[Special Feature: The Corona Crisis and Universities] Countermeasures Against COVID-19: Not Just Bailing Out Water, but Plugging the Holes / Hiroaki Miyata

2020/08/06

Entering July, the number of new COVID-19 infections in Tokyo has exceeded 100 daily. Unlike the situation before the state of emergency declaration, one background factor is that PCR testing is being conducted on close contacts to suppress secondary infections. I believe such a testing strategy is useful. On the other hand, the fact that a certain percentage of positive cases with unknown routes continues to occur is a sign that warrants caution.

In this situation, it is important to not only have "measures to bail out water" to suppress secondary infections but also "measures to plug the holes" to manage the risk of infection. I have been conveying this point to the government and other stakeholders since after the state of emergency declaration. I believe improvements are currently being considered behind the scenes, but I would like to share the points of discussion.

At the stage of March 2020, while effective measures had not yet been identified, many countries implemented measures such as lockdowns or nationwide activity restrictions to temporarily suppress the spread of infection. On the other hand, through the accumulation of various data since then, the effectiveness of wearing masks and ensuring social distancing has been scientifically confirmed. We should refer to regions and cases that are suppressing the spread of infection through risk management incorporating these measures.

In Germany, on May 13, the German Institute for Economic Studies and the Helmholtz Centre for Infection Research collaborated to analyze the relationship between the effective reproduction number (Rt) and economic losses due to COVID-19. As a result, they expressed the view that economic losses would be minimized if restrictions were relaxed so that Rt = 0.75. (https://www.ifo.de/publikationen/2020/aufsatz-zeitschrift/die-auswirkungen-der-coronakrise-auf-die-deutsche-wirtschaft)

Due to measures backed by such simulations, Germany is a region that has maintained a state of lull until now. Germany's strategy cannot be adopted as-is by Japan, which has different testing and medical systems, but there are parts we should refer to in terms of a virus coexistence strategy.

Meanwhile, in Norway, social experiments were being conducted under lockdown. It was shown that in gyms, where cluster infections have also been reported in Japan, infections do not spread if used after implementing appropriate infection control measures. (Randomized Re-Opening of Training Facilities during the COVID-19 pandemic | medRxiv)

However, the important thing here is "after implementing appropriate infection control measures." Because Japan's previous behavioral restrictions were a simple message of "Stay Home," they were effective even with vague calls for self-restraint. On the other hand, while measures that manage risk according to how people work and spend time can reduce the sacrifice to the economy, it is also difficult to achieve results through simple calls alone.

In fact, many regions in Europe are also struggling. In cases where the regional spread of infection is judged to be uncontrollable, measures such as lockdowns or simultaneous business closures are being taken. In Barcelona, measures were established to mandate mask-wearing in indoor and outdoor public places regardless of social distancing, with fines set for violators. (https://www.newsweekjapan.jp/stories/world/2020/07/post-93915.php)

Based on these efforts in various countries, there are points that Japan should also improve from the perspective of feasibility. Among them, I believe the initiative in Saitama Prefecture starting July 13 is an important step forward. This involves certifying restaurants with entertainment services, such as bars and clubs, that operate based on COVID-19 risk management guidelines, and issuing closure requests based on Article 24, Paragraph 9 of the Special Measures Act to stores that do not comply. (https://news.livedoor.com/article/)

To make risk management an effective initiative, continuous improvement based on data is important: (a) carefully updating guidelines based on updated scientific evidence, (b) having stores report that they are operating based on the guidelines to understand the actual situation, (c) monitoring whether sufficient measures are being taken, and (d) evaluating the impact of those measures.

(a) is being done by many governments, but continuous updates based on scientific evidence are necessary. Even in this past week, it was scientifically shown that in enclosed spaces, ensuring social distancing alone is not sufficient for infection control. It is necessary to pay attention to the fact that guidelines for restaurants where enclosed spaces are unavoidable are changing overseas. Looking at stores in Tokyo, I feel that measures in this regard are lax.

Regarding (b), responses are being made based on the "doctrine of innate goodness," such as the certification of voluntary efforts. However, it is not possible to confirm to what extent risk management based on guidelines is being carried out in the region. The emergence of Civic Tech is desired to visualize the guideline registration rate of the entire region while also including small-scale stores that face challenges in IT utilization.

If users can check websites like Tabelog or Gurunavi before visiting, it can serve as a criterion for choosing a store. Furthermore, for tourist areas, showing themselves as regions that have implemented sufficient infection control measures could lead to branding.

Regarding (c), Saitama Prefecture has just taken a step forward. On the other hand, it is not just stores where clusters are occurring. I believe it is also necessary to monitor offices in combination with the Act on Maintenance of Sanitation in Buildings (though I am not sure if this specific law is appropriate...).

Also, activities where crowding and enclosed spaces can occur, such as live music venues and events, have a large impact when a cluster occurs. The analysis that the Liverpool vs. Atletico Madrid football match held on March 11 spread the infection in the UK had a significant impact. We must prevent such tragedies by implementing measures that involve understanding the actual situation and making improvements, rather than just relying on efforts based on voluntary standards. (Holding of CL Liverpool match linked to "41 additional" COVID deaths: Reports | AFPBB News)

Regarding (d), it is important to continuously understand the effects of measures. For example, the percentage of stores complying with guidelines can be calculated for each region and evaluated in combination with indicators of infected persons and positivity rates. By conducting such verification continuously, it is possible to evaluate whether regional measures are being carried out effectively. Furthermore, there is a possibility that the same measures may no longer be effective in the future due to virus mutations, changes in temperature, or an increase in the infection rate in the region. Monitoring is important to capture various situational changes and respond quickly.

The above is an example of a risk management strategy as of the current time (mid-July). While some parts may no longer be effective measures due to future changes in the situation, I believe it is important to understand the actual situation through data and continuously verify the effects.