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Experts divided over Japan gov't decision to lift state of emergency in Tokyo area

Shigeru Omi, head of the government's coronavirus countermeasures subcommittee, is seen in this December 2020 file photo taken in Tokyo's Chiyoda Ward. (Mainichi/Hiroyuki Harada)

TOKYO -- The coronavirus state of emergency that remained in Tokyo and neighboring Kanagawa, Chiba and Saitama prefectures was decided to be lifted during a March 18 meeting of the Advisory Committee on the Basic Action Policy, headed by Japan Community Health Care Organization chairman Shigeru Omi.

    The state of emergency was repeatedly extended due to the spread of coronavirus infections, resulting in it running for the longest period of two and a half months. But as the hospital bed occupancy rate has improved, the decision gained a certain level of understanding.

    However, the number of infections, which had been declining at one point, has been on the rise since March, raising concerns about a resurgence in coronavirus cases. Experts spoke to the Mainichi Shimbun about their views of whether the decision was appropriate and if extending the state of emergency was effective.

    The meeting of the government's advisory committee began at 7:30 p.m. on March 18 at the auditorium on the first floor of the Central Government Building No. 8 in Tokyo's Chiyoda Ward.

    Economic revitalization minister Yasutoshi Nishimura, who is in charge of the coronavirus response, asked for committee members' understanding over the decision, explaining, "We were able to reduce the number of infected people by 80%, and firmly achieve the initial target. The results would be limited once we narrowed down countermeasures (such as requesting eateries to shorten their business hours), and even if the declaration period is extended further, it will not have a sufficient effect. It is necessary to lift it first, and then enter the next stage to take proper measures."

    Though there was much positive feedback over the decision to lift the state of emergency, some committee members expressed concerns, such as, "We are not in a state where we can wholeheartedly agree that the situation has improved," and, "We ask that you provide an explanation to the public about countermeasures while avoiding to give the message that the decision signifies a positive sign."

    In response to this, the government has established five pillars as countermeasures after the state of emergency is lifted: Taking thorough prevention measures when eating and drinking outside, strengthening measures against mutant strains, taking prevention measures against the spread of infections including monitoring tests, promoting vaccinations, and enhancing the health care system.

    After the meeting was over, Omi told a reporter that all committee members had agreed with the decision, and explained, "It is extremely likely that the Tokyo metropolitan area will see a resurgence in infections. The consensus is to prevent this after the state of emergency is lifted, and avoid burdening medical care and public health services."

    Japan Medical Association executive board member Satoshi Kamayachi told reporters that he said in the meeting that "securing the health care system requires building consensus in accordance with the circumstances in each area. If it is forced, there are parts that will not go well."

    Regarding the effectiveness of the most recent state of emergency, Nobuhiko Okabe, head of the Kawasaki City Institute for Public Health, who is considered the brains behind Prime Minister Yoshihide Suga's approach to tackling the coronavirus, said, "Although its effects were not perfect, it scored about an 80. The state of emergency was declared because the health care system was overwhelmed and there needs to be a system to properly take in sick people. In the last two weeks (of the extension), the number of infections became stabilized. I think we have met the conditions for lifting the declaration."

    He added, "Even if the number of daily infections in Tokyo exceeds 500 from the current state, people can rest assured if health facilities to accept patients have been properly prepared."

    Meanwhile, some experts on infectious diseases have disagreed with the decision to lift the state of emergency. A member of the Ministry of Health, Labor and Welfare's advisory board of experts questioned the decision, saying, "Is it OK to lift the declaration at this point? They say they will catch the signs of a resurgence at an early stage, but those signs are probably already showing. The prefectures of Hokkaido, Miyagi and Saitama and the city of Nagoya are already seeing a resurgence in infections among younger people."

    Another expert emphasized, "The number of infections is too high now. They have to be reduced even further. Tokyo will probably soon exceed 500 daily infections. It is important to thoroughly analyze the situation and identify what problems each area is facing and take tailor-made measures."

    An executive of the health ministry explained, "Mr. Omi and Mr. Okabe showed understanding toward the decision, but many middle-ranking experts were cautious about it." It can be said that there is a difference in opinions between veterans who are relatively close to the government's decision-making process and mid-level experts who are close to the clinical side.

    Some experts are cautious about lifting the state of emergency because the number of infections could already be on the rise again. In Tokyo, the number of infections exceeded that of the same day a week ago for nine consecutive days from March 9. The number of infections at certain times are said to be reflecting the movements of people 10 to 14 days ago, and a health ministry executive explained, "Since the state of emergency was earlier lifted in six prefectures including Osaka, Aichi and Fukuoka on Feb. 28, people may have let their guards down, which is likely causing the resurgence of infections."

    Okabe also said, "If people start traveling, it's inevitable for the number of infections to increase. Perhaps it's due to people letting their defenses down. The movement of people is not just because individuals are becoming relaxed, but depending on the situation it could be demanded by society. Under those circumstances, we can't just forcibly continue to extend the state of emergency. If it's not showing any effect, then there needs to be a change."

    Many things remain unknown about coronavirus variants from the United Kingdom, South Africa and Brazil, and it is unclear how much they are contributing to the resurgence of infections. "We're not in a state to conduct analysis, because the majority of what we are seeing is still caused by conventional strains," said one infectious disease expert.

    How to effectively curb the number of infections after lifting the state of emergency is the issue at hand. There is not much new about the five pillars of infection control. Okabe emphasized, "Since these pillars are determined by how much medical institutions are overwhelmed, tests and other factors, there are no numerical targets (for the level to which infections have to be suppressed). I think that infections can be controlled somehow, but ideally, we should reduce the number of infections even further."

    Kamayachi called for cautious measures, saying, "We are seeing signs of a fairly rapid spread of infections in the Kansai region where the state of emergency was lifted, so we have to thoroughly sound the alarm. It (the state of emergency) will be lifted for the Tokyo metropolitan area, but we have to make sure that the public does not misunderstand and think that everything will be fine."

    (Japanese original by Ryosuke Abe, Sooryeon Kim and Takuya Murata, Lifestyle and Medical News Department)

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