14th meeting of the COVID-19 advisory board of Ministry of Health, Labour and Welfare (November 19, 2020).   Document 4

Latest infection status, etc

Trends in the number of new infections

• The increasing trend of new infections has been stronger since November; it has increased more than twice within 2 weeks and has reached a record high. Although the infection has not spread considerably in some regions, remarkable increases in infection cases are observed especially in Hokkaido and the Tokyo metropolitan, Kansai, and Chubu areas, and these increases have led to a nationwide increase in infected cases. The spread of infection is accelerating. If this situation is left unsolved, it may even lead to rapid spreading of infection, and a severe situation is continuing.
     Effective reproduction number: On a national basis, it remains at a level exceeding 1. It basically remains at a level exceeding 1 in Hokkaido, Tokyo, Osaka, Aichi, etc.
• Clusters causing the spread of infection have been observed in the entertainment districts in local cities, as well as places where people eat/drink together, workplaces, communities of non-Japanese people, young people such as university students, medical facilities, and facilities for the elderly, etc., which indicate that they are spreading to other regions and diversifying. Potential clusters are also expected, and it is considered that clusters with infected persons who are difficult to detect or identify have contributed to the spread of infection.
• Although it is difficult to clearly determine the causes of such spread of infection, basic measures to prevent infection may not be taken properly, or an increase in the movement of people and a decrease in temperature under such circumstances may cause spread of the infection.
• On the other hand, the proportion of patients aged 60 years or older among the infected persons has remained stable although the number of infections is increasing. The number of inpatients and severe patients are increasing, and the bed occupancy rate is also increasing. If these conditions continue, it will be difficult to keep a balance with routine medical care, because it will inevitably be necessary to limit scheduled surgery, the acceptance of cases for emergency medical care, etc.

[Trends in regions where the infection has spread]

(1) Hokkaido Clusters occurred mainly in restaurants or nightclubs with hospitality services in Sapporo City; the infection spread, and also spread all over Hokkaido, including the suburbs of Sapporo City. Clusters increased in other places than restaurants or nightclubs with hospitality services, e.g., workplaces, schools, medical institutions and facilities for the elderly. It is becoming difficult to take actions for persons who have been in close contact with infected persons and the conditions are becoming severe. Conditions at medical institutions have also become severe, i.e., there are not enough available beds at medical institutions mainly in Sapporo City due to the increase in the number of patients and it has become difficult to adjust to the situation.

(2) Tokyo The infection is spreading all over Tokyo. The routes of infection include home infection, which occurs most frequently, followed by workplaces, facilities for the elderly, and places where people eat/drink together; the proportion of cases with an unknown infection route is more than half. Increased socioeconomic activities may increase the chances of enhancing the risk of the spread of infection mainly in young people, and the scenes of infection may have become diversified, including universities, etc..

(3) Osaka The infection is spreading all over Osaka. The proportion of cases with an unknown infection route is approximately 60%. Cases of infection have been identified in various scenes, e.g., between persons involved in/visitors at entertainment districts, at home, and in offices. Clusters occurred at facilities for the elderly, medical institutions, schools, etc..

(4) Aichi The infection is spreading all over Aichi. The proportion of cases with an unknown infection route is approximately 40%. In Nagoya City, infected persons have increased mainly in entertainment districts, and the burden on health centers has increased. The age of infected persons and the places where infection occurred have diversified, and infections have also occurred during extracurricular activities of universities, e.g., at facilities for the elderly. It has also become severe to take actions at medical institutions. Clusters other than those in Nagoya City have also been diversified and have sporadically occurred among communities of non-Japanese people, at universities, and in facilities for the elderly.

In some regions of Hokkaido, it is considered that strong measures such as reducing contact opportunities and restricting behavior are required. In Tokyo, Osaka, and Aichi, the conditions are almost reaching a state where such strong measures are required.

Future actions

• The increasing trend in infections is becoming strong; and to maintain the public health system and medical care provision system other than the measures against novel coronavirus infection, it is necessary to achieve a downward trend in the infections as soon as possible.
• It is urgent to take actions against diversifying clusters. Appropriate actions will be taken according to the situation for restaurants and nightclubs with group eating/drinking and hospitality services, workplaces, young people such as university students, communities of non-Japanese people, medical institutions and facilities for the elderly. Actions against clusters that are difficult to detect are also necessary.
• Based on an urgent proposal by the subcommittee on November 9, we need to take steady actions according to the characteristics of the clusters (e.g., thorough approach at restaurants and nightclubs providing hospitality services, and support for communities of non-Japanese people who have difficulty to receive medical care, etc.), as well as prompt actions (e.g., thorough testing at medical institutions and facilities for the elderly where infections are increasing).
• Therefore, as suggested under “Further Reinforcement of Measures Against Clusters to Respond to the Recent Spread of Infection” in a discussion at the government Headquarters on November 16, it is necessary to promptly take such actions as (1) to request for cooperation by the business operators of local public bodies and support for the cooperation, (2) measures against clusters that are difficult to detect early, (3) to secure a testing/medical care provision system, and (4) to secure personnel/support for health centers.
• In addition to these cluster measures, it is of utmost importance that individuals and business operators thoroughly take basic infection prevention measures to strengthen the “factors to reduce” infections. Information such as the “Five Scenes” where the risk of infection increases need to be provided mainly to young people who frequently go places and do many things. In addition, it is also necessary to enhance providing information that will change people’s actual behavior, including the thorough wearing of a mask, also at scenes of eating and drinking, and to thoroughly conform to the guidelines for each industry such as restaurants. Such basic infection prevention measures need to be thoroughly taken to prevent the movement of people from becoming a risk for the spread of infection.
• While such actions are taken, there is concern about situations where infections cannot be addressed only by taking these measures against clusters or thoroughly keeping basic measures against infection. It is necessary that each prefectural government should take prompt and necessary actions to concentrate on the status of beds, etc. for any regions where the infection is rapidly expanding in each prefecture and to take actions limited to regions, not only for the overall trend of prefecture.
• If the rapid spread of infection cannot be avoided and there are signs that hospital beds are being overwhelmed, etc. in the future, it will be necessary to promptly take even stronger measures. To avoid such situations, it is necessary for the public to unite and take measures.
• In the future situation of increasing infection, it will also be required to fulfill the necessary functions of consultation systems for DV, sexual violence, suicide, etc. Consideration should also be given to the influences on women and children when making decisions on whether to close schools and kindergartens/nursery schools.

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