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Expert says lifting Japan's COVID-19 state of emergency at end of May not feasible

The Ebisu Bridge in the Dotonbori entertainment district in Osaka's Chuo Ward is seen almost deserted on the morning of April 25, 2021, when the third coronavirus state of emergency was declared. (Mainichi/Kazuki Yamazaki)

TOKYO -- While three weeks have passed since the Japanese government declared a state of emergency for four prefectures, including Tokyo and Osaka, on April 25, the number of infections and occupancy rates of hospital beds have shown no signs of improving, and it is unclear whether the government will be able to achieve its exit strategy of lifting the declaration at the end of May.

    During the latest state of emergency, stronger measures, including temporary business closure requests to department stores and movie theaters, were taken compared to the period under the previous declaration, and perhaps because of this, there has been relatively limited movement of people on the street. However, some locations have seen increased outings.

    "If figures aren't falling even though we've enforced such strong measures, where are the infections spreading?" said a puzzled Minister of Health, Labor and Welfare Norihisa Tamura during a press conference following a Cabinet meeting on May 14, the day it was decided that three more prefectures, including Hokkaido, would be added to areas covered by a state of emergency declaration.

    While Japan's third state of emergency amid the fourth wave of coronavirus infections was in place from April 25 in four prefectures including Tokyo and Osaka, it is unclear whether it was effective in curbing infections. The number of new infections per 100,000 members of the population fell from 89.36 cases -- recorded between April 21 and 27, the first week Osaka Prefecture was covered under a state of emergency -- to 67.62 cases in the period between May 5 and 11. However, the number of new cases is still at a transmission level of "Stage 4" -- which indicates an "explosion of infections" -- in the 4-point classification created by the Japanese government's coronavirus countermeasures subcommittee. In the capital, figures for the same periods increased from 37.55 to 41.45 cases.

    When viewing the change in figures of new coronavirus cases following the past two instances that a state of emergency was declared, after the first state of emergency declaration which began on April 7, 2020, the number of new cases nationwide saw a 25% decrease from 377 to 284 after three weeks. The figure fell to 20 by the time the state of emergency was lifted after about two months.

    Following the second state of emergency which started on Jan. 8 this year, although measures were limited to mainly a reduction in business hours at eateries, the initially recorded figure of 7,844 cases dropped by about half in three weeks. By the time the declaration was lifted about three months later after it was extended twice, the figure saw an 85% decrease to 1,110 infections.

    Although the first and second state of emergency declarations effectively reduced the number of COVID-19 cases, following the third state of emergency, infections rose over three weeks from 4,434 to 5,247 on May 16, despite measures being bolstered from the earlier declarations, such as department stores and cinemas being requested to close temporarily. The number of patients with severe symptoms has also stood at high levels exceeding 1,200 cases daily.

    Atsuo Hamada, a professor at Tokyo Medical University and an expert on infectious diseases, said, "Although measures to curb infections should be stronger than the time of the previous declaration, there have been no great effects in Osaka and Tokyo even after three weeks. Instead, there has been a rise in coronavirus cases nationwide, including core cities of regional areas and not just metropolises, and an unprecedented situation has arisen in Japan."

    The N501Y coronavirus variant, which is thought to be highly transmissible, seems to be hindering a containment of the spread of infections. According to the National Institute of Infectious Diseases (NIID), 90% of coronavirus strains causing nationwide infections have been replaced with mutant variants. Furthermore, it is said that if infected with the variant, the risk of developing severe symptoms is 1.4 times that when infected with the original strain in general, and this increased rate is particularly high among individuals aged between 40 and 64, who have 1.66 times a greater risk of developing severe cases.

    Regarding the future outlook on infections, NIID director-general Takaji Wakita, chairperson of the coronavirus countermeasures advisory board to the health ministry, pointed out during a press conference following a board meeting on May 12 that "in order to reduce the number of infections to the level of 'Stage 2' (where cases are increasing gradually), it is necessary to have a state of emergency in place for at least 44 days in Tokyo, and around 28 days for Osaka."

    Professor Hamada said, "As coronavirus variants are highly transmissible and have high risks of causing severe symptoms, the number of infections won't easily decrease, and they have also been directly linked with a strained health care system. When looking at the state of infections in Osaka and Tokyo, we are hardly in a situation where we can lift the state of emergency at the end of May. With enforcement measures the way they are under the current state of emergency, a considerable number of days is necessary to have the number of infections lowered to a state on par with a 'Stage 2' level." He added, "More deaths will arise and the economy will likely be affected as well. The government must take stricter measures, such as requesting companies to have employees stay at home, even for short periods, without waiting until the end of May."

    (Japanese original by Naomi Hayashi, Lifestyle and Medical News Department)

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