20th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (January 6, 2021). Document 4
Evaluation of the latest infection status, etc
Infection status
- The number of new cases of infection in Japan is still showing an increasing trend with an increase in cases in the Tokyo metropolitan area (Tokyo and three neighboring prefectures), centered on Tokyo, toward the end of the year and has reached a record high.
Effective reproduction number: On a national basis, it remains above 1 (as of Dec. 19). The average weekly level also exceeds 1 in metropolitan areas such as Tokyo and Aichi, etc. (as of Dec. 21). - Many new cases of infection occurred in the Tokyo metropolitan area, the Chubu area, and the Kansai area during the period including the New Year holidays, and the increasing trend is continuing for inpatients, severe patients, and deaths. The staff in health centers and medical institutions who continue to respond to the infection are already exhausted to a considerable extent. Regular medical care has been affected by the infection, for example, and adjustment for hospitalization becomes difficult as beds for regular medical care are required for use by patients with infection. There is concern that it is becoming difficult to rapidly respond to the occurrence of infection or to find a proper balance between the medical care for novel coronavirus infection and regular medical care in more regions. There have also been cases where patients had to wait before they could be hospitalized due to clusters in facilities for elderly people, amidst the difficulty to adjust for hospitalizations.
- Cases of a new mutant strain that are increasing in the United Kingdom and South Africa have also been detected worldwide. In Japan, such cases have only been detected among patients with a history of overseas travel or contact with such people. Considering the possibly of higher infectivity of these strains compared to the original strains, there is a risk of more rapid spreading than before if the infection continues to occur in Japan.
[Trends in regions where the infection has spread]
(1) Hokkaido: Although new cases of infection are decreasing, this decreasing trend has slowed down recently. Many new cases of infection occurred in hospitals and facilities. It is necessary to continuously pay attention to the infection status at medical institutions and welfare facilities in Asahikawa City.
(2) Tokyo metropolitan area: The number of new infections is continuing to increase, exceeding 45 per 100,000 persons for the last week. The medical care provision systems remain under very severe pressure. The rate of responding to the demand for emergency care has started to be affected. It is necessary to divert beds for regular medical care to the care of patients infected with coronavirus; however, it is becoming difficult for medical institutions to respond to the infection by their own efforts alone. Adjustments allowing hospitalization, etc. at health centers are also under increasing pressure. Effective actions to suppress the infection are required now. The route of infection is unknown in many cases, but it is considered that the infection mainly spreads at the scenes of eating and drinking. The number of new cases of infection is continuing to increase in Saitama, Kanagawa, and Chiba throughout the metropolitan area, and the medical care provision system is under severe pressure.
(3) Kansai area: The number of cases of new infection is gradually decreasing in Osaka, though it is still high. The medical care provision system remains under severe pressure. Cases of infection continue to occur in hospitals and facilities, as well as cases of community-acquired infection. Infections are also continuing to occur in Hyogo. The medical care provision systems is under severe pressure. An increasing trend in the number of new infections is continuing in Kyoto, Shiga, and Nara.
(4) Chubu area: Infections are continuing to occur in and around Nagoya City. In Nagoya City, the number of new infections remains high and a decreasing trend is not observed. The number of elderly patients aged 65 years or older has increased due to infections at facilities. The situation of the medical care provision system and the public health system is worsening. The number of new cases of infection also increased in Gifu due to cluster infections.
*Also in Tochigi, Gunma, Hiroshima, Fukuoka, Nagasaki, Kumamoto, Miyazaki, and Okinawa, etc., there is a tendency of newly spreading and re-spreading infections, and many new cases of infection continue to occur.
Analysis of infection status
Among the regions where the local government has requested shortening of business hours, the number of persons infected with the virus has decreased in Hokkaido and Osaka, but the infection is spreading in Tokyo, and the flow of people did not decrease by the end of the year. In Tokyo, many cases of infection occurred among persons in their 20s to 50s who are actively engaged in social activities such as eating and drinking. It is considered that the scenes of eating and drinking are the major cause of the spread of infection, at least through the end of last year, and has resulted in infections in workplaces, homes, hospitals and facilities.
This spread of infection in Tokyo affected the neighboring regions; new cases of infection increased in the Tokyo metropolitan area including Saitama, Chiba, and Kanagawa at the end of the year, and reached a record high. New cases of infection for the last week in Tokyo accounts for a quarter of those in Japan, and those in Tokyo and the three neighboring prefectures accounts for half. This 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 suppressed in large cities.
Necessary measures
The number of new cases of infection continued to increase at the end of the year in the metropolitan area including Tokyo. The monitoring meeting in Tokyo metropolitan government concluded that the medical care provision system is overwhelmed and is experiencing a critical situation. Based on the recommendations made at the meeting of the Subcommittee on January 5, effective measures to reduce infections are required as soon as possible.
The spread of the infection is continuing, and the medical care provision and public health systems are under very severe pressure. It is necessary to promptly reduce the number of new infections. In addition, the current situation of the medical care provision system is very severe and is expected to continue. Under these circumstances, support to secure the necessary systems are required while utilizing the “package of medical care provision system” prepared at the end of last year.
Infections occurred in regions where large-scale infection had not occurred before, and they occurred frequently in medical institutions and welfare facilities. Since a rapid increase in cases of infection may rapidly cause impending situations in the medical care provision system, it is very important to facilitate preparation and to secure the medical care provision system, including accommodation facilities. If the spread of infection occurs, it is necessary to discuss measures such as shortening of the business hours of restaurants.
The cooperation of citizens is crucial to suppress the spread of infection. New year has come, social activities will be vitalized and New Year’s parties may be held. People are required to change their behavior that may lead to an increase in the chances of infection, by refraining from holding or participating in New Year’s parties and avoiding crowded places when shopping. And it is necessary for the national and local governments to deliver messages to achieve these with a sense of unity.
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 situation in Japan. It is required to monitor mutant strains and to conduct an active epidemiological survey when an infected person is detected. As for mutant strains, avoidance of 3 Cs, the wearing of a mask, and hand washing, etc. are also recommended as basic preventive measures for individuals.