Early Stage of a Japan Outbreak: The Policies Needed to Support Coronavirus Patients

Some Unknown Infection Routes

Cases of novel coronavirus continue to increase in Japan, with new patients identified in Kanagawa, Tokyo, Wakayama, and Aichi Prefectures. On February 13, a woman in her eighties who had been infected with the virus died, marking the first COVID-19 death in Japan.

As of February 18, there have been 616 confirmed coronavirus cases, including 52 among domestic residents, 13 who returned on a charter plane from China, and 542 on a cruise ship docked in Yokohama. Meanwhile, in China there have been 72,436 persons infected with the virus and 1,868 deaths.

Recent infections within Japan have included cases where the transmission route is unclear. For example, a doctor in Wakayama Prefecture who was confirmed on February 13 to have contracted the virus had not traveled to China; nor did he seem to have personally examined anyone who was infected with COVID-19. Infections have also been confirmed in a medical colleague of the doctor and a family member of a hospitalized patient. A total of 12 cases have been identified in the prefecture, including a new case involving someone who has not recently visited the hospital in question.

Dr. Kunishima Hiroyuki, a professor at St. Marianna Medical University and director of its Center for Infectious Diseases, said that “a few infections seem to have occurred that did not originate from contact with persons traveling from China.” He also stressed that this situation was anticipated: “It’s not surprising that such cases of unknown transmission could arise.”

The Early Stage of a Domestic Outbreak

The meeting of experts on the coronavirus crisis concurred that Japan, as of February 16, is in the “early stage of a domestic outbreak.” They also stated that the situation has not yet advanced to the more serious stage that would require the government to declare an epidemic. Infections have spread to a total of 12 prefectures in Japan as of February 17, making this a critical moment for whether the spread of the virus can be stopped or not. 

What policies should be prioritized moving forward? One important measure, according to Dr. Kunishima, is to “provide appropriate medical care to persons with serious symptoms.” Persons contracting pneumonia from COVID-19 complain of fever, sore throats, coughing, and fatigue, but in around 80% of the cases those symptoms are mild. However, as seen in Wuhan, China, where the virus originated, symptoms can worsen rapidly, making this a dangerous disease capable of causing numerous deaths.

Analysis conducted by the World Health Organization shows that symptoms become severe in around 20% of all patients who contract COVID-19. Dr. Kunishima points to the need to “promptly identify patients with severe conditions who require an artificial respirator or other devices and quickly give them the treatment they require.”

The Japanese medical profession faces other challenges. “Recently some hospitals are crowded because outpatients visit due to their concerns even if they have no symptoms, which only ends up increasing their risk of infection,” Dr. Kunishima observes. “Crowded hospitals create a problem because it delays the response to those patients with severe symptoms who truly need medical treatment.”

The risk of serious complications from COVID-19 is particularly high among the elderly and persons suffering from chronic ailments like diabetes or heart disease. Special caution must be exercised so that infections do not spread at facilities for the elderly.

A Wave of Event Cancelations

Concerns about the spread of the virus have led to a sudden curtailment of planned events. The planned public reception for Emperor Naruhito’s birthday on February 23 has been called off. Participation of the roughly 38,000 amateur runners in the Tokyo Marathon, to be held on March 1, has also been canceled. The marathon, which doubles as a qualifying race for the 2020 Tokyo Olympics, has been drastically reduced in scale, limiting the competitors only to invited runners. Other important events that have been canceled due to concerns about COVID-19 include a performance of Beethoven’s Ninth Symphony that was to be held at the Kokugikan in Ryōgoku, Tokyo, with some 5,000 people in the chorus. 

Professional baseball, however, intends to open its season on March 20 as planned, including games held at domed stadiums. The Olympic Torch has arrived in Japan, and the nationwide Olympic Torch Relay will begin on March 26 as originally scheduled.

With this summer’s Tokyo Olympics and Paralympics fast approaching, Japan will be in a tough race against time to prevent the coronavirus from spreading.

(Originally written in Japanese. Banner photo: Passengers waiting for flights at Tokyo’s Haneda Airport wear masks to avoid infection on February 17, 2020. © Jiji.)