24th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (February 18, 2021). Material 1
Evaluation of the latest infection status, etc
Infection status
- The number of new infections reached 36 per 100,000 population in the week ending January 11 based on the reporting date, but has continued to decrease since the middle of January, and the number in the most recent week is approximately 7 per 100,000 population. (Based on the date of onset, the number has seen a decreasing trend from the beginning of January.)
Effective reproduction number: The effective reproduction number has fallen below 1 from the beginning of January nationwide and has been 0.76 recently (as of February 1). In Tokyo and its 3 neighboring prefectures, as well as Osaka/Hyogo/Kyoto, Aichi/Gifu, and Fukuoka, where the measures for the state of emergency have been employed, the levels continue to be below 1. (as of February 2)
- Decrease in the number of inpatients, the number of severe patients, and the number of deaths is continuing. In contrast, since the proportion of new patients aged 60 years or older was increasing, decrease in the number of severe patients seems to take more time than the decrease in the number of new infections and inpatients. Although the number of infected patients is decreasing, it requires long time for public healthcare centers and medical institutions to deal with issues, and there is a concern about the impact on operations. The occurrence of clusters in elderly facilities has also continued.
[Local trends]
*The value of new infections is the number of people per 100,000 in the total number for the latest week on the basis of reporting dates.
- (1) Metropolitan area:
In Tokyo, the number of new infections has decreased and reached below one-fifth of the peak in the period under the Declaration of the State of Emergency, but it is still approximately 18. Although arrangements for hospitalization in local municipalities has also been gradually improving, the state of the medical care provision system remains difficult. In Kanagawa, Saitama, and Chiba, the number of new infections continues to decrease, approximately 9, 13, and 14, respectively, which are lower than the index for stage III, 15. In contrast, the situation in the medical care provision system remains harsh in all three prefectures. It is necessary to pay attention to the impact on the burden of the medical care provision system associated with the decrease in the number of new infections. - (2) Kansai Area:
In Osaka, the number of new infections continues to decrease, reaching approximately 9, which is lower than the 15. However, the medical care provision system is under severe pressure. Clusters in places such as elderly facilities continue to occur. In Hyogo and Kyoto, the number of new infections is on a declining trend and has reached approximately 6 and 5, respectively, but the situation in the medical care provision system remains tough. Including Osaka, it remains necessary to pay attention to the impact on the burden of the medical care provision system associated with the decrease in the number of new infections. - (3) Chukyo Area:
In Aichi, the number of new infections continues to decrease, reaching approximately 6, which is lower than the 15. In Gifu, the number of new infections has decreased continuously, reaching approximately 6. In both cases, the use rates of beds are decreasing, but the medical care provision systems are under tough conditions. It remains necessary to pay attention to the impact on the burden of the medical care provision system associated with the decrease in the number of new infections. - (4) Kyushu Area:
In Fukuoka, the number of new infections continues to decrease, reaching approximately 10, which is lower than the 15. However, the number of severe patients remains high. The medical care provision system is under severe pressure. It remains necessary to pay attention to the impact on the burden of the medical care provision system associated with the decrease in the number of new infections. - (5) Areas other than those listed above:
The number of new infections is generally continuing to decrease.
[Mutant strain]
- The new mutations, which have been increasingly found in the UK, South Africa and other countries, have been spreading worldwide. These strains were also detected in Japan from people who did not travel overseas and might have been affected by domestic infection. In addition, diffuse outbreaks, which are clusters including infected patients across prefectures, have occurred. The mutations may have higher infectivity than the original strains. In case the mutations continue to spread across the country, there is a high possibility of more rapid spreading than before. Concerning the UK strains, attention should also be paid to the impact of the mutations on the seriousness of the infection. In addition, variants with the E484K mutation not containing the N501Y mutation, which appeared to have been transmitted from overseas, were detected by genome analysis.
Analysis of infection status
- In 10 prefectures employing the measures for the state of emergency, the effective reproduction numbers have been decreasing from the beginning of the year, and have been at around approximately 0.9 during the period under the declaration. Furthermore, the numbers of new infections have been decreasing, but increase in the number of people coming and going during nighttime hours is observed again in some areas. There is a possibility that the speed of infection reduction has slowed down, so it is necessary to take extra care. The number of cluster occurrences in restaurants has been decreasing, partly due to cooperation with the efforts following the recent Declaration of the State of Emergency focusing on restaurants. However, clusters have occurred mainly in medical facilities, welfare facilities, and homes, and also continues to occur in restaurants depending on the area. Since the proportion of patients aged 60 years or older in the number of infected patients is increasing, it may take time to see a decrease in the number of severe patients and deaths.
- During the year-end and New Year holidays, infection spread from urban areas to the surrounding areas. In the current decreasing phase, the decrease in the number of infected patients has been delayed in urban areas compared to surrounding areas. There is a concern that the decrease may slow down in large cities, and there is a risk of mutant strains. Therefore, efforts to continue decreasing trends are required.
- Mutant strains have also been detected sporadically in Japan. It is necessary to detect and contain infection by mutant strains at an early stage.
Measures to be taken
- Thorough measures are required to maintain the decreasing trend of new infections and reduce the number of severe patients and deaths, as well as to reduce the burden on medical facilities for allow for future vaccinations. Also, these measures are necessary to prevent reoccurrences and to enable accurate detection of mutant strains.
- In 10 prefectures employing the measures for the state of emergency, the number of new infections has fallen below 15, except Tokyo, and the use rate of hospital beds is generally declining, but the impact on the burden of the medical care provision system and the public health system needs to be carefully watched.
- Even in the areas where the Declaration of the State of Emergency was removed, it is necessary to take measures to detect the source of infection and continue to reduce it, considering that a certain level of infection continued and led to re-expansion after the decrease of infection in the summer of last year. For this purpose, it is required to establish a system that can reinforce active tests and active epidemiological studies again according to the infection risk. In addition, by means of tests and other methods for monitoring, it is necessary to evaluate and analyze the core places for spread of infection and changes in the impact, and to consider new measures to be taken.
- In order to prevent re-expansion, the actions of people at the milestones are key, such as avoidance of dining out in a large group. At the end of the fiscal year, it is necessary to send out an effective message so that people can cooperate to avoid farewell parties, thank-you parties, graduation trips, and cherry-blossom viewing.
- To “protect the elderly,” efforts to prevent the spread of infection are required at welfare facilities where clusters have continued to occur. Moreover, measures to protect staff members of the facilities are also needed. It is required to steadily implement inspections for staff of welfare facilities based on plans formulated by prefectures and to support measures against infectious diseases by dispatching experts to facilities, as well as to support facilities promptly when infected persons are confirmed.
- In addition, although distribution of a vaccination has begun, it is required to watch the effect of this vaccination on the status of infection.
[Mutant strain]
- To monitor the influx of mutant strains into Japan, it is necessary to continue strengthening the quarantine system based on risk assessment. Furthermore, by strengthening the domestic screening test system for mutant strains promptly (taking account of tests by private institutions), the following measures are required: early detection of those infected with mutant strains, identification of the source of infection by active epidemiological survey, prompt implementation of measures to prevent the spread of mutant strains, and support for dealing with diffuse outbreaks. In addition, it is necessary to analyze characteristics of infectivity and pathogenicity. For variants with the E484K mutation not containing the N501Y mutation, it is needed to continue to grasp the actual situation through pathogen surveillance. Avoidance of the 3 Cs, especially avoidance of the 5 settings with high risk, wearing of a mask and hand washing, etc. are also recommended as basic preventive measures for individuals. In addition, if symptoms are present, appropriate tests/examinations should be performed.