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Despite vaccination surge, will lifting Japan's COVID emergency trigger infection rebound?

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TOKYO -- The Japanese government has decided it will lift the state of emergency affecting 19 prefectures and quasi-state of emergency measures covering eight prefectures on Sept. 30. The choice was made with consideration for accelerating vaccinations and a downward trend in newly reported infections.

    But concerns remain over a rise in breakthrough infections -- in which people inoculated twice for the coronavirus still contract it -- accompanying increased activity after the measures are withdrawn. Some experts are also warning the decision could lead to an infections rebound and resultant sixth wave.

    At a Sept. 27 meeting of the Ministry of Health, Labor and Welfare's Advisory Board (AB), its compiled analysis of the current state of infections said: "Along with the fall in newly reported infections, a decline in numbers of people in recovery and with serious COVID-19 cases is also continuing."

    But although the government intends to completely lift the state of emergency effective in 19 prefectures and the quasi-state of emergency measures in eight more, the AB warned: "The reopening of universities and other locations will mean that opportunities for people to be in contact with individuals they don't normally meet will increase, among other factors. There are fears it will lead to a rebound in new infections cases."

    Behind the government's decision to lift the measures is the improvement in infections data. Health ministry totals show Japan's coronavirus fifth wave peaked nationally on Aug. 20, when 25,852 new cases were reported. Conversely, Sept. 26 saw just 2,129 cases nationwide -- a fall to less than 10% of the number just over a month prior.

    New daily reported infections were down to just 154 in Tokyo on Sept. 27, the first time the tally has dipped below 200 since March 22. Early September saw some 2,200 people nationwide classed as having severe COVID-19 symptoms, but now the tally has fallen by half to about 1,100 people. It is also reported that the 135,000 people recovering at home is now down to about 30,000 individuals.

    Occupancy rates for hospital beds for patients with COVID-19 and beds for severe cases, a key metric in the government's decision on whether to lift the state of emergency, have also improved. As of Sept. 26, Tokyo had a 23% occupancy rate for coronavirus patient beds, and 44% for severe COVID-19 patient beds, while Osaka Prefecture was at 34% and 31%, respectively, and Kanagawa Prefecture logged 33% and 37%, respectively. All the values were below the 50% occupancy rate deemed a factor in whether to lift the state of emergency.

    While a two-week downward trend in infections is also required, Takaji Wakita, chair of the AB and head of the National Institute of Infectious Diseases, was positive about the data: "Looking at the new indices for withdrawing, they have been almost entirely cleared."

    Regarding the factors in the fall in new daily coronavirus infections, the AB and the health ministry broadly agree that they include a fall in trips outside with the end of the summer holiday and long periods of rain, effects of information and reports on issues including medical system pressure, the cooler weather helping improve ventilation and other infection prevention measures ingrained among the public, the ease of seasonal transmission unique to summer and winter, and other factors.

    It appears that vaccinations have contributed to reducing the rates of infections and group outbreaks in care homes for the elderly. In the central Japan city of Nagoya, infections at facilities for seniors made up 11% of the city's total infections in the third wave taking place between November 2020 and March 2021, whereas in the fifth wave that began in July this year, they represented just 1.3%.

    But hospital bed occupancy rates in prefectures including Tokyo, Osaka and Kanagawa are still tracking above the 20% level required for quasi-emergency measures. The situation does not allow for complacency. Wakita also stated, "There are concerns that rescinding emergency measures will lead people to feel secure and significantly increase their activities, and thereby come into contact with more people, and bring about another infections spread. We want to ask people to take thorough ventilation measures and actions to avoid enclosed or crowded spaces when going outside."

    Kazunori Oishi, an expert in infectious diseases and the head of the Toyama Institute of Health in the central Japan prefecture of Toyama, also voiced concern: "Tokyo is still producing three-digit new infection numbers on a daily basis. There cannot be a full withdrawal of measures.

    "Without a progressive lifting of measures in which areas are switched to quasi-emergency measures or local governments request shorter business hours, we could see a rebound. There could be some people who take what's happening to mean that infection prevention measures are no longer necessary at all."

    (Japanese original by Hidenori Yazawa and Natsuko Ishida, Lifestyle and Medical News Department)

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