How we treat Cruise Ship` Diamond Princess` with 3700 passengers - - PowerPoint PPT Presentation

E-mail itake@myad.jp

How we treat Cruise Ship` Diamond Princess` with 3700 passengers Ichiro Takeuchi

Chief Professor Yokohama City University

Japanese Corona(+) 1st case

In Japan COVID-19 1st case was January 16 and then,

we have made efforts not to spread Corona Virus.

Spread speed

Japanese death rate and spreading speed is very low Sill now Japanese medical system is not collapsed.

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50 100 150 200 250 300 350 400 450 500 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

Death Days after first death case

Italy France Japan Korea USA UK

From WHO Situation Reports

How we treat Cruise Ship` Diamond Princess` with 3700 passengers (700 Corona + pts) and why EMS system was not collapsed in Yokohama.

February 3 the cruise ship arrived Yokohama port Quarantine for 14 days began

2600 passengers 1000 Crew Total 3700 Novel Corona virus PCR was examined

PCR(+) passengers were transferred to the hospitals

The number of PCR(+) passengers was increased day by day

February

Saturday Friday

Feb 10 60 passengers were transported

EMS collapse? By 700 passengers

PCR(+) 700 passengers

We afraid of EMS collapse

regular EMS patients (Trauma, ACS・・・ etc)

Yokohama City Emergency Hospital

EMS crisis in Italy

Emergency Hospital

Corona (+) Slight illness Corona (+) serious illness Corona (+) Super severe illnes

Regular EMS patients（Trauma ACS

EMS collapse in Italy All patients go to Emergency hospital.

Medical team on board divided to 3 groups

Medical Judgement

need urgent treatment Dyspnea, Spo2 ≦ 94% , ACS, cerebral Infarction) Intubation need medical treatment O2 supply PCR (+) without any symptom to Emergency Center in Yokohama (as soon as possible via Fire Ambulance) hospitals in Kanagawa prefecture (within 2 hour) distant hospital (3hour and more by bus )

Medical team on board divided the PCR(+)patients to 3 group

3700 passengers 700 PCR (+)patients

Balancing COVID-19 with regular EMS pts

We focus balancing with regular EMS system Parallel with accepting patients from regular ambulance is very important.

Ichiro Takeuchi. COVID-19 First Stage in Japan -How we treat `Diamond Princess Cruise Ship` with 3700 passengers? Acute Medicine and Surgery 2020. on line publication

Yokohama City University Medical Center

COVID-19 patients 20 pts

• Severe COVID-19 patients

ECMO 3 pts

Ventilator 6 pts

• Severe Disease with corona (+)

ACS with corona(+) （immediate PCI）

Perforation with corona (+) （Emergency surgery operation） Cerebral Infarction with corona(+) （immediate catheter）

Low Death rate in the Cruse Ship

Johns Hopkins Univ COVID-19 CCSE・厚労省高山先生作成

Death rate in Italy 9.3％ Spain 6.2％ Japan 3.7％

Cruse Ship only 1.1％

Italy 9.3% Spain 6.2%

Japan Cruse Ship 3.7% 1.1%

Lesson from Cruise Ship

To avoid Emergency Medical Care System collapse

If all PCR (+) patients go to the hospital, it would be overshoot Corona (+) Slight illness patients should be in their home. Corona (+) serious illness pts to Emergency hospital →need Oxygen on bed Corona (+) Super severe illness pts to Emergency Center →need ventilator and ECMO

Balancing with accepting regular EMS is important

See the detail in AMS journal on line

Ichiro Takeuchi. COVID-19 first stage in Japan – how we treat ‘Diamond Princess Cruise Ship’ with 3700 passengers? Acute Med & Surg 2020 1; e 506

Treatment

Taniguchi, Takeuchi. Veno-Venous Extracorporeal Membrane Oxygenation for Severe Pneumonia: First COVID-19 Case in Japan . Acute Med & Surg 2020 in press TV program in Japan

ECMO Case (Yokohama City university hospital)

General Ward General Intensive Care Unit ECMO unit Cefepime 1g ‎Clindamycin 1800mg per day Lopinavir 800mg/ Ritonavir 200mg per day

day1 day2 day3 day4 day5 day6 day7 day8 day9 day10 day11 day12 day13

400 350 300 250 200 150 100 50 50 40 30 20 10

+550 +335 +300 +286 +1826 +1071 +1068

• 2594 -3487 -702

+537 +85 +870 MV:PCV mode

(FiO21.0,ΔP15,PEEP12,RR20)

MV:PCV mode

(FiO20.3 ΔP10, PEEP10,RR10)

Spontaneous Breathing

(FIO20.6)

PaO2/FiO2 mmHg

Static lung compliance ml/cmH2O

PaO2/FiO2 CRRT

VV-ECMO

(FiO21.0, Flow4L, Sweep gas4L)

Static lung compliance

0.1γ

Norepinephrine

0.25γ 0.2γ 0.07γ

Taniguchi, Takeuchi. Veno-Venous Extracorporeal Membrane Oxygenation for Severe Pneumonia: First COVID-19 Case in Japan . Acute Med & Surg 2020 in press

ECMO Case (Yokohama City university hospital)

Japanese ECMO to COVID-19

ECMO total 36case Success 20case On going ECMO 13case Death 3case

Medical Treatment

Japanese TV program

Medical Treatment

Avigan Favipiravi r Remdesivir Lopinavir/ ritonavir Ciclesonide

IL-6 inhibitors (tocilizumab)?

Now we are checking COVID-19 cytokine level including IL-6, IL-10 and IFN-α β

Vaccine BCG may provide immune boost against coronavirus, herpes, and

• ther viral infections

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Death Days after first death case

Italy France Japan Korea USA UK

Thank you for your attention ! Ichiro Takeuchi E-mail itake@myad.jp

Japanese Corona(+) 1st case

COVID-19 in Japan 1st case was January 16th and then, we have made efforts not to spread Corona Virus.

Italy France Japan US death

4032 death 450 death 201 35death

korea

UK

Days after first death

Japanese Corona(+) 1st case

COVID-19 in Japan 1st case was January 16th and then, we have made efforts not to spread Corona Virus.

Fr J

r first death