From the Frontlines of COVID-19 (JNA)

VOL. 2 Efforts of Public Health Nurses responding to COVID-19
The Japanese Government specified COVID-19 as a
Designated Infectious Disease in February 2020 andestablished countermeasures including hospitalization
for patients, the provision of publicly funding
healthcare, and surveys on the incidence of infections,the trends and their causes. Public Health Centers hada central role in this response, as did the nurses working
there, namely Public Health Nurses*1. There are 469
government-run Health Centers*2 in Japan, with around
8,000 Public Health Nurses. In this article, we will

Ms. Murai and Section Head Akane Kasai

introduce the work of the Public Health Nurses at theTama District Health Center in Tokyo, where thehighest number of COVID-19 infections was marked insuspected or infected COVID-19, follows the steps
below (as of July 2020).
First, the following support is given to the person

Japan.

suspected COVID-19.
The Tokyo Minamitama Health Center is one of five
health centers in the Tama District of Tokyo. It has
around 424,000 people under its jurisdiction of thepublic health administration. There are 67 people
working at the center, including 20 Public Health
Nurses, only three of whom are responsible for

As with Health Centers throughout the country,
HealthContacts Consultation Center'▽ Coordination/support/transport for consultation
at the Returnees and Close Contacts Outpatient Center▽ Coordination for PCR testing, specimen
collection of the PCR test carried out at a
hospital/clinic, and specimen transport to the health &infection control.

Minamitama▽ Triage via telephone at the 'Returnees and Close

Centerhas

followed

theinstructions of the government and set up a 'Returnees
and Close Contacts Consultation Center' as acentralized point of contact for COVID-19 enquiries
from city residents. However, as Section Head Akane
Kasai explains, "from the end of March when infections
in Tokyo began to sharply increase, all of our services
were overwhelmed and the Public Health Nurses
worked all week long until late at night to cope with thedemand."In reality, the work that Public Health Nurses perform
in relation to COVID-19 covers many areas. According
to Ms. Kasai, Public Health Nurses at Minamitama
Health Center provides support for a person withsafety research center.
If the test result is positive, once a physician-issued'Incidence Notification of Novel Coronavirus
Infection' is received, the following steps are taken.
▽ Coordination/transport to hospital for admission▽ Active epidemiology survey (the patient andfacilities)▽ Support/consultation for those under home
isolation for specific reasons▽ Transport for inpatients transferring hospitals if
the infection becomes more serious▽ Contact at the time of discharge, and perform thePCR test to confirm negative test result for patients
under home isolation (until late May)
▽ Sterilization orders sent to the relevant facilities
based on the active epidemiology survey for positiveFrom the Frontlines of COVID-19 (JNA)

created a problem.
Ms. Murai explains, "There are many residents who
do not want their neighbors knowing they are infected.
If rumors of an infection spread, they may no longer beable to live in their community, and they may even haveto move or change jobs. So, we can't enter their homes
wearing our white gear (PPE)."
After some trial and error, residents needing tests
were asked to meet at places such as local parks or
A specimen taken by a doctor is wrapped in 3 layers byunder bridges away from prying eyes, and the Healtha Public Health Nurse and taken to the lab

Center physician would collect the specimen from themwhile in their car.

cases

Ms. Murai says, "We waited in our car with our PPE▽ Handling of various queries from facilities in
preparation for a positive case being identified

gear on, and the individual would come to the outsideof the car. There was less infection risk for us, and it▽ Identification of close contacts, contacting those

did not attract the attention of neighbors. Time-wise,people and requesting their nearest Health Center for athis was also the most efficient."

health check-up and PCR test

Public Health Nurses also have an important role in▽ Treatment consultations and health check-ups forpreventing prejudice and mental abuse in these sorts ofclose contacts, and from May 29, PCR tests for all close

communities. As the most accessible public healthcontacts in line with government instructions

providers for people living in the community, Public
Health Nurses continue their work in the midst of

In addition to the above, the work of Public Health
Nurses also involves the following: liaison andCOVID-19 to protect the health of the people.
(Last updated Sep.2020)

coordination with relevant organizations and other
HealthCenters,

writingreports

tosendtogovernment/Tokyo Metropolitan authorities, and, if
requested by Quarantine Stations, health check-ups foroverseas returnees from areas where COVID-19 isprevalent.
Public Health Nurse Yasuko Murai says that as part of
the whole process of treatment and support, Public
Health Nurses make great efforts to protect and support
infected individuals and their close contacts against
prejudice and mental abuse.
Here is one example of the type of incidence that hasoccurred. When visiting the home of suspected
infection to take a sample for a PCR test, while it isessential for Public Health Center staff to wear PersonalProtective Equipment (PPE) to prevent infection, thisPublic Health Nurses busy handlingarrangements for residents

From the Frontlines of COVID-19 (JNA)*1: Public Health Nurses

A Health Center, as a broad, specialist and technical'Public Health Nurse' means a person licensed bybase for disease prevention and improving health,the Minister of Health, Labour and Welfare to use therefers to the service in which support is given for

title of Public Health Nurse and provide healththe health of local residents. They are established inguidance as a profession. (Act on Public Healthprefectures, designated cities, core cities and special

Nurses, Midwives, and Nurses, Article 2)administrative districts (wards).

Public Health Nurses work at government facilities

City/town/village health centers provide a generalincluding Health Centers and city/town/village

level of service directly to local residents, including

offices, as well as in industry and hospital locations.

health consultations, health guidance and healthThose working at city/town/village offices have beencheck-ups.

on an increasing trend every year. A 2016 survey ofwork locations showed that the proportion was
58.5% at Health Centers and city/town/village
offices, 25.8% at hospitals or clinics, and 5.0% atplaces of business.
Public Health Nurses, who are responsible forpublic health and nursing activities, are specialists
who have continued to preserve their district nursing
work that involves health and nursing in thecommunity. These activities have enabled thediscovery of health problems common to theircommunities,

andtheyarepositioned

asprofessionals whose work involves exploring paths
to solutions, while placing importance on creating
partnerships and collaborating with residents. The
work of Public Health Nurses is relied upon forsolutions to more diversified and complex healthissues, and in recent years in particular, their role has
been even more necessary to respond to urgent anddifficult issues such as lifestyle diseases and suicide
prevention, a need that is continuing to rise.
*2: Health Center

These centers are run by national or local
government bodies for the purpose of maintaining
and enhancing the health of local residents. HealthCenters and city/town/village health centers havebeen set up by local governmental bodies throughout
Japan in accordance with the Community Health Act.