Evaluation of current status
On current status
- Number of new cases had plateaued nationally after peaking in the first week of August; however, it has shown an increasing trend since October and that trend has further increased in November. Especially the increases have been prominent in Hokkaido, Osaka, and Aichi, which is leading to a national increase in number of transmissions
- Effective reproductive rate: It has remained above 1 nationally. In places like Hokkaido, Osaka, and Aichi, it has remained over 1. Tokyo has been fluctuating around 1.
- Clusters, which are the sources of increase in transmissions, have been expanding and becoming more variable in setting in addition to nightlife industries in large cities outside of Tokyo to social gatherings and work places as well as foreign nationals’ communities, medical institutions, and social welfare facilities. In certain areas, rate of increase in transmissions have increased. It is necessary to strengthen transmission “reduction factors”. If things are left as is, it is possible that the transmissions could increase rapidly.
- On the other hand, the portion of patients over the age of 60 has remained steady. Bed occupancy in hospitals has remained steady as well, but hospitalizations and severe cases have been around 10%. However, hospitalizations and severe cases have increased since end of October, and in some areas, bed occupancy has been increasing and caution is necessary.
- While the death rate and severe cases have been relatively low through layers of measures by citizens, healthcare workers, public health labs, and businesses as well as standardization of treatment, in order to avoid overburdening our public health systems and medical care systems, transmissions need to trend downward as quickly as possible.
- In regions where increase in transmissions are occurring, cluster formation causes should be analyzed by region and response should be implemented. Measures to secure public health lab capacity and medical care capacity in such regions as cases increase are needed as well as support for such measures.
- While we see an increase in variation of clusters and expansion in geography, it is important to 1) further strengthen cluster response and 2) thorough implementation of basic transmission risk reduction measures (such as strengthening public communication that can lead to the public behavior change such as leveraging “5 situations”) to strengthen transmission “reduction factors” .
- Based on Expert Panel’s recommendations, response based on cluster characteristics, such as strengthening measures for restaurants that involve entertainment as well as providing more support for communities of foreign nationals who face more challenges in receiving medical care should be implemented. In addition, quickly ramping up more testing at medical institutions, etc. as well as sharing of cluster information would be necessary.
- Also, for those entering from overseas, information should be provided on quarantine as well as what needs to be reported to local municipalities, how to receive care when symptoms appear, etc. based on their specific needs. Similarly, support should be provided to local municipalities as well as medical care facilities.
- Even through implementation of such measures, if there is a rapid increase in transmissions or number of available beds become scarce, a more severe response to limit a certain level of social and economic activity may be needed. In order to avoid such situation, citizens need to come together to respond to the current situation.
Specific action recommendations
Action1: Strengthen cluster response
- Put in place effective and efficient response that addresses the characteristics of each type of cluster (e.g., dining establishments with entertainment, communities of foreign nationals, higher education institutions (universities and trade schools, etc.), work places)
- In order to identify clusters that are “difficult to identify”, “Event-based surveillance (EBS)” should be implemented. Local municipalities can leverage the council in each prefecture and work with senior centers as well as medical care facilities as well as use analysis systems that use absence/transmission information systems among schools and use SNS data.
- Quickly establish a system that can rapidly share ①Date of onset, ② Real time information of cluster occurrence, and ③ Good practices for cluster response among local municipalities as well as with the country.
- 1) Response based on each type of cluster
[Dining establishments with entertainment]
- All local municipalities around the country has received a report from the “Nightlife Industries Working Group” that shows policies going forward. Going forward, this policy will be promoted and Cabinet Office as well as Nightlife Industries Working Group will provide guidance to local municipalities around their response implementation. When there are clusters in nightlife districts, including non-Tokyo metropolitan cities, a mass/regionally concentrated PCR testing efforts will be promoted
[Communities of foreign nationals]
- National government as well as local municipalities will work towards communicating to the public in multiple languages/easier Japanese in order to prevent transmissions and increase in transmissions among foreign nationals residing in Japan. In addition, will work with embassies of various countries as well as use SNS to provide more information and promote appropriate transmission prevention measures for foreign nationals in Japan. In addition, establish ab advice line, etc. and provide necessary advice in conjunction with public health labs as well as NPOs so that foreign nationals can have early access to medical care (will be discussed at Expert Panel this month)
[Higher education (universities, trade schools, etc.)]
- Request to local municipalities that, in collaboration with health management centers, etc. who are responding to inquiries from students in their areas, promote transmission risk reduction through educating and informing people of how to respond if clusters occur while emphasizing the need for maintaining learning opportunities. Also to work towards quickly ramping up testing when needed.
- Request to higher education institutions to increase messaging around high risk activities (e.g., dining together or drinking together, etc.) and ensure increased awareness of 5 high risk situations” among students, etc.
- Based on expertise from experts such as Japan Society for Occupational Health, conduct public information campaign through labor organizations and industry organizations so that appropriate cluster response can be implemented based on each work places’ circumstance
- 2) Event based surveillance
- Share specific recommendations based on expert opinions with local municipalities so that each local municipality can implement “event based surveillance”
- Through analysis of data from SNS, etc., early detect and predict increase in transmissions
- 3) Build a system to rapidly share information among local municipalities and with national government
- Collect cases where there was success in early containment of clusters, etc. and share widely. Also continue to work towards leveraging HER-SYS.
- Going forward, also work towards sharing good practices and statuses of cluster occurrence among local municipalities by working with meeting of prefectural governors
Action 2: Interactive information dissemination
- Spread information in a format that is interesting, especially among younger generations and those who attend year end parties/new year parties, on “5 high risk situations” and “how to enjoy social gatherings while reducing risk”. In doing so, leverage SNS including platforms where videos can be posted
- Disseminate information with understanding for how the recipient might feel, and check that that impact of effect might be
- Share information around “5 high risk situations” and “how to enjoy social gatherings while reducing risk” on platforms such as special COVID information website (corona.go.jp). Establish special websites for year end/new years and create effective PR campaigns
- Leverage SNS, celebrity COVID response supporters, and advertisements to create information campaign that can interest citizens including younger generations
- Get support from experts in risk communication, etc. and get advice on how to understand behavior patterns of younger generations and create messaging that understands the feelings and reception of such messages of recipients
Action 3: Thorough implementation of prevention measures at stores and work places
- Businesses should consider where “5 high risk situations” might be occurring in their stores or work places, and implement recommended guidelines for each industry. In doing so, work together with local shopping malls and organizations. Based on past experiences, improve implementation of industry specific guidelines.
- As we go into winter months, to improve prevention measures such as ventilation especially in colder regions, specific indicators should be shown such as monitoring of CO2 levels especially in restaurants.
- A system of PDCA should be established to ensure implementation of industry specific guidelines from the perspective of strengthening activities to protect the industries as well as preventing cluster formation/re-formation as they monitor cluster occurrence data.
- With regards to prevention measures in colder regions, in order to maintain social and economic activities while preventing transmissions, appropriate ventilation and humidity management should be summarized based on expert knowledge and be disseminated widely
Action 4: Strengthening activities to re-start international flow of people
- As these activities will need to be done in coordination between measures at borders and local municipalities, the national government should 1) quickly summarize and publicize information on countries where people have stayed, tests by region, number of people tested, etc., and 2) provide information that will be pertinent to local municipalities’ efforts in quarantine.
- The national government should quickly establish a system that can help local municipalities to follow up foreign national travelers. Also, at time of quarantine, basic information on monitoring health, etc. should be translated to multiple languages and be shared.
- Strengthen support for medical facilities that can accept foreign nationals
- Publish information on website regarding countries stayed, number of tests conducted by region, number of tests conducted, and number of positive cases through quarantine. In addition, expedite provision of each arrival’s health survey information to local municipalities by improving operations, etc.
- Currently, information is being shared in multiple languages regarding health check follow ups from public health labs during the 14 day quarantine that arrivals receive. Improvements should be made to further increase awareness
- Strengthen support for receiving foreign nationals at medical facilities, such as increasing phone-based translating services, etc.
- Provide support so that phone based translating services can also be used in tasks conducted by public health labs
Action 5: Promote genomic analysis to evaluate prevention measures
By sequencing DNA of the virus, not only the origin of clusters can be identified, but also can be used to evaluate the prevention measures. As such, 1) Share information with National Institute of Infectious Diseases after Local Health Institutes have sequenced DNA, or 2) Local Health Institutes to send samples to National Institute of Infectious Diseases for sequencing, and in such cases, 3) also provide location specific epidemiological information.
- Based on sample collection status at various local municipalities, request to local municipalities to send samples to National Institute of Infectious Diseases. In addition, request support from private testing institutions, etc. to collect samples widely.