17th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (december 10, 2020). Document 4
Latest infection status, etc
Trends in the number of new infections
- The number of new infections is still at a record high level, and the situation continues to require a maximum state of alert. Particularly in Hokkaido, the Tokyo metropolitan area, the Kansai area, and the Chubu area, many new cases of the infection are occurring every day. In addition, a tendency toward the spread of the infection is being observed in regions where no large-scale infection has been reported. As it is considered that factors that tend to cause an increase in the number of infections, such as the decreasing temperature, may strengthen, the infection may spread even in regions where a spread has not yet been reported, and caution is required.
Effective reproduction number: Slightly below 1, nationwide (as of Nov. 22). The average weekly level also exceeds 1 in Hokkaido, Tokyo, and Aichi, etc. (as of Nov. 24). - With the recent spread of the infection, the number of new infections is increasing to a greater extent, and the absolute number of elderly patients is also increasing. The numbers of inpatients and severe patients are increasing, as are the burdens being placed on the medical care provision system and the public health system. Further, the number of deaths is also increasing. An increase in the number of severe patients tends to be delayed, relative to that of new infections. Accordingly, the number of severe patients may continue to increase for a time, and the medical care provision system, which is currently responding to the large number of inpatients and severe patients, has already been affected by this situation. In some regions, the provision of support via nurses from other regions or the Self-Defense Force has been initiated. In addition, there have been cases where adjustments for the hospitalization of persons, such as those with dementia or those who require dialysis has become difficult, as well as cases involving limitations of scheduled surgeries and acceptance for emergency medical care, and the patient transfers to secure beds for persons infected with the virus. It continues to be difficult to balance treatment of the novel coronavirus disease with usual care, in various regions.
- Clusters of infected individuals who are difficult to detect or identify are considered to have contributed to the spread of the infection. Secondary infections have occurred more frequently via persons in their 20s to 50s with active social lives, who have a history of movement under the current coronavirus situation, compared to other generations. Because these generations often exhibit no symptoms or only mild symptoms even when infected, they are assumed to have spread the infection unintentionally, and this spread is considered to have caused infections in medical institutions and facilities for the elderly.
[Trends in regions where the infection has spread]
(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.
Future actions
- Particularly in regions where the infection is spreading, in order to focus medical resources on patients who are at risk of becoming severe, it is necessary to discuss the organization of a system of accommodation facilities and home recuperation for asymptomatic carriers and patients with mild symptoms who have been determined by physicians to not require hospitalization, including elderly patients requiring nursing care. In addition, in accordance with the needs of local governments, it is necessary to engage in supportive actions such as the dispatch of public health nurses to public health centers and support for adjustments for hospitalization among local governments, dispatch of medical staff such as nurses to regions where the medical care system is overwhelmed, and dispatch of specialist physicians in cooperation with related academic societies, particularly to regions that are experiencing an increase in the number of severe patients.
- On the other hand, infections are also occurring in regions where a large-scale spread of the infection has not yet been reported. The medical care provision system has deteriorated rapidly in regions where the system is relatively weak, and the infection may spread rapidly. In addition, an increase in the number of infections during the New Year holiday season may result in a crisis for the medical care provision system. Accordingly, even in regions where a large-scale spread of the infection has not yet been observed, it is necessary to engage in immediate preparations and secure the medical care provision system, including accommodation facilities for recuperation, with a sense of crisis that a rapid spread of the infection may occur in any area.
- In the midst of the spread of the infection, the customary behaviors of the New Year holiday season may lead to a further spread of the infection, under the severe conditions of the medical care provision system. It is necessary to prepare and promptly implement appropriate measures based on the status of the infection, under the leadership of the prefectural governors. In addition, the cooperation of citizens is necessary, with respect to spending quiet times during the New Year holidays, in order to avoid causing a spread of the infection at New Year parties, end-of-year parties, and homecoming visits. It will be necessary to deliver messages to citizens, in order to obtain their cooperation.
- In addition, secondary infections have occurred more frequently via persons in their 20s to 50s with active social lives, who have a history of movement under the current coronavirus situation, compared with other generations. It is necessary to make use of various channels, especially for young persons and those who are in the prime of life, to encourage them to change their behaviors, such as by thoroughly wearing masks in situations such as eating and drinking.
- The measures based on the recommendations from the Subcommittee to the government have thus far been taken under cooperation between the national and local governments. Although these measures have resulted in some effects in regions where they were taken early, it cannot necessarily be said that they have been successful in reducing the number of new infections, as a whole. If the spread of the infection still cannot be halted, the public health system, including measures against the novel coronavirus infection, and the entire medical care provision system may be at risk. The New Year holiday season, during which time the medical care provision system will become relatively weak, is fast approaching, and it is necessary to cope with the situation with a sense of urgency. It is necessary to evaluate whether or not the spread of infection will subside by the middle of December, and to promptly consider additional measures for the future.