Novel Coronavirus Expert Meeting

It was established on 14 February to advise the Cabinet of Japan from a medical point of view, following the first confirmed COVID-19 death in Japan.^[1][2]

Takaji Wakita, Director of the National Institute of Infectious Diseases, chairs the Expert Meeting and Shigeru Omi who was instrumental in SARS measures as director of WHO Regional Office for the Western Pacific and later worked to respond to the 2009 swine flu pandemic in Japan is a vice chairman. The members are composed of Prof. Hitoshi Oshitani, who is the leader of the Cluster Measures Team and remedied the situation in the SARS outbreak as an infectious disease advisor at WHO Regional Office for the Western Pacific, and others.^[3][4][5]

At a press conference on June 24, Yasuhiro Nishimura, Minister for Economic and Fiscal Policy, announced that the Expert Meeting would be abolished and replaced by a new subcommittee of infectious disease experts under The Advisory Council on Countermeasures against Novel Influenza and Other Diseases. According to Minister Nishimura, the decision to dissolve the Expert Meeting was because "it was not based on the law and its position was unstable". The announcement appeared to come as a surprise, and Vice Chairman Shigeru Omi, who was present, was visibly unable to conceal his confusion. On July 3, The Novel Coronavirus Infectious Disease Control Subcommittee was officially established under the Novel Coronavirus Special Measures Act. The members consisted of infectious disease specialists as well as local representatives, trade union executives, economists, risk communication specialists and other experts. Shigeru Omi serves as chairman.^{[6][7][8][9][10]}

Summarize Fact Check

The aim of the Expert Meeting is to curb the pandemic while maintaining socio-economic activities. If countries around the world repeatedly block the city and lift the blockade every time an outbreak occurs, the global economy and society will collapse. They think that urban blockade is a 19th-century measure, and that there is a 21st-century-type measure to curb the spread of infection by controlling the behavior of people.^[3][11]

Vaccine development takes time, and we don't know if we can actually make a vaccine. Herd immunity cannot be achieved unless a large number of victims are killed and about 70% of the population is infected.^[12]

There were three pillars of basic strategy that they chose. (1) Early "cluster crushing" by investigation of mass infection. (2) "Preventing aggravation" by strengthening the medical system. (3) "Changing people's behavior" to prevent the spread of infection.^[12][13]

The Expert Meeting analyzed the outbreak from Wuhan, which became the first wave of COVID-19 in Japan, and discovered the conditions under which clusters occur, "Three C's (3つの密, Mittsu no Mitsu)". They concluded that most of the primary cases that touched off large clusters were either asymptomatic or had very mild symptoms, and thought it is impossible to stop the emergence of clusters just by testing many people. The first strategy they hammered out was to avoid places of "Three C's (Closed spaces, Crowded spaces and Close-contact settings)."^{[3][14][15][16]} The main routes of infection were considered to be "contact infection", which is transmitted by touching a substance to which the virus is attached, and "droplet infection", which is transmitted by inhaling droplets from a sneeze or cough. However, it has been pointed out that the possibility of "micro droplet infection" is pointed out as a new infection route. A small particle of less than 10 micrometers in diameter containing the virus, a micro-spray floats in the air for 20 minutes, and the infection spreads by people nearby sucking it in.^[12]

One of the features of the measures for the new coronavirus in Japan is the strategy of cluster surveillance. Japan has deterred outbreaks through epidemiological surveys centered on cluster surveillance.^[11][4][17]

In early February, Oshitani and Hiroshi Nishiura, a members of the Cluster Measures Team, found that 80% of patients did not infect others with the coronavirus, but certain patients infected many people, by analyzing the data of the first wave from China. The Expert Meeting set their eyes on that, they decided to prevent outbreaks by tracking infected people and testing those who were in close contact with them. 80% of these infected don't infect anyone with the new coronavirus, so we don't need to find all the infected. If we can find a cluster, we can control this disease to some extent.^{[3][4][11][12][18]}

If the number of positives is small, it is possible to suppress the spread of infection by tracking the cluster, and it is possible to continue the infectious disease measures while maintaining a constant economic activity.^[4]

When the infection rate is very low, the infection will not spread by testing only high-risk people. PCR tests cause false positives, so many tests at low infection rates can even cause false positives to outnumber true positives. They took that strategy with that in mind.^[17]

Behind that was that the medical resources in Japan were vulnerable. Unlike other Asian countries, Japan was not well prepared to test for infectious diseases because SARS did not land. The new coronavirus became a designated infectious disease, so those who tested positive were required to be hospitalized even for mild cases, and there were few sickbeds.^[4]

However, they also thought that it was a big problem that the number of PCR tests did not increase in the rapid increase of the infected person, and they have gradually increased the number of PCR tests since mid-March.^[3][17]

The strategy worked well until mid-March, and it succeeded in preventing the first wave from China, but the second wave via returnees from Europe and the US could not be stopped, and the outbreak occuared in April. That was revealed in May by a genomic molecular epidemiology survey of the new coronavirus (SARS-CoV-2).^[3][19]

The outbreak occurred in April, and the government declared a "statement of emergency" and asked people to quarantine themselves. The Expert Meeting asked people to “reduce contact between people by 80% more than usual” in order to reduce the rate of increase in the number of infected people and allow cluster surveillance again. They doubted the 80% goal was achieved, but there was fairly extensive voluntary national compliance. Japan's mild "lockdown" seemed to have a real lockdown effect. When the government lifted the state of emergency in May, they then proposed "new lifestyle" for people.^{[3][16][20][21][22]}

Summarize Top Qs Fact Check

Taking lifting a state of emergency, they made an assessment at that point on their efforts. Japan achieved a certain amount of results in suppressing the increase in the number of infected people and reducing the number of deaths and serious injuries compared to Western countries. Four factors were cited: (1) the universal health insurance system, (2) high medical level, (3) public health centers in each region, (4) high public awareness of hygiene.^[23][24]

In addition, it was evaluated that "early detection of the spread of two waves of infection from China and Europe" and "cluster countermeasures" were effective. Generally, the media and others call the spread of infection in April as the first wave in Japan. However, the Expert Meeting called the wave from China the “first wave” and the wave from Europe and the US "the second wave." In stopping the two waves, accurately catching the epidemic has helped prevent the rapid spread of infection. The increase in the cumulative number of people infected between February 18 and February 25 confirmed that. At that time, the number of cases did not increase significantly in Germany, France, and the UK, etc., but it is possible that it advanced unnoticed. The spread of the infection actually occurred in western countries, but it may have progressed beneath the surface. It is conceivable that it might have led to a subsequent outbreak.^[23][24]

Cluster surveillance played an important role in capturing the spread of infection in Japan. Cluster surveillance using active epidemiological surveys, such as interviewing infected people, is also common abroad, but there is a big difference in the method between Japan and them. Japan has conducted two types of surveys: a "prospective contact tracing", which identifies close contacts with infected people starting with new cases, and "retrospective contact tracing", which identifies where new patients were infected and identifies close contacts together with them at their common source of infection. However, most countries have not carried out this "retroactive contact tracing" though some cases were confirmed in Taiwan. The Expert Meeting speculated that there might be a difference in their ultimate goals in the background. Other countries are aiming to contain this virus, but Japan is not aiming for it in the first place, and frequently announces that it is impossible. "Prospective contact tracking" is a basic strategy for cluster surveillance that is carried out when aiming for virus containment, and has a history of being used during SARS and Ebola. However, it was pointed out from the beginning in Japan that the containment of this new coronavirus is almost impossible. If only "prospective contact tracking" aimed at containment is performed, it is inevitable to overlook the spread of infection below the surface. It was fortunate that the public health centers in Japan have been conducting investigations of the source of infection along with the tracing close contacts with infected people from the beginning. The Expert Meeting said that they will continue to scrutinize why they were able to investigate the source of infection in Japan first, and then speculated that it might be due to the constant effort to find the source of tuberculosis.^[23][24]

When the reporters pointed out that the PCR tests for close contacts was insufficient, the Expert Meeting said, "There is a misunderstanding about the PCR tests. Even if they develop, not all cases can be found. The sensitivity of the test kit to asymptomatic people is not very high. No one knows when they're going to get infected, so we'll have to test everyone every day to confirm. Is that the right choice? , We need to consider." In response to the opinion that the low number of PCR tests delayed their response, the Expert Meeting said, "Even if close contact is missed to some extent, most of them do not infect anyone with the virus. Even if there are some misses, many chains will naturally disappear. By clarifying the locations of many clusters, we were able to identify areas where infection was likely to occur, such as "3C's," and sent a message to avoid such an environment." However, The Expert Meeting also admitted that the number of tests was not sufficient at the time when the number of cases increased in April, and called on the country and each prefecture to develop the system.^[23][24]

The Expert Meeting gave a tentative assessment of the effect of the government's declaration of emergency on 7 April, but pointed out that the peak of the actual infection was around 1 April, before the declaration, and had already been on a downward trend due to a curfew announced by the Governor of Tokyo.^[23][24]

The Expert Meeting showed the recognition that it is important to prevent the spread of infection and the severity of the patient by providing early diagnosis and early medical care for infected people. The Expert Meeting said the re-emergence of the spread of infection of latent cases could have already occurred in some areas of Japan, and that it is important to being cautious about and being on the watch for that while continuing socio-economic activity. The Expert Meeting listed three initiatives for that purpose: (1) enabling early diagnosis of infected people by rapid tests such as antigen tests, (2) elucidating initial symptoms and narrowing down the test targets, (3) conducting research to find signs of progression of a patient's condition from subclinical to moderate.^[23][24]