 is as important as promoting public hygiene.

A telephone consultation system has been developed in each public health center to answer people’s questions regarding COVID-19. PHNs answer general kinds of questions and consult physicians about cases of those who are suspected of being infected with COVID-19 to assess whether they need to take PCR testing or not (Japan Ministry of Health, Welfare, and Labour, 2020c).

Conclusion
The public health center is playing a critical role in controlling COVID-19 in Japan. Collaborating with the staff of public health centers, PHNs are one of the front-line staff to support COVID-19 patients, their close contacts, and the general population. Being a TB middle-burden country, PHNs have usually supported TB patients and their families in the community and have conducted intensive active surveillance. They are well-trained and have rich experience in infection control as their daily practice. They are now applying all their skills and infection control system to support COVID-19 patients. This may be one reason behind the low level of infection and death rate in Japan and will contribute to minimize the scale of the epidemic.

References
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Ministry of Health, Labour and Welfare. (2018). Health administration report. Overview of employment medical personnel. Retrieved from: https://www.mhlw.go.jp/toukei/saikin/hw/eisei/18/ (in Japanese). [last accessed 27 March 2020]

Ministry of Health, Labour and Welfare. (2020a) Basic Policies for Novel Coronavirus Disease Control. Retrieved from: https://www.mhlw.go.jp/content/10200000/000603610.pdf [last accessed 27 March 2020]

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Ministry of Health, Labour and Welfare. (2020c) PCT testing system for novel corona virus covered by medical insurance. Retrieved from: https://www.mhlw.go.jp/content/10900000/000606696.pdf [last accessed 27 March 2020]

World Health Organization Europe. (2020a). 2019-nCoV outbreak is an emergency of international concern. Retrieved from: http://www.euro.who.int/en/health-topics/health-emergencies/international-health-regulations/news/news/2020/2/2019-ncov-outbreak-is-an-emergency-of-international-concern [last accessed 27 March 2020]

World Health Organization. (2020b) Situation report – 71 Coronavirus disease 2019 (COVID-19) 31 March 2020. Retrieved from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200331-sitrep-71-covid-19.pdf?sfvrsn=4360e92b_4 [last accessed April 1, 2020]

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