TOKYO: Hospitals in Japan are increasingly turning away sick people, as the country struggles with surging coronavirus infections and its emergency medical system collapses.

In one recent case, an ambulance carrying a man with a fever and difficulty breathing was rejected by 80 hospitals and forced to search for hours for a hospital in downtown Tokyo that would treat him. Another feverish man finally reached a hospital after paramedics unsuccessfully contacted 40 clinics.

The Japanese Association for Acute Medicine and the Japanese Society for Emergency Medicine say many hospital emergency rooms are refusing to treat people, including those suffering strokes, heart attacks and external injuries.

Japan initially seemed to have controlled the outbreak by going after clusters of infections in specific places, usually enclosed spaces such as clubs, gyms and meeting venues. But the spread of the virus outpaced this approach and most new cases are untraceable.

The outbreak has highlighted underlying weaknesses in medical care in Japan, which has long been praised for its high quality insurance system and reasonable costs.

Apart from a general unwillingness to embrace physical distancing, experts fault government incompetence and a widespread shortage of the protective gear and equipment medical workers need to do their jobs.

Japan lacks enough hospital beds, medical workers or equipment. Forcing hospitalization of anyone with the virus, even those with mild symptoms, has left hospitals overcrowded and understaffed.

The “collapse of emergency medicine” has already happened, a precursor to the overall collapse of medicine, the Japanese Association for Acute Medicine and the Japanese Society for Emergency Medicine said in a joint statement.

By turning away patients, hospitals are putting an excessive burden on the limited number of advanced and critical emergency centers, the groups said. “We can no longer carry out normal emergency medicine,” said Takeshi Shimazu, an Osaka University emergency doctor.

There are not enough protective gowns, masks and face shields, raising risks of infection for medical workers and making treatment of Covid-19 patients increasingly difficult, said Yoshitake Yokokura, who heads the Japan Medical Association.

In March, there were 931 cases of ambulances getting rejected by more than five hospitals or driving around for 20 minutes or longer to reach an emergency room, up from 700 in March last year. In the first 11 days of April, that rose to 830, the Tokyo Fire Department said.

Department official Hiroshi Tanoue said the number of cases surged largely because suspected coronavirus cases require isolation until test results arrive. Infections in a number of hospitals have forced medical workers to self-isolate at home, worsening staff shortages.

Tokyo’s new cases started to spike in late March, the day after the Tokyo Olympics was postponed for a year. They’ve been rising at an accelerating pace for a current total of 2,595. Most patients are still hospitalized, pushing treatment capacity to its limits.

With about 10,000 cases and 170 deaths, Japan’s situation is not as dire as New York City’s which has had more than 10,000 deaths, or Italy’s, with more than 21,000 fatalities, according to Johns Hopkins University. But there are fears Japan’s outbreak could become much worse.

A government virus task force has warned that, in a worst-case scenario where no preventive measures were taken, more than 400,000 could die due to shortages of ventilators and other intensive care equipment.

Prime Minister Shinzo Abe has said the government has secured 15,000 ventilators and is getting support of Sony and Toyota Motor Corp. to produce more.

Japanese hospitals also lack ICUs, with only five per 100,000 people, compared to about 30 in Germany, 35 in the United States and 12 in Italy, said Osamu Nishida, head of the Japanese Society of Intensive Care Medicine.