国立感染症研究所

26th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (March 3, 2021).  Material 1

Evaluation of the latest infection status, etc.

Infection status

• The number of new cases of infections in Japan has continued to decrease since the middle of January based on the reporting date (from the beginning of January based on the date of onset), and has become approximately 5 per 100,000 people over the last week. The decreasing speed has slowed down since the middle of February, and the possibility of bottoming out and recurrences should be carefully monitored.

  Effective reproduction number:The effective reproduction number has fallen below 1 from the beginning of January nationwide and has been 0.84 recently (as of February 14). In Tokyo and its 3 neighboring prefectures, Osaka/Hyogo/Kyoto, Aichi/Gifu, and Fukuoka, the levels remain below 1. (as of February 15)

• The decreasing trend in the numbers of inpatients, severe patients, deaths, and patients receiving treatment is continuing. In contrast, the proportion of new patients aged 60 years or older has exceeded 30%, and decreases in the number of severe patients and deaths seems to take more time than the decreases in the number of new cases of infections and inpatients.

[Local trends]

* The value of new cases of infections is the number of people per 100,000 in the total number for the latest week on the basis of reporting dates

1. (1) Metropolitan area:
   In Tokyo, the decreasing trend in the number of new cases of infections is continuing and has reached approximately 13, which is lower than the index for stage III, 15. In Kanagawa, Saitama, and Chiba, the decreasing trend in the number of new cases of infections is continuing, i.e., approximately 8, 9, and 14, respectively. A decreasing trend has been observed throughout Tokyo and its 3 neighboring prefectures. However, the speed of decreasing infections has slowed down, and the number of new infections remains at the level close to 15 in Tokyo and Chiba. With decreases in the numbers of new cases of infections and patients receiving treatment, adjustments for hospitalization, etc. by local governments have improved and the burden has been reduced, for example, the figures below the index of Stage IV. However, the medical care provision systems are under severe pressure, such as high use rate of beds.
2. (2) Kansai Area:
   The decrease in the number of new cases of infections has continued, and the number of new cases of infections has dipped below 5, excluding Osaka. Although the medical care provision systems are still under severe pressure in all areas, the burden has been reduced with decreases in the numbers of new cases of infections and patients receiving treatment. On the other hand, clusters in facilities for the elderly have continued in Osaka, etc. Attention should be paid to increases in the burden associated with hospitalization of elderly persons.
3. (3) Areas other than those listed above:
   The number of new cases of infections is generally continuing to decrease. On the other hand, caution is required as clusters have occurred in some regions.

[Mutant strain]

• For the mutant strains detected in the UK and South Africa, etc. whose effects become a concern, the risk of more rapid spread is high. Cases of infection with mutant strains have been continuously detected in Japan. Possibly because of active epidemiological investigations by local governments, an increasing trend of infections and cluster reports has been observed.

Analysis of infection status

• In the 4 prefectures under the state of emergency measures, the effective reproduction number is around 0.9 and the decreasing trend in the number of new cases of infections is continuing, however the decreasing speed has slowed down. There are many cases with unknown source of infection and place of cluster occurrence in the Tokyo metropolitan area, and a tendency of re-increase in people coming and going during nighttime is observed. It is important to prevent recurrences and maintain the decreasing trend.
• Clusters have continued to occur in facilities for the elderly, and also at restaurants in some regions. Furthermore, there is a trend of bottoming out in the number of infections in young people and clusters in regions where the infections had decreased, and therefore attention should be paid to such situations.
• The decrease in the number of new cases of infections has been delayed in urban areas compared to surrounding areas. Efforts to maintain the decreasing trend are needed in the presence of the risk of mutant strains. A trend of increasing patients with mutant strains is observed even under the Declaration of a State of Emergency, and an increase in the opportunities of social contacts or relaxing the measures against infection may cause a shift in the prevalent strains from the existing ones. There is a concern about the spread of the risk than before.

Measures to be taken

• It is important to reduce the burden on medical care provision systems, secure a system for stable vaccination, and reduce risks of the spread of mutant strains, etc. by continuing to reduce the number of new cases of infections. In this context, concern about recurrences induced by lifting the Declaration of a State of Emergency should be noted. Especially in the Tokyo metropolitan area, the number of infections is higher than in the other areas, and the continued infection has a great influence on the other areas. It is necessary to maintain the number of infections as low as possible to prevent re-spread of infection. In order to achieve this, efforts required to further reduce infections such as measures based on the information and assessments from active epidemiological investigations should be made in view of local situations of infection. Similar efforts are required also in regions where the state of emergency measures have been lifted.
• It is necessary for the national and local governments to send out consistent messages about the need for cooperation in the efforts to reduce infections.
• To reduce the risk of infection when eating and drinking out, it is important to publicize how the users of restaurants should behave in these situations, as well as the efforts of business operators.
• It is also necessary to send out effective messages so that people will refrain from parties and trips related to annual events from the end to the beginning of fiscal year (graduation ceremonies, welcome and farewell parties, and cherry-blossom viewing).
• It is important to take measures in case of another wave of infection as well as to prevent re-spread. Specifically, such efforts as the following are required: (1) steady promotion of vaccination; (2) strengthening measures against mutant strains; (3) early detection using active implementation of the test according to the risk of infection and re-strengthening active epidemiological investigations, promotion of the preventive measures against infection, such as continuation of measures for restaurants and facilities for the elderly; and (4) enhancement of medical care provision systems to flexibly provide medical care for the novel coronavirus infection.

[Mutant strain]

• Considering that the effects of mutant strains will become larger, measures to minimize the effects are required. To realize this, the following measures are required according to the package of the measures against mutant strains presented some days before: (1) continuation of strengthening the border control measures, (2) prompt reinforcement of the surveillance system of mutant strains in Japan (with cooperation with private testing organizations and universities. The national government will regularly confirm the number of tests conducted by local governments), (3) early detection of persons infected with mutant strains, identification of close contacts and the source of infection through active epidemiological investigations and prompt implementation of preventive measures against infection, (4) assessment and analysis of the epidemiological information on the infectivity and pathogenicity of mutant strains (continuing to understand the present situation of variants with mutations such as E484K other than N501Y variants) and proper dissemination of information, and (5) promotion of centralized collection of samples and clinical information/research development such as analyses.

Figures (Number of new infections reported etc.) (PDF)

25th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (February 24, 2021).  Material 1

Evaluation of the latest infection status, etc.

Infection status

• The number of new cases of infection in Japan has continued to decrease since the middle of January based on the reporting date (since the beginning of January based on the date of onset), and the number in the most recent week is approximately 7 per 100,000 population. The speed of infection reduction has slowed down since the middle of February and the number of new cases of infection may bottom out, though attention should be paid to recurrences.

  Effective reproduction number: The effective reproduction number has fallen below 1 from the beginning of January nationwide and has been 0.78 recently (as of February 8). In Tokyo and its 3 neighboring prefectures, as well as Osaka/Hyogo/Kyoto, Aichi/Gifu, and Fukuoka, where the measures for the state of emergency have been employed, the levels continue to be below 1. (as of February 7)

• The declining trend in the number of inpatients, the number of severe patients, the number of deaths, and the number of patients receiving treatment is continuing. In contrast, since the proportion of new patients aged 60 years or older has exceeded 30%, decreases in the number of severe patients and deaths are expected to take more time than the decrease in the number of new cases of infection and inpatients. The burden on health centers and medical institutions has been reduced with decreases in the number of infections and the number of patients receiving treatment. However, on-site personnel have long been responding to the situation of the disease and the impact on their tasks has not been resolved. The occurrence of clusters in elderly facilities has also continued.

[Local trends]

*The value of new cases of infection is the number of people per 100,000 in the total number for the latest week on the basis of reporting dates.

1. (1) Metropolitan area:
   In Tokyo, the number of new cases of infection is continuing to decrease, i.e., approximately 16, however, the speed of infection reduction has slowed down. Admission arrangements by local governments has improved. In Kanagawa, Saitama, and Chiba, the declining trend in the number of new cases of infection is continuing, approximately 9, 12, and 14, respectively, which are lower than the index for stage III, 15. A trend toward increase has been observed over the last few days in Chiba, and attention should be paid to recurrences. In Tokyo, Kanagawa, Saitama and Chiba, the burden has been reduced with decreases in the number of new cases of infection and the number of patients receiving treatment. However, the use rate of beds is still high and the medical care provision systems are under severe pressure.
2. (2) Kansai Area:
   In Osaka, the number of new cases of infection continues to decrease, reaching approximately 7, which is lower than the 15. Clusters have continuously occurred in elderly facilities, etc. In Hyogo and Kyoto, the number of new cases of infection is on a declining trend and has reached approximately 5 and 4, respectively. In both prefectures, the medical care provision systems are under severe pressure, however, the burden has been reduced with decreases in the number of new cases of infection and the number of patients receiving treatment. On the other hand, it should be noted that the declining trend in the number of infections in the elderly is slowing down, but hospitalizations of elderly persons, which put a large burden on clinical sites, are increasing.
3. (3) Chukyo Area:
   In Aichi, the number of new cases of infection continues to decrease, reaching approximately 5, which is lower than the 15. In Gifu, the number of new cases of infection has decreased continuously, reaching approximately 4. In both prefectures, the medical care provision systems are under severe pressure, however, the burden has been reduced with decreases in the number of new cases of infection and the number of patients receiving treatment. On the other hand, it should be noted that the declining trend in the number of infections in the elderly is slowing down, but hospitalizations of elderly persons, which put a large burden on clinical sites, are increasing.
4. (4) Kyushu Area:
   In Fukuoka, the number of new cases of infection continues to decrease, reaching approximately 8, which is lower than the 15. The medical care provision systems are under severe pressure; however, the burden has been reduced with decreases in the number of new cases of infection and the number of patients receiving treatment.
5. (5) Areas other than those listed above:
   The number of new cases of infection is generally continuing to decrease.

[Mutant strain]

• For the new mutant strains that are increasing in the United Kingdom and South Africa, cases possibly due to infections in Japan are continuing to occur. The mutant strains may have higher infectivity than the original strains and thus may have more diffusive effects. While the mutant strains continue to spread across the country, there is a high possibility of more rapid spreading than before. Concerning the UK strains, attention should also be paid to the impact of the mutations on the seriousness of the infection. In addition, mutant strains with the E484K mutation not containing the N501Y mutation, which appeared to have been transmitted from overseas, were detected by genome analysis.

Analysis of infection status

• In 10 prefectures in the regions under the state of emergency measures, the effective reproduction number is below around 0.8 and the number of new cases of infection is decreasing. However, the flow of people during nighttime seems to be increasing again. Measures including shortening of the business hours of restaurants serving alcoholic beverages have been taken so far. The speed of infection reduction has slowed down and a trend toward increase is observed especially in Chiba. Attention should be paid to recurrences. However, the number of patients receiving treatment is decreasing with the decrease in the number of new cases of infection, the use rate of beds is on a general decline, and the burden on medical care provision systems and public health systems have been reduced. These trends should be continued.
• Clusters have occurred mainly in medical institutions/welfare facilities and at home, and they are continuing to occur also at restaurants in some regions. It should be noted that there is a trend of bottoming out in the number of infections in young people.
• Regarding the current decreasing phase in the number of new cases of infection, the decrease in urban areas is more delayed than in the surrounding areas. Efforts to maintain this declining trend are required in the midst of the risk of mutant strains. Mutant strains have also been detected continuously in Japan. It is necessary to detect and contain infection by mutant strains at an early stage.

Measures to be taken

• The declining trend of new cases of infection should be continued, recurrences should be prevented, and the numbers of severe patients and deaths should be surely reduced. In addition, measures should be thoroughly taken from now on to reduce the burden on medical institutions that are engaged in vaccination and to accurately detect mutant strains in local areas.
• Considering the bottoming out of the number of infections, continued burden on medical care provision systems, and the risk of mutant strains, the concern that lifting the Declaration of the State of Emergency may induce recurrences should be noted. Even if the Declaration of the State of Emergency is lifted, efforts to reduce infections when eating and drinking, etc. should be continuously made to achieve Stage II or lower according to the situations of infection in local areas. It is necessary to take measures to detect the source of infection and continue to reduce it, considering that a certain level of infection continued and led to re-expansion after the decrease of infection in the summer of last year. For this purpose, it is required to establish a system that can reinforce active tests and active epidemiological studies again according to the infection risk. It is necessary to take actions in case of future waves of infection based on the assessment of current efforts.
• In order to prevent re-expansion, the actions of people at the milestones are key, such as annual events. In order to avoid dining out in a large group in the future, for the period from the end of the fiscal year to the beginning of the new year, it is necessary to send out an effective message so that people can cooperate to avoid farewell parties, thank-you parties, graduation trips, and cherry-blossom viewing.
• To “protect the elderly,” efforts to prevent the spread of infection are required at welfare facilities where clusters have continued to occur. It is required to steadily conduct the test for the staff of facilities based on the plan and support the measures against infection by dispatch of specialists, etc.
• Vaccination was started first for healthcare professionals. It is necessary to assess and analyze the effects on the situations of infection based on the vaccination.

[Mutant strain]

• As well as strengthening the quarantine system, measures should be taken considering that the effects of the mutant strains will become larger. Early detection of the persons infected with mutant strains, the identification of the sources of infection by active epidemiological surveys, prompt implementation of the measures to prevent the spread of infection, and support for the cases of spread in a wide area are required through strengthening the surveillance system of mutant strains in Japan (cooperation with private test laboratories and universities. The national government should regularly check the number of tests conducted by the local governments). In addition, it is necessary to assess and analyze the epidemiological information on the characteristics of infectivity and pathogenicity. For mutant strains with the E484K mutation not containing the N501Y mutation, it is needed to continue to grasp the actual situation. Reduction in opportunities of contact (avoidance of 3 Cs, especially the 5 situations that increase the risk of infection), wearing of a mask and hand washing, etc. are also recommended as basic preventive measures for individuals. In addition, if symptoms are present, appropriate tests/examinations should be performed. And it is necessary to provide the whole picture of these efforts.

Figures (Number of new infections reported etc.) (PDF)

24th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (February 18, 2021).  Material 1

Evaluation of the latest infection status, etc

Infection status

• The number of new infections reached 36 per 100,000 population in the week ending January 11 based on the reporting date, but has continued to decrease since the middle of January, and the number in the most recent week is approximately 7 per 100,000 population. (Based on the date of onset, the number has seen a decreasing trend from the beginning of January.)

  Effective reproduction number: The effective reproduction number has fallen below 1 from the beginning of January nationwide and has been 0.76 recently (as of February 1). In Tokyo and its 3 neighboring prefectures, as well as Osaka/Hyogo/Kyoto, Aichi/Gifu, and Fukuoka, where the measures for the state of emergency have been employed, the levels continue to be below 1. (as of February 2)

• Decrease in the number of inpatients, the number of severe patients, and the number of deaths is continuing. In contrast, since the proportion of new patients aged 60 years or older was increasing, decrease in the number of severe patients seems to take more time than the decrease in the number of new infections and inpatients. Although the number of infected patients is decreasing, it requires long time for public healthcare centers and medical institutions to deal with issues, and there is a concern about the impact on operations. The occurrence of clusters in elderly facilities has also continued.

[Local trends]

*The value of new infections is the number of people per 100,000 in the total number for the latest week on the basis of reporting dates.

1. (1) Metropolitan area:
   In Tokyo, the number of new infections has decreased and reached below one-fifth of the peak in the period under the Declaration of the State of Emergency, but it is still approximately 18. Although arrangements for hospitalization in local municipalities has also been gradually improving, the state of the medical care provision system remains difficult. In Kanagawa, Saitama, and Chiba, the number of new infections continues to decrease, approximately 9, 13, and 14, respectively, which are lower than the index for stage III, 15. In contrast, the situation in the medical care provision system remains harsh in all three prefectures. It is necessary to pay attention to the impact on the burden of the medical care provision system associated with the decrease in the number of new infections.
2. (2) Kansai Area:
   In Osaka, the number of new infections continues to decrease, reaching approximately 9, which is lower than the 15. However, the medical care provision system is under severe pressure. Clusters in places such as elderly facilities continue to occur. In Hyogo and Kyoto, the number of new infections is on a declining trend and has reached approximately 6 and 5, respectively, but the situation in the medical care provision system remains tough. Including Osaka, it remains necessary to pay attention to the impact on the burden of the medical care provision system associated with the decrease in the number of new infections.
3. (3) Chukyo Area:
   In Aichi, the number of new infections continues to decrease, reaching approximately 6, which is lower than the 15. In Gifu, the number of new infections has decreased continuously, reaching approximately 6. In both cases, the use rates of beds are decreasing, but the medical care provision systems are under tough conditions. It remains necessary to pay attention to the impact on the burden of the medical care provision system associated with the decrease in the number of new infections.
4. (4) Kyushu Area:
   In Fukuoka, the number of new infections continues to decrease, reaching approximately 10, which is lower than the 15. However, the number of severe patients remains high. The medical care provision system is under severe pressure. It remains necessary to pay attention to the impact on the burden of the medical care provision system associated with the decrease in the number of new infections.
5. (5) Areas other than those listed above:
   The number of new infections is generally continuing to decrease.

[Mutant strain]

• The new mutations, which have been increasingly found in the UK, South Africa and other countries, have been spreading worldwide. These strains were also detected in Japan from people who did not travel overseas and might have been affected by domestic infection. In addition, diffuse outbreaks, which are clusters including infected patients across prefectures, have occurred. The mutations may have higher infectivity than the original strains. In case the mutations continue to spread across the country, there is a high possibility of more rapid spreading than before. Concerning the UK strains, attention should also be paid to the impact of the mutations on the seriousness of the infection. In addition, variants with the E484K mutation not containing the N501Y mutation, which appeared to have been transmitted from overseas, were detected by genome analysis.

Analysis of infection status

• In 10 prefectures employing the measures for the state of emergency, the effective reproduction numbers have been decreasing from the beginning of the year, and have been at around approximately 0.9 during the period under the declaration. Furthermore, the numbers of new infections have been decreasing, but increase in the number of people coming and going during nighttime hours is observed again in some areas. There is a possibility that the speed of infection reduction has slowed down, so it is necessary to take extra care. The number of cluster occurrences in restaurants has been decreasing, partly due to cooperation with the efforts following the recent Declaration of the State of Emergency focusing on restaurants. However, clusters have occurred mainly in medical facilities, welfare facilities, and homes, and also continues to occur in restaurants depending on the area. Since the proportion of patients aged 60 years or older in the number of infected patients is increasing, it may take time to see a decrease in the number of severe patients and deaths.
• During the year-end and New Year holidays, infection spread from urban areas to the surrounding areas. In the current decreasing phase, the decrease in the number of infected patients has been delayed in urban areas compared to surrounding areas. There is a concern that the decrease may slow down in large cities, and there is a risk of mutant strains. Therefore, efforts to continue decreasing trends are required.
• Mutant strains have also been detected sporadically in Japan. It is necessary to detect and contain infection by mutant strains at an early stage.

Measures to be taken

• Thorough measures are required to maintain the decreasing trend of new infections and reduce the number of severe patients and deaths, as well as to reduce the burden on medical facilities for allow for future vaccinations. Also, these measures are necessary to prevent reoccurrences and to enable accurate detection of mutant strains.
• In 10 prefectures employing the measures for the state of emergency, the number of new infections has fallen below 15, except Tokyo, and the use rate of hospital beds is generally declining, but the impact on the burden of the medical care provision system and the public health system needs to be carefully watched.
• Even in the areas where the Declaration of the State of Emergency was removed, it is necessary to take measures to detect the source of infection and continue to reduce it, considering that a certain level of infection continued and led to re-expansion after the decrease of infection in the summer of last year. For this purpose, it is required to establish a system that can reinforce active tests and active epidemiological studies again according to the infection risk. In addition, by means of tests and other methods for monitoring, it is necessary to evaluate and analyze the core places for spread of infection and changes in the impact, and to consider new measures to be taken.
• In order to prevent re-expansion, the actions of people at the milestones are key, such as avoidance of dining out in a large group. At the end of the fiscal year, it is necessary to send out an effective message so that people can cooperate to avoid farewell parties, thank-you parties, graduation trips, and cherry-blossom viewing.
• To “protect the elderly,” efforts to prevent the spread of infection are required at welfare facilities where clusters have continued to occur. Moreover, measures to protect staff members of the facilities are also needed. It is required to steadily implement inspections for staff of welfare facilities based on plans formulated by prefectures and to support measures against infectious diseases by dispatching experts to facilities, as well as to support facilities promptly when infected persons are confirmed.
• In addition, although distribution of a vaccination has begun, it is required to watch the effect of this vaccination on the status of infection.

[Mutant strain]

• To monitor the influx of mutant strains into Japan, it is necessary to continue strengthening the quarantine system based on risk assessment. Furthermore, by strengthening the domestic screening test system for mutant strains promptly (taking account of tests by private institutions), the following measures are required: early detection of those infected with mutant strains, identification of the source of infection by active epidemiological survey, prompt implementation of measures to prevent the spread of mutant strains, and support for dealing with diffuse outbreaks. In addition, it is necessary to analyze characteristics of infectivity and pathogenicity. For variants with the E484K mutation not containing the N501Y mutation, it is needed to continue to grasp the actual situation through pathogen surveillance. Avoidance of the 3 Cs, especially avoidance of the 5 settings with high risk, wearing of a mask and hand washing, etc. are also recommended as basic preventive measures for individuals. In addition, if symptoms are present, appropriate tests/examinations should be performed.

Figures (Number of new infections reported etc.) (PDF)

23th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (February 11, 2021).  Material 1

Evaluation of the latest infection status, etc

Infection status

• The number of new infections reached approximately 36 per 100,000 population in the week ending January 11 based on the reporting date, but has shown a downward trend since the middle of January, and the number in the most recent week is approximately 11 per 100,000 population. (Based on the date of onset, the number is keeping a decreasing trend from the beginning of January.)

  Effective reproduction number: The effective reproduction number has fallen below 1 from the beginning of January nationwide and has been 0.76 recently (as of January 25). In Tokyo and its 3 neighboring prefectures, Osaka/Hyogo/Kyoto, Aichi/Gifu, and Fukuoka, the levels remain below 1. (as of January 25)

• The number of hospitalized patients continues to decrease. In addition, the number of severe patients is clearly showing a decreasing trend while the number of deaths has also decreased. Since the proportion of newly infected patients aged 60 years or older is increasing, it may take time to decrease the number of severe patients. Although the number of cases under adjustment of hospitalization and medical care has decreased, staff members of public healthcare centers and medical facilities who continue to respond remain under a lot of strain, thus resulting in concern about the impact on their work. While the number of infected patients continues to increase mainly in urban areas, it remains difficult to maintain both medical care for novel coronavirus cases as well as usual medical care, and there are also cases in which the situation affects the emergency response. On top of this, clusters in elderly facilities continue to occur.

[Local trends]

* The value of new infections is the number of people per 100,000 in the total number for the latest week on the basis of reporting dates.

1. (1) Metropolitan area:
   In Tokyo, the number of new infections has decreased and reached below one-third of the peak in the period under the Declaration of the State of Emergency, but it is still approximately 26. The medical care provision systems remain under very severe pressure. It also remains difficult for local governments to make arrangements for hospitalization. In Kanagawa, Saitama, and Chiba, the number of new infections continues to decrease, approximately 14, 18, and 19, respectively. The situation in the medical care provision system remains harsh in all three prefectures.
   In Tochigi, the number of new infections has decreased, reaching approximately 6. The use rate of beds is on a general decline.
2. (2) Kansai Area:
   In Osaka, the number of new infections continues to decrease and has reached approximately 13, which is lower than the index for stage III, 15. In contrast, the situation in the medical care provision system and arrangements including admission by local governments remain difficult. Clusters in places such as elderly facilities continue to occur and the number of severe patients remains high. In Hyogo and Kyoto, the number of new infections is on a declining trend and has reached approximately 10 and 8, respectively, but the situation in the medical care provision system remains tough. It is necessary to pay attention to the impact on the burden of the medical care provision system associated with the decrease in the number of new infections.
3. (3) Chukyo Area:
   In Aichi, the number of new infections continues to decrease, falling below approximately 8, which is lower than the 15. In Gifu, the number of new infections has decreased continuously, reaching approximately 9. In both cases, The use rate of beds decreasing, but the medical care provision systems are under tough conditions. It is necessary to pay attention to the impact on the burden of the medical care provision system associated with the decrease in the number of new infections.
4. (4) Kyushu Area:
   In Fukuoka, the number of new infections continues to decrease, reaching approximately 12, which is lower than the 15. However, the number of severe patients is showing a general increase. The medical care provision systems are under severe pressure. It is necessary to pay attention to the impact on the burden of the medical care provision system associated with the decrease in the number of new infections.
5. (5) Areas other than those listed above:
   The number of new infections continues to decrease. In Okinawa, the medical care provision system remains under extremely tough conditions, but the number of new infections has decreased to approximately 17. In Okinawa, since the proportion of people aged 65 years or older is high, caution is required.

[Mutant strain]

• The new mutations, which have been increasingly found in the UK, South Africa and other countries, have been spreading worldwide. These strains were also detected in Japan from people who did not travel overseas and might have been affected by domestic infection. In addition, diffuse outbreaks, which are clusters including infected patients across prefectures, have occurred. The mutations may have higher infectivity than the original strains. In case the mutations continue to spread across the country, there is a risk of more rapid spreading than before. Concerning the UK strains, attention should also be also paid to the impact of the mutations on the seriousness of the infection.

Analysis of infection status

• The effective reproduction numbers have been decreasing from the beginning of the year in Tokyo and its 3 neighboring prefectures, as well as Aichi/Gifu, and Osaka/Hyogo/Kyoto. Under the Declaration of the State of Emergency, the effective reproduction numbers are maintained at around just below 0.8, and the number of new infections has been decreasing, but attention needs to be paid to the slowdown of the decline in the number of people coming and going. The number of cluster occurrences in restaurants has been decreasing, partly due to cooperation with the efforts following the recent Declaration of the State of Emergency focusing on restaurants. However, clusters have occurred mainly in medical facilities, welfare facilities, and homes, and also continues to occur in restaurants. The number of infected patients in their 20s to 50s has decreased nationwide, but the decreasing trend has been weak in those 80 and older, and the proportion of those aged 60 or older in the total number of infected patients has been increasing. Since this trend may delay the decrease of severe patients and deaths, attention should be paid to it.
• Considering the spread of infection from urban areas to surrounding areas during the year-end and New Year holidays, it is indispensable to maintain infection control strictly and prevent re-expansion in large cities to reduce infection in rural areas.

  * As for the number of new infections in the most recent week, Tokyo accounts for just over one-quarter of the entire country. Tokyo and its 3 neighboring prefectures account for just under 55%. The 10 prefectures which are subject to the Declaration of the State of Emergency account for just under 80% of new infections.

Measures to be taken

• Thorough measures are required to ensure the decreasing trend of new infections and reduce the number of severe patients and deaths in future, as well as to reduce the burden on medical facilities for allow for future vaccinations. Also, these measures are necessary to prevent reoccurrences and to enable accurate detection of mutant strains.
• The Declaration of the State of Emergency issued in 11 prefectures was decided to be extended, excluding Tochigi Prefecture, on February 2. Although the number of new infections has fallen below 15 and the use rate of hospital beds is declining in some regions, the impact on the burden of the medical care provision system and the public health system needs to be carefully watched. Assuming a situation where there will be a large number of hospitalized and severe patients continuously, the necessary medical care provision system should be continuously secured.
• Even in regions where the Declaration of the State of Emergency has been removed, it is necessary to continue efforts to reduce the number of infected patients so that it will not lead to a renewed increase. For that purpose, it is required to establish a system that can reinforce active tests and active epidemiological studies again according to the infection risk. In addition, it is necessary to evaluate and analyze the core places for spread of infection and changes in the impact, and to consider new measures to be taken.
• “Protect the elderly.” Efforts to prevent the spread of infection are required at welfare facilities and medical facilities where clusters have continued to occur. Moreover, measures to protect staff members of the facilities are needed. Periodic examinations of staff members of the facilities should be conducted while support is required for infectious disease control measures through dispatch of experts to facilities in cooperation between the welfare division for the elderly and the infectious disease control division within each local government. In addition, if even one case of infection is confirmed in an elderly facility, local healthcare resources should be utilized to expedite medical support to the facility.

[Mutant strain]

• To monitor the influx of mutant strains into Japan, it is necessary to strengthen the quarantine system based on risk assessment. Furthermore, by strengthening the domestic screening test system for mutant strains, it is required to conduct early detection of mutant infected people and to carry out active epidemiological survey and measures to promptly prevent the spread of the mutant strains, as well as to support dealing with diffuse outbreaks. Avoidance of the 3 Cs, wearing of a mask and hand washing, etc. are also recommended as basic preventive measures for individuals.

Figures (Number of new infections reported etc.) (PDF)

22th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (February 1, 2021).  Material 1

Evaluation of the latest infection status, etc

Infection status

• The number of new infections nationwide reached approximately 36 per 100,000 population in the week ending on January 11 based on the reporting date, but has shown a downward trend since the middle of January, and the number in the most recent week is approximately 19 per 100,000 population. (Based on the date of onset, the number shows a decreasing trend from the beginning of January.)

  Effective reproduction number: The effective reproduction number has fallen below 1 from the middle of January nationwide and has been 0.80 recently (as of January 15). In Tokyo and its 3 neighboring prefectures, Osaka, Hyogo and Kyoto, Aichi and Gifu, Fukuoka, and Tochigi, the levels generally remain below 1. (as of January 16)

• The number of inpatients has decreased, but the numbers of severe patients and deaths continue to reach record highs. It will take a certain time before the decrease in new infections is reflected in a decrease in inpatients and severe patients. The staff of public health centers and medical facilities who are continuously handling the situation are extremely exhausted and there is concern about the impact on the way they perform their tasks. While the number of infected patients continues to increase, it remains difficult to maintain both medical care for novel coronavirus cases as well as usual medical care, and there are also cases in which the situation affects the emergency response. There are also still many cases in which hospitalizations and recuperating patients need to be coordinated due to a shortage of beds. The occurrence of clusters in elderly facilities has also increased.

[Local trends]

1. (1) Metropolitan area:
   the number of new infections has decreased and has fallen below half the peak in the period under the Declaration of the State of Emergency, reaching approximately 43 per 100,000 population in the most recent week. The continuously tough situation in the medical care provision system affects the emergency response. It also remains difficult for local governments to make arrangements for hospitalization. In Kanagawa, Saitama, and Chiba, the number of new infections has also decreased and the number was approximately 30, 25, and 33 per 100,000 population, respectively. The situation in the medical care provision system remains harsh in all three prefectures.
   In Tochigi, the number of new infections has decreased, reaching approximately 11 per 100,000 population in the most recent week. The use rate of hospital beds has been on a declining trend, but attention should be paid to the impact on the burden of the medical care provision system.
2. (2) Kansai area:
   In Osaka, the number of new infections continues to decrease, and has reached approximately 26 per 100,000 population in the most recent week, which is close to 25, the index of stage IV. In contrast, the situation in the medical care provision system and the admission arrangements by local governments remain serious. Clusters in places such as elderly facilities continue to occur. In Hyogo and Kyoto, the number of new infections is on a declining trend, and has reached approximately 20 and 27 per 100,000 population, respectively, but the situation in the medical care provision system remains tough.
3. (3) Chukyo area:
   In Aichi, the number of new infections continues to decrease, reaching approximately 16 per 100,000 population in the most recent week. In Gifu, the number of new infections has decreased continuously, and has reached approximately 14 per 100,000 population in the most recent week. The medical care provision system in both prefectures are in a serious situation. It is necessary to pay attention to the impact on the burden of the medical care provision system associated with the decrease in the number of new infections.
4. (4) Kyushu:
   In Fukuoka, the number of new infections continues to decrease, and has reached approximately 22 per 100,000 population in the most recent week. The medical care provision system is under severe pressure. It is necessary to pay attention to the impact on the burden of the medical care provision system associated with the decrease in the number of new infections.
5. (5) Areas other than the above:
   In Ibaraki, the number of new infections continues to decrease, but it has exceeded 15 per 100,000 population in the most recent week. In Okinawa, there is a decreasing trend, but the infection is spreading in Miyakojima. The number of new infections exceeds 35 per 100,000 population and the situation in the medical care provision system is extremely serious.

[Mutant strain]

• In Japan, the new mutants that are increasingly found in the UK, South Africa and other countries, were detected from people who had travelled overseas and their contacts. The mutants have also been detected from those who did not travel overseas but might have experienced secondary infection. The mutants may have higher infectivity than the original strains. In case the mutants continue to spread across the country, there is a risk of more rapid spreading than before. Concerning the UK strains, attention should also be also paid to the impact of the mutations on the seriousness of the infection.

Analysis of infection status

• The number of infected patients is on a downward trend after the steep proliferation during the year-end and New Year holidays. Although infections in restaurants have decreased, infection and clusters at medical facilities and welfare facilities have occurred across the country. The nationwide sharp increase in infected patients by the date of onset from the beginning of the year, which was mostly observed among people in their 20s to 50s, decreased thereafter. However, patients in their 80s and 90s have not decreased and severe patients and deaths may increase, and it is therefore necessary to pay attention to the trend. The trends in the number of infected patients and the positive rates during the year-end and New Year holidays may have been affected by infections at such locations as year-end parties, intergenerational transmission through homecoming visits, and an increase in the number of examinations performed before homecoming visits or the first working day of the year. The tendency should be analyzed continuously.
• Considering the geographical spread of infection from urban areas to surrounding areas during the year-end and New Year holidays, it is effective to maintain infection control in large cities to reduce infection in rural areas.
• *As for the number of new infections in the most recent week, Tokyo accounts for just under one-quarter of the entire country. Tokyo and its 3 neighboring prefectures account for just over half. The 11 prefectures under the Declaration of the State of Emergency account just under 80% of new infections.

Measures to be taken

• The Declaration of the State of Emergency was issued in the metropolitan area (Tokyo and its 3 neighboring prefectures) on January 7, and in 7 prefectures including the Kansai area, the Chukyo area, Fukuoka, and Tochigi on January 13. The number of new infections in these areas is on a downward trend through cooperation with recent efforts focused on restaurants. Especially in Tochigi, the number has declined to under 15 per 100,000 population and the use rate of beds is also on a declining trend, although the impact on the burden of the medical care provision system and the public health system needs to be carefully watched. Measures to decrease new infections need to be taken continuously to prevent an increase in the number of severe patients and deaths. Measures corresponding to locations as the core of infection spreading and changes in the impact should also be examined.
• To ensure a downward trend, the measures under the Declaration of the State of Emergency should be thoroughly implemented. It is also necessary to continue trying to decrease infected patients, because it is important to prevent an immediate rapid resurgence when people are no longer subject to measures in the future. Since hospitalized and severe patients are assumed to be observed continuously, the necessary medical care provision system should be secured. It is also necessary to improve the environment for home care such as efficient use of accommodation care, outsourcing of follow-up to medical associations and efficient monitoring, and to ensure strengthening of the inspection system.
• Efforts to prevent spreading of infection at welfare facilities and medical facilities are required. Efforts for facilities should be made for infection control, prevention of infection spread, early detection of infection by tests, actions at the time of occurrence, and strengthening of actions to be taken at the time of occurrence, and support to actually take actions at the site should be sought. It is required to utilize self-check by guidance and videos, various government support measures, and to establish a system for dispatching specialists.
• To monitor the influx of mutant strains into Japan, it is necessary to strengthen the quarantine system based on risk assessment. The mutation testing system should also be strengthened inside the country. If infected patients are found, an aggressive epidemiological survey should be conducted. In addition, genomic analysis needs to be continued. Avoidance of 3 Cs, wearing of a mask and hand washing, etc. are also recommended as basic preventive measures for individuals.

  Figures (Number of new infections reported etc.) (PDF)

21th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (January 13, 2021).  Material 5

Evaluation of the latest infection status, etc

Infection status

• There is a growing trend of increasing new cases of infection all over Japan with a rapid increase in new cases of infection in the Tokyo metropolitan area, especially Tokyo, with record numbers of new infections. New cases of infection have also rapidly increased in the Chukyo area, the Kansai area, as well as the Kita-kanto and Kyushu regions from the beginning of the new year.

  Effective reproduction number: On a national basis, it remains above 1 (as of Dec. 27). The average weekly level also exceeds 1 in metropolitan areas such as Tokyo, Osaka and Fukuoka, etc. (as of Dec. 27).

• The increasing trend in the number of inpatients, the number of severe patients, and the number of deaths is continuing. The number of new cases of infection rapidly increased mainly among young people (in their 30s and younger).
• The staff in health centers and medical facilities who continue to respond to the infection are already considerably exhausted. In the local governments showing a rapid increase in the number of infections, it becomes increasingly difficult to make adjustments to accommodate hospitalizations, and patients are forced to wait in facilities for the elderly, etc. before they can be hospitalized. In more and more regions, it is becoming difficult to balance treatment for novel coronavirus infection and regular medical care. With the increase in the number of new cases of infection, it is becoming impossible to provide the regular treatment that should have been ongoing in the routine medical setting. The burden of data input, etc. at local governments has also increased.
• Cases of a new mutant strain that are increasing in the United Kingdom and South Africa have also been detected worldwide. In Japan, these cases have only been detected among patients with a history of overseas travel or contact with such persons. Considering the possibly that these strains may demonstrate higher infectivity than the original strains, there is a risk of more rapid spreading than before if the infection continues to occur in Japan. A new variant with various of the mutations found in these variant strains was detected in persons who returned from Brazil. It is difficult to determine the infectivity and pathogenicity at present.

[Trends in regions where the infection has spread]

1. (1) Hokkaido
   The number of new infections had been decreasing, but has turned to increase again. Infections are continuing to occur in hospitals and facilities. The mass infections in medical facilities and welfare facilities in Asahikawa City have almost settled down.　
2. (2) Tokyo metropolitan area
   The number of new cases of infection is continuing to increase, i.e., it has been just below 90 per 100,000 persons for the last week. The medical care provision systems remain under very severe pressure. The emergency response is also affected. Adjustments to accommodate hospitalizations, etc. at health centers are under even more severe pressure. Although the route of infection is unknown in many patients, it is assumed that the infection spreads mainly at the scenes of eating and drinking. The number of new infections is continuing to increase in Saitama, Kanagawa, and Chiba throughout the metropolitan area, and the medical care provision system is under severe pressure. New cases with positive test results also rapidly increased in Tochigi with an increase in Tokyo and the neighboring three prefectures; the number of positive test results exceeded 40 per 100,000 persons for the last week, and the medical care provision systems are under severe pressure.
3. (3) Kansai area
   The number of new cases of infection had gradually decreased in Osaka, and it rapidly increased after the beginning of the new year, exceeding 40 per 100,000 persons for the last week. At the beginning of the new year, infection among young people in their 30s and younger are notable. The medical care provision system remains under severe pressure. Adjustments to allow hospitalization at health centers are also under increasing pressure. The infection rapidly spread and the number of infections exceeded 30 per 100,000 persons in Hyogo and Kyoto, subjecting the medical care provision systems to severe pressure. The increasing trend in the numbers of new cases of infection is also continuing in Shiga and Nara.
4. (4) Chukyo area
   The number of new cases of infection had remained high in Aichi, and rapidly increased after the beginning of the new year, i.e., just below 30 per 100,000 persons for the last week. The medical care provision system remains under severe pressure. Adjustments to allow hospitalization at health centers are also under increasing pressure. The number of new cases of infection also rapidly increased in Gifu. The medical care provision systems are under severe pressure.
5. (5) Kyushu
   The number of new cases of infection rapidly increased in Fukuoka. Over the last week, the number of new cases of infection exceeded 40 per 100,000 persons. The medical care provision systems have been under more severe pressure. The numbers of new cases of infection also increased in Saga, Nagasaki, Kumamoto, and Miyazaki.
6. (6) Other regions than those mentioned above
   In Miyagi, Ibaraki, Gunma, Yamanashi, Nagano, Shizuoka, Okayama, Hiroshima, and Okinawa too, there is a tendency of newly spreading and re-spreading infection, and many new cases of infection continue to occur; the figure exceeded 15 per 100,000 persons for the last week.

Analysis of infection status

• As for the spread of infection at the end of last year mainly in metropolitan areas such as Tokyo, it is considered that parties at workplaces and scenes where young people eat and drink were the main causes for spread of the infection, which has led to infections at workplaces and home. There is concern about further spread of the infection to elderly people in the future. On the other hand, one of the causes of the rapid increase in the number of infections nationwide from the beginning of the new year is considered to be homecoming visits and eating and drinking with relatives. This needs to be investigated continuously.
• This spread of infection in Tokyo affected the neighboring regions; new cases of infection are continuing to increase in the Tokyo metropolitan area including Saitama, Chiba, and Kanagawa since the beginning of the new year, and reached a record high. New cases of infection for the last week in Tokyo accounts for just under 30% of those in Japan, and those in Tokyo and the three neighboring prefectures account for just more than half. These tendencies are also observed in the Kansai area including Kyoto, Osaka and Hyogo, the Chukyo area including Aichi and Gifu, and the Kyushu region including Fukuoka. The numbers of new cases of infection in these prefectures account for just under 80% of those in Japan. The 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 immediately suppressed in large cities.

Necessary measures

• A Declaration of Emergency was issued on January 7 in metropolitan areas including Tokyo. The infection rapidly spread, not only in the Tokyo metropolitan area but also the Kansai and Chukyo areas. Considering the severe circumstances of the medical care provision and public health systems, it is essential to immediately take effective measures to reduce infections in these metropolitan areas to prevent spread of the infection in local regions. The infection has rapidly spread in Tochigi, a prefecture neighboring on the Tokyo metropolitan area, and Fukuoka and it is therefore considered necessary to take appropriate actions.
• The infection is continuing to spread, and the medical care provision and public health systems are under extremely severe pressure. It is necessary to promptly reduce the number of new cases of infection. The medical care provision system is currently under very severe pressure and this situation is expected to continue. Under these circumstances, it is necessary to secure the necessary systems while utilizing the “medical care provision system package” with expanded measures of support that had been prepared at the end of last year. Cooperation of citizens, in addition to shortening of business hours at restaurants and restrictions on events, is crucial to suppress the spread of infection. It is important to voluntarily refrain from non-essential and non-urgent outings, and from eating and drinking in ways that are likely to cause spreading of the infection, even before 20:00, to prevent infection. It is also important to reduce opportunities of contact by remote working, etc. It is necessary for the national and local governments to deliver messages to achieve these goals with a sense of unity.
• It is important to analyze and evaluate the effects of emergency measures based on the number of new cases of infection, the effective reproduction number, and the burden on the medical systems, etc., continuously discuss how to take measures based on the above-mentioned analysis and evaluation, while making efforts to prevent a rapid re-increase immediately after lifting the state of emergency.
• 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 circumstances in Japan, and to strengthen the entire quarantine system. It is necessary to monitor mutant strains and conduct an active epidemiological survey when an infected person is detected. In consideration of the mutant strains found in persons coming from Brazil too, recommendation of mask wearing, hand washing, and avoidance of the 3 Cs, etc. remain in place as basic preventive measures for individuals.

Figures (Number of new infections reported etc.) (PDF)