20th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (January 6, 2021). Document 4
(1) Hokkaido: Although new cases of infection are decreasing, this decreasing trend has slowed down recently. Many new cases of infection occurred in hospitals and facilities. It is necessary to continuously pay attention to the infection status at medical institutions and welfare facilities in Asahikawa City.
(2) Tokyo metropolitan area: The number of new infections is continuing to increase, exceeding 45 per 100,000 persons for the last week. The medical care provision systems remain under very severe pressure. The rate of responding to the demand for emergency care has started to be affected. It is necessary to divert beds for regular medical care to the care of patients infected with coronavirus; however, it is becoming difficult for medical institutions to respond to the infection by their own efforts alone. Adjustments allowing hospitalization, etc. at health centers are also under increasing pressure. Effective actions to suppress the infection are required now. The route of infection is unknown in many cases, but it is considered that the infection mainly spreads at the scenes of eating and drinking. The number of new cases of infection is continuing to increase in Saitama, Kanagawa, and Chiba throughout the metropolitan area, and the medical care provision system is under severe pressure.
(3) Kansai area: The number of cases of new infection is gradually decreasing in Osaka, though it is still high. The medical care provision system remains under severe pressure. Cases of infection continue to occur in hospitals and facilities, as well as cases of community-acquired infection. Infections are also continuing to occur in Hyogo. The medical care provision systems is under severe pressure. An increasing trend in the number of new infections is continuing in Kyoto, Shiga, and Nara.
(4) Chubu area: Infections are continuing to occur in and around Nagoya City. In Nagoya City, the number of new infections remains high and a decreasing trend is not observed. The number of elderly patients aged 65 years or older has increased due to infections at facilities. The situation of the medical care provision system and the public health system is worsening. The number of new cases of infection also increased in Gifu due to cluster infections.
*Also in Tochigi, Gunma, Hiroshima, Fukuoka, Nagasaki, Kumamoto, Miyazaki, and Okinawa, etc., there is a tendency of newly spreading and re-spreading infections, and many new cases of infection continue to occur.
Among the regions where the local government has requested shortening of business hours, the number of persons infected with the virus has decreased in Hokkaido and Osaka, but the infection is spreading in Tokyo, and the flow of people did not decrease by the end of the year. In Tokyo, many cases of infection occurred among persons in their 20s to 50s who are actively engaged in social activities such as eating and drinking. It is considered that the scenes of eating and drinking are the major cause of the spread of infection, at least through the end of last year, and has resulted in infections in workplaces, homes, hospitals and facilities.
This spread of infection in Tokyo affected the neighboring regions; new cases of infection increased in the Tokyo metropolitan area including Saitama, Chiba, and Kanagawa at the end of the year, and reached a record high. New cases of infection for the last week in Tokyo accounts for a quarter of those in Japan, and those in Tokyo and the three neighboring prefectures accounts for half. This spread of infection in the metropolitan area is considered to be related to recent occurrences of infection in local regions. It is difficult to suppress the infection in local regions unless the infection is suppressed in large cities.
The number of new cases of infection continued to increase at the end of the year in the metropolitan area including Tokyo. The monitoring meeting in Tokyo metropolitan government concluded that the medical care provision system is overwhelmed and is experiencing a critical situation. Based on the recommendations made at the meeting of the Subcommittee on January 5, effective measures to reduce infections are required as soon as possible.
The spread of the infection is continuing, and the medical care provision and public health systems are under very severe pressure. It is necessary to promptly reduce the number of new infections. In addition, the current situation of the medical care provision system is very severe and is expected to continue. Under these circumstances, support to secure the necessary systems are required while utilizing the “package of medical care provision system” prepared at the end of last year.
Infections occurred in regions where large-scale infection had not occurred before, and they occurred frequently in medical institutions and welfare facilities. Since a rapid increase in cases of infection may rapidly cause impending situations in the medical care provision system, it is very important to facilitate preparation and to secure the medical care provision system, including accommodation facilities. If the spread of infection occurs, it is necessary to discuss measures such as shortening of the business hours of restaurants.
The cooperation of citizens is crucial to suppress the spread of infection. New year has come, social activities will be vitalized and New Year’s parties may be held. People are required to change their behavior that may lead to an increase in the chances of infection, by refraining from holding or participating in New Year’s parties and avoiding crowded places when shopping. And it is necessary for the national and local governments to deliver messages to achieve these with a sense of unity.
It is also necessary to prevent the spread of infection due to the influx of mutant strains observed in the UK, etc. under the severe infection situation in Japan. It is required to monitor mutant strains and to conduct an active epidemiological survey when an infected person is detected. As for mutant strains, avoidance of 3 Cs, the wearing of a mask, and hand washing, etc. are also recommended as basic preventive measures for individuals.
January 12, 2021
National Institute of Infectious Diseases, JAPAN
Read more: Brief report: New Variant Strain of SARS-CoV-2 Identified in Travelers from Brazil
19th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (December 22, 2020). Document 4
(1) Hokkaido: The number of new infections is decreasing. Many of new infections occurred in hospitals/facilities. For medical and welfare facilities in Asahikawa City, continued attention should be paid to infection status.
(2) Tokyo metropolitan area: The number of new infections in Tokyo continues to increase, exceeding 30 per 100,000 persons in the last week. The medical care provision system also continues to be in a very tough situation. It is becoming difficult to accept severe patients. There is a growing need to divert the beds for usual care in order to secure beds for patients with coronavirus disease. Effective efforts are required to suppress infections. While the route of infection is unknown in many cases, the spread of infection via gathering to drink and eat is anticipated. The number of new infections also increases in Saitama, Kanagawa and Chiba throughout the metropolitan area, making the medical care provision system be in a severe situation.
(3) Kansai area: In Osaka, the number of new infections is decreasing but still at a high level. The number of severe patients continues to increase, putting more pressure on the medical care provision system. Hospital- and community-acquired infections continue to occur. The proportion of cases with an unknown route of infection is approximately 60%. In Hyogo, infections also continue to occur. The medical care provision system is in a difficult situation. In Kyoto, the number of new infections continues to increase. In Nara, infections also continue to occur.
(4) Chubu area: Infections continue to occur in and around Nagoya City. In Nagoya City, the number of new infections remains high, and no decreasing trend is observed. The medical care provision system continues to be in a difficult situation. In Gifu, infections also continue to occur.
* In Okinawa, the number of new infections is decreasing while infections continue to occur. The infection is spreading newly or starting to spread again even in regions where no large-scale infection had occurred, such as Miyagi, Gunma, Okayama, Hiroshima, Kochi, Fukuoka, and Kumamoto. Especially in Hiroshima, the number of new infections has significantly increased mainly in Hiroshima City, and the situation surrounding the medical care provision system is rapidly becoming severe.
18th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (December 16, 2020). Document 4
(1) Hokkaido There is a decreasing trend in the number of new infections, however infections are continuing to occur mainly in Sapporo City and Asahikawa City. Many cases of infection are related to hospitals/facilities, and schools. Infections in Sapporo City have decreased, and the public health centers are somewhat relieved of impending situations. In Asahikawa City, normal care has been affected, and the situation is still severe.
(2) Tokyo metropolitan area Many cases of the infection are continuing to occur throughout Tokyo, and medical institutions are experiencing very severe conditions. It is becoming difficult to accept severe patients. There is also a growing need to divert the beds for usual care in order to secure beds for patients with coronavirus disease. In the entire metropolitan area, the medical care provision system is under severe pressure due to spreading of infections in Saitama, Kanagawa, and Chiba too. In addition, new infections decreased once in Tokyo, Chiba and Kanagawa, and then have started to increase again. An clear increasing trend in new infections is continuing in Saitama.
(3) Kansai area In Osaka, the number of new infections has remained high, and then slightly decreased, though it is still at a high level. New infections are gradually increasing outside Osaka City. The number of severe patients is continuing to increase, resulting in increasingly severe pressure on the medical care provision system. Nosocomial infections and community-acquired infections are continuing to occur. The proportion of cases with an unknown route of infection is approximately 60%. Infections are also continuing to occur in Hyogo. The medical care provision system is experiencing severe pressure. An increasing trend is also observed in Kyoto, etc. Infections are also continuing to occur in Nara.
(4) Chubu area The infection has spread in and around Nagoya City. In Nagoya City, the number of new infections remains high and no decreasing trend is observed. Mass infections have occurred at welfare facilities and workplaces. The medical care provision system is experiencing severe pressure. The infection has also spread in Gifu.
(5) Okinawa The number of new infections is showing a decreasing trend, however infections are continuing to occur. The infection is spreading to daily situations of eating and drinking, and workplaces. The pressure on the medical care provision system is becoming increasingly severe.
*Other than the above, the tendency of new spreading and re-spreading of infections is observed in regions where large-scale infection has not previously been observed, e.g., Miyagi, Gunma, Hiroshima, Kochi, Fukuoka, Kumamoto, and Oita.
17th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (december 10, 2020). Document 4
(1) Hokkaido The number of new infections is now showing a decreasing trend; however, many cases of the infection are continuing to occur, and the medical care system is experiencing severe conditions, mainly in Sapporo City. Also in Asahikawa City, nosocomial infections are continuing to occur, as are institutional infections and community-acquired infections, and the situation remains severe.
(2) Tokyo metropolitan area Many cases of the infection are continuing to occur throughout Tokyo, where the situation has not shifted to a decreasing trend, and the medical care system is experiencing very severe conditions. The proportion of cases with an unknown route of infection is approximately 60%. Infections are occurring in Saitama, Kanagawa, and Chiba throughout the metropolitan area, and the medical care system is experiencing severe conditions. In particular, no decreasing trend has been observed in Saitama.
(3) Kansai area New infections are occurring, mainly in Osaka City in Osaka. The number of severe patients is continuing to increase, resulting in increasingly severe conditions for the medical care system. Nosocomial infections and community-acquired infections are continuing to occur. The proportion of cases with an unknown route of infection is approximately 60%. The infection has also spread in Hyogo. The medical care system is experiencing severe conditions. A further increasing trend is being observed in Kyoto.
(4) Chubu area The infection has spread in and around Nagoya City. The proportion of cases with an unknown route of infection is approximately 50%. It has also become much more difficult for medical institutions to respond to the situation. Also in Shizuoka, clusters have occurred at restaurants and nightclubs with hospitality services, and the infection is continuing to spread. The infection has also spread in Gifu.
(5) Okinawa Clusters have occurred at restaurants and nightclubs with hospitality services, and the infection is continuing to spread. The proportion of cases with an unknown route of infection is approximately 50%. The situation of the medical care system is becoming increasingly severe.
16th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (december 3, 2020). Document 4
(1) Hokkaido The infection has spread throughout Hokkaido, including the suburbs of Sapporo City. Large clusters have occurred at welfare facilities and medical institutions. In addition, the number of available beds is decreasing due to an increase in patients and an outbreak of nosocomial infections, mainly in Sapporo City. There are cases where nosocomial infections have occurred in Asahikawa City, making it difficult to make adjustments for patient admissions.
(2) Metropolitan area The infection has spread throughout Tokyo. The infection route is unknown in more than half of these patients. The infection is also spreading in Saitama, Kanagawa, and Chiba in the metropolitan area, and clusters have occurred in a variety of facilities, including medical institutions, welfare facilities, and restaurants and nightclubs with hospitality services, resulting in severe conditions for the medical care system. The proportion of infected persons with unknown routes of infection has increased to approximately 40 to 50%. Also in Ibaraki, clusters have occurred at restaurants and nightclubs with hospitality services, and the number of infected persons has increased.
(3) Kansai area The infection has spread considerably, mainly in Osaka City in Osaka. Clusters have occurred at medical institutions and facilities for the elderly. The proportion of infected persons with unknown routes of infection has reached approximately 60%, and the number of severe patients is increasing, resulting in severe conditions for the medical care system. In Hyogo, clusters have occurred at facilities for the elderly and a university, etc. The medical system is experiencing severe conditions. The infection has spread also in Kyoto.
(4) Chubu area The infection has spread throughout Aichi. The proportion of cases with an unknown route of infection is approximately 40%. In Nagoya City, the number of infected persons has increased mainly in the entertainment district, and the burden on health centers has increased. Medical institutions are experiencing severe conditions in response to these conditions. Also in Shizuoka, clusters have occurred at restaurants and nightclubs with hospitality services, and the infection has spread.
15th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (November 24, 2020). Document 4
(1) Hokkaido: The infection has spread throughout Hokkaido, including the suburbs of Sapporo City. Large clusters have occurred at welfare facilities and medical institutions. In addition, the number of available beds is decreasing due to an increase in patients and an outbreak of nosocomial infections, mainly in Sapporo City. There are cases where nosocomial infections have occurred in Asahikawa City, making it difficult to make adjustments for patient admissions.
(2) Metropolitan area: The infection has spread throughout Tokyo. The infection route is unknown in more than half of these patients. The infection is also spreading in Saitama, Kanagawa, and Chiba in the metropolitan area, and clusters have occurred in a variety of facilities, including medical institutions, welfare facilities, and restaurants and nightclubs with hospitality services, resulting in severe conditions for the medical care system. The proportion of infected persons with unknown routes of infection has increased to approximately 40 to 50%. Also in Ibaraki, clusters have occurred at restaurants and nightclubs with hospitality services, and the number of infected persons has increased.
(3) Kansai area: The infection has spread considerably, mainly in Osaka City in Osaka. Clusters have occurred at medical institutions and facilities for the elderly. The proportion of infected persons with unknown routes of infection has reached approximately 60%, and the number of severe patients is increasing, resulting in severe conditions for the medical care system. In Hyogo, clusters have occurred at facilities for the elderly and a university, etc. The medical system is experiencing severe conditions. The infection has spread also in Kyoto.
(4) Chubu area: The infection has spread throughout Aichi. The proportion of cases with an unknown route of infection is approximately 40%. In Nagoya City, the number of infected persons has increased mainly in the entertainment district, and the burden on health centers has increased. Medical institutions are experiencing severe conditions in response to these conditions. Also in Shizuoka, clusters have occurred at restaurants and nightclubs with hospitality services, and the infection has spread.
Figures (Number of new infections reported etc.) (PDF)
14th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (November 19, 2020). Document 4
(1) Hokkaido Clusters occurred mainly in restaurants or nightclubs with hospitality services in Sapporo City; the infection spread, and also spread all over Hokkaido, including the suburbs of Sapporo City. Clusters increased in other places than restaurants or nightclubs with hospitality services, e.g., workplaces, schools, medical institutions and facilities for the elderly. It is becoming difficult to take actions for persons who have been in close contact with infected persons and the conditions are becoming severe. Conditions at medical institutions have also become severe, i.e., there are not enough available beds at medical institutions mainly in Sapporo City due to the increase in the number of patients and it has become difficult to adjust to the situation.
(2) Tokyo The infection is spreading all over Tokyo. The routes of infection include home infection, which occurs most frequently, followed by workplaces, facilities for the elderly, and places where people eat/drink together; the proportion of cases with an unknown infection route is more than half. Increased socioeconomic activities may increase the chances of enhancing the risk of the spread of infection mainly in young people, and the scenes of infection may have become diversified, including universities, etc..
(3) Osaka The infection is spreading all over Osaka. The proportion of cases with an unknown infection route is approximately 60%. Cases of infection have been identified in various scenes, e.g., between persons involved in/visitors at entertainment districts, at home, and in offices. Clusters occurred at facilities for the elderly, medical institutions, schools, etc..
(4) Aichi The infection is spreading all over Aichi. The proportion of cases with an unknown infection route is approximately 40%. In Nagoya City, infected persons have increased mainly in entertainment districts, and the burden on health centers has increased. The age of infected persons and the places where infection occurred have diversified, and infections have also occurred during extracurricular activities of universities, e.g., at facilities for the elderly. It has also become severe to take actions at medical institutions. Clusters other than those in Nagoya City have also been diversified and have sporadically occurred among communities of non-Japanese people, at universities, and in facilities for the elderly.
In some regions of Hokkaido, it is considered that strong measures such as reducing contact opportunities and restricting behavior are required. In Tokyo, Osaka, and Aichi, the conditions are almost reaching a state where such strong measures are required.
Figures (Number of new infections reported etc.) (PDF)
13th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (November 11, 2020). Document 4
Figures (Number of new infections reported etc.) (PDF)
The 14th Meeting of the Subcommittee on Novel Coronavirus Disease Control
If we do not take appropriate infection control measures in the course of revitalizing social and economic activities, “increasing factors” for infection will get stronger and exceed the “decreasing factors” (e.g., basic infection prevention measures by people, and cluster control by local governments). Recently, clusters have been increasing, and moreover, they are diversifying. Under such circumstances, the infection is more likely to spread rapidly unless we enhance the “decreasing factors” immediately. Continuous social efforts by citizens, medical professionals, staff at public health centers, business operators, etc. and the standardization of treatment have controlled fatalities and the rate of disease aggravation. However, to prevent excessive burdens on our medical care provision system, we should take actions to decrease the number of infections as quickly as possible.
In this urgent proposal, we summarize the 5 specific actions required of each citizen, local governments and the national government, based on our past proposals and the broad direction by the national government (*) so that they can be compatible with social and economic activities during the first winter we will experience after the outbreak of novel coronavirus infection.
As a subcommittee, we make this proposal to the government.
* “Actions against Novel Coronavirus Disease” (Report of the 44th Meeting of the Headquarters for Novel Coronavirus Disease Control; October 30, 2020)
Background
Clusters are increasing, and moreover, they are diversifying. In particular, the number of clusters that are “difficult to detect early” or “difficult to contain” is increasing. Actions against clusters have been taken only after infection was confirmed by PCR test, etc. (e.g., handling persons who had close contact with infected patients) so far. However, it is now more necessary than ever before to realize the signs of cluster infections before confirmation with a test.
Based on the results of analyses, clusters are divided into several categories according to their characteristics.
Specific actions
(1) Take effective and efficient measures according to the characteristics of each cluster.
(2) To detect “difficult-to-detect early” clusters, a system to detect an unusual situation of unclear cause is required. This should be called “abnormal event detecting surveillance” and is also recommended as event-based surveillance (EBS) internationally. Local governments should therefore utilize an existing council on novel coronavirus disease control in each prefecture, etc. and cooperate with other organizations such as facilities for elderly persons and medical facilities. The (Nursery) School Absenteeism/Infectious Disease Surveillance System, and a system for analyzing data on SNS, etc. should also be utilized.
(3) Promptly establish a system to speedily share information among local governments and with the national government on (i) the onset date of infection, (ii) the latest information on the occurrence status of clusters,
and (iii) the best examples of cluster control, which have frequently been pointed out.
Background
We repeatedly sent out messages that the 3 Cs and speaking loudly increase the risk of infection. We have recently also proposed the “5 High-risk Scenes” and the “Ways to Enjoy Eating or Drinking Together while Reducing the Risk of Infection” to the government. Based on the recent infection status, however, it is possible that these messages have not always been delivered sufficiently to modify people’s actual behavior or maintain their modified behavior.
Specific actions
(1) Notify people, especially young people and participants of drinking parties (including year-end and new-year parties), of the “5 High-risk Scenes” and the “Ways to Enjoy Eating or Drinking Together while Reducing the Risk of Infection” (e.g., remove a mask only when eating/drinking and wearing it during conversation), etc. in a way that attracts their interests. In doing so, utilize various media including SNSs (e.g., video posting site).
(2) Provide information after understanding the possible feelings or reactions of recipients. Then, survey the effect and impact of the information, and make use of its result for the next provision.
Background
While the development of guidelines by industry type has been proceeded on site, clusters are still observed.
Specific actions
(1) Business operators should consider where the “5 High-risk Scenes” specifically exist at their own shops or workplaces and implement the guidelines by industry type on site without fail. In such cases, the relevant organizations such as the local government and local shopping district association should cooperate with them. The effectiveness of guidelines by industry type should be further improved based on past experience and new knowledge.
(2) For infection prevention measures in cold regions during the winter (e.g., ventilation), specific guidelines should be presented (e.g., carbon dioxide level should be monitored, especially at restaurants).
Background
During the course of gradually resuming interactions with overseas countries, we should simultaneously implement joint quarantine measures and local infection control.
It is extremely hard for public health centers to individually monitor the health condition of people who have entered each regions in Japan because they have to handle such people in multiple languages. Increased numbers of people to follow up lead to a huge administrative burden and interfere with the operations of public health centers. In addition, increased numbers of infected patients from overseas require more beds.
Specific actions
(1) To simultaneously implement joint quarantine measures and local infection control, the government should (i) promptly organize and publicize information such as the number of quarantined persons as well as the numbers of persons who were tested and who tested positive by country/region where they stay at quarantine stations, and (ii) speedily provide information related to quarantine to local governments.
(2) The government should immediately discuss a system to support the follow-up of foreigners in local governments. In addition, basic information on health monitoring, etc. should be provided in multiple languages during quarantine.
(3) Support for medical facilities that accept foreigners, etc. should be reinforced.
Background
Investigation of the viral gene sequence is effective to detect the origin of infection in regions where the situation concerning the spread of the infection is unclear. The number of cases where the link of the infected patient cannot be tracked in the region is increasing. Recently, cluster infections in communities of foreigners have also been reported by several prefectures. While some of them are found to be caused by domestically derived coronavirus, many of them are caused by coronavirus of uncertain origin.
Specific actions
(1) Investigation of the viral gene sequence is not only effective to detect the origin of a cluster, but also to assess infection control. Therefore, (i) make sure to send samples to the National Institute of Infectious Diseases via the Public Health Institute or (ii) analyze the genetic sequences at the Public Health Institute and share the results with the National Institute of Infectious Diseases, and (iii) share field epidemiological information at the same time.
Dispersing the New Year holidays,
Promoting small-scale, decentralized travel, and
Reinforcing public health center functions and the medical care provision system.
Needless to say, it is essential to further promote these actions.
12th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (October 28, 2020). Document 3
11th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (October 22, 2020). Document 3
*“Trends in the number of inpatients” are based on the “Surveillance of Status of Care for Patients with Novel Coronavirus Infection and Number of Beds” by the Ministry of Health, Labour and Welfare. In this surveillance, results as of 0:00 on the presentation date are to be published.
For the number of severe patients, the subject criteria are different from those for data published before August 14. ↑, ↓, and → indicate an increase, a decrease, and the same level, compared to the previous week, respectively.