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The issue of going out

Japanese

In order to prevent an "overshoot," or an explosive spread of infection, national and local government leaders are making requests to refrain from going out, unless it is absolutely necessary. Going to school is a kind of "work" for children. However, many schools are likely to remain closed until the end of May.

It may be safer to stay indoors, but spending a long time in a confined space can create considerable mental stress in addition to problems arising due to lack of exercise.

Here are some non-essential and non-urgent examples of "going out" which involve a lower risk of either being infected by SARS-CoV-2 (new coronavirus) or infecting others, even if you are an asymptomatic patient from a medical viewpoint.

Some western countries where stringent lockdown measures were imposed are reported to allow taking a walk with family members only and without meeting anyone. Japan is legally unable to impose such severe restrictions, still, as responsible citizens we should make efforts to prevent the spread of SARS-CoV-2.

Here are some examples of safe ways of going out, for yourself and for others, instead of just staying home during the period when staying home is strongly requested.

Taking a walk in the neighborhood, visiting nearby parks or going on a picnic with your family. If your children want to play with a small number of friends, it is better to avoid physical contact such as push and shove or sumo. It is all right to play catch ball or badminton, etc. as a family in the park, but avoid areas with large numbers of people around.

It is safe to go for a drive and go on a hike or play in the river with your family as long as there are not many people involved. However, I think it's better to avoid long distance driving or stopping at service areas on highways and/or roadside rest areas.

It is advisable to avoid long train rides. Opening windows for ventilation in warmer weather is effective to prevent infection. It is better to avoid subways because the air underground is stagnant by nature.

"Refrain from going out unless absolutely necessary" does not apply to work that cannot be done at home, shopping for food and daily necessities, or visits to hospitals and clinics.
Hospital visits are necessary to maintain health and treat diseases. At the same time, it is well known that there is a higher risk of infection in crowded waiting rooms. In particular, I tell my own patients to avoid physical examinations and development consultation as much as possible in the influenza season.

Do you think you should avoid hospital visits now that SARS-CoV-2 is becoming rampant? Let us think about this, according to the purpose of hospital visits.

First of all, you cannot avoid a hospital visit in emergency cases including sudden fever, diarrhea, or vomiting, or injuries with heavy bleeding. We do not want to think about it, but there is a possibility of SARS-CoV-2 infection concealed in the symptoms. The early symptoms of COVID-19 are a fever lasting over four days and coughing, though diarrhea as an early symptom was also often reported among the Wuhan cases.

Hospital visits for development checks and immunization shots should be avoided now. Schedules for physical examination and/or immunization should be used as a rough guideline, and a delay of a few months will do no harm. Consultations regarding developmental disorders (delay in speech, hyperactivity, communication problems), which is my special field, should also be postponed for now. There is no need to make decisions in haste.

The hardest decision to make concerns the continued use of medicine for chronic diseases such as asthma and atopic dermatitis, and hypertension and diabetes among adults. The symptoms will not radically worsen if you stop taking the medicine for a short time, but going for weeks without medication is a problem.

Though it depends on the individual policy of hospitals and clinics, you should ask if it is possible to get prescribed extra medicine (a two-month supply, for example). From my experience, more medicine tends to be prescribed at the year-end anyway, so I think many hospitals and clinics will agree to prescribe more medicine in the current situation when SARS-CoV-2 is prevailing.

Another method is the use of online treatment. It may vary depending on the policy of the hospital or clinic, but if you are a regular visitor to receive prescription you can call them to give your medical chart number. They will then call a designated drugstore so that you can receive medicine there without going to the clinic/hospital, as long as the prescription remains unchanged. A consultation fee is still charged even if you are just calling on the phone.

Regardless of the nature of acute or chronic disease, online treatment is currently prohibited for first-time patients (consulting the doctor for a particular symptom or disease for the first time). The Medical Practitioners' Act mandates face to face examination on the first consultation. However, the prevailing situation of COVID-19 is likely to bring about a change in the law.

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sakakihara_2013.jpg Yoichi Sakakihara
M.D., Ph.D., Professor Emeritus, Ochanomizu University; Director of Child Research Net, Executive Advisor of Benesse Educational Research and Development Institute (BERD), President of Japanese Society of Child Science. Specializes in pediatric neurology, developmental neurology, in particular, treatment of Attention Deficit Hyperactivity Disorder (ADHD), Asperger's syndrome and other developmental disorders, and neuroscience. Born in 1951. Graduated from the Faculty of Medicine, the University of Tokyo in 1976 and taught as an instructor in the Department of the Pediatrics before working with Ochanomizu University.
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