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Covid-19: Japan prepares to extend state of emergency nationwide as “untraceable” cases soar

BMJ 2020; 369 doi: (Published 16 April 2020) Cite this as: BMJ 2020;369:m1543

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  1. Mun-Keat Looi
  1. The BMJ, London

The Japanese government has announced that it will extend the state of emergency to the whole country amid reports of untraceable transmission.

On 7 April the prime minister, Shinzo Abe, announced a state of emergency in seven major prefectures, including Tokyo, set to run until 6 May.1 This will now be applied to all 47 prefectures. The health minister, Katsunobu Kato, said that the number of covid-19 patients had doubled since the emergency measures were declared.

The Abe government had been considering the capacity and state of healthcare in each region amid worrying signs that the origin of many new infections seemed untraceable. It has urged citizens to stay at home and to avoid unnecessary travel, particularly from cities to rural areas where many elderly citizens live. Japan has the highest proportion of over 65s in the world, comprising nearly a third of its population.

Experts from a government appointed panel said that they could not verify where or when patients had become infected in as many as 40% of reported cases. Of 197 new cases reported in Tokyo on 11 April, authorities were unable to trace the source of infection in 77%.

Osaka, Fukuoka, Aichi, and Okinawa prefectures said that unknown transmission accounted for 50-75% of daily cases. The government’s task force on covid-19 warned that as many as 420 000 people could die without preventive measures. And a health ministry official told the Japan Times that patients’ reluctance to share information, as well as a shortage of public health staff, was making contact tracing difficult.

Japan has recorded over 9000 cases of covid-19 (including 712 on the Diamond Princess cruise ship), around a quarter of which have been in Tokyo, and 192 deaths have occurred as of 16 April.2


The number of patients receiving extracorporeal membrane oxygenation (ECMO) machine life support treatment has nearly doubled in two weeks—from 40 patients during the six weeks until 30 March to at least 75 patients3—say surveys of Japanese medical associations such as the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine. The government and medical equipment makers are looking to increase production of ECMO machines.

Meanwhile, the municipal government of Osaka city issued a public plea for donations of plastic raincoats owing to a shortage of personal protective equipment (PPE) in hospitals. Reuters reported that some doctors had resorted to wearing rubbish bags.4

Japan’s Nationwide Doctors Union has called on the Ministry of Health to provide pay and insurance to the rising number of “unpaid doctors,” including graduate medical students, who are attending to patients during the crisis.

Elsewhere, 18 trainee doctors at Tokyo’s Keio University Hospital tested positive for coronavirus after 40 of them attended a party after work, the Mainichi newspaper reported.5 Yuko Kitagawa, head of the hospital, called it “an intolerable act [by] persons engaging in medical care who should protect patients.”

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