Updates to epidemiological status in Japan by experts.
Analysis based on data as of 11/14/2020
Current Status
Globally, as of 11/16/2020, the number of cumulative cases is now more than 55 million affecting all continents with US, India, Brazil, France and Russia marking the highest cumulative incidence. Japan, as of 11/14/2020, the cumulative tally of cases stand at 115,765 and cumulative deaths is at 1,879. Over the previous 2 weeks (10/31/2020-11/14/2020), 15,158 new confirmed cases were reported. We have observed the second wave, which has impacted the increase in cases beginning in early June. Since the beginning of this new wave, there have been more cases reported than all cases combined between March through May. The confirmed daily cases peaked at 1,732 cases on 8/7/2020 and had trended down to around 500 cases in September and early October. An increase of confirmed cases, however, is being observed since the middle of October, and it likely hasn’t reached its peak yet with the daily cases now ~1700.
Over the previous 2 weeks, high number of new confirmed daily cases were reported, particularly in Tokyo (3241), Osaka (2403), Hokkaido (2068), Kanagawa (1306), followed by Aichi (1277), Saitama (861), and Chiba (656). When looking at the confirmed cases per 100,000 population over the previous one and two weeks, Hokkaido (22.8 and 39.4) ranked the highest, followed by Osaka (16.77 and 37.23), Tokyo (13.53 and 23.24), Okinawa (12.86 and 23.86) and Aichi (9.74 and 16.91). Over the previous 2 weeks, female cases accounted for 44% (6524 )and those in their 20’s, 30’s and 40’s account for ~55% of all newly reported cases, followed by those in their 50’s and 60’s (23%), those who are over70 (14%) and those who are under 20 (9%). The number of deaths over the past two weeks were at 125 with 0.1 per 100,000 persons.
Analysis:
The impact of the COVID-19 is formidable globally, regionally and locally. Since the first case was reported on 1/15/2020, it has been spreading throughout Japan. The first wave that was presumably derived from the oversee returnees peaked at 674 confirmed cases on 4/11/2020 and subsequently subsided by the end of May (see details in Summary section) . This allowed for the state of emergency to be lifted. The number of cases re-surged beginning around the end of June, and the number of daily reported cases reached more than 1,500 in early August and trended down to around 500 cases per day by early October. However, before the wave had subsided, we have observed that the daily case counts have been climbing at more than 1500 cases per day since the middle October. The current wave may be called the “third” wave but in the current discussion, we describe it as an extension of the second wave.
This resurgence of COVID-19 cases was seen especially in metropolitan areas of Japan; however, there have been high incidence in the non-metropolitan prefectures especially through large cluster formation. Hokkaido and Aichi in addition to Tokyo and Osaka have been hit the hardest. In the early phase of the second wave, the cases were mainly seen in younger generation in their 20’s to 40’s; however, the recent trend show that the cases are distributed among the elderly and even those under 20. The internal mobility of the population as the economic activities are being enhanced is likely contributing to this increasing trend, and the chains of transmission among restaurants and the night life industries, hospitals and nursing home/long-term care facilities, and workplace related infection have continued to be the primary reported clusters. In addition, the cluster formations among foreign nationals and their communities should also be monitored closely . Those populations may not have access to health services due to language and cultural barriers. In addition. there may be fear that infection among such communities may lead to unnecessary prejudice and stigmatizations. Hence, it would be pertinent to expand and enhance on-going interventions against clusters in such communities to protect them.
As per Survey of Critically ill COVID-19 patients in Japan conducted by ECMOnet for COVID-19, COVID-19 cases on mechanical ventilator with/without ECMO has fluctuated between 150-200 over the past 2 weeks with upward trend. Likewise, the number of hospital admissions reveal a gradual increase nationally and locally especially in Tokyo, Aichi, Osaka and Hokkaido.
In summary, we have observed a gradual increase of confirmed cases since October 2020. Multifaceted interventions including early detection and response adapting cluster based-approach, implementation of infection control and prevention practices in medical facilities and nursing homes, enhanced self-protective rituals such as wearing masks, and requesting the public to avoid “avenues” of transmission such as nightlife industries will all be important. Above all, we continue to emphasize the importance of avoiding three Cs: 1) closed spaces with poor ventilation, 2) crowded spaces with many people, and 3) close contact, such as from intimate conversations, loud cheering, singing, or exercise within a short distance from others. In addition, it would be important to avoid 5 high risk situations (5Ds) identified through study of clusters over the past several months: 1) Dinner and other gatherings with alcohol, 2) Drinking and eating in large groups (>4) or long time, 3) Dialogues & conversations without masks, 4) Dorms, shared bathrooms, etc. – cohabitating in small spaces, and 5) Dressing rooms and break rooms where people relax. Such interventions need to be continued as it can help to reduce the number of severe cases and deaths to preserve medical resources. We have also seen new forms of clusters, and, we will continue to elaborate the interventions specific to those clusters as well. Attempting to maintain a balance between keeping transmission at bay while allowing life and economic activities to carry on more “normally” is crucial. The experts and policy makers are expected to share the policy decision-making processes with the public for more inclusivity and transparency.
Past statuses:
Data:
Case data are collected from publicly available data including press releases of local jurisdictions, prefectural governments, media, and Ministry of Health, Laboure, and Welfare (MHLW). The data of death was collected from both MHLW and Yomiuri Shinbun websites. We excluded passengers and crewmembers infected on the Diamond Princess; cases detected among Japanese citizens and their relatives on charter flights from Wuhan City, China between January 2020 and February 2020; cases found at quarantine stations; and passengers and crewmembers infected on the Cost Atlantica in Nagasaki prefecture. Furthermore, when a case shows the multiple positive COVID-19 testing results, we count this as one.
Collected data are saved in a repository and reformulated to the interactive web-based dashboard. The values used in the dashboard are subject to change without notification as data cleaning is underway.
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