Tuesday, February 18, 2020

THE GOOD DOCTOR IWATA



PHILIP J CUNNINGHAM

Iwata Kentaro is the man of the moment. It’s a moment nobody would ever wish for, but when contagion strikes, it’s only right that an infectious disease specialist should step forward.

A doctor in the Division of Infectious Diseases Therapeutics at Kobe University, Dr. Iwata has “battled” Ebola in Africa and SARS in China, he has written books on best practices and has conducted advanced research in therapeutic treatment. When a man with 20-years of experience on a dangerous frontline that nobody in their right mind wants to get close to, talks, people ought to listen.

Iwata Kentaro on "Beyond" cover

What Dr. Iwata has to say about Diamond Princess after going on board to inspect conditions on February 18 is nothing short of shocking.

He is now observing self-quarantine for fear of infecting others, and will miss two weeks of work at his home hospital in Kobe. In a pair of recordings, in Japanese and in English, posted on YouTube, he describes what he saw onboard. The interior of the Diamond Princess was “absolute chaos.” Japanese officials failed to establish red and green zones and went about their business with a “lack of protection” and “eating with gloves on.”   

There was “no safe zone” and he noticed the failure to segregate those infected from others. It was, in his words, “worse than what I observed in Africa” where he worked to stem the spread of Ebola, and scarier than dealing with SARS in China in 2003. 

Basic hand sanitation procedure was ignored, and they were all using smart phones. He cites an egregious breach of infection control practice. A sheet of paper is passed from cabin to cabin to collect passenger signatures. Why is this permitted? The coronavirus is known to persist on smooth surfaces for hours, if not days, yet the signature sheet goes from cabin to cabin, touched by hand after hand.

Why was this not done over the phone? He asks. Of course, that’s the wrong question to ask paper-pushers, and the on-board officials ask him to leave the ship.

He fears that if strict measures are not taken immediately, the contagion will spread, threatening not just those who remain on board but officials and medical staff as well. 




He finishes his home-made recording with a heartfelt plea to “help people inside the ship!” 

(The original recording was removed by Iwata himself from YouTube under pressure to avoid a "misunderstanding" but then restored with other links)

Dr. Iwata’s dedication and bravery shows on several counts. He left the safety and comfort of his home in Kobe to visit the afflicted. He is trained to shield himself from contagious disease, but the uncontrolled environment he discovered on the ship put him at risk. He has now incurred the wrath of Japanese officialdom, which can be hard to bear, as Carlos Ghosn, among others, can attest.

Like most people in Japan, he watched the coronavirus contagion explode from a distance.  

In the weeks following the first troubling news reports about a new SARS-like illness spreading in China’s heartland, Dr. Iwata’s tweets on the topic are both sharp and sympathetic and at times quite technical. He has written numerous books and has hundreds of citations in medical journals.  He wonders if Japan, if it were ever to face such a crisis, would be capable of timely and effective countermeasures.

But he continues to tweet about sport and film as much as medicine through early February, cheering his hometown soccer team, the Vissel Kobe.  He comments on Parasite, Joker and other films nominated for Academy Awards.

He begins to express doubts, even when Japan has only a handful of cases, in an interview with Buzzfeed Japan, published on February 5, 2020.

“The Chinese government's measures against the new coronavirus so far have been largely successful,” he says, noting that it is inevitable that some things will go wrong. He added that blocking the city (Wuhan) was effective in the sense that it reduced the infection rate elsewhere.

He wonders if Japan had the wherewithal to lockdown a city or stop the Shinkansen, and wonders how the Olympics might drive government thinking.

When conditions in Wuhan worsen and Japanese are then evacuated, he is not too worried as long as quarantine is implemented for at least two weeks, but he’s curious to know “the incidence rate as opposed to the infection rate” of each of the returning aircraft.

Dr. Iwata’s tweets about the outbreak get more circumspect and doubtful as Japan becomes home to the second largest concentration of cases outside China.

By mid-February, the Diamond Princess has become a global “hot spot” for the virus.

Driven to understand better what is happening, he travels from Kobe to Yokohama and seeks permission from Japan’s Health Ministry to board the vessel. At first, he is turned down, but he eventually is allowed on board and spends the day of February 18 on the ship.

He finds it odd that Japan doesn’t have a CDC like other countries; after observing the site firsthand, it is painfully obvious that Japan’s Health Ministry isn’t equipped to deal with this, nor are well-meaning members of Japan’s Self-Defense Force.

As Dr. Iwata records his impression from his room in isolation, he coughs several times and seems to be sweating. He has sounded a clarion call to get serious about the threat of Covid-19 at a time of complacency, reminiscent of China’s first reluctant whistle-blower, the now-departed doctor Li Wenliang in Wuhan.


Dr. Li Wenliang of Wuhan
May the good work of Dr. Li Wenliang of Wuhan Central Hospital, Dr. Liu Zhiming of Wuchang Hospital and all others who have fallen to this viral plague not be in vain.

Hopefully good sense, good health and good protective measures will prevail, and politicians will put aside their pride to listen to the experts in order to deal more fairly and efficiently in helping the afflicted.