People crowd a crosswalk in front of JR Shinjuku Station during the evening rush hour on Aug. 17, 2021. (Mainichi/Kentaro Ikushima)

       TOKYO -- The Japanese government decided on Aug. 17 to add seven more prefectures to the list of six prefectures already under a state of emergency over the coronavirus crisis, but due to the national spread of COVID-19, some in the government are doubtful that the declaration can be lifted by the Sept. 12 time limit that has been set.

       At a meeting of the Japanese government's coronavirus countermeasures subcommittee on Aug. 17, many medical and infectious disease experts voiced their concerns over the current situation. "People have scattered about the country for the Obon holiday season, and infections will rise going forward," one said. Meanwhile, another expert suggested, "Shouldn't a state of emergency be declared for the entire country?" Ultimately, the government's proposal, which incorporated the extension of current state of emergency declarations and the issuance of a state of emergency declaration in several other prefectures was accepted. But there is a sense of stalemate as infections spread at an explosive pace that shows no signs of abating.

       The effects of vaccines -- in which the Japanese government has placed great faith -- has been overshadowed by the fierceness of the Delta variant of the coronavirus. According to the office of Prime Minister Yoshihide Suga, 49.7% of the Japanese public have received their first dose of the coronavirus vaccine, while 37.6% have received their second dose needed to be fully immunized. Among those 65 and older, 84.3% have received both doses of the vaccine. However, in the greater Tokyo region, the Delta variant, said to be twice as strong as the conventional strain, has almost completely replaced the latter. On Aug. 17, the number of newly confirmed cases of people with COVID-19 in Tokyo was 4,377, a record high for a Tuesday. There has been an explosion of infections all over the country, with the number of people infected with the coronavirus nationwide exceeding 20,000 on Aug. 13.

       Clusters of the Delta variant have been popping up around the country. "People have been traveling more because of the summer holidays, and as things stand, we see no factors that will curb the spread of infections at this rate," International University of Health and Welfare professor Tetsuya Matsumoto, who is well versed in infectious diseases, said. "The possibility that the nationwide number of people infected with the coronavirus will decrease during the month of August is low."

       Those with severe cases of COVID-19 reached a record high of 1,646 on Aug. 17, and a shortage of hospital beds has struck, particularly in the greater Tokyo region. According to a tally by the Mainichi Shimbun, 47 people died from the coronavirus on Aug. 17. While that number is fewer than some days this past May through June when more than 100 or so died, the view that "because the number of deaths rises in a delayed manner, it will double very quickly" -- which one member of Prime Minister Suga's Cabinet said -- is a widely held one.

       Because of the lack of hospital beds, increasingly more patients are recuperating at home or waiting at home to be admitted to hospitals. In Tokyo, the number of such people exceeded 30,000. A doctor who sees patients who are resting at home in Tokyo online revealed, "Patients who have moderate symptoms and need supplemental oxygen, and therefore should be hospitalized, are unable to be admitted right away, and there are cases in which I provide in-home medical care for several days."

       The health care system is continuing to hang on by a thread, and the effects of the state of emergency declaration issued in Tokyo on July 12 have been limited. Crowding is said to have a strong correlation to the spread of infection; foot traffic in Shinjuku Ward's Kabukicho entertainment district, and Shibuya Ward's Center-gai shopping street decreased compared to the previous week, but at places such as Tokyo and Shinagawa stations, increased dramatically. A senior government ministry official said, "The aim of declaring something as impactful as a nationwide state of emergency is to curb foot traffic in urban areas, but that sort of effect can no longer be expected," revealing the reason why the government has not expanded the state of emergency to cover the entire country.

       Following the end of the government's coronavirus countermeasures subcommittee meeting, the chair of the subcommittee, Shigeru Omi, told reporters that he wanted the public in Tokyo to cut down their outdoor activities by 50%. "If you go shopping four times a week, make that twice a week. If instead of meeting in a group of five people you make that two people, you're cutting the chances of coming into contact with others by half, thereby curbing the speed at which infections spread." He added, "I would like the prime minister and governors to send out the message that this is an all-out war."

       Believing that the effects of vaccinations will gradually begin to show, the government is hoping to use indices such as the percentage of hospital beds in use and the number of people with severe symptoms of COVID-19 to determine when to lift the state of emergency, and not the number of newly confirmed cases of people infected with the coronavirus. But because infections are expanding more quickly than the government had anticipated, some in the government have voiced doubts that it will be possible to lift the state of emergency by Sept. 12.

       (Japanese original by Hidenori Yazawa, Yuki Nakagawa and Yuki Ogawa, Lifestyle and Medical News Department)

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