Lessons Learned from Japan's Response to the First Wave of COVID-19: A Content Analysis

'We were having a rather long conversation about the uproar': memorable messages about COVID-19 vaccinations in a mostly young, white sample

BACKGROUND

Interpersonal communication motivates many decisions related to COVID-19 prevention practices. Previous research shows that the frequency of interpersonal communication is significant. Less is known, however, about who messages interpersonal communication about COVID-19 and what information those messages convey. We sought to understand better these interpersonal communication messages for individuals who are asked to become vaccinated against COVID-19.

METHODS

Using a memorable messages approach, we interviewed 149 adults, mostly young, white, college students, about their vaccination choices as they were influenced by messages about vaccination they had received from respected members of their interpersonal networks. Date was analyzed using thematic analysis.

RESULTS

Three themes emerged from these interviews of primarily young, white, college students: a dialectic of feeling forced to become vaccinated vs. choice to become vaccinated; a tension between protecting oneself vs. protecting others through vaccination; and, finally, perceptions that family members who were also medical experts were particularly influential.

CONCLUSIONS

The dialectic between feelings of choice versus force may require further study into the longer-term impacts of messages that may prompt feelings of reactance and produce undesired outcomes. The dialectic between messages being remembered for their altruism as compared to their selfishness opens opportunities to consider the relative influence of these two impulses. These findings also provide insight into broader topics about countering vaccine hesitancy for other diseases. These findings may not be generalizable to older, more diverse populations.

COVID-19 Pandemic Risk Assessment: Systematic Review

Background

The COVID-19 pandemic presents the possibility of future large-scale infectious disease outbreaks. In response, we conducted a systematic review of COVID-19 pandemic risk assessment to provide insights into countries' pandemic surveillance and preparedness for potential pandemic events in the post-COVID-19 era.

Objective

We aim to systematically identify relevant articles and synthesize pandemic risk assessment findings to facilitate government officials and public health experts in crisis planning.

Methods

This study followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and included over 620,000 records from the World Health Organization COVID-19 Research Database. Articles related to pandemic risk assessment were identified based on a set of inclusion and exclusion criteria. Relevant articles were characterized based on study location, variable types, data-visualization techniques, research objectives, and methodologies. Findings were presented using tables and charts.

Results

Sixty-two articles satisfying both the inclusion and exclusion criteria were identified. Among the articles, 32.3% focused on local areas, while another 32.3% had a global coverage. Epidemic data were the most commonly used variables (74.2% of articles), with over half of them (51.6%) employing two or more variable types. The research objectives covered various aspects of the COVID-19 pandemic, with risk exposure assessment and identification of risk factors being the most common theme (35.5%). No dominant research methodology for risk assessment emerged from these articles.

Conclusion

Our synthesized findings support proactive planning and development of prevention and control measures in anticipation of future public health threats.

Lessons from health insurance responses in counteracting COVID-19: a qualitative comparative analysis of South Korea and three influential countries

BACKGROUND

The COVID-19 pandemic has caused delays and restrictions in providing medical services. In response to the medical surge, countries with social insurance systems provided financial incentives to medical institutions. This study aimed to present the directions for health insurance support by comparing countries in terms of the domains and contents of COVID-19 health insurance support to ensure timely support in case of future pandemics.

METHODS

An analysis framework was developed to compare health insurance policy interventions for COVID-19 and non-COVID-19 domains, and detailed policy interventions were divided into sub-domains (space, staff, and stuff) for each domain. Data were collected by country from the websites of the Ministry of Health and Social Insurers, Organisation for Economic Co-operation and Development, and European Observatory on Health Systems and Policies and were analyzed using qualitative comparative analysis.

RESULTS

The countries provided comprehensive support for both the COVID-19 and non-COVID-19 domains. In the COVID-19 domain, overall support was provided in all three sub-domains. Additional cost support was provided to prevent infection and provide secure facilities to treat confirmed patients. Outpatient services were mainly supported, and an intensive intervention was developed in the staff sub-domain for the non-COVID-19 domain. The point of policy intervention was the surge of the first confirmed case. Continuous revisions were subsequently made. The government provided financial support through health insurance.

CONCLUSIONS

Regarding where policy support through health insurance should be focused, the workload of medical personnel increased according to the change in the service provision environment due to the pandemic, and the medical service delivery system changed to prevent further infection. Consequently, incentives should be provided to aid the provision of stable services to patients and should be an auxiliary means to implement the national quarantine policy more effectively via a health insurance response system that promptly provides additional financial support in case of future crises.

Improvement of the software for modeling the dynamics of epidemics and developing a user-friendly interface

The challenges humanity is facing due to the Covid-19 pandemic require timely and accurate forecasting of the dynamics of various epidemics to minimize the negative consequences for public health and the economy. One can use a variety of well-known and new mathematical models, taking into account a huge number of factors. However, complex models contain a large number of unknown parameters, the values of which must be determined using a limited number of observations, e.g., the daily datasets for the accumulated number of cases. Successful experience in modeling the COVID-19 pandemic has shown that it is possible to apply the simplest SIR model, which contains 4 unknown parameters. Application of the original algorithm of the model parameter identification for the first waves of the COVID-19 pandemic in China, South Korea, Austria, Italy, Germany, France, Spain has shown its high accuracy in predicting their duration and number of diseases. To simulate different epidemic waves and take into account the incompleteness of statistical data, the generalized SIR model and algorithms for determining the values of its parameters were proposed. The interference of the previous waves, changes in testing levels, quarantine or social behavior require constant monitoring of the epidemic dynamics and performing SIR simulations as often as possible with the use of a user-friendly interface. Such tool will allow predicting the dynamics of any epidemic using the data on the number of diseases over a limited period (e.g., 14 days). It will be possible to predict the daily number of new cases for the country as a whole or for its separate region, to estimate the number of carriers of the infection and the probability of facing such a carrier, as well as to estimate the number of deaths. Results of three SIR simulations of the COVID-19 epidemic wave in Japan in the summer of 2022 are presented and discussed. The predicted accumulated and daily numbers of cases agree with the results of observations, especially for the simulation based on the datasets corresponding to the period from July 3 to July 16, 2022. A user-friendly interface also has to ensure an opportunity to compare the epidemic dynamics in different countries/regions and in different years in order to estimate the impact of vaccination levels, quarantine restrictions, social behavior, etc. on the numbers of new infections, death, and mortality rates. As example, the comparison of the COVID-19 pandemic dynamics in Japan in the summer of 2020, 2021 and 2022 is presented. The high level of vaccinations achieved in the summer of 2022 did not save Japan from a powerful pandemic wave. The daily numbers of cases were about ten times higher than in the corresponding period of 2021. Nevertheless, the death per case ratio in 2022 was much lower than in 2020.

Lessons Learned from the Lessons Learned in Public Health during the First Years of COVID-19 Pandemic

(1) Objectives: to investigate the main lessons learned from the public health (PH) response to COVID-19, using the global perspective endorsed by the WHO pillars, and understand what countries have learned from their practical actions. (2) Methods: we searched for articles in PubMed and CINAHL from 1 January 2020 to 31 January 2022. 455 articles were included. Inclusion criteria were PH themes and lessons learned from the COVID-19 pandemic. One hundred and forty-four articles were finally included in a detailed scoping review. (3) Findings: 78 lessons learned were available, cited 928 times in the 144 articles. Our review highlighted 5 main lessons learned among the WHO regions: need for continuous coordination between PH institutions and organisations (1); importance of assessment and evaluation of risk factors for the diffusion of COVID-19, identifying vulnerable populations (2); establishment of evaluation systems to assess the impact of planned PH measures (3); extensive application of digital technologies, telecommunications and electronic health records (4); need for periodic scientific reviews to provide regular updates on the most effective PH management strategies (5). (4) Conclusion: lessons found in this review could be essential for the future, providing recommendations for an increasingly flexible, fast and efficient PH response to a healthcare emergency such as the COVID-19 pandemic.

Assessing the impact of local context and priorities regarding domestic disease outbreaks and imported risk on early pandemic response: Cross-continental comparisons

Introduction

Containment and closure policies are effective measures used in the early stages of a highly transmissible global pandemic such as COVID-19 to mitigate the spread and reduce transmissions. However, these policies can have negative impacts on the economy and personal freedom. Governments must carefully consider the necessity of increasing their stringency. Local contexts and priorities regarding domestic disease outbreaks and the risk of imported cases from other countries may vary among different countries, and could influence the decision to increase containment measures. Thus, this study aimed to differentiate the impacts of these affecting factors on the stringency of governmental containment measures through cross-continental comparisons.

Methods

This study utilized a zero/one inflated beta (ZOIB) regression model to investigate how domestic epidemic, imported risk, and local context affect government responses to a pandemic. We used a country's weekly confirmed case and death numbers as a measure of its domestic threat. The imported risk was measured using a combination of weekly new cases in each country and the air passenger traffic between countries.

Results

The findings indicate that domestic case numbers are a primary concern for governments when deciding to increase policy stringency. Countries with higher development levels tend to implement stricter policies as they can better handle the negative impacts. Additionally, there is an interaction between case numbers and development level, with countries at the second or third highest development level focusing more on domestic outbreaks than imported risks, while those at the highest level have similar concerns for both.

Conclusions

We concluded that most countries adjust policies' stringency majorly based on the variation of domestic case number rather than the other pandemic factors and the countries with a high development level tend to implement strict policies since their socio-economical condition could afford such policies. These insights can aid policymakers in improving containment and closure policies for future pandemics.

COVID-19 and science advice on the 'Grand Stage': the metadata and linguistic choices in a scientific advisory groups' meeting minutes

Science advice for governments attracted great scrutiny during the COVID-19 pandemic, with the public spotlight on institutions and individual experts-putting science advice on the 'Grand Stage'. A review of the academic literature identified transparency, a plurality of expertise, the science and policy 'boundary', and consensus whilst addressing uncertainty as key themes. The Scientific Advisory Group for Emergencies (SAGE) has been the primary provider of coordinated scientific and technical advice to the UK Government during emergencies since 2009. Using the first 89 of SAGE's meeting minutes (study period: 22 January 2020-13 May 2021), the 'metadata' and linguistic choices are analysed to identify how SAGE's role and protocols are communicated. This includes understanding which experts were regularly taking part in discussions, the role of scientific experts in the science advisory system and their influence on policy choices, and the degree of consensus and uncertainty within this group of experts-all of which relate to the degree of transparency with the public. In addition, a temporal analysis examines how these practices, such as linguistically marking uncertainty, developed over the period studied. Linguistic markers indexing certainty and uncertainty increased, demonstrating a commitment to precise and accurate communication of the science, including ambiguities and the unknown. However, self-references to SAGE decreased over the period studied. The study highlights how linguistic analysis can be a useful approach for developing an understanding of science communication practices and scientific ambiguity. By considering how SAGE presents to those outside the process, the research calls attention to what remains 'behind the scenes' and consequently limits the public's understanding of SAGE's role in the COVID-19 response.

A narrative review on drug development for the management of antimicrobial- resistant infection crisis in Japan: the past, present, and future

INTRODUCTION

Antimicrobial resistance (AMR) is a major threat to global health requiring continuous development of new antimicrobial agents. Antimicrobial research and development (R&D) should be promoted in the pharmaceutical industry and academia to ensure sustainable patient access to new treatment options and reduce the global AMR burden.

AREAS COVERED

This review describes the historical challenges in novel antimicrobial drug development in Japan, current national efforts to promote the development, and proposals to effectively manage future AMR pandemics. Literature searches were performed in the PubMed database (from inception to January 2022).

EXPERT OPINION

R&D activities in the antimicrobial space in Japan have been insufficient due to multiple factors, including unfavorable cost-profit balance and differences in regulatory requirements between Japan and Western countries. However, the situation is improving with the implementation of the Japanese AMR action plan, drug R&D programs led by the Japan Agency for Medical Research and Development, and efforts of regulatory agencies in the United States, Europe, and Japan in aligning and expediting the clinical development process. Further actions during the interpandemic period will strengthen antimicrobial R&D, including international and interdisciplinary collaboration, continued funding and investment with the national government's leadership, and fostering of new-generation academic research leaders.PLAINLANGUAGE SUMMARYEvery year, many people suffer and die of antimicrobial-resistant infections worldwide. New treatment options are required to tackle antimicrobial-resistant infections; however, pharmaceutical companies have not been very active in developing antimicrobial agents in the last two decades. This was mainly due to the difficulty in discovering new and effective compounds and insufficient funds being spent on drug discovery. In addition, differences in drug development requirements between the United States (US), Europe, and Japan have made it difficult for Japanese pharmaceutical companies to develop antimicrobial agents that can be used in all regions in a timely manner. In the last decade, several measures have been taken to re-activate antimicrobial research and development in the pharmaceutical industry, as well as in academia, in Japan. These measures include a national action plan to combat antimicrobial-resistant infections and research support programs led by the Japan Agency for Medical Research and Development. Regulatory authorities in the US, Europe, and Japan have initiated efforts to expedite the development of drugs to treat infections. Moreover, pathways for accelerated regulatory review have been established to reduce the time taken for new drugs to be approved, and this has already been applied to several new anti-infective drugs. To combat the coronavirus disease 2019 (COVID-19) pandemic, the development of novel vaccines and antiviral drugs has been accelerated with unprecedented speed. Additional actions, such as international research collaboration programs and investment in new antimicrobial development, may help promote antimicrobial research and development activities in Japan.

A Robust Design-Based Expert System for Feature Selection and COVID-19 Pandemic Prediction in Japan

Expert systems are frequently used to make predictions in various areas. However, the practical robustness of expert systems is not as good as expected, mainly due to the fact that finding an ideal system configuration from a specific dataset is a challenging task. Therefore, how to optimize an expert system has become an important issue of research. In this paper, a new method called the robust design-based expert system is proposed to bridge this gap. The technical process of this system consists of data initialization, configuration generation, a genetic algorithm (GA) framework for feature selection, and a robust mechanism that helps the system find a configuration with the highest robustness. The system will finally obtain a set of features, which can be used to predict a pandemic based on given data. The robust mechanism can increase the efficiency of the system. The configuration for training is optimized by means of a genetic algorithm (GA) and the Taguchi method. The effectiveness of the proposed system in predicting epidemic trends is examined using a real COVID-19 dataset from Japan. For this dataset, the average prediction accuracy was 60%. Additionally, 10 representative features were also selected, resulting in a selection rate of 67% with a reduction rate of 33%. The critical features for predicting the epidemic trend of COVID-19 were also obtained, including new confirmed cases, ICU patients, people vaccinated, population, population density, hospital beds per thousand, middle age, aged 70 or older, and GDP per capital. The main contribution of this paper is two-fold: Firstly, this paper has bridged the gap between the pandemic research and expert systems with robust predictive performance. Secondly, this paper proposes a feature selection method for extracting representative variables and predicting the epidemic trend of a pandemic disease. The prediction results indicate that the system is valuable to healthcare authorities and can help governments get hold of the epidemic trend and strategize their use of healthcare resources.

Empirical evidence on the efficiency of backward contact tracing in COVID-19

Standard contact tracing practice for COVID-19 is to identify persons exposed to an infected person during the contagious period, assumed to start two days before symptom onset or diagnosis. In the first large cohort study on backward contact tracing for COVID-19, we extended the contact tracing window by 5 days, aiming to identify the source of the infection and persons infected by the same source. The risk of infection amongst these additional contacts was similar to contacts exposed during the standard tracing window and significantly higher than symptomatic individuals in a control group, leading to 42% more cases identified as direct contacts of an index case. Compared to standard practice, backward traced contacts required fewer tests and shorter quarantine. However, they were identified later in their infectious cycle if infected. Our results support implementing backward contact tracing when rigorous suppression of viral transmission is warranted.

Factors Associated with Delayed Diagnosis among Patients with COVID-19 in Okinawa, Japan

The delayed presentation and diagnosis of COVID-19 can contribute to spread of the disease to others but can also cause severe conditions. This study examined factors associated with delayed diagnosis among patients with COVID-19 in Okinawa, Japan. We used the data from 7125 reported cases of people living in Okinawa prefecture with symptom onset between September 2020 and March 2021. The outcome variable was the number of days from symptom onset to diagnosis. The predictor variables included age, sex, occupation, residential area, presumed infection route, and the day of the week. Cox regression analysis was used to compare the outcome between categories for each predictor variable. The median number of days from onset to diagnosis was 3 days, with an interquartile range of 1 to 5 days. Significantly more time from onset to diagnosis was observed in patients in their 60s vs. those in their 20s (hazard ratio: 0.88; 95% confidence interval: 0.81-0.96); hospitality workers were compared to office workers (0.90; 0.83-0.97), patients with unknown infection routes to those with known infection routes (0.77; 0.70-0.84), and those with symptom onset on Sundays/national holidays to those with symptom onset on weekdays (0.90; 0.85-0.96).

Job stress among workers who telecommute during the coronavirus disease (COVID-19) pandemic in Japan: a cross-sectional study

OBJECTIVES

The work system reform and the COVID-19 pandemic in Japan have prompted efforts toward telecommuting in Japan. However, only a few studies have investigated the stress and health effects of telecommuting. Therefore, this study aimed to clarify the relationship between telecommuting and job stress among Japanese workers.

MATERIAL AND METHODS

This was a cross-sectional study. In December 2020, during the "third wave" of the COVID-19 pandemic, an Internet-based nationwide health survey of 33 087 Japanese workers (The Collaborative Online Research on Novel-coronavirus and Work, CORoNaWork study) was conducted. Data of 27 036 individuals were included after excluding 6051 invalid responses. The authors analyzed a sample of 13 468 office workers from this database. The participants were classified into 4 groups according to their telecommuting frequency, while comparing scores on the subscale of the Job Content Questionnaire (JCQ) and subjective job stress between the high-frequency, medium-frequency, low-frequency, and non-telecommuters groups. A linear mixed model and an ordinal logistic regression analysis were used.

RESULTS

A significant difference in the job control scores of the JCQ among the 4 groups was found, after adjusting for multiple confounding factors. The high-frequency telecommuters group had the highest job control score. Further, after adjusting for multiple confounding factors, the subjective job stress scores of the high- and medium-frequency telecommuters groups were significantly lower than those of the non-telecommuters group.

CONCLUSIONS

This study revealed that high-frequency telecommuting was associated with high job control and low subjective job stress. The widespread adoption of telecommuting as a countermeasure to the public health challenges associated with the COVID-19 pandemic may also have a positive impact on job stress. Int J Occup Med Environ Health. 2022;35(3):339-51.

Association between work-related changes caused by the COVID-19 pandemic and severe psychological distress among Japanese workers

This study aimed to evaluate the association between work-related changes caused by COVID-19 and psychological distress among Japanese workers. The cross-sectional study was conducted from August 25 to September 30, 2020. The participants were 15,454 employees who were registered as panelists with an online survey company. The Kessler psychological distress scale with a 13-point cutoff was used to measure psychological distress. Multiple logistic regression was performed. Of the respondents, 8.9% were evaluated as having severe psychological distress. Among five examined work-related changes, being laid off and changing jobs (adjusted odds ratio [aOR] = 5.43; 95% confidence interval [CI]: 4.18-7.05), experiencing temporary workplace closure (aOR = 1.94; 95% CI: 1.67-2.25), being forced to visit the workplace for paperwork (aOR = 1.84; 95% CI: 1.58-2.15), and starting telework from home (aOR = 1.18; 95% CI: 1.01-1.37) were associated with increased psychological distress; no significant association was found for participation in work-related online meetings. The impact on psychological distress was greater among men, especially for being laid off and changing jobs because of COVID-19. It is important to assess and reduce negative mental health effects among workers experiencing work-related changes caused by the COVID-19 pandemic, taking gender differences into account.

Assessment of Traffic Accidents in Japan during the COVID-19 Pandemic vs. Previous Years: A Preliminary Report

Beginning in April 2020, social distancing measures were implemented to mitigate the COVID-19 pandemic in Japan. We assessed whether traffic accident rates had decreased from April 2020 to December 2021 as compared with previous years. The analysis included 2,934,477 traffic accidents, and the trend of decreasing rates of traffic accidents in recent years and seasonal fluctuations in traffic accidents were considered. The yearly change in the traffic accident rate between 2015 and 2019 was estimated, and the traffic accident rate in 2020 and 2021 was predicted. This was followed by the comparison of observed vs. predicted traffic accident rate. In 2020, the observed vs. expected rates of traffic accidents were lower in April to December 2020, and the rate of traffic accidents in Japan was 30–40% lower in April–May 2020 than would be expected based on trends from previous years. In 2021, rates of traffic accidents remained lower than expected between January and November, but the magnitude of decrease was not as pronounced. These findings could be explained by social distancing policies, including the declaration of the state of emergency, and the relaxation of public health and social measures over time.

Role of stay-at-home requests and travel restrictions in preventing the spread of COVID-19 in Japan

COVID-19 is one of the worst global health crises in a century. Japan confirmed its first case of COVID-19 in mid-January and declared a state of emergency in April and May 2020, urging people to stay at home and reduce travel. Using Mobile Spatial Statistics (i.e., population statistics created from operational data of mobile terminal networks), we estimated daily intra- and inter-prefectural population mobility in the Tokyo Megalopolis Region, Japan in 2020. Then, we developed a compartmental model with population mobility to explore the role of stay-at-home requests and travel restrictions in preventing the spread of COVID-19. This model describes the COVID-19 pandemic through a susceptible-exposed-presymptomatic infectious-undocumented and documented infectious-removed (SEPIR) process and incorporates intra- and inter-prefectural population mobility into the transmission process. We found that people significantly reduced travel during the state of emergency, although stay-at-home requests and travel restrictions were recommended rather than mandatory. The reduction in population mobility, combined with other control measures, resulted in a substantial reduction in effective reproduction numbers to below 1, thus controlling the first wave of the pandemic. Moreover, the relationship between population mobility and COVID-19 transmission changed over time. The dampening of the second wave of the pandemic indicated that smaller reductions in population mobility could result in pandemic control, probably because of other social distancing behaviors. Our proposed model can be used to analyze the impact of different public health interventions, and our findings shed light on the effectiveness of soft containments in curbing the spread of COVID-19.

Older adults’ perceptions of government handling of COVID-19: Predictors of protective behaviors from lockdown to post-lockdown

Background

Distrust, and more broadly, public perception of government’s handling of a crisis, has been a widely studied topic within health crisis research and suggests that these perceptions are significantly associated with the behavior of its citizens.

Purpose

To understand which aspects of the public’s perception of government handling of the COVID-19 pandemic predicted engagement of protective behaviors among older adults, who are the most vulnerable to COVID-19.

Methods

Participants were recruited from an ongoing biopsychosocial study on aging amongst community-dwelling older adults. There were two rounds of data collection, during the national lockdown and post-lockdown. The average length of follow-up was 5.88 months. N = 421 completed the first round of data collection and N = 318 subsequently completed the second round of questionnaires.

Results

During the lockdown, perceptions that pandemic-related measures in place were sufficient, effective, timely, provided a sense of safety, important information was easily accessible, and government handling of the pandemic could be trusted, were found to significantly predict engagement in protective behaviors. During post-lockdown, only perceptions that measures in place were sufficient, provided a sense of safety, and important information was easily accessible, remained significant predictors. The perception that COVID-19 measures were clear and easy to understand now became a significant predictor.

Conclusions

Public perceptions of government handling of the pandemic predicted engagement in protective behaviors but were less important during post-lockdown. To effectively engage older adults in protective behavior, our findings suggest for pandemic-related information to be accessible, introducing timely safety measures, and having easy-to-understand instructions for nuanced measures.

Mosques in Japan responding to COVID-19 pandemic: Infection prevention and support provision

Religious activities tend to be conducted in enclosed, crowded, and close-contact settings, which have a high potential of transmitting the coronavirus disease, 2019 (COVID-19); therefore, religious communities are expected to take appropriate infection prevention measures. Meanwhile, during past disasters, religious communities have provided various types of support to affected people; hence, their role in disaster risk reduction has received much attention. In this study, we aimed to identify the infection prevention measures and support provision implemented by mosques-Islamic institutions managed and operated mainly by foreign Muslims living in Japan-during the one year from January 2020. We collected information from newspaper articles (18 articles on 19 mosques) and interviews with representatives of three mosques. We found that various infection control measures were implemented in mosques-refraining from mass prayers and closing buildings from an early stage (around February 2020); canceling large-scale events during the month of Ramadan; moving some activities online; and ensuring indoor ventilation and safe physical distance even when continuing face-to-face prayer activities. We also found that various types of support were provided by mosques-donating masks to the local government; listening to problems of people affected by COVID-19 regardless of their nationality; providing financial support to them; translating and disseminating information to foreign Muslims; and providing religious meals for them. This study provides actual examples of infection prevention measures taken by mosques in a Muslim-minority society and suggests that mosques appropriately responded to the needs of religious minorities during disasters, including COVID-19.

The Role of Leadership in Public Sector Innovation: A Systematic Review and Meta-Analysis of the Management of COVID-19 in Asian Countries

Strong leadership in public sector innovation can empower governments to address community challenges in new ways in light of the challenges posed by the global coronavirus pandemic. Coronavirus management policy, pandemic responses, needs, and options are reflected in various Asian countries in respective published literature, but a summarized synthesis is not available. Using a systematic review approach (PRISMA), this study has analyzed the role of leadership in public sector innovation in COVID-19 management and synthesized 23 articles from 23 different Asian countries. In the light of available data, public sector innovation (PSI) and the role played by the leadership of each country' have been found to be largely inter-dependent. The current review provides a cross-section of the ongoing nature of the pandemic, as management responses and trend data in the countries are still emerging or evolving. Additionally, our study contributes a current state report regarding the barriers facing the leadership of Asian countries in mitigating the global pandemic through PSI. Our study found that a strong political leadership presence combined with a technocratic approach and a highly-skilled public sector workforce, could lead to more tremendous success in managing the outbreak. Furthermore, religious leadership was also found to have a potentially significant role in COVID-19 management strategies.

Disrupted care during the COVID-19 state of emergency and productivity loss attributed to presenteeism in workers: a nationwide cross-sectional study

OBJECTIVES

The COVID-19 pandemic has caused medical care delays and avoidance around the globe. However, little is known about the relationship between disrupted care and productivity loss attributed to presenteeism during the COVID-19 pandemic. We aimed to investigate whether disrupted care during the COVID-19 state of emergency was associated with health status and productivity loss.

METHODS

We used data from a nationwide, cross-sectional, Internet-based, self-administered survey. We performed multiple logistic regression analysis on data from 14 545 participants to investigate the associations among variables related to disrupted care, health status and the Work Functioning Impairment Scale, with a cut-off of 21 points.

RESULTS

Participants who experienced exacerbation of underlying disease (adjusted OR (aOR) 2.84; 95% CI 2.28 to 3.53) or any type of disrupted care were more likely to show low productivity at work. Experiencing disruptions in routine and non-routine clinical settings (aOR 4.64; 95% CI 3.64 to 5.92 and aOR 6.29; 95% CI 4.74 to 8.34, respectively), and running out of drugs (aOR 6.13; 95% CI 4.60 to 8.18) were strongly associated with exacerbation of underlying disease.

CONCLUSIONS

Workers who experienced disrupted care were much more likely to show productivity loss. Exacerbation of underlying disease is one possible pathway through which disrupted care could affect productivity loss attributed to presenteeism. Our study provides evidence of the importance of early diagnosis and continuous treatment of non-COVID-19 patients to enable them to remain healthy and continue to work during the pandemic.

COVID-19 pandemic and the impact of cross-cultural differences on crisis management: A conceptual model of transcultural crisis management

In this paper, leadership tasks and stakeholder response during transboundary crisis management are analyzed based on findings from Hofstede’s study, GLOBE Project, and theoretical concepts in cross-cultural management. Accordingly, a conceptual model of transcultural crisis management is proposed. Seven propositions (P) and sixteen sub-propositions (SP) are developed and then tested using the case method. The case of the COVID-19 pandemic is studied to note the effects of cross-cultural differences and intercultural communication in the pre-crisis, crisis, and post-crisis stages. Cross-cultural differences are found to affect sense-making, decision-making, sense-giving and meaning-making during pre-crisis and crisis management stages. Implications of these findings and further research agenda are discussed.

Content Analysis of the Free COVID-19 Telephone Consultations Available during the First Wave of the Pandemic in Japan

This cross-sectional study aimed to (1) describe the unclassified contents of telephone consultation services provided by a public health center during the first wave of COVID-19 in Japan and (2) examine whether the contents required assistance from public health nurses (PHNs). We analyzed a total of 207 calls in which the purpose of the call was unclassified into pre-set categories. PHNs transcribed the exact text of the consultation conversations recorded from 25 March to 20 April 2020 in City A. Approximately half of the calls were from residents. Seven categories were extracted through a qualitative content analysis. The most common topic was infection control measures, where the presence of COVID-19 infection was assumed (n = 62); the second most common was extreme anxiety and fear of infection (n = 50). Questions about the COVID-19 response system (n = 30), discrimination and misunderstandings about COVID-19 (n = 24), and response measures for COVID-19 outbreaks within organizations (n = 18) were also included. The unclassified consultations included various topics, several of which required the expertise of a PHN. Each local government should consider sharing and task-shifting telephone consultation services among PHNs and other staff to reduce their burden and allow them to concentrate on conducting infection control more effectively.

Orthodoxy, illusio, and playing the scientific game: a Bourdieusian analysis of infection control science in the COVID-19 pandemic

Background:

Scientific and policy bodies’ failure to acknowledge and act on the evidence base for airborne transmission of SARS-CoV-2 in a timely way is both a mystery and a scandal. In this study, we applied theories from Bourdieu to address the question, “How was a partial and partisan scientific account of SARS-CoV-2 transmission constructed and maintained, leading to widespread imposition of infection control policies which de-emphasised airborne transmission?”.

Methods:

From one international case study (the World Health Organisation) and three national ones (UK, Canada and Japan), we selected a purposive sample of publicly available texts including scientific evidence summaries, guidelines, policy documents, public announcements, and social media postings. To analyse these, we applied Bourdieusian concepts of field, doxa, scientific capital, illusio, and game-playing. We explored in particular the links between scientific capital, vested interests, and policy influence.

Results:

Three fields—political, state (policy and regulatory), and scientific—were particularly relevant to our analysis. Political and policy actors at international, national, and regional level aligned—predominantly though not invariably—with medical scientific orthodoxy which promoted the droplet theory of transmission and considered aerosol transmission unproven or of doubtful relevance. This dominant scientific sub-field centred around the clinical discipline of infectious disease control, in which leading actors were hospital clinicians aligned with the evidence-based medicine movement. Aerosol scientists—typically, chemists, and engineers—representing the heterodoxy were systematically excluded from key decision-making networks and committees. Dominant discourses defined these scientists’ ideas and methodologies as weak, their empirical findings as untrustworthy or insignificant, and their contributions to debate as unhelpful.

Conclusion:

The hegemonic grip of medical infection control discourse remains strong. Exit from the pandemic depends on science and policy finding a way to renegotiate what Bourdieu called the ‘rules of the scientific game’—what counts as evidence, quality, and rigour.

A SWOT Analysis of the Guidelines on Prevention of HIV/AIDS in Japan in the Context of COVID-19

In January 2018, the Minister of Health, Labour and Welfare, Japan, released an amended Guideline on the Prevention of Specified Infectious Diseases on Acquired Immunodeficiency Syndrome (AIDS) to propose measures to control the human immunodeficiency virus (HIV)/AIDS. Content analysis was performed to examine the strengths, weaknesses, opportunities, and threats of the guidelines in the context of the ongoing COVID-19 pandemic, thus aiming to promote discussions on the guideline itself and the national HIV/AIDS strategy in Japan in the years ahead. The strengths included the incorporation of the latest scientific advancements, clarification of high-risk populations, an alignment with measures against sexually transmitted diseases (STDs), and willingness towards international cooperation in the Asia-Pacific region. The weaknesses that were exposed included a lack of explicit targets for controlling and containing HIV/AIDS, insufficient descriptions about pre-exposure prophylaxis (PrEP), and aggregated discussions on HIV/AIDS among foreign residents. Although several opportunities for re-energizing the discussions around HIV/AIDS were recognized, insufficient political will and funding, along with the emergence of the ongoing COVID-19 pandemic, could operate as threats. Addressing barriers that were recognized before 2019 and exposed due to the COVID-19 pandemic, and tackling underlying health inequalities through the concept of social determinants of health will be critical.

Orthodoxy, illusio, and playing the scientific game: a Bourdieusian analysis of infection control science in the COVID-19 pandemic

Background: Scientific and policy bodies’ failure to acknowledge and act on the evidence base for airborne transmission of SARS-CoV-2 in a timely way is both a mystery and a scandal. In this study, we applied theories from Bourdieu to address the question, “How was a partial and partisan scientific account of SARS-CoV-2 transmission constructed and maintained, leading to widespread imposition of infection control policies which de-emphasised airborne transmission?”. Methods: From one international case study (the World Health Organisation) and four national ones (UK, Canada, USA and Japan), we selected a purposive sample of publicly available texts including scientific evidence summaries, guidelines, policy documents, public announcements, and social media postings. To analyse these, we applied Bourdieusian concepts of field, doxa, scientific capital, illusio, and game-playing. We explored in particular the links between scientific capital, vested interests, and policy influence. Results: Three fields—political, state (policy and regulatory), and scientific—were particularly relevant to our analysis. Political and policy actors at international, national, and regional level aligned—predominantly though not invariably—with medical scientific orthodoxy which promoted the droplet theory of transmission and considered aerosol transmission unproven or of doubtful relevance. This dominant scientific sub-field centred around the clinical discipline of infectious disease control, in which leading actors were hospital clinicians aligned with the evidence-based medicine movement. Aerosol scientists—typically, chemists, and engineers—representing the heterodoxy were systematically excluded from key decision-making networks and committees. Dominant discourses defined these scientists’ ideas and methodologies as weak, their empirical findings as untrustworthy or insignificant, and their contributions to debate as unhelpful. Conclusion: The hegemonic grip of medical infection control discourse remains strong. Exit from the pandemic depends on science and policy finding a way to renegotiate what Bourdieu called the ‘rules of the scientific game’—what counts as evidence, quality, and rigour.

Containment, Health, and Social Policies in the Time of COVID-19 - Patterns and Determinants of Initial Reponses from Spring 2020 Across 120 Countries

The COVID-19 pandemic has triggered an unprecedented number of policy responses around the world across multiple policy domains. While governments have combined containment and health policies with social policies (CHSP) during the initial phase of the pandemic in various ways, current literature offers little knowledge of the patterns of these combinations and their determinants and outcomes. This paper fills this gap by investigating CHSP combinations across more than 120 countries. We further examined whether the CHSP policy response was determined by political regimes or compensation hypotheses-serving the purposes of responding to pre-existing economic downturns, inequality, or social unrest. We also investigated the associations between CHSP responses and mobility, virus infection, and unemployment. Using policy data from the Oxford COVID-19 Government Response Tracker, results from sequence analysis indicated that governments' CHSP responses could be clustered into five categories: high social policies (SP), middle SP, containment and health (CH) leading SP, low SP, and gradual high SP. We used multinomial regression models to investigate determinants of CHSP responses. We found that CHSP policy responses did not differ by political regime, and CHSP combinations were not driven by compensation hypotheses. Instead, GDP per capita and government effectiveness were the key drivers for high levels of policy responses. We also found that low SP responses were associated with fewer mobility changes. Taken together, our findings suggest that lower income countries required more support and resources in order for them to adopt necessary CH and SP responses.

Dynamic associations between temporal behavior changes caused by the COVID-19 pandemic and subjective assessments of policymaking: A case study in Japan

To design effective policies against COVID-19, there is a need for more evidence-based research. However, associations between actual policies and temporal behavior changes have remained underexplored. To fill this important research gap, a nationwide retrospective life-oriented panel survey on individuals' behavior changes from April to September 2020 was implemented in Japan. Reliability of information sources, risk perceptions, and attitudes toward policymaking were also investigated. Valid data were collected from 2643 respondents residing in different parts of the country. Risks were reported about general infections and public transport use. Attitudes toward policymaking were mainly about policymaking capacity and PASS-LASTING based policy measures. A dynamic structural equation model (DSEM) was developed to quantify dynamic associations between individuals' behavior changes over time and subjective assessments (i.e., attitudes) of policymaking. Survey results revealed that behavior changes are mostly characterized by avoidance behaviors. Modeling estimation results showed a statistically-significant sequential cause-effect relationship between accumulated behavior changes in the past, subjective factors, and the most recent behavior changes. The most recent behavior changes are mostly affected by accumulated behavior changes in the past. Effects of subjective assessments of policymaking on the most recent behavior changes are significant but moderate. Among attitudes toward policymaking, attitudes toward policymaking capacity are more influential than willingness to follow PASS-LASTING based policy measures. High risks of using public transport are found to significantly influence the most recent behavior changes, together with other risk perception factors. Insights into effective COVID-19 policymaking are summarized.

A Cross-Sectional Study of the Mismatch Between Telecommuting Preference and Frequency Associated With Psychological Distress Among Japanese Workers in the COVID-19 Pandemic

OBJECTIVE

To examine how the mismatch between telecommuting preference and telecommuting frequency was associated with psychological distress during the COVID-19 pandemic.

METHODS

Data from 33,302 workers throughout Japan were obtained using an Internet survey. Among 33,302 participants, 20,395 who telecommuted were included in the analysis. Participants' telecommuting preference and frequency during the COVID-19 pandemic were determined using a questionnaire. Psychological distress was assessed using Kessler 6 (K6).

RESULTS

Among participants who did and did not prefer to telecommute, those who telecommuted four or more days per week had an OR of psychological distress of 0.67 (P < 0.001) and 1.87 (P = 0.001), respectively, compared with those who rarely telecommuted.

CONCLUSIONS

The association between telecommuting and psychological distress differs depending on telecommuting preference.

Secondary Attack Rate among Non-Spousal Household Contacts of Coronavirus Disease 2019 in Tsuchiura, Japan, August 2020-February 2021

Household secondary attack rate (HSAR) by risk factor might have a higher transmission rate between spouses. We investigated risk factors for the HSAR among non-spousal household contacts of patients with coronavirus disease 2019 (COVID-19). We studied household contacts of index cases of COVID-19 in Tsuchiura, Japan, from August 2020 through February 2021. The HSARs of the whole household contacts and non-spousal household contacts were calculated and compared across risk factors. We used a generalized linear mixed regression model for multivariate analysis. We enrolled 496 household contacts of 236 index COVID-19 cases. The HSAR was higher for spousal household contacts (37.8%) than for other contacts (21.2%). The HSAR was lower for non-spousal household contacts with a household size (number of household members) of two (18.2%), compared to the HSAR for contacts with a household size ≥4. The HSAR was higher for non-spousal household contacts of index patients with ≥3 days of diagnostic delay (period between onset and diagnosis) (26.0%) compared to those with ≤2 days’ delay (12.5%) (p = 0.033). Among non-spousal household contacts, the HSAR was low for those with a household size of two and was high for contacts of index patients with a long diagnostic delay.

Characteristics of COVID-19-Related Free Telephone Consultations by Public Health Nurses in Japan: A Retrospective Study

This study aimed to (1) describe the characteristics of community residents who used coronavirus disease 2019 (COVID-19)-related telephone consultation systems by public health nurses (PHNs) and (2) analyze the concerns they had during the first wave of COVID-19 in Japan. Among 1126 telephone consultations, PHNs recorded telephone consultations between 25 March, and 30 April, 2020, in City A, Japan. We analyzed 1017 consultations involving 799 (79%) community residents (resident group) and 218 (21%) organizational representatives (organization group) located in City A. Half of the consultations were made during midmorning, and most of the consultations were regarding COVID-19 symptoms. Among the resident group, visiting a primary care doctor was the most common recommendation by the PHNs; there was no difference in provision of consultation by sex. Health- and welfare-related organizations mainly consulted PHNs about "having COVID-19-related symptoms" and "undergoing PCR testing," and PHNs' recommended them to visit a primary care doctor and coordinate PCR testing. The results suggest that public health centers should provide more helpful information on COVID-19 that accurately reflects the concerns of the population.

Modeling population-wide testing of SARS-CoV-2 for containing COVID-19 pandemic in Okinawa, Japan

To break the chains of SARS-CoV-2 transmission and contain the coronavirus disease 2019 (COVID-19) pandemic, population-wide testing has been practiced in various countries. However, scant research has addressed this topic in Japan. In this modeling exercise, we extracted the number of daily reported cases of COVID-19 in Okinawa from October 1 to November 30, 2020, and explored possible scenarios for decreasing COVID-19 incidence by combining population-wide screening and/or social distancing policy. We reveal that permanent lockdown can be theoretically replaced by mass testing but sufficient target population at an adequate frequency must be mobilized. In addition, solely imposing a circuit breaker will not bring a favorable outcome in the long run, and mass testing presents implications for minimizing a period of lockdown. Our results highlight the importance of incentivizing citizens to join the frequent testing and ensure their appropriate isolation. This study also suggests that early containment of COVID-19 will be feasible in prefectures where the mobility is low and/or can be easily controlled for its geographic characteristics. Rigorous investment in public health will be manifestly vital to contain COVID-19.

HIV Testing by Public Health Centers and Municipalities and New HIV Cases During the COVID-19 Pandemic in Japan

BACKGROUND

During the COVID-19 outbreak, facility capacity for HIV testing has been limited. Furthermore, people may have opted against HIV testing during this period to avoid COVID-19 exposure. We investigated the influence of the COVID-19 pandemic on HIV testing and the number of reported HIV cases in Japan.

METHODS

We analyzed quarterly HIV/AIDS-related data from 2015 to the second quarter of 2020 using an anomaly detection approach. The data included the number of consultations, the number of HIV tests performed by public health centers or municipalities, and the number of newly reported HIV cases with and without an AIDS diagnosis. We further performed the same analysis for 2 subgroups: men who have sex with men (MSM) and non-Japanese persons.

RESULTS

The number of HIV tests (9,584 vs. 35,908 in the year-before period) and consultations (11,689 vs. 32,565) performed by public health centers significantly declined in the second quarter of 2020, whereas the proportion of new HIV cases with an AIDS diagnosis (36.2% vs. 26.4%) significantly increased after removing the trend and seasonality effects. HIV cases without an AIDS diagnosis decreased (166 vs. 217), but the reduction was not significant. We confirmed similar trends for the men who have sex with men and non-Japanese subgroups.

CONCLUSIONS

During the COVID-19 pandemic, the current HIV testing system in Japan seems to have missed more cases of HIV before developing AIDS. Continuously monitoring the situation and securing sufficient test resources by use of self-testing is essential to understand the clear epidemiological picture of HIV incidence during the COVID-19 pandemic.

Orthodoxy, illusio, and playing the scientific game: a Bourdieusian analysis of infection control science in the COVID-19 pandemic

Background: Scientific and policy bodies’ failure to acknowledge and act on the evidence base for airborne transmission of SARS-CoV-2 in a timely way is both a mystery and a scandal. In this study, we applied theories from Bourdieu to address the question, “How was a partial and partisan scientific account of SARS-CoV-2 transmission constructed and maintained, leading to widespread imposition of infection control policies which de-emphasised airborne transmission?”. Methods: From one international case study (the World Health Organisation) and four national ones (UK, Canada, USA and Japan), we selected a purposive sample of publicly available texts including scientific evidence summaries, guidelines, policy documents, public announcements, and social media postings. To analyse these, we applied Bourdieusian concepts of field, doxa, scientific capital, illusio, and game-playing. We explored in particular the links between scientific capital, vested interests, and policy influence. Results: Three fields—political, state (policy and regulatory), and scientific—were particularly relevant to our analysis. Political and policy actors at international, national, and regional level aligned—predominantly though not invariably—with medical scientific orthodoxy which promoted the droplet theory of transmission and considered aerosol transmission unproven or of doubtful relevance. This dominant scientific sub-field centred around the clinical discipline of infectious disease control, in which leading actors were hospital clinicians aligned with the evidence-based medicine movement. Aerosol scientists—typically, chemists, and engineers—representing the heterodoxy were systematically excluded from key decision-making networks and committees. Dominant discourses defined these scientists’ ideas and methodologies as weak, their empirical findings as untrustworthy or insignificant, and their contributions to debate as unhelpful. Conclusion: The hegemonic grip of medical infection control discourse remains strong. Exit from the pandemic depends on science and policy finding a way to renegotiate what Bourdieu called the ‘rules of the scientific game’—what counts as evidence, quality, and rigour.

COVID-19 and Heat Illness in Tokyo, Japan: Implications for the Summer Olympic and Paralympic Games in 2021

The 2020 summer Olympic and Paralympic Games in Tokyo were postponed to July-September 2021 due to the coronavirus disease 2019 (COVID-19) pandemic. While COVID-19 has emerged as a monumental health threat for mass gathering events, heat illness must be acknowledged as a potentially large health threat for maintaining health services. We examined the number of COVID-19 admissions and the Tokyo rule for emergency medical care, in Tokyo, from March to September 2020, and investigated the weekly number of emergency transportations due to heat illness and weekly averages of the daily maximum Wet Bulb Globe Temperature (WBGT) in Tokyo in the summer (2016-2020). The peak of emergency transportations due to heat illness overlapped the resurgence of COVID-19 in 2020, and an increase of heat illness patients and WBGT has been observed. Respect for robust science is critical for the decision-making process of mass gathering events during the pandemic, and science-based countermeasures and implementations for COVID-19 will be warranted. Without urgent reconsiderations and sufficient countermeasures, the double burden of COVID-19 and heat-related illnesses in Tokyo will overwhelm the healthcare provision system, and maintaining essential health services will be challenging during the 2021 summer Olympic and Paralympic Games.

Long Diagnostic Delay with Unknown Transmission Route Inversely Correlates with the Subsequent Doubling Time of Coronavirus Disease 2019 in Japan, February-March 2020

Long diagnostic delays (LDDs) may decrease the effectiveness of patient isolation in reducing subsequent transmission of coronavirus disease 2019 (COVID-19). This study aims to investigate the correlation between the proportion of LDD of COVID-19 patients with unknown transmission routes and the subsequent doubling time. LDD was defined as the duration between COVID-19 symptom onset and confirmation ≥6 days. We investigated the geographic correlation between the LDD proportion among 369 confirmed COVID-19 patients with symptom onset between the 9th and 11th week and the subsequent doubling time for 717 patients in the 12th–13th week among the six prefectures. The doubling time on March 29 (the end of the 13th week) ranged from 4.67 days in Chiba to 22.2 days in Aichi. Using a Pearson’s product-moment correlation (p-value = 0.00182) and multiple regression analyses that were adjusted for sex and age (correlation coefficient −0.729, 95% confidence interval: −0.923–−0.535, p-value = 0.0179), the proportion of LDD for unknown exposure patients was correlated inversely with the base 10 logarithm of the subsequent doubling time. The LDD for unknown exposure patients was correlated significantly and inversely with the subsequent doubling time.

Accounting for health inequities in the design of contact tracing interventions: A rapid review

Background

Contact tracing has been a central control measure for coronavirus disease 2019 (COVID-19) transmission. However, without consideration of the needs of specific populations, public health interventions can exacerbate health inequities.

Aim

The purpose of this rapid review was to determine if and how health inequities were included in the design of contact tracing interventions in epidemic settings.

Methods

A search of the electronic databases MEDLINE and Web of Science was conducted. The following inclusion criteria were applied for article selection: (1) described the design of contact tracing interventions, (2) published between 2013 and 2020 in English, French, Spanish, Chinese, or Portuguese, (3) and included at least 50% of empiricism, according to the Automated Classifier of Texts on Scientific Studies (ATCER) tool. Various tools were used to extract data.

Results

Following screening of the titles and abstracts of 230 articles, 39 met the inclusion criteria. Only seven references were retained after full text review. None of the selected studies considered health inequities in the design of contact tracing interventions.

Conclusions

The use of tools/concepts for incorporating health inequities, such as the REFLEX-ISS tool, and ‘proportionate universalism’ when designing contact tracing interventions, would enable practitioners, decision-makers, and researchers to better consider health inequities.

Workplace measures against COVID-19 during the winter third wave in Japan: Company size-based differences

OBJECTIVES

Little is known about workplace measures against coronavirus disease 2019 (COVID-19) in Japan during the winter of 2020, especially in micro-, small-, and medium-sized enterprises (MSMEs). This study aimed to provide an overview of the current situation of anti-COVID-19 measures in Japanese enterprises during the winter, considering company size.

METHODS

This study was an Internet-based nationwide cross-sectional study. Individuals who were registered as full-time workers were invited to participate in the survey. Data were collected using an online self-administered questionnaire in December 2020. The chi-squared test for trend was performed to calculate the P-value for trend for each workplace measure across company sizes.

RESULTS

For the 27 036 participants, across company sizes, the most prevalent workplace measure was encouraging mask wearing at work, followed by requesting that employees refrain from going to work when ill and restricting work-related social gatherings and entertainment. These measures were implemented by approximately 90% of large-scale enterprises and by more than 40% of micro- and small-scale enterprises. In contrast, encouraging remote working was implemented by less than half of large-scale enterprises and by around 20% of micro- and small-scale enterprises. There were statistically significant differences in all workplace measures by company size (all P < .001).

CONCLUSIONS

We found that various responses to COVID-19 had been taken in workplaces. However, some measures, including remote working, were still not well-implemented, especially in smaller enterprises. The findings suggest that occupational health support for MSMEs is urgently needed to mitigate the current wave of COVID-19.

Measles and Rubella during COVID-19 Pandemic: Future Challenges in Japan

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted essential health services. Simultaneously, it has created opportunities for citizens to raise awareness of personal hygiene, mask wearing, and other preventive measures. This brief report aims to clarify the epidemiological trends of measles and rubella in Japan and to explore future challenges for controlling these diseases during and after the COVID-19 pandemic. Although Japan eliminated measles in 2015, the number of measles patients has gradually increased since then, and reached 744 in 2019. In the 2010s, Japan experienced two large rubella epidemics, and the majority of the patients were reported in Tokyo and other metropolitan areas. While the transmission of measles and rubella seems to be suppressed during the COVID-19 pandemic, closing the gap in routine childhood vaccination will be challenging in any country. Moreover, supplementary immunization campaigns for adults have also been disrupted, and they must be invigorated. While the pandemic has a devastating effect on a global scale, it should be utilized as a good opportunity to regain faith in vaccines, implement an evidence-based vaccination policy, and strengthen international cooperation.

High Probability of Long Diagnostic Delay in Coronavirus Disease 2019 Cases with Unknown Transmission Route in Japan

Long diagnostic delays (LDDs) in patients with coronavirus disease 2019 (COVID-19) might decrease the effectiveness of patient isolation in reducing subsequent transmission. We assumed that direction of government considerably increased probability of LDD among COVID-19 cases with unknown exposure in Japan. This study aimed to investigate association of route of case detection and proportion of LDD of COVID-19 in Japan. We included confirmed COVID-19 patients with symptom onset between the ninth and eleventh week in 2020, in 6 prefectures of Japan. LDD was defined as the duration between COVID-19 symptom onset and confirmation ≥6 days. We used multivariable logistic regression analyses to elucidate factors associated with LDD. The mean diagnostic delay for 364 cases was 6.3 days. Proportion of LDD was 38% for cases with known exposure, and 65% for cases with unknown exposure. The probability of LDD in cases with unknown exposure was significantly higher than that for known exposure cases (adjusted odds ratio: 2.38, 95% confidence interval: 1.354–4.21). Early PCR test after symptom onset, strengthening of PCR test capacity, and investigations to study impact of high proportion of LDD in cases without known exposure might be necessary.