16th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (december 3, 2020). Document 4
Latest infection status, etc
Trends in the number of new infections
- The increasing trend of new infections has been stronger since November; it has increased more than twice within 2 weeks and has reached a record high. Although there are some regions in which the infection has not spread significantly, remarkable increases in the number of cases of infection have been observed, particularly in Hokkaido and the Tokyo metropolitan, Kansai, and Chubu areas, which has led to a nationwide increase in infected cases. The infection has already spread rapidly in some regions, which may have a significant impact on the medical care provision system and the public health system if this trend continues.
Effective reproduction number: On a national basis, it remains at a level that exceeds 1. It exceeds 2 in Osaka, Kyoto, and Hyogo. It essentially remains at a level that exceeds 1 in Hokkaido, Tokyo, Aichi, etc. - Clusters that are causing the spread of the infection have diversified, and are spreading to neighboring regions. In addition, the existence of latent clusters is also expected, and clusters with infected individuals who are difficult to detect or identify are considered to have contributed to the spread of the infection.
- The factors behind the spread of the infection are considered to be a lack of proper implementation of basic measures to prevent infection and an increase in movements of people under such conditions, in addition to the effects of lower temperatures and population density.
- The numbers of inpatients and severe patients are continuing to increase. There are cases of limitations of scheduled surgeries and emergency admissions, transfers of patients to other hospitals to secure beds, and physicians from completely different departments who have been forced to treat patients with the novel coronavirus infection. While the number of beds and staff cannot easily be increased, it is becoming difficult to maintain a balance between treatment for the novel coronavirus infection and regular medical care. If this situation continues, it will become impossible to save lives that could be saved by regular medical care.
[Trends in regions where the infection has spread]
(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.
Future actions
- The balance between “increasing factors” and “decreasing factors” for the infection is being lost. In order to maintain the public health system and the medical care provision system, including measures against the novel coronavirus infection, it is necessary to achieve a downward trend in infections, as soon as possible.
- In the “Recommendations from the Subcommittee to the Government” on November 20, the following were proposed as measures that are stronger than those currently in place: (1) shortening of business hours, (2) requests for voluntary restraint on movements across regions, (3) a review of the operations of the GoTo campaign project, (4) a more thorough implementation of existing measures, (5) consideration for the economy and employment, and (6) permeation of behavioral changes among individuals. On November 21, Headquarters announced policies regarding a request for a review of the GoTo Travel and the GoTo Eat projects, support related to requests for shortening business hours, and facilitation of testing for the novel coronavirus at medical care facilities and facilities for the elderly, with the aim of suppressing the occurrence of severe cases. The national and local governments are required to implement these policies, immediately.
- In regions where the infection is widespread, the conditions of the public health system and medical care provision system are becoming severe. The national government should proactively grasp such local situations, judge the local conditions regarding the infection and the medical care provision system under close cooperation with local governments, and promptly take the necessary measures to improve conditions. Particularly in such regions, in order to focus medical resources on patients who are at risk of becoming severe, it is necessary to allow asymptomatic carriers and patients with mild symptoms who have been determined by physicians to not require hospitalization, including elderly persons, to rest or receive treatments at other accommodations (home treatment, if possible). In addition, depending on the needs of local governments, the provision of coordination support will be continued, including the prompt and agile dispatch of specialized personnel such as health nurses, and approaches to securing beds.
- On the other hand, even in regions where major numbers of infections are not currently being observed, it is necessary to engage in immediate preparations and secure the medical care provision system, in preparation for a rapid spread of the infection.
- In addition, it is necessary to make use of various channels, especially for young people and those in the prime of life, to make them change their behaviors, such as by thoroughly wearing masks in situations such as eating and drinking. Also, it has been suggested that some persons may avoid undergoing testing for some reason, despite having noticed the possibility of infection, and may have caused secondary infections. It is necessary to again inform people to consult with their primary care physicians, which will lead to the necessary tests, in cases where symptoms of the infection are suspected.
- In regions where it has already become difficult to provide medical care, strong measures to reduce the number of infected persons (e.g., reducing chances for contact with infected individuals) are required. To prevent the spread of infection in the future, the national and local governments, citizens, and business operators should cooperate to promote measures against the spread of the infection.