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Tokyo to raise coronavirus alert to highest level following infection surge

Japan gov't use of 2013 action plan led to insufficient access to PCR testing

TOKYO -- As many people in Japan are voicing anxiety and frustrations over high hurdles for receiving polymerase chain reaction (PCR) tests despite suffering from suspected symptoms of the novel coronavirus, it has emerged that the government failed to flexibly respond to the pandemic after basing its measures on a 2013 action plan for a potential infectious disease pandemic.

While the strategy indicated border control and countermeasures in the event of a new infectious virus making it into Japan, it did not anticipate carrying out PCR testing in large volumes in the first place.

According to "Our World in Data" released by researchers at Oxford University, the total number of PCR tests per population of 1,000 stood at 2.42 in Japan as of May 6, well below the figures for Italy at 38.22, the United States at 23.52 and South Korea at 12.54. Japan's figure is even less than the 2.77 for Taiwan, which is said to have succeeded in curbing infections.

As there are cases in Japan where people with suspected coronavirus symptoms died during self-isolation at home while being unable to undergo PCR testing, there is strong public criticism against the government.

During a government liaison council meeting held at the prime minister's office in late March, Prime Minister Shinzo Abe addressed the attendees, "I want you to make sure that people can undergo testing without fail if doctors deem it necessary. Although there are fewer tests on some days, testing should be steadily conducted." However, a government expert panel had indicated on Feb. 17 a list of rough standards for "consulting and visiting medical institutions" over suspected coronavirus symptoms, such as having a fever of at least 37.5 degrees Celsius for four or more continual days. It was obvious that the panel was aiming to curb examinations as a precondition for PCR testing. On May 8, however, the controversial "37.5 degrees Celsius" yardstick was deleted from the list under the new guidelines on the grounds that normal body temperature varies between individuals.

In reality, the policy of restricting PCR testing had already been decided under an action plan based on the special measures law on new types of influenza and other infectious diseases. The action plan envisaged five phases -- the pre-outbreak phase; the overseas outbreak phase; the early phase of a domestic outbreak; the domestic pandemic phase; and the remission phase. With regard to PCR testing in the early phase of a domestic outbreak, the action plan stated that "when the number of patients has increased, such tests should be limited to severe cases."

The action plan also stipulated the need to "curb the expansion of infection and delay the epidemic peak so as to secure sufficient time to develop a relevant medical care system and produce a vaccine." This strategy served as the basis for a policy decided by the expert panel on Feb. 24 to "concentrate limited resources on severe cases." A senior official at the prime minister's office said that this strategy "served as an extremely useful reference."

The guidelines for the action plan refer to the regional epidemic phase in prefectures under the aforementioned domestic pandemic phase, and state that "it will be difficult to stop infections from spreading, and the primary focus of countermeasures will be shifted to damage mitigation." The guidelines also indicated limiting PCR testing to severe cases, stating, "Diagnostic confirmation (of coronavirus cases) by PCR testing on all patients with suspected symptoms will be suspended." This policy was aimed at preventing medical systems from falling apart with patients flocking to hospitals.

An individual close to the government recalled the situation at the time, saying, "It was assumed that once we enter the outbreak phase, all of those who have developed symptoms will be regarded as suffering a new type of influenza and be administered curative drugs such as Tamiflu." The source then said, "There was a lack of discussion on carrying out massive volumes of testing for a new infectious disease like the latest one, in which there are no curative drugs or no symptoms (among some patients)."

During an online program streamed on May 8, economic revitalization minister Yasutoshi Nishimura, who is in charge of the revised special measures law on new types of influenza and other infectious diseases, was questioned whether the limited PCR testing was aimed at avoiding putting burdens on the medical front lines. His answer was "yes." "Although there is criticism, it should be evaluated favorably that Japan focused on PCR testing on severe cases to protect them," Nishimura said. A high-ranking government official confided, "Based on the lessons we learned from (the outbreak of a new type of flu) in 2009, we were concerned about a possible panic with would-be test-takers swarming into hospitals if PCR testing was widely conducted."

In fact, the government explains that its measures against coronavirus infection clusters, in which PCR testing was intensively conducted on people who had come in close contact with infected individuals, have proved successful in containing the "first wave" of coronavirus infections emanating from China. Analysis released by the National Institute of Infectious Diseases (NIID) in late April concluded that Japan "succeeded in containing the Chinese route of infections (the first wave)" and that it "was able to contain (the initial wave) by quickly detecting (close contacts)," after analyzing the genome sequence of the coronavirus extracted from infected people in Japan.

However, the NIID report also referred to the "second wave" of infections from Europe and the United States and stated, "By the time self-imposed restrictions on travel began in mid-March, the entry of a second wave had been allowed through people returning from overseas, and the virus was transmitted to all areas of the country within the space of a few weeks."

As it stands now, the routes of infection can no longer be traced by cluster countermeasures, and it has become necessary to further expand PCR testing.

(Japanese original by Shinichi Akiyama and Hironori Takechi, Political News Department)

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