This electron microscope photo provided by the National Institute of Infectious Diseases shows the coronavirus isolated at the facility. (Photo Courtesy of the National Institute of Infectious Diseases)

       OSAKA -- A characteristic of Japan's fifth wave of the coronavirus is that it has produced many people with moderate or mild symptoms of COVID-19. Such cases are often viewed as being benign when weighed against severe cases of the disease, but how do they actually compare? One man who spoke to the Mainichi Shimbun about his battle with a "moderate" case of COVID-19 commented, "It was the closet I felt to death in my life."

       According to treatment guidelines produced by Japan's Ministry of Health, Labor and Welfare, a mild case of COVID-19 is designated as one in which there are no symptoms of breathing difficulties or in which the person only has a cough with no breathing trouble. There are two stages for those with moderate symptoms -- stage I, in which a person has difficulty breathing with signs of pneumonia, and stage II, in which the oxygen saturation level in the person's blood falls to 93% or less, making it necessary to give them oxygen. If a person has to go into an intensive care unit or if they need to be attached to an artificial respirator, their condition is regarded as severe.

       In April this year, one 30-year-old man from Osaka Prefecture showed symptoms of a stage II moderate case of COVID-19. Japan was in the midst of a fourth wave of infections at the time, and Osaka, in particular, was strained when it came to securing hospital beds for people with the disease even if their symptoms were serious. It was difficult for him to be hospitalized, and he was forced to recuperate at home.

       The man started getting a cough on April 13, and two days later, his temperature rose to 37 degrees Celsius. When he tried to talk, he started coughing, and there were times when he even found it difficult to hold a conversation. On April 16, he made a reservation at a medical institution, and received a PCR test, in which he tested positive for the coronavirus. He found it hard to breathe all of the time, only being able to manage shallow panting breaths. Each time he breathed he felt pain in his chest. On April 17, when he measured his blood oxygen saturation with a device provided by a local public health center, it was as low as 88% at times -- corresponding to stage II of a moderate case of the disease.

       He asked the public health center that he be hospitalized, but because he was young and didn't have any other underlying conditions, he says he was merely told, "Contact us if the (oxygen saturation) level constantly remains below 90%." He sought coordination to be moved into an accommodation facility for patients, and found out that the public health center worker who spoke to him had been under the impression that he was already in such a facility. In the meantime, his symptoms worsened, and be became unable to talk, and so he conversed with the health center via email.

       "I think the public health center was also in a state of confusion, but on top of my worsening symptoms, it made me anxious that they weren't aware of the circumstances of my recuperation," he said. He lived by himself and said he constantly worried about dying, wondering if he would "go to sleep and never wake up."

       This image partially modified for privacy shows an email that the man who was recuperating at home wrote to a public health center. In the email he reports pain in his chest and asks if there is anywhere he could be treated or if he could be moved to accommodation for COVID-19 patients.

       On April 20, he was finally moved to accommodation for COVID-19 patients. Around the same time, his symptoms improved, and on April 22 his temperature returned to normal, and he was able to eat meals. When he returned home on April 27, he found that in just two weeks, his weight had dropped from 65 kilograms to 58 kg. He paid to get a chest X-ray and he was diagnosed as recovering from pneumonia.

       "The pain of the coronavirus went beyond what I had imagined. I survived, but I realized it was a disease that could kill people if the symptoms worsen. I want people to get vaccinated and take measures against becoming infected so they don't experience the kind of suffering that I went through."

       Not only patients, but doctors, too, feel a gap between the image people have of mild and moderate cases of COVID-19 and the actual symptoms. Masaya Yamato, director of the Infectious Diseases Center at Rinku General Medical Center in the Osaka Prefecture city of Izumisano, commented, "When people hear the phrase 'moderate symptoms,' they imagine something light, but with stage II moderate cases, it becomes difficult to breathe just by sitting up, and this is the equivalent of a severe case overseas. A severe case in Japan is on the level of a critical condition overseas."

       If a person is deemed to have a mild case, people tend to think of it as a mere cold, but Yamato explained, "The only way it is different from a moderate case is that the blood oxygen saturation level is 96% or higher, and there are no signs of pneumonia. Even with a mild case, there can actually be heavy symptoms, like a feeling of weariness over the whole body." He added, "Even if cases are mild or moderate, I don't want people to treat them lightly."

       (Japanese original by Satoshi Takano, Osaka City News Department, and Satoshi Kondo, Osaka Science & Environment News Department)

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