30th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (April 14, 2021). Material 1
Evaluation of the latest infection status, etc.
Infection status
- The number of new cases of infection nationwide has continued to increase since early March based on the reporting date, and the number in the most recent week is approximately 18 per 100,000 population. With a rapid increase in the Kansai area, the rate of increase has risen since late March. With the increase in the number of new cases of infection, the number of severe patients has been increasing from late March.
The effective reproduction number exceeded 1 in late February and has recently reached 1.18 (as of March 28). The figure was below 1 on March 27 in Miyagi, and above 1 in Tokyo and its 3 neighboring prefectures, Osaka, Hyogo, Kyoto, and Okinawa; of which Osaka, Hyogo and Kyoto were particularly high at 1.54.
- There is still an increasing trend in the number of persons infected with the mutant strain N501Y, designated as a variant of concern (VOC). In particular, many cases of infection have been reported in Osaka and Hyogo. The proportion of mutant strains (VOC) detected by screening tests, which are just based on mechanical estimate, remains high and the number of persons infected with mutant strains (VOC) is also increasing in the surrounding areas. The proportion has increased not only in the Kansai area but in many other areas including Tokyo and Aichi, indicating rapid replacement in predominant strains of the novel coronavirus in Japan.
[Local trends]
*The value of new cases of 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 (Tokyo and its 3 neighboring prefectures): The number of new cases of infection has continued to increase since mid-March to approximately 25 in Tokyo. The proportion of mutant strains (VOC) also increased. The number of new cases of infection started to increase in April in Kanagawa and Saitama while remaining stable/decreasing in Chiba, and it is at a high level in and around Tokyo. In Tokyo, the number of inpatients took an upturn in mid-March, the use rate of beds increased, and the cases of hospitalization/medical care being adjusted are increasing.
- (2) Kansai area/Chukyo area/Kyushu: The prevalent strains have been replaced with mutant ones in the Kansai area. Moreover, the number of cases of infection are increasing in all generations, especially in the those in their 20s and 30s. Furthermore, the number of cases of infection has rapidly increased since mid-March in Osaka and Hyogo, and the figure has also considerably increased since late March in Kyoto, Nara, and Wakayama. In Osaka, the infection is spreading in cities, other than Osaka City, despite a decrease in the rate of increase, and the number of new cases of infection is approximately 71. In Osaka and Hyogo, the overall use rate of beds and the use rate of beds by patients in severe conditions are continuously increasing with the upsurge in number of new cases of infection, putting the medical care provision systems under very severe pressure. In Aichi, the number of new cases of infection is increasing mainly in persons in their 20s and 30s from late March, i.e., approximately 15. The rate of increase also remains high. In April there have also been signs of increase in Fukuoka, and the rate of increase is rising.
- (3) Areas other than those listed above: In Okinawa, the infection has rapidly spread since late March. Although the rate of increase lowered, the number of new cases of infection is approximately 57. While the proportion of persons with infection in their 20s to 50s is large, the number of inpatients has increased. The infection had rapidly spread in Miyagi and Yamagata, however, the number of new cases of infection began to decrease at the end of March to approximately 27 and 15, respectively. In Yamagata, the proportion of elderly patients with infection increased and bottomed out, and the progress should be carefully monitored. In Fukushima, the number of persons with infection in their 20s and 30s rapidly increased. The number of infections due to clusters, etc. rapidly increased in some other regions. Furthermore, in the Shikoku area, the number of cases of infection remains high due to an increase in infected persons in their 20s and 30s in Ehime, and the figure is also increasing in Tokushima.
Analysis of infection status
- The spread of infection is due to the increase in infected persons in their 20s and 30s in most areas. Spread of infection to the elderly may increase the number of severe patients in the future.
- The status of infection varies from region to region, not uniformly nationwide, and it is necessary to take actions based not only on national trends but also on trends of infection in each region.
- There is still great concern that the infection may spread in the Kansai area. The number of cases of infection is increasing not only in Osaka and Hyogo, but also in the surrounding areas. Attention should be paid to the rapid increase in the number of cases of infection with mutant strains in the surrounding areas as well. The flow of people is decreasing in Osaka, however, it will take a certain period of time to see a decrease in the number of new cases of infection. Continued spread of infection and increase in the number of inpatients are also expected. Medical care provision systems are already under severe pressure. The necessary measures must be implemented more thoroughly and the necessary support provided.
- In the Tokyo metropolitan area, the nighttime population rapidly increased in Tokyo after the Declaration of a State of Emergency was lifted. The number of cases of infection began to decrease thereafter, but the infection spread in those in their 20s and 30s, and the total cases of infection are increasing. In the Kansai area, primarily in Osaka and Hyogo, the flow of people increased after the measures including the requests for shortening of business hours under the Declaration of State of Emergency were lifted, and the infection spread from around 3 weeks after the lifting of such restrictions. The proportion of mutant strains (VOC) detected by a screening test is showing an increasing trend in Tokyo and there is concern that the infection may spread continuously or rapidly in metropolitan areas, such as Tokyo, as in the Kansai area.
- In Aichi, the number of cases of infection has increased since late March mainly in people in their 20s and 30s, and the proportion of mutant strains (VOC) detected by a screening test is also increasing. There is also an increase in infected persons in the neighboring prefectures of Mie and Gifu with concern for even further spread of infection.
- The government of Okinawa initiated its own measures. Although the increase in the number of cases of infection slowed down, the increasing trend continued, and the infection is spreading mainly in young people. The progress in these trends should be monitored from now on.
- The places of clusters are diverse, including medical institutions, welfare facilities, schools, workplaces, restaurants, scenes of eating and drinking, and sports. Clusters have occurred in restaurants and karaoke bars during the day. Such clusters should be carefully monitored.
Measures to be taken
- In regions which were designated as areas subject to priority measures, such as prevention of the spread of infection in view of the rapid spread of infection (Miyagi, Tokyo, Osaka, Kyoto, Hyogo, and Okinawa), necessary measures should be steadily taken including thorough patrols and requests for restaurants, including the shortening of business hours to 20:00, which should be implemented in application of this measure, as well as priority testing, securing medical care provision systems, and requesting restaurants to refrain from using karaoke equipment. Particularly in Osaka and Hyogo, reported cases of mutant strains (VOC) increased among many cases of infection reported. The medical care provision systems have already been under severe pressure, and securing beds and healthcare professionals for patients in severe conditions, which are expected to increase, should be prioritized. Flexible support by the national government is also required. The infection is rapidly spreading beyond Osaka City to neighboring Kyoto, Nara, and Wakayama. Avoidance of non-essential and non-urgent outings and movements are crucial to prevent spread of mutant strains associated with movements of people to other regions. Prompt and appropriate measures should be additionally taken as needed in view of the status of infection, changes in the flow of people, and the conditions of medical care provision systems. It is also required to conduct analyses of the causes of the spread of infection and take measures against the spread of infection based on these analyses.
- For the Tokyo metropolitan area, the number of cases of infection is increasing in Tokyo as well as Saitama and Kanagawa. There is much concern surrounding the future course of the disease considering the nighttime population and the proportion of mutant strains detected. As in the Kansai area after lifting of the Declaration of State of Emergency, the infection may rapidly spread not only in Tokyo but to its surrounding areas. It is necessary to promptly organize testing/consultation systems assuming re-spread of infection and medical care provision systems including recuperation at accommodation facilities and at home, as well as sufficient and timely measures responding to the infection status.
- In other regions where the number of cases of infection is increasing such as Aichi, it is necessary to promptly make efforts to control the infection while carefully monitoring the infection status. It is of the utmost importance that certain measures be taken, such as requests to shorten the business hours of restaurants and patrols, requests asking people to avoid going out, improvements for systems to conduct tests without delay, and prompt surveys of close contacts and the sources of infection. Based on such measures, it is necessary to secure medical care provision systems and public health systems to respond to further spread of infection, in addition to support by the national government.
- There is a nationwide trend of infection spread mainly in people in their 20s and 30s. It is necessary to control the causes of the spread of infection in this generation and to be alert to the spread of infection to the elderly. In order to prevent the spread of infection, it is necessary to ask people to avoid getting together in places such as the 3Cs (closed spaces, crowded places, and close contact settings), and parties associated with various events. Furthermore, for the prevention of infection, people should be appropriately informed of the risk of infection in situations where the elderly get together, such as daytime karaoke and product sales with customer service, eating and drinking together for a long time during the day, and actual situations of clusters. In addition, it is necessary to urge patients with symptoms to undergo the test followed by rapid conduct of the test.
- As the number of infected people increases, it is important to prevent infection among the personnel in medical and welfare facilities. Therefore, a system for prompt testing in staff members with mild symptoms should be organized, in addition to thorough implementation of preventive measures against infection and quick response to the occurrence of infection, as well as periodic testing for personnel.
- Prompt action regarding the mutant strain N501Y (VOC) are required based on evaluations/analyses of epidemiological information on the regional status of infection, infectivity, and pathogenicity considering the recent increase in the number of cases of infection.