19th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (December 22, 2020). Document 4
Latest infection status, etc
Infection status
- The number of new infections in Japan continues to increase, reaching a record high level. It maintains an upward trend in the Tokyo metropolitan area (mainly in Tokyo), and no obvious decrease is seen in the Kansai and Chubu areas. The situation in metropolitan areas has extended to other regions where no significant spread of infection had been seen before. The infection is now spreading nationwide due to such persistent spread in each region.
Effective reproduction number: Above 1, nationwide (as of Dec. 6). The average weekly level exceeds 1 in metropolitan areas such as Tokyo, Aichi, Kyoto, Osaka, and Hyogo. (as of Dec. 6). - Despite measures taken in and after November, no apparent decrease in the number of new infections has been seen in the Kanto, Chubu and Kansai areas. Accordingly, the numbers of inpatients, severe patients and deaths have continued to increase. Staffs at public health centers and medical facilities are already exhausted from continuous work. The situation has also impacts on usual care service, such as limitations on scheduled surgery procedures and emergency admissions, the transfer of patients to other hospitals to secure beds, and difficulty in adjustment for the hospitalization of those who have dementia or require dialysis. Under circumstances close to the year-end and New Year holidays when the medical care provision system will get relatively weakened, there is concern about rapid responses to the occurrence of disease while it has become difficult to balance the treatment of novel coronavirus disease with usual care in various regions.
- For a new variant which recently became the most common strain in the UK, ECDC and other relevant agencies have no data suggesting that it causes severe condition but point out that it is highly infectious. It arouses concern about burden on medical care. Although this variant has not been found in Japan so far, attention should be paid to the risk of import.
[Trends in regions where the infection has spread]
(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.
Analysis of infection status
- An analysis was conducted for the impact of measures taken in and after November on infection status mainly in Hokkaido, the Tokyo metropolitan area, Aichi and Osaka. In Hokkaido, the flow of people has decreased since November in Sapporo, where a request to restaurants and bars for shortened opening hours was made early, and the effective reproduction number continues to be 1 or less. The number of new infections also continues to decrease in the entire Hokkaido. However, attention should be paid because the effective reproduction number is reaching 1 recently.
- In Tokyo, the effective reproduction number was below 1 temporarily in late November. But it turned to be 1 or more after that, and the same level continues. Despite a request for shortened opening hours, no decrease in the flow of people has been seen. The persistent spread of infection in Tokyo has extended to surrounding regions, and the number of new infections continues to increase throughout the Tokyo metropolitan area including Saitama, Chiba and Kanagawa.
- In Osaka, a decrease in the flow of people has been seen since late November in some areas of Osaka City where a request for shortened opening hours was made, and the effective reproduction number became around 1. In Osaka, the number of new infections also started to decrease slightly in mid-December. For other regions of the Kansai area, it still continues to increase in Kyoto and remains high in Hyogo.
- In Aichi, the degree of decrease in the flow of people is small, and the effective reproduction number continues to be around 1. The number of new infections remains high.
- There is a certain relationship between the increase/decrease in the flow of people and that in the effective reproduction number.
- As described above, no apparent decrease in the number of new infections has been seen except in Hokkaido. It continues to increase in the Kanto area. The continuous infections in Tokyo especially contribute to the spread in its surrounding regions. The spread of infection in metropolitan areas probably affected the recent outbreak in local regions. It will be difficult to control infections in local regions if infections in large cities cannot be suppressed.
- Infected persons are dominated by those in their 20-50s who are active in social activities (e.g., eating and drinking together). The recent spread of infection in various regions including metropolitan areas is attributed mainly to eating and drinking together.
Necessary measures
- In regions where the spread of infection is expanding/continuing, especially in regions which require measures for Stage III and correspond to Scenario 3 or 2 proposed by the subcommittee, reinforcement of measures is needed. Especially in the Tokyo metropolitan area, where the number of new infections continues to increase, measures should be strengthened immediately.
- Infections have been reported even from regions where no large-scale infection had been seen, and infections in medical and welfare facilities have frequently occurred. The rapid spread of infection may swiftly deteriorate the medical care provision system. It is therefore necessary to promptly prepare/secure the medical care provision system including an accommodation facility for the end of year. If infections spread, additional measures such as a request to restaurants and bars for shortened opening hours should be considered.
- Cooperation of citizens is essential to suppress the spread of infection. Appropriate and strong messages should be delivered to ask them to spend quiet year-end and New Year holidays by avoiding a year-end/new-year party and crowded shopping place.
- A plan to strengthen measures for the New Year was shown at the meeting of the Novel Coronavirus Response Headquarters on December 14. The analysis/evaluation of infection status should be conducted while monitoring the effect of such efforts carefully. And if such efforts are found to be insufficient, necessary measures should be considered.
- Even under the severe situation, it is also necessary to prevent the spread of infection due to the import of new variant found in the UK or other foreign countries. For this reason, appropriate actions should be taken promptly regarding the way of people’s coming and going between Japan and related countries as well as the way of testing/monitoring.