18th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (December 16, 2020). Document 4
Latest infection status, etc
Infection status
- The number of new infections in Japan has remained high, and has then started to increase recently; it is still at a record high. There is not a clear decrease in the number of infections in the Tokyo metropolitan, Kansai and Chubu areas. The tendency of new spreading and re-spreading of infections is observed in regions where large-scale infection has not been observed before, and there is concern that the infection may spread all over Japan, including other regions.
Effective reproduction number: Slightly above 1, nationwide (as of Nov. 29). The average weekly level exceeds 1 in metropolitan areas such as Tokyo, Aichi, Kyoto, and Hyogo, etc. (as of Nov. 30). - With the recent spreading 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 on the medical care provision system and the public health system. The number of deaths is also showing an increasing trend. The rate of new infections among people aged 60 years or older has increased and severe patients may continue to increase for the time being, and there is concern that deaths may further increase. The staff in public health centers and medical institutions who are responding to the disease are already exhausted to a considerable extent, the usual care services have been affected, for example, there are cases of limitations on scheduled surgery procedures and emergency admissions, the transfer of patients to other hospitals to secure beds, and cases of adjustments for the hospitalization of persons with dementia or those who require dialysis, which has become difficult, and there is concern about rapid responses to the occurrence of disease while it has become difficult to balance treatment of the novel coronavirus disease with usual care in various regions.
[Trends in regions where the infection has spread]
(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.
Analysis of infection status
- So far, spreading of infection has mainly been observed in metropolitan areas; however, it has also been observed in local regions. In the past 1 week, approximately 20% of all infected persons were in Tokyo and nearly 15% were in Osaka. The infected persons in these 2 areas account for 1/3rd of all persons infected in Japan. Furthermore, the infected persons in Hokkaido, Saitama, Chiba, Tokyo, Kanagawa, Aichi, Kyoto, Osaka, and Hyogo account for approximately 75% of all infected persons in Japan. Firstly, the infection continues/spreads in places with a large population, and then spreads to local regions. It becomes difficult to control the infection in local regions if the infection in large cities is not controlled. It is necessary to immediately suppress the spreading and continuation of the infection in large cities and to prevent the spread of infection in local regions.
- In recent cases of spreading of the infection, clusters related to restaurants or nightclubs serving food and drinks and hospitality services, which have been used for year-end parties, are increasing, especially in local regions. Scenes of eating and drinking have already been identified as places where the infection spread, also outside Japan. As seen in Materials 2-3 of the Advisory Board dated December 3, it is reported that restaurants are places with a high risk of infection (Chang S, et al., Nature 2020). In Sapporo, it has been suggested that shortening of business hours in entertainment districts to finish earlier may reduce infections. On the other hand, it is difficult to trace a link in large cities such as Tokyo because many unspecified people visit restaurants, and it is difficult to identify them as the infection sources. Therefore, such places may be involved in continuation of infection.
- There are also more cases of infection among people in their 20s-50s who are active in social activities such as eating and drinking compared to those in other age groups. Since these age groups often do not exhibit any symptoms or only mild symptoms, even when infected, they have spread the infection unintentionally, and this spread is considered to have caused infections at home, and in medical institutions and facilities for elderly people, leading to the increase in severe patients.
Necessary measures
- Various measures have already been taken in regions where the infection has spread. If the infection status does not improve, it is necessary to discuss strengthening of the efforts to prevent the spread of infection, including coverage of a request to shorten the business hours of restaurants serving alcoholic beverages.
- Infections have also occurred in regions where large-scale spreading of the infection has not yet been reported. The medical care provision system may deteriorate rapidly in regions where the system is relatively weak and rapid spreading of infection can occur, and it is therefore necessary to immediately prepare/secure the medical care provision system, including accommodation facilities.
- Increased infections during the New Year holiday season may lead to a crisis of the entire medical care provision system. Prompt implementation of appropriate measures based on the infection status and the preparation for measures are required. It is also necessary for citizens to spend their time quietly during the New Year holidays to avoid causing the spreading of the infection at New Year parties, end-of-year parties, and homecoming visits. Appropriate messages to citizens are required.
- Based on the previous recommendations from the Subcommittee to the government, the discussion at the government headquarters on December 14 presented the efforts to strengthen the preventive measures throughout the beginning of the new year. It is necessary to carefully monitor the effects of these efforts and promote the evaluation and analysis of the infection status. Based on these, necessary measures should be considered if such efforts are found to be insufficient.