48th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (August 18, 2021).  Material 1

Evaluation of the latest infection status, etc.

Infection status

• The number of new cases of infection nationwide continues to reach record highs, with approximately 101 per 100,000 population for the latest week of reporting dates. The spread of infection has not stopped, and 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 is rapidly increasing, making it the largest ever. 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 continues to be close to disaster levels.

  Effective reproduction number: On a national basis, it remains above 1 at 1.15 most recently (as of August 1). The figure is 1.11 in the Tokyo metropolitan area and 1.16 in 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 continue in Tokyo. The number of new cases of infection is still increasing and has become approximately 228, with the ratio of this week to last week of 1.14.* The largest-ever spread of infection is continuing. The infection is spreading mainly in persons in their 20s to 40s, and the number of elderly persons and people in their teens and under 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 60s. The numbers of inpatients and severe patients continue to reach record highs, and there are cases where 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 149, 138, and 160, 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 has steadily decreased in Tokyo, it has not reached the level during the period under the previous declaration. The nighttime population has continued to decrease in Saitama, Chiba, and Kanagawa. Attention should be paid as to whether decrease in the de facto population leads to a decrease in the number of new cases of infection.

2. Okinawa

   Emergency measures continue to be taken. The number of new cases of infection continues to increase and has become approximately 312, which is the highest nationwide and at an unprecedentedly high level, with a rate of this week to last week of 1.26.* New cases are mainly in those in their 20s to 30s. The use rate of beds and the use rate of beds for severe patients are in severe situations at more than 80%, those for whom arrangement is being made are increasing. The nighttime population tends to increase again after the start of the Obon holidays, and the spread of infection may continue.

3. Kansai area

   In Osaka, the number of new cases of infection was approximately 126, with a rapidly increasing ratio of this week to last week at 1.46. 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 tended to decrease. Attention should be paid as to whether it leads to a decrease in the number of new cases of infection.

   In Shiga, Kyoto and Hyogo, the number of new cases of infection is still in an increasing trend, reaching approximately 76, 104, and 81, respectively. The number of inpatients rapidly increased across all prefectures. In Kyoto, the use rate of beds fore severe patients is rising rapidly, and the situation is severe. The nighttime population is slightly decreasing in Shiga and staying flat in Kyoto. In Hyogo, there is a sharp decrease. Attention should be paid as to whether the decrease in the area leads to a decrease in the number of new cases of infection.

   The trend of rapid increase in the number of new cases of infection is also continuing in Nara with the figure reaching approximately 63. In Wakayama also, the number of new cases of infection turns upward, reaching approximately 34.

4. Hokkaido

   The number of new cases of infection is increasing and has become approximately 55 (approximately 85 in Sapporo City), with a ratio of this week to last week at 1.26. The use rate of beds for severe patients remains below 20%. The nighttime population has decreased but remains at a high level, and the spread of infection may continue.

   * Regarding the number of newly infected people in the Tokyo metropolitan area and Okinawa prefecture, it has been pointed out that the actual number of infected people is underestimated when the positive rate of tests is rising, so caution is required in trend analysis.

5. North Kanto

   The number of new cases of infection is still in a trend of increase in Ibaraki, Tochigi and Gunma, reaching approximately 65, 55 and 69, respectively. In each case, the number of inpatients and the number of severe patients are increasing, and the use rate of beds is in a severe situation. The nighttime population has been flat recently in Ibaraki, but the others tended to decrease. Attention should be paid as to whether the trend leads to a decrease in new cases of infection.

6. Chukyo/Tokai

   In Aichi, the number of new cases of infection continued to increase at a rapid rate and reached approximately 62, with the ratio of this week to last week at 1.90. In Shizuoka, the number of new cases of infection was approximately 66, with a rapidly increasing ratio of this week to last week at 1.74. In each case, the numbers of inpatients and severe patients continue to increase. In each case, the nighttime population decreased. Attention should be paid as to whether it leads to a decrease in new cases of infection.

   The number of new cases of infection shows rapid increases also in Gifu and Mie, reaching approximately 54 and 56, respectively. In particular, in Gifu, ratio of this week to last week continued to exceed 2.

7. Kyushu

   In Fukuoka, the number of new cases of infection has shown an increasing trend and reached approximately 112, with the ratio of this week to last week at 1.18. The number of inpatients continues to increase and the situation is severe. The use rate of beds for severe patients is below 20%. The nighttime population is decreasing rapidly. Attention should be paid as to whether it leads to a decrease in the number of new cases of infection.

   In Kumamoto and Kagoshima, the number of new cases of infection has been increasing to approximately 77 and 70, respectively. Especially in Kagoshima, the ratio of this week to last week rapidly increased and exceeded 2. In Kagoshima, the use rate of beds exceeds 50%, and the situation is severe.

   Rapid increase in the number of new cases of infection is observed in other prefectures. In Saga, Nagasaki, Oita, and Miyazaki, the figure has exceeded 25, reaching approximately 76, 33, 58 and 37, respectively, and the spread of infection is especially rapid in Saga and Oita.

8. Other areas subject to priority measures

   In Fukushima, the number of new cases of infection has been increasing at a rapid rate and reached approximately 45, with the ratio of this week to last week at 1.40. The use rate of beds has exceeded 50%; the situations is severe. The nighttime population decreased. Attention should be paid as to whether it leads to a decrease in new cases of infection. In Ishikawa, the number of new cases of infection has stopped decreasing and was approximately 47. The nighttime population has decreased but the movement is slow, and there is concern that infection may spread again.

   In addition, in Miyagi, Toyama, Yamanashi, Okayama, Hiroshima, Kagawa, and Ehime, which were newly designated as areas of priority measures, the number of new cases of infection continues to rapidly increase, at approximately 51, 45, 60, 63, 42, 51, and 38, respectively. In particular, in Miyagi, Toyama, Okayama, Hiroshima, Kagawa, and Ehime, the ratio of this week to last week has increased rapidly to over 1.5. In Miyagi, Yamanashi, and Kagawa, the use rate of beds exceeds 50%, and the situation is severe.

9. Other than the above

   The number of new cases of infection rapidly increased in many other regions; especially in Aomori, Niigata, Nagano, Yamaguchi, and Kochi, the figure was approximately 27, 27, 30, 29, 26, and 25, respectively, which exceeded 25, indicating rapid spread of infection.

Analysis of mutant strains

• For the B.1.617.2 lineage variant (Delta variant), the positive rate in the screening tests (mechanical estimation, August 2 to August 8) is approximately 79%. Recently, it is estimated that it exceeds 90% in each region, and it is considered that the B.1.1.7 variant (Alpha variant) has almost been replaced, except in some regions.

Future outlook and measures to be taken

• Despite the continuation and expansion of emergency measures and priority measures taken so far, the reduction in the de facto population is limited, the replacement with the Delta variant is progressing, the number of infected people is increasing nationwide on an unprecedented scale, and it is expected that the number of infected people will increase further due to the effects of Obon holidays. Under these circumstances, the number of severe patients has reached a record high, and the number of deaths is beginning to increase, but the number of elderly infected people is also increasing, and there is concern that the number of deaths will further increase in the future. It is necessary to take action based on the recognition that the situation is at a disaster level nationwide.
• However, there are limits to the expansion of the medical care system and public health system. It has become difficult to arrange hospitalization for moderate and severe patients, and there are cases where general medical care such as surgery is restricted and transportation in emergencies is difficult. If the situation is left as it is, there is fear of a critical situation in which lives that could be saved will not be, and it is necessary to promptly suppress the spread of the current infection as soon as possible. In order to promptly reduce the number of new infections, it is necessary to further reduce the opportunities for contact, strengthen the medical care system, prioritize public health center operations, and strengthen support.
• Although the daytime and nighttime populations tend to decrease, it has not reached 50% of the population immediately before the declaration of emergency, and there are many people in the 40 to 64 years old group. In many areas, the PCR positive rate is 20% or more, and it is considered that the number of infected persons is not adequately grasped by the test. The government and citizens share a sense of crisis that the highly infectious Delta variant is a virus of a different level than before, and further efforts are now needed.
• For this reason, based on the revised basic treatment policy and the proposal of the new coronavirus infectious disease countermeasures subcommittee on August 12, the national and local governments must further strengthen the countermeasures thus far and make detailed calls, and reduce contact opportunities by reducing the number of outings in the lives of citizens to less than half and avoiding crowded places.

1. ★ [Measures required in citizens' lives] Refrain from traveling or going out across prefectural borders, and avoid meeting people you do not normally meet

   Opportunities to meet people who do not usually meet have been shown to increase the risk of infection, and it is necessary to reduce such chances of infection as much as possible.

   Citizens, including those who have already been vaccinated, should refrain from moving or going out across prefectures and spend at home as much as possible in order to protect themselves and their families.

2. ★ [Social measures] Thorough basic measures against infection

   In particular, working age groups are in the process of vaccination, and 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. 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 also be continued.

3. ★ [Measures for the medical system] Maximize the efficient use of medical resources in the face of the ongoing crisis

   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 according to each regional situation in order to secure required medical care. In addition, on the premise that the severe infection situation will continue nationwide for at least the time being, it is necessary to take immediate measures, including the use of Article 16-2 of the revised Infectious Diseases Control Law and the establishment of temporary medical facilities.

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