Fears of '4th wave' rise with surging rural Japan coronavirus infections

Drastic increases in coronavirus cases are being witnessed not just in highly populated areas like Tokyo and Osaka, but also in Japan's regional areas, in a trend prompting experts to admit concern that a "fourth wave" of infections may be coming.

The coronavirus cases resurgence has produced alarm among experts, while at the same time a series of infections by variant strains thought to be highly transmissible have also been confirmed across the country. Japan Medical Association President Dr. Toshio Nakagawa said, "Infection tallies in Tokyo have been surpassing earlier weeks' for consecutive days," and indicated at a March 24 press conference that he feels a sense of crisis over the latest state of infections.

On the same day, 420 new coronavirus infections were confirmed in the capital -- the highest total for March so far. During the most recent week, the infections' daily average topped 300 on March 21 for the first time in about a month. New infections recorded in west Japan's Kansai region are also on the rise, with Osaka Prefecture registering 262 cases on March 24, exceeding 200 for the first time since Feb. 5. The following day, the prefecture confirmed another 266 cases.

But in regional areas, too, the state of infections has gotten worse. On March 24, northeast Japan's Miyagi Prefecture recorded a single-day high of 171 infections. On the same day, Kazuko Kori, mayor of the prefectural capital of Sendai, admitted to deep concerns, saying, "In the event infections show no signs of decreasing, we will be forced to declare a state of emergency or concentrate countermeasures in specific areas."

Of the new infections registered March 24, 131 alone were in Sendai -- nearly 80% of the prefecture's daily total. People in their 20s or 30s accounted for over 40% of the 131 cases, while residents in their 60s or older made up nearly 20%. In addition, 102 of them contracted the virus via unknown infection routes, and a city official said, "One after another we're seeing cases where we're unable to trace how individuals were infected; in this position we can't eliminate the root cause of the virus."

From the end of last year into early February, the Miyagi Prefectural Government called on Sendai eateries to reduce business hours, and in the first half of February daily coronavirus totals were mostly in the single digits. But infections rose when the Go To Eat subsidy program to boost demand for restaurant services resumed on March 23. Miyagi Gov. Yoshihiro Murai decided to halt the program March 15, stating, "We cannot say there is no causal relationship between (the subsidy program) and the spread of infections." Although the prefecture issued its own state of emergency on March 18, infections have continued spreading even further.

As of March 24, 33.3 per 100,000 Miyagi Prefecture residents in the preceding seven days were infected -- the highest among all Japan's prefectures. On March 25, the prefectural government again began requesting eateries in Sendai shorten business hours.

Neighboring Yamagata Prefecture registered a record high 49 new infections on March 25. Yamagata Gov. Mieko Yoshimura expressed astonishment, saying, "I want countermeasures to be thoroughly adopted so that the collapse of the already strained health care system does not become a reality."

The Yamagata Prefectural Government and Yamagata Municipal Government issued their own state of emergency declarations for the city on March 22, and are set to file requests for eateries to shorten business hours from March 27.

In southern Japan's Okinawa Prefecture, infection figures per 100,000 people during the week ending March 24 were the second highest they had seen. Gov. Denny Tamaki stressed that the prefecture was entering an infections "fourth wave."

When Okinawa lifted its own state of emergency lasting about 40 days at the end of February, it also withdrew requests for shorter hours for eateries. But daily new infection totals gradually increased from around 20 in mid-February to 77 on March 25.

With the spring break season, tourist numbers are also on the up, and the prefectural government has urged the public to use polymerase chain reaction (PCR) testing sites at Naha Airport. Gov. Tamaki also asked residents to refrain from holding welcome and farewell parties customary in the March and April period, because "daily infection numbers risk growing to an alarming number."

On March 25, Ehime Prefecture also recorded 59 new infections, greatly exceeding its single-day high of 38 cases announced Jan. 8. A cluster infection at an entertainment district in the prefectural capital of Matsuyama was connected to 47 of the 59 cases released March 25. Ehime Gov. Tokihiro Nakamura held a press conference where he revealed plans to demand shorter business hours from eateries serving alcohol. The prefectural government will arrange with the city government to decide the time frame, applicable areas, and subsidies to eateries.

Gov. Nakamura said, "We've entered the fourth wave. I'd like the public to interpret these measures as a de facto 'state of emergency'."

According to the Ministry of Health, Labor and Welfare, the average number of nationwide infections recorded during the week until March 24 was 1,399, greater than the 1,175 the week earlier. The spread of reportedly highly-transmissible coronavirus variants is also inviting concern.

Regarding why infections are rising, Atsuo Hamada, a professor at Tokyo Medical University and an infectious diseases expert, said, "The lingering parts of the almost-finished third wave seem to have spread due to the state of emergency being lifted." While Hamada recognized that "it's gotten warm and people want to go outside, resulting in more events like cherry blossom-viewing and welcome or farewell parties," he speculated that "increased opportunities to remove masks may be another factor."

Regarding coronavirus variants, he said, "The health care system is not in a secure state yet, and an infections increase risks straining the system again. If community spread of coronavirus variants occur, there will be a full-scale infections 'fourth wave.' It's important to curb the spread of coronavirus variants at least until vaccinations for elderly people are completed."

(Japanese original by Yuki Ogawa, Lifestyle and Medical News Department; Ami Jinnai, Sendai Bureau; Takayasu Endo, Naha Bureau; and Yuichi Nakagawa, Matsuyama Bureau)