Print

105th Meeting of the COVID-19 Advisory Board of the Ministry of Health, Labour and Welfare (November 9, 2022) Material 1

 

Evaluation of the latest infection status, etc.

Overview of the infection status

  • The number of new cases of infection nationwide (by date of report) was approximately 338 per 100,000 of the population in the last week, showing an increasing trend with a ratio of this week to last week of 1.40 and regional differences.
    It is also necessary to pay attention to the future impact of increased contact opportunities due to the reactivation of socioeconomic activities on the infection status.
  • The use rate of beds is increasing nationwide, and the number of severe cases is increasing, but the number of deaths has remained flat.

Reference: Local trend

* The number of new cases of infection is an approximate figure per 100,000 of the population, as the total for the current week, which is the reported number in HER-SYS as of Nov 8, 00:00 AM (the same time point is used for the ratio to the previous week), and the use rate of beds is a figure as of the writing of this document on Nov 8.

Infection status and future outlook

Infection status
  • Nationwide, the number of new cases of infection has increased and the ratio to the previous week is over 1.0. On the other hand, at present, the increase has not been rapid compared to the time of infection expansion this summer.
  • There are regional differences in the current status of infection. In Hokkaido, the level was high around the peak of infection spread in the summer this year, and there has been an increase in many regions including the Tohoku, Hokuriku, Koshinetsu and Chugoku regions. In contrast, the numbers per 100,000 of the population in the Tokyo metropolitan area, Kyushu and Okinawa are lower than the national average. There are also still mass infections in some facilities for elderly people and medical institutions.
  • The number of new cases of infection per population in each age group is higher in younger age groups including teens. In areas where the number of new cases of infection is high, the increase is especially large among teenagers and young people. The number of new cases of infection and severe cases among elderly people has also been increasing and the number of deaths has leveled off.
  • As the provisional report of deaths among children since January this year suggests, attention must be paid to the occurrence of severe cases and deaths associated with an increase in the number of infected children.
    Attention should also be paid to trends in the number of pediatric inpatients.
Future outlook
  • Regarding the future infection status, the number of cases of infection may continue to increase and lead to spreading of the infection, as in the summer this year, despite regional differences and uncertainty, based on the short-term forecast in large cities. It is also necessary to pay attention to the future impact of increased contact opportunities due to reactivation of socioeconomic activities on the infection status.
  • The level of seasonal influenza is low at present, but attention needs to be paid to future changes including simultaneous occurrence with the novel coronavirus infection.
Factors that increase and suppress infection
  1. [Immunity as a result of vaccination and infection]

    Immunity acquired both from vaccination and natural infection may decline over time. Although the vaccination rate is higher among people in their 60s and older than those in their 20s to 40s, the acquisition of immunity by infection is lower, and there is concern about the spread of infection among elderly people.

  2. [Contact patterns]

    Although there are regional differences, the nighttime population has remained almost flat recently. There is concern about increased contact opportunities due to the reactivation of socioeconomic activities toward the end of the year.

  3. [Epidemic strain]

    In Japan, the BA.5 lineage has largely become mainstream. It is necessary to pay close attention to the strains that have been pointed out to be dominant in the increase in the number of infected persons overseas, such as BQ.1 and BQ.1.1 lineages (sublineages of the BA.5.3 lineage), as the proportion may increase further in the future.

  4. [Climatic and seasonal factors]

    Weather conditions are currently favorable for ventilation, but proper ventilation may be difficult due to a decline in temperature in the days ahead.
    In addition, respiratory virus infections tend to increase in winter.

Situation of the medical care provision system
  • Nationwide, the use of beds tended to increase, exceeding 30% in regions with a large number of infected patients. The use rate of beds for severe cases is at a low level, but we need to watch for effects associated with a further increase in the number of new cases of infection in the future.
  • In the field of nursing care, patients are being treated in facilities and infection is seen among elderly people and workers.
  • Cases of problems with emergency transportation have been increasing nationwide both for suspected non-COVID-19 cases and suspected COVID-19 cases and in some areas the problem is severe.

Measures to be taken

Basic concepts
  • To address re-spreading of the novel coronavirus infection and simultaneous seasonal influenza epidemics, measures to strengthen and focus the healthcare system should be taken in case of limited medical resources to provide appropriate medical care to elderly people and persons at risk of aggravation.
  • Each citizen will be asked to take voluntary actions to prevent infection, and strengthening and prioritization of the health care system will be promoted to protect those at high risk of aggravation, such as elderly people, and to ensure regular medical care.
  • The national and local governments will remind the public of the need for routine infection control measures, and take measures to support the public's efforts to prevent infection.
  1. 1. Further promotion of vaccinations
    • As for the “vaccine for the Omicron variant," vaccination of all persons aged 12 and over who have completed the first vaccination should proceed.
    • Vaccination for the BA.4 and BA.5 lineages has also started. As both vaccines for the BA.1 and the BA.4 and BA.5 lineages are expected to be more effective than the previous vaccines, it is necessary to proceed with vaccination with the vaccine that can be given sooner. As the vaccination interval from the last vaccination was shortened from 5 to 3 months, all eligible persons who wish to receive vaccination will be asked to receive the vaccine for the Omicron variant within this year.
    • Those who have not received vaccination will be encouraged to consider getting the initial vaccination as soon as possible.
    • For children (ages 5 to 11), booster vaccinations will be promoted along with the initial vaccination.
    • The initial vaccination for children (aged 6 months to 4 years) has been approved by the PMDA and positioned as an extraordinary vaccination, and initial vaccination in this age group will proceed.
  2. 2. Use of tests
    • Based on the recommendations of the 17th meeting of the Novel Coronavirus Subcommittee, the national and local governments are required to secure a system that enables testing, and further utilize testing.
    • Perform frequent tests (about 2 or 3 times a week for facility workers) for workers at facilities for elderly people.
    • Establishment of a system for fever outpatients should be further promoted, so that patients with symptoms can self-test using an antigen qualitative test kit, and if the result is positive, they can promptly undergo health observation at a health follow-up center, etc.
    • Further promotion of the utilization of antigen qualitative test kits, which have been switched to OTC and are sold on the internet.
  3. 3. Securing a medical care provision system
    • Prefectural governments must take measures to avoid overcrowding of beds and fever outpatient sections with the support of the national government.
    • In addition to facilitating the use of available hospital beds and developing temporary medical facilities to supplement hospital beds, making efforts to avoid a shortage of hospital beds and emergency medical care, such as utilization of lodging facilities and resting beds
    • Making appropriate adjustments so that patients requiring inpatient treatment can be hospitalized preferentially, performing frequent tests at facilities for elderly people, etc., and further strengthening medical support
    • Securing and expanding logistical support hospitals, and improving the hospital turnover rate, such as by dissemination of the standard for early discharge of 4 days, as a rule
    • Promotion of effective and less burdensome measures against infection, such as flexible and efficient use of hospital beds through zoning of each hospital room
    • Expansion and promotion of fever outpatient services, including the use of online medical care, etc., and further promotion of the development of a “fever outpatient self-examination system”
    • Local residents should be informed that they should refrain from visiting an emergency outpatient unit only to receive a precautionary examination without symptoms, according to the actual situation in the region. In addition, in order to respond to concerns and questions at the time of worsening physical conditions, the consultation service by healthcare professionals via telephone should be thoroughly publicized, and this service should also be strengthened.
    • Ensuring that workplaces and schools do not require test certificates at the start of medical treatment
  4. 4. Response to simultaneous epidemics of novel coronavirus infection and seasonal influenza
    • Assuming that there are also many patients with fever during simultaneous epidemics, the following measures should be promoted according to the actual situation of each region: strengthening of fever outpatient clinics, strengthening of telephone and online examination services in preparation for cases of overcrowding at fever outpatient clinics, smooth supply of therapeutic drugs, expansion of health follow-up centers, securing of self-examination kits, and strengthening of the consultation system.
    • The prefectures will formulate plans to establish systems such as strengthening of outpatient medical care systems in accordance with the actual conditions in each region.
    • Efforts will also be made to provide information to the public and to call for cooperation at outpatient consultations/treatment depending on the risk of becoming severe and prepare antigen qualitative test kits and antipyretic analgesics, etc. from an early stage.
    • To prevent the infection of infected patients from becoming severe as far as possible, vaccination against the novel coronavirus as well as the influenza virus should also be promoted among the target population for vaccination.
    • In case the number of infected persons sharply increases and hospitals are overcrowded, or changes in the characteristics of the viruses increase their pathogenicity, measures depending on the situation are required, including requests/calls for residents and business operators to prevent spreading of the infection and to maintain the functions of the medical system, as well as highly effective measures to prevent the spread of infection including behavioral restrictions.
  5. 5. Surveillance
    • Deterioration of the accuracy of current surveillance is a concern due to the limited scope of notification, prioritization of notification items, delays in testing and diagnosis/reporting due to many infections, and changes in healthcare-seeking behavior. It is necessary to promptly promote consideration of effective and appropriate surveillance to grasp the epidemic status.
      It is also necessary to continue monitoring the trends of variants through genomic surveillance.
  6. 6. Effective ventilation
    • Based on the recommendations of the 17th meeting of the Novel Coronavirus Subcommittee, it is necessary to publicize and recommend effective ventilation methods to prevent insufficient indoor ventilation (how to create airflow considering aerosols, installation of partitions that do not block airflow, etc.).
  7. 7. Re-inspection and implementation of basic infection control

    Re-inspection and implementation of the following basic infection control measures are needed.

    • Continue proper wearing of nonwoven masks according to the situation, hand hygiene, thorough ventilation, etc.
    • Avoid situations with a high risk of infection, such as the three Cs, congestion, or loud voices.
    • Eating and drinking should be done with as few people as possible, and masks should be worn except while eating and drinking.
    • People with symptoms such as sore throat, cough, and fever should refrain from going out.
    • Refer to guidelines for hospital visits and use of an ambulance.
    • Prepare antigen qualitative test kits/antipyretic analgesic at home, etc.
    • To reduce the chances of contact as far as possible, it is necessary for measures at the workplace, such as again promoting the use of telework.
    • Organizers of events or meetings should fully evaluate the epidemic situation and risk of infection in the area and consider whether or not to hold the event. If the event is held, measures should be taken to minimize the infection risk.
    • Since the risk of infection remains during the shortened period of home care of those who test positive, they should monitor their own physical condition, such as measuring their own temperature, and taking thorough measures against infection when going out. They must also be asked to avoid contact with people who are at risk of severe disease, such as elderly people.
    • To allow the minimum necessary outings, such as shopping for groceries, after 24 hours have passed since symptoms have subsided or when there are no symptoms, it is necessary to take voluntary actions to prevent infection, such as wearing a mask when going out, keeping contact with other people at the minimum period of time necessary, and not using public transportation.
<< Reference: Findings on the characteristics of the Omicron variant and its sublineages >>
  1. [Infectivity/transmissibility]

    It has been confirmed that compared to the Delta variant, the generation time has shortened to approximately 2 days (approximately 5 days for Delta). The doubling time and incubation period have also shortened, the risk of re-infection and secondary infection after infection has increased, and the speed of infection spread is very fast. According to the reported data, pre-symptomatic transmission has probably occurred to some extent as with the previous strains.

  2. [Place/route of infection]

    In Japan, many cases of infection have occurred through the same opportunities as before (spending time indoors in locations with inadequate ventilation, eating and drinking, etc.), and infection is considered to have occurred via the same routes as before (droplets adhering to the mucosa, aerosol inhalation, contact infection, etc.).

  3. [Severity, etc.]

    It has been suggested that infection with the Omicron variant presents a lower risk of hospitalization or aggravation than with the Delta variant. However, analyses to date show that there are more deaths due to infection with the Omicron variant than seasonal influenza. It also seems as if the incidence of pneumonia is higher than that of seasonal influenza, but given the limited data, it needs to be investigated by various analyses.

    Concerning the death toll from the previous outbreak, it is reported that there are many cases in which the novel coronavirus infection is not the direct cause of death compared to last summer's outbreak, for example, elderly people who have been in a facility for the elderly before the infection are infected but die due to worsening of the underlying disease. There were many cases of serious respiratory failure due to typical viral pneumonia caused by novel coronavirus infection from the beginning of the novel coronavirus outbreak until the Delta variant outbreak. However, during the Omicron variant outbreak, it was reported that other diseases than pneumonia are the main causes of death, such as exacerbation of the underlying disease that was present before hospitalization and the onset of other complications during hospitalization.

    In the current spread of infection, the rate of severe cases has decreased compared to the previous outbreak and the ratio of elderly people among hospitalized patients has increased compared to last summer's outbreak. Among the deaths during this outbreak, mechanical ventilation/nasal high flow use rates and steroid prescription rates have decreased compared to the previous outbreak.
    Among fatal cases in which endogenous death was identified in infected children, cases without underlying diseases were also found. Preliminary reports on the results of on-site investigations have stated that it is necessary to pay attention to neurological symptoms such as convulsions and disturbance of consciousness, and systemic symptoms other than respiratory symptoms such as vomiting and poor oral intake.

  4. [Virus shedding period]

    According to Japanese data, risk of infection remains until 10 days after onset, and infectivity is high until 7 days after onset. Even after waiting for 5 days, 1/3 of patients are still shedding infectious viruses. On Day 8 (after waiting 7 days), most patients (approximately 85%) had not shed infectious virus, and it was reported that even in those who shed the virus, the amount of virus decreased to one-sixth after 7 days compared to the initial stage.

  5. [Vaccine effect]

    For infection with the Omicron variant, the preventive effects of a first vaccination against infection and disease onset are markedly reduced. Its preventive effect on hospitalization is reported to be maintained at a certain level for the first 6 months, but subsequently decreases to 50% or less. On the other hand, it has been reported overseas that a third vaccination restores the infection-preventing effect, onset-preventing effect, and hospitalization-preventing effect against infection by the Omicron variant, and information on how these vaccine effects are attenuated after a third vaccination has become available. Regarding the fourth vaccination, it has been reported that while the aggravation-preventing effect was not reduced for 6 weeks, the infection-preventing effect lasted only for a short time.

  6. [Sublineages of the Omicron variant]

    While the BA.5 lineage continues to be mainstream in the world, there are many reports of sublineages of the Omicron variant and recombinants which have characteristic mutations in the spike protein. There are also sublineages for which superiority in an increase in infected patients has been indicated, including the BQ.1 and BQ.1.1 lineages (sublineages of the BA.5.3 lineage), which are frequently reported in Europe and the United States, as well as the XBB lineage (recombinant of the BJ.1 lineage [sublineage of the BA.2.10 lineage] and the BM.1.1.1 lineage [sublineage of the BA.2.75.3 lineage]), which has been reported mainly in India and Singapore. In Europe and the United States, the proportion of BQ.1 and BQ.1.1 lineages is increasing in some countries, and it is expected that the proportion will increase further in the future, but at present, a significant increase in the number of infected persons has not been confirmed. The World Health Organization (WHO), etc., points out that the immune escape of these variants may lead to dominance in increasing the number of infected persons, but the information obtained so far does not suggest that either the infectivity or seriousness of the variants is increasing. It is necessary to continue to collect data and analyze the situation and findings in other countries regarding these characteristics of the new sublineages and recombinants, and to continue monitoring by genome surveillance.

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

 

Copyright 1998 National Institute of Infectious Diseases, Japan