ASOURCE Times

COVID-19 is difficult to end this year
Repeat some peaks

The expansion of COVID-19 does not stop. As of the end of April 2020, the number of infected people nationwide has exceeded 13,000 and the number of deaths has exceeded 350, and the number is still increasing. The end of the infection is the wish of all the people, but in a situation unpredictable by experts, the only thing I can say is that the fight against the new coronavirus is long-term.

Since the report of the first infected person in Japan on January 16, the first wave of the epidemic is from the end of February, and the second wave is from the beginning of March to the present (Fig.). .. After that, I think that it will converge while repeating the 3rd wave, the 4th wave, and so on. However, the complete end of the year will be difficult. I feel that the new coronavirus is a tough virus with a different dimension than before. The worst scenario I envision is that this season (until next spring), 200,000 to 300,000 people will be infected in the country and the number of deaths will reach the level of thousands.

However, it is thought that the infectivity of the new coronavirus will be weakened in an environment with high temperature and high humidity, and it is predicted that it will be in a lull once around August. However, as it gets cooler, it is likely that the number of infected people will start to increase again. And it is expected that it will gradually converge over the spring of next year, repeating some peaks again.

In addition to influenza virus, viruses that cause seasonal cold syndrome that are currently prevalent in Japan from autumn to spring include rhinovirus, coronavirus, RS virus, parainfluenza virus, and adenovirus. As far as coronaviruses are concerned, four types have spread so far, but the new coronavirus could be the fifth “indigenous” coronavirus. The epidemic caused by the H1N1 subtype virus that occurred in Japan in May 2009 ended in March of the following year, but the epidemic has been repeated almost every year since then. Similarly, COVID-19 may be prevalent every year. This would create an effective vaccine that would be needed to reach a large number of people in order to end the pandemic of the virus.

Figure 1 Number of infected people in Japan (March-) * Excluding cruise ships (Yokohama Port), but including confirmation of infection after returning home

Source: NHK New Coronavirus Special Site
https://www3.nhk.or.jp/news/special/coronavirus/#infection-status

Infestation risk for all people due to postponement of infection
Symptoms should immediately go to a designated medical institution for infectious diseases

The new coronavirus is tough because it has some differences from previous viruses. First of all, regarding the symptoms, some people complain of cold symptoms such as runny nose, cough, fever, mild sore throat, muscle pain, and malaise, as well as olfactory and taste disorders. Symptoms such as headache, sputum and bloody sputum, and diarrhea are also observed. As it progresses, it may develop upper respiratory tract inflammation, bronchitis, pneumonia, and dyspnea. Also, as I recently learned, it seems that a cytokine storm (immune runaway) may be involved in the sudden aggravation, and there are few cases where multiple organ failure suddenly develops from shock and unfortunate turning point is taken. It seems to be bleeding. Even more troublesome is that there are many asymptomatic people who do not have these symptoms even if they are infected, and there are many mild people who do not have many symptoms, and asymptomatic people and mild people also infect people, so the infection is easy to spread from there. is.

There are various routes of infection. In addition to droplet infections caused by sneezing and coughing, there are contact infections that are transmitted by touching doorknobs, switches, straps of trains and buses, and handrails that the infected person touches or has droplets on. Furthermore, it has been pointed out that micromists and aerosols of about 1 μm discharged by conversation and breathing continue to float in the space and become infected by inhaling them. Asymptomatic people may unknowingly shed the virus in their normal lives.

Under the current testing system, not only asymptomatic people but also mildly ill people are not included in the test. Since it is not diagnosed whether or not the person is infected, it is not known whether or not the person who consulted the medical institution for abdominal pain is infected, and there is no way to prevent the infection in the medical institution. In fact, in-hospital clusters have occurred all over the country, and in-facility infections in facilities for the elderly are occurring one after another. Medical institutions with in-hospital clusters have stopped accepting outpatients and new inpatients. These medical dysfunctions are actually happening.

In order to prevent such a situation, it is necessary to treat patients on the assumption that they are all infected with the source of infection, that is, the new coronavirus. Wear PPE (Personal Protective Equipment) such as a surgical mask, and be sure to wash your hands or disinfect your hands with alcohol after examining one patient.

If you have any symptom of suspected COVID-19, immediately refer it to your local infectious disease designated medical institution. However, it is said that about 40% of people complain of fever from the beginning, so even if it is not a typical cold symptom, even if it is suspected that you have traveled abroad or contacted with a COVID-19 patient by interview, designated medical care I will introduce it to the institution.

Protecting yourself with PPE is a major premise of medical care
Abundant supply of medical equipment and materials

Patients who go to the outpatient department due to injury or are transported to the emergency outpatient department are also required to be treated as infected. Proper use of PPE such as gloves, masks, caps, apron gowns, face shield goggles, and if the patient complains of fever, cough, suffocation, etc. during the procedure, X-rays or CT scans will show pneumonia. You also need to check for the presence.

Protecting the safety of medical staff is the basis of continuing medical care, which leads to the safety, security and lifesaving of patients. Currently, there is a shortage of PPE such as masks, gloves, and gowns in the medical field, and it is hoped that all medical institutions will be supplied with abundant medical equipment and materials including PPE.

In preparation for an emergency like this one, we should stockpile a huge amount of basic PPE. We believe this should be stocked by the state, and rather than stocking vaccines that are not guaranteed to work, we are prepared for a sudden epidemic of respiratory viruses, especially respiratory diseases such as masks, goggles and gowns. It is better to stock PPE adapted to.

An urgent issue is the expansion of the PCR inspection system. It is no longer the stage to suppress the spread of infection by manually tracking the flow of the cluster. The phase has changed, and more aggressive PCR testing is required to pick up infected people under the surface.

Patients should be sorted according to the degree of symptoms based on the results of PCR tests and medical examinations, and each should be treated differently. In the early days of the epidemic, this distribution was not done properly, and a large number of mildly ill people occupied the beds, resulting in a shortage of beds for the severely ill. Some local governments have started to put mildly ill people "waiting at home", which is a sign of the collapse of medical care. There is a high risk of infection within the family, and even people living alone may go out to procure daily necessities and increase the number of infected people. In addition, it has been reported that people living alone cannot respond quickly to sudden changes and take an unfortunate turning point.

Based on this situation, we believe that further strengthening cooperation between medical institutions and national and local governments and taking prompt, timely, and appropriate measures are essential for the end of COVID-19.