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

How we treat Cruise Ship` Diamond Princess` with 3700 passengers Ichiro Takeuchi Chief Professor Yokohama City University E-mail itake@myad.jp

Japanese Corona(+) 1 st case In Japan COVID-19 1 st case was January 16 and then, we have made efforts not to spread Corona Virus.

Spread speed 500 [値] 450 400 Italy France 350 300 Death 250 [値] 200 [値] 150 UK USA [値] 100 Korea Japan [値] 50 [値] 0 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 Days after first death case From WHO Situation Reports Japanese death rate and spreading speed is very low Sill now Japanese medical system is not collapsed.

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 Corona (+) Slight Corona (+) Super severe illness illnes Corona (+) serious illness Regular EMS patients （ Trauma ACS Emergency Hospital EMS collapse in Italy All patients go to Emergency hospital.

Medical team on board divided to 3 groups 3700 passengers 700 PCR (+)patients Medical Judgement Medical team on board divided the PCR(+)patients to 3 group need urgent treatment Dyspnea, Spo2 ≦ 94% , PCR (+) without any need medical treatment ACS, cerebral Infarction) symptom O2 supply Intubation to Emergency Center in distant hospital hospitals in Kanagawa Yokohama (as soon as (3hour and more by bus ) prefecture possible via Fire (within 2 hour) Ambulance)

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 Italy 9.3% Spain 6.2% Japan 3.7% Death rate in Italy 9.3 ％ Spain 6.2 ％ Japan 3.7 ％ 1.1% Cruse Ship Cruse Ship only 1.1 ％ Johns Hopkins Univ COVID-19 CCSE ・厚労省高山先生作成

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

ECMO Case (Yokohama City university hospital) TV program in Japan 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) VV-ECMO (FiO 2 1.0, Flow4L, Sweep gas4L) CRRT Spontaneous Breathing MV:PCV mode MV:PCV mode (FiO 2 0.3 Δ P10, PEEP10,RR10) (FIO 2 0.6) (FiO 2 1.0, Δ P15,PEEP12,RR20) 400 50 0.1 γ 0.25 γ 0.2 γ 0.07 γ PaO 2 /FiO 2 mmHg Static lung compliance ml/cmH 2 O Norepinephrine 350 40 300 250 30 200 Static lung 20 compliance 150 PaO 2 /FiO 2 100 10 50 +550 +335 +300 +286 +1826 +1071 +1068 +537 +85 +870 0 0 day1 day2 day3 day4 day5 day6 day7 day8 day9 day10 day11 day12 day13 -2594 -3487 -702 Cefepime 1g ‎ Clindamycin 1800mg per day Lopinavir 800mg/ Ritonavir 200mg per day General Ward General Intensive Care Unit ECMO unit Taniguchi, Takeuchi. Veno-Venous Extracorporeal Membrane Oxygenation for Severe Pneumonia: First COVID-19 Case in Japan . Acute Med & Surg 2020 in press

Japanese ECMO to COVID-19 ECMO total 36case Success 20case On going ECMO 13case Death 3case

Medical Treatment Japanese TV program

Medical Treatment Avigan Remdesivir Lopinavir/ ritonavir Ciclesonide Favipiravi r

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 other viral infections 500 [値] 450 400 Italy France 350 300 Death 250 [値] 200 [値] 150 UK USA [値] 100 Korea Japan [値] 50 [値] 0 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 Days after first death case

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

Japanese Corona(+) 1 st case COVID-19 in Japan 1 st case was January 16 th and then, we have made efforts not to spread Corona Virus. 4032 death 450 death France Italy death 201 US UK korea Japan 35death Days after first death

Japanese Corona(+) 1 st case COVID-19 in Japan 1 st case was January 16 th and then, we have made efforts not to spread Corona Virus. Fr J r first death