47th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (August 11, 2021).  Material 1

Evaluation of the latest infection status, etc.

Infection status

• The number of new cases of infection nationwide has been increasing at a rapid rate on the basis of reporting dates with the ratio of this week to last week of 1.33. The record-high levels have been updated, reaching approximately 78 per 100,000 population in the most recent week. The spread of infection is remarkable in the Tokyo metropolitan area and Okinawa. The number of new cases of infection is rapidly increasing across almost all regions nationwide, resulting in an unprecedented spread of infection.
• With the rapid increase in the number of infections, the number of severe patients that had been kept low is rapidly increasing. And the number of patients for whom adjustment is made for hospitalization, etc. is rapidly increasing with the increase in the number of patients receiving treatment. The public health systems/medical care provision systems are under very severe pressure mainly in the Tokyo metropolitan area, which is already close to disaster levels.
• It should be noted that the most recent figure of infected persons may continuously increase following 3-day weekend, etc.

  Effective reproduction number: On a national basis, it remains above 1 at 1.39 most recently (as of July 25). The figure is 1.37 in the Tokyo metropolitan area and the Kansai area.

Analysis of infection status [local trends]

* The value of new cases of infection is the total number for the latest week of reporting dates per 100,000 population.

1. Tokyo metropolitan area (Tokyo and its 3 neighboring prefectures)

   Emergency measures have been taken in Tokyo. The number of new cases of infection is still on an increasing trend and has become approximately 200, with the ratio of this week to last week of 1.19. The largest-ever spread of infection exceeding the spread during the year-end and New Year holidays is continuing. The infection is spreading mainly in persons in their 20s to 40s, and the number of elderly persons with infection is also on an increasing trend. The number of inpatients continued to increase mainly in those in their 20s to 50s. The number of persons in their 60s and older is also increasing. The number of severe patients using mechanical ventilators or artificial heart and lung apparatus have been increasing, mainly in those in their 40s to 50s. The numbers of inpatients and severe patients reached a record high, and it is difficult to accept/arrange for hospitalization for some cases during nighttime, etc. With the rapid increase in infections, patients receiving medical care at home and those for whom arrangement is being made rapidly increased. In addition, general medical services have been restricted, such as care in intensive care unit, etc. In Saitama, Chiba, and Kanagawa, the number of new cases of infection has also been rapidly increasing mainly in those in their 20s and 30s, reaching approximately 120, 107, and 140, respectively. As in Tokyo, the use rate of beds and the use rate of beds for severe patients are rapidly increasing. Although the nighttime population is decreasing in Tokyo, it has not reached the level during the period under the previous declaration. And not only persons in their 20s and 30s, but also 40s and 50s, account for high proportions of the nighttime population. The nighttime population started to decrease in Saitama and Chiba, but remains flat in Kanagawa. The infection is expected to spread for the time being in the Tokyo metropolitan area.

2. Okinawa

   Emergency measures have been continuously taken. The number of new cases of infection is still in a trend of rapid increase and has become approximately 248, which is the highest nationwide and at an unprecedentedly high level, with a rate of this week to last week of 1.38. New cases are mainly in those in their 20s to 30s. Rapid increase in the number of inpatients is continuing. The use rate of beds and the use rate of beds for severe patients are in severe situations. The nighttime population started to decrease again to below the level during the first declaration of the state of emergency. Attention should be paid as to whether the trend leads to a decrease in the number of new cases of infection.

3. Kansai area

   In Osaka, the number of new cases of infection has been increasing at a rapid rate and reached approximately 86, with the ratio of this week to last week at 1.25. New cases are mainly in those in their 20s to 30s. The number of inpatients continued to increase, and the number of severe patients also increased. The nighttime population turned downward but remains at a high level, and it is expected that the spread of infection will continue.

   In Shiga, Kyoto and Hyogo, the number of new cases of infection is still in an increasing trend, reaching approximately 45, 71, and 51, respectively. The number of inpatients rapidly increased across all prefectures. In Kyoto and Hyogo, the nighttime population decreased. Attention should be paid as to whether it leads to a decrease in the number of new cases of infection.

   he trend of rapid increase in the number of new cases of infection is also continuing in Nara with the figure reaching approximately 44.

4. Hokkaido

   The number of new cases of infection is rapidly increasing and has become approximately 44 (approximately 80 in Sapporo City), with a ratio of this week to last week at 1.34. The use rate of beds remains below 20%, but is in an increasing trend most recently. The nighttime population has decreased but remains at a high level, and the spread of infection may continue.

5. Chukyo area

   In Aichi, the number of new cases of infection has been increasing at a rapid rate and reached approximately 33, with the ratio of this week to last week at 1.48. In Shizuoka, the number of new cases of infection is rapidly increasing and has become approximately 38 with the ratio of this week to last week at 1.65. In any case, the number of inpatients continues to increase. The use rate of beds for severe patients is below 20%. In Aichi, the nighttime population turned upward most recently and the spread of infection may continue.

   The number of new cases of infection shows a trend of rapid increase also in Mie, reaching approximately 28.

6. Kyushu

   In Fukuoka and Kumamoto, the number of new cases of infection is rapidly increasing and has become approximately 95 and 44, respectively, with the ratio of this week to last week exceeding 1.5. The number of inpatients continues to increase. The use rate of beds for severe patients is below 20%. The nighttime population decreased. Attention should be paid as to whether it leads to a decrease in the number of new cases of infection. Rapid increase in the number of new cases of infection is observed in other prefectures. Especially in Saga, Oita and Kagoshima, the figure has exceeded 25, reaching approximately 32, 25 and 32, respectively, indicating rapid spread of infection.

7. Other areas subject to priority measures

   The number of new cases of infection is still in a trend of rapid increase in Ibaraki, Tochigi and Gunma, reaching approximately 61, 47 and 50, respectively. In Fukushima and Ishikawa, it is approximately 32 and 45, respectively, at high levels or shows a decreasing trend. In all the prefectures, the use rate of beds exceeds 50%. The nighttime population decreased. Attention should be paid as to whether it leads to a decrease in the number of new cases of infection.

8. Other than the above

   The number of new cases of infection rapidly increased in almost all other regions; especially in Miyagi, Toyama, Fukui, Yamanashi, Tottori, Okayama and Kagawa, the figure was approximately 28, 30, 25, 48, 31, 36 and 29, respectively, which exceeded 25, indicating rapid spread of infection and the infection staying at a high level.

Analysis of mutant strains

• For the B.1.617.2 lineage variant (Delta variant), the positive rate in the screening tests (mechanical estimation, July 26 to August 1) is approximately 67%. The rate is increasing and the existing strains have been replaced by this variant. Especially in Tokyo, the figure is around 80%, and is estimated to be around 95% most recently, indicating that almost all of the existing variants have been replaced by the Delta variant. It is considered to be a major factor of the current spread of infection.

Future outlook and measures to be taken

• Emergency measures and priority measures have been taken. While the existing strains have been replaced by the Delta variant, the reduction in the de facto population is limited and the number of infections is increasing on an unprecedented scale; the number of severe patients is also rapidly increasing. Attention should be paid to the increase in absolute numbers of not only relatively young severe patients, but of patients in their 60s as well.
• The spread of infection has entered a hitherto unseen phase. Enhancement of medical care provision systems and public health systems provides only limited care to adequately respond to the recent situations of infection, and there are cases where general medical services, such as care in intensive care units or emergency transportation, become difficult to perform. There is concern that a critical situation where many lives cannot be saved will occur and it is necessary to contain the current spread of infection as promptly as possible. Again, it is necessary to address this situation by sharing a sense of crisis between the government and citizens, and to promptly further reduce situations of contact.

1. ★ Please refrain from moving across prefectures and outings in the Obon holiday: consider postponement of visit your hometown during this holiday

   It is necessary to reduce the opportunities for infection as much as possible. Opportunities to meet with people to whom one does not usually meet increase the risk of infection. To protect ourselves and families, it is necessary to refrain from moving across prefectures and outings as much as possible, and to stay with our own families during the Obon holiday, which starts this week, as well as during summer vacation.

2. ★ Thorough basic measures against infection

   The infection is rapidly spreading to workplaces and schools as well as commercial facilities in various regions. It is necessary to continue to take thorough measures for scenes of eating and drinking, and to thoroughly prevent transmission to home and workplaces due to eating and drinking behaviors. Even for those who have already been vaccinated, it should be reminded that guidelines for each industry should be thoroughly implemented once more. This includes the tightening of infection control in offices, conducting meetings online, promoting telework (especially for persons with underlying diseases and pregnant women), and encouraging voluntary restraint of persons with symptoms on going to the office; in addition to basic practices for infection control, such as wearing a mask, hand washing, and keeping social distances, and ventilation. Furthermore, it is necessary to encourage people to visit a hospital early, receive tests proactively and recuperate appropriately, in case of feeling physically sick, even for mild cold symptoms. Proactive vaccination should be continued in addition to these basic measures.

3. ★ Maximize effective use of medical resources

   In regions where the infection is rapidly spreading, prefectures should lead in making full use of medical resources to use new neutralizing antibody drugs with fast-track approval and promptly organize a system for quick responses to exacerbation based on the newly presented “Concept of Treatments for Patients” according to each reginal situation in order to secure required medical care. Furthermore, it is necessary to promote measures including a system of nighttime emergency services on the assumption that rapid increase of infection will continue nationwide. In addition, it is necessary to promptly organize and take action regarding handling persons who have close contact with infected persons through healthcare workers.

4. ★ Promotion of testing

   When an individual receives a positive PCR test or antigen test, it is considered that doctors and medical institutions should urge persons who may have close contact with the pertinent person to undergo a test even without a determination by public health center.

Figures (Number of new infections reported etc.) (PDF)