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Japan gov't experts say 2-week emergency extension too short amid threat of mutant strains

Takaji Wakita, director of the National Institute of Infectious Diseases and head of a panel advising the Ministry of Health, Labor and Welfare on coronavirus prevention measures, right, is seen at a press conference after a board meeting, on March 3, 2021, in Chiyoda Ward, Tokyo. (Mainichi/Hidenori Yazawa)

TOKYO -- While Prime Minister Yoshihide Suga was announcing on March 3 that he intended to extend the state of emergency declaration in effect in Tokyo and three other prefectures in the capital sphere by two weeks, the government's coronavirus expert advisory board was meeting at the Ministry of Health, Labor and Welfare.

    At the meeting, experts focused on the state of infections in the capital region, the only part of Japan still under emergency measures. "We're seeing a falling trend in new cases, but the rate of that fall has slowed," one expert pointed out.

    The board meeting headed by Takaji Wakita, director of the National Institute of Infectious Diseases (NIID), began at 6 p.m. on March 3, at a conference space on the health ministry's 17th floor.

    About 30 minutes later, Prime Minister Suga announced: "Tokyo and three other prefectures (in the capital region) are at a crucial stage in terms of infection prevention measures as the state of emergency is scheduled to end on the 7th. We are still hard-pressed to secure hospital beds, and our indices are showing close numbers, so to protect the people's lives and livelihoods we must extend (the state of emergency) by about two weeks."

    Right before this statement, Minister of Health, Labor and Welfare Norihisa Tamura reportedly attended a meeting of Cabinet members concerned, and rushed to the advisory board meeting to explain the situation.

    Individuals including members of a panel advising the Ministry of Health, Labor and Welfare on coronavirus prevention measures, are seen exchanging opinions during a meeting in Chiyoda Ward, Tokyo, on March 3, 2021. (Mainichi/Hidenori Yazawa)

    Questions from the panel included: "What preventive measures will be taken in the event of an extension?" Shigeru Omi, head of the government's coronavirus task force and president of the Japan Community Health Care Organization, reportedly responded, "If the Advisory Committee on the Basic Action Policy meets on Friday (March 5), I will have to speak clearly about it."

    In explaining the reason for planning to set the extension at two weeks, a senior government official said. "Even now people are getting complacent so it wouldn't be possible for them to hold out for a whole month. Experts say the declaration's effect is waning. If at this point we said it would last for one more month, it would immediately no longer be sustainable. Two weeks is the limit."

    But one medical expert said, "Even if the people work hard on prevention, we won't know whether their efforts have worked until two weeks have passed. Two weeks could pass without seeing any effects. If we don't decide ahead of time what we're doing this for, it will be difficult (to reduce new infection numbers in two weeks)."

    Another expert specializing in infectious disease prevention said, "If we extend (the state of emergency) by two weeks, we'll have to extend it by another two weeks. Even if we say we're taking tough measures now, we'll only be able to see if the numbers are falling after two weeks elapse."

    It appears, then, that two weeks may not be sufficient to perceive an effect. But to what extent do infections need to fall for the state of emergency to end in Tokyo and its surrounding prefectures? The current requirement is to reduce a Stage 4 situation marked by an explosive rise in infections to Stage 3 where infections are merely surging, and continue preventive measures until the state of infections is on par with Stage 2 or below.

    Minister of Health, Labor and Welfare Norihisa Tamura, front left, is seen speaking at a panel advising the health ministry on coronavirus prevention measures, on March 3, 2021, in Tokyo. Takaji Wakita, the panel's head and the director of the National Institute of Infectious Diseases, is seen sitting at the front right of the frame. (Mainichi/Hidenori Yazawa)

    Some of those attending the advisory board meeting, however, called for stricter measures. "We must aim for a 'Stage 1' level of infections (where cases are only sporadic)," one participant said.

    Motoi Suzuki, head of the Infectious Diseases Surveillance Center at NIID, said to a group of reporters, "I think a realistic goal might be for Tokyo to get under 200 (new infections) a day." A senior health ministry official who attends the advisory board meetings commented, "It's important it goes lower than it is now."

    Among the experts, there was a largely shared perception that tougher measures are needed. At the board meeting, strong views surfaced, with one participant suggesting, "We should implement a lockdown similar to what has been done in Europe and the U.S.," but when it came to concrete measures, nothing was clearly set. One infectious disease expert said, "The issue is that we don't know concrete measures. We don't know fully what the infection sources are. The problem isn't restricted to food and drink businesses alone."

    Reflecting on the options available, Suzuki said with concern, "There was discussion (among advisory board members) regarding possible measures to further reduce the numbers, but no clear answers. The declaration this time will keep them (infections) down in urgent areas like nighttime spots, but people can still go to school and work during the day.

    "If the way it is now doesn't work, it becomes logical that if we don't embark on some kind of comprehensive daytime limits on going outdoors, numbers won't fall. But it's difficult to know whether we can say that to residents at this stage. There have been arguments even for limits on going out and requesting that businesses close, but there's no consensus now on whether this is the time to be taking those measures.

    "We probably wouldn't be able to get understanding (from the people) on it. That's the dilemma we face now. But we are agreed that some kind of message needs to be conveyed."

    Satoshi Kamayachi, an executive board member at the Japan Medical Association, called for a more precise response to the spread of the virus, saying, "Thorough investigations in areas thought to be hot spots with a high risk of infections, including asymptomatic cases, should be given priority going forward."

    Discussions at the advisory board revolved around concerns over the spread of variant strains of the virus. Already variant clusters have been confirmed in central Japan's Niigata Prefecture and the city of Kobe in the west, among other areas. Documents presented by one expert showed that the effective reproduction number of infections (an average number of infections that a single person transmits) may already lie between 1.2 and 1.3, based on calculations from current infections.

    In its analysis of the situation, the advisory board stated, "There is a risk we'll see a much faster spread with mutant strains confirmed in the U.K. and South Africa than we're seeing now. Cases of infection with variants are being confirmed continuously in Japan, and the results of active epidemiological investigations by municipal authorities suggest a rising trend in individual and cluster infections."

    It appears that actions by each member of the public will be key to keeping down infections. An expert in clinical issues on the ground who attended the advisory board meeting said, "The best response is to explain (to the public) the facts behind why it's being extended.

    "If things were to revert now and infections rose, the medical system wouldn't be able to cope. Active epidemiological investigations would also become difficult. If mutant variants spread and we can't follow their movement, investigations become unworkable. Everything would head in a negative direction, and it would have the effect of bringing about a fourth wave of infections in a relatively short period. Will Japan be able to weather that when it comes? If we lift (the state of emergency) there's a high possibility it will happen.

    "By way of comparison, we're currently at about the point we were at the start of December 2020. If we do nothing and get complacent, a fourth wave will come soon." The expert added, "We must communicate that there is a possible worst-case outcome, and overturn the current feeling in society. I hope Prime Minister Suga can communicate that to people."

    (Japanese original by Ryosuke Abe, Hiroyuki Harada and Sooryeon Kim, Lifestyle and Medical News Department)

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