basic policies for novel coronavirus disease control march ... · the government of japan...
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Basic Policies for Novel Coronavirus Disease Control
March 28, 2020(Revised on April 16, 2020)
Decisions by the Headquarters for Novel Coronavirus Disease Control
The government of Japan recognizes that counter measures against the novel coronavirus infections are a
critical issue in terms of crisis management, and has made every effort to protect the lives of the people by
taking countermeasures at the water's edge, preventing the spread of the disease, and providing medical
care.
However, in Japan, there have been sporadic outbreaks in areas where the number of patients with
unknown routes of infection has been increasing, and the spread of infection has been observed in some
areas.
In light of this situation, on March 26, 2020, the Minister of Health, Labour and Welfare reported to the
Prime Minister that there was a high risk of the spread of the novel coronavirus infection based on Article
14 of The Act on Special Measures for Pandemic Influenza and New Infectious Diseases Preparedness and
Response (Act No. 31 of 2012; hereinafter referred to as the “Act”), which is applied by replacing the
terms of Article 1-2, paragraphs(1) and (2) of the Supplementary Provisions. On the same day, March 26,
2020, the Headquarters for Novel Coronavirus Disease Control based on Article 15, paragraph 1 of the Act
was established.
In order to protect the lives of the people, it is important to control the number of infected people and to
maintain the health care delivery system and social functions.
Based on this, the first step is to further promote the avoidance of the "Three Cs" and contain the outbreak
of the cluster (populations that have been found to be related to the patient, hereinafter referred to as "the
cluster") through active epidemiological surveys. It is important to contain the outbreak of the so-called
overshoot, an explosive spread of infection (hereinafter referred to as "overshoot") in order to prevent the
outbreak of the disease and to minimize the number of infected, seriously ill and dead.
In addition, it is important to control the rate of spread of infection as much as possible by combining the
avoidance of “Three Cs” with the reduction of human to human contact, such as through requests to refrain
from going outside in order to achieve the above containment and to prevent the collapse of the healthcare
delivery system.
At the same time, it is also necessary to prepare for a rapid increase in the number of infected cases in
Japan, and to establish the necessary systems for healthcare delivery, mainly for the seriously ill.
With respect to the novel coronavirus infection that has already been detected in Japan, as shown in the
following section, "1. Facts about the situation of the new coronavirus infection outbreak", it can be
comprehensively judged that
・The novel coronavirus tends to cause pneumonia at a considerably higher frequency than in the case of
seasonal influenza, and there is a risk of causing significant damage to the lives and health of the people.
・It is a situation that has a risk of having an enormous impact on the lives of the people and the national
economy due to the rapid spread of the disease throughout the country due to the large number of cases
with no identifiable route of infection and a rapid increase in the number of cases.
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On the basis of this, on April 7, 2020, the Head of the Novel Coronavirus Response Headquarters declared
a state of emergency under Article 32, paragraph 1 of the Act on Special Measures for Pandemic Influenza
and New Infectious Diseases Preparedness and Response.
The period during which emergency measures should be taken under the declaration is 29 days from April
7 to May 6, 2020. Areas where emergency measures should be taken are Saitama, Chiba, Tokyo,
Kanagawa, Osaka, Hyogo and Fukuoka Prefectures. Due to widespread COVID-19 infections similar to
the previously mentioned seven prefectures, as of April 16, 2020, a state of emergency declaration has been
additionally designated for the following prefectures: Hokkaido, Ibaraki, Ishikawa, Gifu, Aichi, and Kyoto.
In addition to the prefectures recently designated to be under a state of emergency, it was decided that all
prefectures would also be subject to emergency measures for the reasons stated on page 5 and beyond. The
period for implementing emergency measures in these areas are from April 16, 2020, to May 6, 2020. If the
emergency measures are deemed no longer necessary, the state of emergency will be released immediately
even within the period.
In light of the current situation of the novel coronavirus infection and the issues to date, the declaration of a
state of emergency requires the use of measures based on the law to prevent the spread of infection. Under
this declaration, the public, including the government, local governments, medical personnel, experts, and
businesses, should work together to avoid the infection of themselves and ensure that they do not infect
others by implementing basic infection prevention measures, such as refraining from leaving the house in
an emergency, and avoiding the "Three Cs" described below.
In order to implement effective measures comprehensively, reliably and swiftly, it is an urgent task to
strengthen the system for cluster measures and to secure the medical care delivery system, and we will
implement the necessary measures by implementing the existing measures with sufficient effectiveness,
and in particular by strongly requesting people to refrain from going out of the house on unnecessary and
urgent occasions, and by thoroughly reducing human-to-human contact.
If the people of Japan can work together to implement these measures, it is possible to bring the current
spread of infection under control. Specifically, people should avoid unnecessary and non-urgent outings,
“Three Cs”, and red-light districts and high risk night entertainments. Also, businesses need to cooperate to
reduce human-to-human contact by using telework, etc., in addition to reducing employee commuting by
40% based on the Business Continuity Plan (BCP).
If a rapid convergence can be successfully achieved in 30 days, it means we succeeded in reducing
contacts by 80% ,based on a mathematical model. Even under the state of emergency, the Government of
Japan will work to minimize the impact on social and economic functions, and will not take compulsory
measures such as "lockdown" (city blockade) that is being implemented in other countries.
In order to protect the lives of the people, this guideline accurately grasps the situation surrounding the
novel coronavirus infection, and the people including the government, local governments, medical
personnel, experts, and businesses work together to further promote countermeasures against the novel
coronavirus infection.
Since the novel coronavirus infection is an infectious disease with a different virus and pathology than the
novel influenza, the government will take immediate action in cooperation with the public, including local
governments, medical personnel, experts, and businesses, while listening to their opinions.
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1. Facts on current situation of the Novel Coronavirus infectious disease
In Japan, since January 15, 2020 when the first case was confirmed, a total of 7,964 infected cases and 119
deaths in 46 prefectures have been confirmed by April 14.. In particular, recently 61% of infected people
are those with unknown routes of transmission (situation up to April 13). This means that in addition to the
infection in specific places where clusters were identified, the risk of infection in daily life, which was
previously limited, has started to increase. Medical provision system is strained in some areas and
strengthening of the system is an urgent issue.
In the assessment by the specialists Meeting on the Novel Coronavirus Disease Control (hereinafter
referred to as the "Specialist Meeting"), an overshoot is not confirmed so far in Japan. However, cluster
infections have been reported one after another mainly in urban areas and the number of patients is
increasing rapidly.
Under such circumstances, some regions are facing a situation where the healthcare delivery system is
getting tight and it has been analyzed that strengthening the healthcare delivery system is an urgent issue.
In particular, from March 16 to April 1, the number of reported cases jumped from 817 to 2,299, with a
doubling time (the time required for the number of infections to double) of 4.0 days. The Specialist
Meeting pointed out the existence of clusters in establishments in downtown areas that provide services
involving human to human physical contact. This has become a major problem along with nosocomial
infections and infections in elderly people and welfare facilities. In addition, some specialists have
indicated that there is a risk of infection spreading from asymptomatic or unclear symptoms.
On the other hand, in terms of the situation overseas, the new coronavirus infection has spread to all
continents except Antarctica, and overshooting has been confirmed in Iran, Europe and in the United States.
Under these circumstances, from mid to late March of this year, there was an increase in the number of
individuals who appear to have been infected overseas and then entered Japan.
The share of infected persons entering from overseas among the total confirmed infections in the country
increased from 13% (March 11-March 18) to 29% (March 19-March 25), with a maximum of over 37% on
some days, but this has now been contained to a certain extent as a result of enhanced quarantine policy.
However, as for the country of origin, although the epidemic was initially concentrated in the People's
Republic of China, it is now expanding mainly in Europe and in the United States, reflecting the global
trend of imported infection cases.
Concerning the domestic medical provision system, Tokyo and Osaka prefectures, where the number of
infected people is rapidly increasing, have announced that patients with mild symptoms who do not need
hospitalization will be switched to treatment at accommodation facilities as there is a possibility that the
provision of inpatient medical care for severely ill patients may be affected.
In addition, Kanagawa Prefecture, which is adjacent to Tokyo and where the number of infected people
exceeds 500, is also planning to switch treatment of patients with mild symptons from inpatient medical
care to accommodation facilities. The medical care delivery system is beginning to appear stringent,
especially in metropolitan areas.
As of April 6, the cumulative number of infected people was 1,123 in Tokyo and 429 in Osaka, and the
doubling time in the past week was 5.0 days in Tokyo and 6.6 days in Osaka. Moreover, there is a risk of a
further surge in the number of infected people. In addition, the cumulative number of infected people in
neighboring prefectures, namely Saitama, Chiba, Kanagawa, Hyogo, and Kyoto, exceeded 100 respectively,
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with almost half of those infected have unknown routes of transmission in all prefectures except Kyoto.
Furthermore, the spread of infection was rapid in Fukuoka prefecture, where the cumulative number of
cases reported is over 100 with the doubling time of about 3 days, and the proportion of cases with
unknown routes of infection accounts for 70%.
As of April 14, the cumulative numbers of Coronavirus case reports were over 100 in Hokkaido, Ibaraki,
Ishikawa, Gifu, Aichi, and Kyoto. In Ibaraki, Ishikawa and Gifu, the doubling time in the most recent week
is less than 10 days, and the doubling time in the most recent week is less than 10 days in Hokkaido, Aichi
and Kyoto, excluding the effects of past epidemics in Hokkaido. In addition, in these prefectures, the ratio
of cases with unknown infection routes has reached nearly half in the last week. It is necessary to proceed
with prevention efforts in these 13 high risk prefectures hereafter collectively referred to as “the special
alert prefectures”.
Even in prefectures that have not been specified as the special alert prefectures, cluster may occur in urban
areas due to the movement of people. In such areas, the healthcare provision system may not be well
established, and if the infection spreads, there is a high possibility that healthcare will become
dysfunctional. Since the declaration of an emergency, many people have cooperated with the Japanese
Government in changing their behavior.
From the data observed on the movement of groups of people, it is necessary to request further cooperation
for changing the behavior of the people by expanding emergency measures nationwide. Looking at the
actual number of infected people, it can be considered that the infection has spread due to some loosening
of caution during mid-March to the consecutive holidays.
During this timeframe, citizens, local and national governments and other public and private organizations
should work together to prevent the spread of infection, especially during the long holiday period between
April 29 and May 6. All prefectures will work together to prevent the spread of infection. Therefore,
Japanese government has declared all prefectures to be areas where emergency measures should be
implemented.
Taking into consideration the fact that national and local governments, medical personnel, specialists, and
business people will unite in this effort to prevent the spread of infection, It is necessary to take appropriate
measures to prevent the spread of infection.
The following are the characteristics of the novel coronavirus infection:
- Although droplet infection and direct contact are considered to be the main route of infection in
general situation, there is a risk of spreading the infection even without symptoms such as coughing
or sneezing under certain circumstances such as conversing with many people at close range in an
enclosed space. The possibility of transmission from asymptomatic individuals has also been noted.
On the other hand, keeping distance between people (social distancing) has been shown to
significantly reduce the risk of infection.
- Given the commonality of the places where mass infections have occurred, there are three conditions
("Three Cs") when combined, the risk of spreading the infection is considered to be high in particular.
“Three Cs” are (1) closed spaces (enclosed spaces with poor ventilation), (2) crowded conditions
(where many people are densely packed), and (3) Close-contact settings (where conversations and
vocalizations take place within touching reach of each other).
In addition, risks are considered to be present in crowds and in close distance conversations,
especially in loud voices and singing.
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It has also been noted that there may be a risk of infection with exercise with vigorous exhalation and
exercise involving loud voices.
- At present, even in areas where infection is spreading, the spread of infection is mainly in clusters of
live music venues/ music pubs, sports gyms, medical institutions, and, more recently, down-town
establishment where customer and servicers comes in direct physical contacts, . The risk of infection
in daily life is limited, and it is not considered to be widespread in the city.
- According to the World Health Organization (WHO), the incubation period is currently estimated to
be 1-14 days (generally about 5 days), and the Ministry of Health, Labour and Welfare has decided to
monitor the health of persons in contact with concentrations for 14 days, based on the information on
the novel coronavirus infections
- When infected with the novel coronavirus, fever and respiratory symptoms often persist for about a
week, and many people complain of strong physical weariness (malaise).
- According to a report in China (published on March 9, 2020), the median length of hospitalization for
the novel coronavirus infections is 11 days, which is longer than the 3 days for seasonal influenza.
- It is reported that about 80% of the infected people are mildly ill and 80% of the infected people does
not infect others. In addition, it has been reported that many cases are cured, including hospitalized
cases.
- In terms of severity, it has been reported that there is a higher risk of death than seasonal influenza. A
report in China (published on February 28, 2020) reported a fatality rate of 2.3% in confirmed patients
and an 18.5% rate of moderate or higher pneumonia.
For seasonal influenza, the fatality rate was reported to be about 0.00016%-0.001%, the rate of
pneumonia was reported to be 1.1%-4.0%, and the ratio of excess deaths to the cumulative estimated
number of patients was reported to be about 0.1%.
Thus, the mortality and pneumonia rates in the novel coronavirus infections are likely to be
considerably higher than in seasonal influenza. In addition, it has been reported that the risk of serious
illness is particularly high among the elderly and those with underlying diseases, so it is important to
take measures against nosocomial infection in medical institutions and nursing homes. In the above
report in China, the percentage of deaths by age was 0.2% for those under 30 years of age, compared
to 6% for those over 60 years of age.
- In accordance with Article 12 of the Infectious Diseases Act, the average time from onset date to
report date was 9.0 days in patients reported by March 31, 2020.
- At present, there are no specific antiviral drugs or vaccines that have been confirmed to be effective,
and symptomatic therapy is the main treatment method. As there is no vaccine available at this time,
measures related to vaccination among those listed in the National Action Plan for Pandemic
Influenza and New Infectious Diseases are not included in this Basic Policies. On the other hand,
several candidate therapeutic agents have emerged from existing ones, and clinical observation
studies are underway.
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2. Overall Policies for Novel Coronavirus Disease Control
- The speed of spread of the infection will be controlled by the containment of clusters and reducing
opportunities for contact in each region through general policies, information provision, sharing, and
measures to prevent the spread of new coronavirus infection.
- We will make every effort to minimize the occurrence of serious illness and fatalities through
surveillance, information gathering, and the provision of appropriate medical care.
- Minimize the impact on social and economic functions through appropriate measures to prevent the
spread of the disease and economic and employment policies.
- These counter measures are not irreversible even when the number of infected people increases. For
example, If the containment of clusters and the reduction of contact opportunities were successful,
and the incidence of infected people in the area was reduced in the early stage, the strengthened
counter measures should be reversed as appropriate.
3. Key points in implementing measures against novel coronavirus disease
(1) Provision and sharing of information
① The government will inform the public accurate, easy-to-understand information and calls to the public
in response to changes in the situation, as described below, to promote awareness-raising that will
contribute to change in behaviour, and to take a calm response.
- Provide accurate information such as clinical information on outbreaks and patients' conditions.
- Provide epidemiological analysis information that is easy for the public to understand.
- Ensure basic infection control measures such as hand washing and coughing etiquette.
- Encourage taking leaves from work/absences from school andrefrain from going out in case of
experiencing illness such as a cold.
- Encourage to call medical institutions by phone in advance in order to receive consultation and reduce
the risk of infection.
- Disseminate in an easy-to-understand manner the "Guidelines for consultation and Examination of
Novel Coronavirus Infections" prepared by the Ministry of Health, Labour and Welfare.
- Call for no discrimination based on misunderstanding or prejudice against infected people, people in
close contact with infected people, medical institutions, medical personnel, and other people involved
in countermeasures.
- Avoid "Three Cs". In particular, in their daily lives and workplaces, they are urged to avoid talking in
crowds or in close distance, shouting or singing in a room full of people, and exercising in a way that
makes exhalation more intense.
Restaurants should avoid scenes with "Three Cs".
- Make employees and students aware of the importance of health management and infection control.
- Avoid mass gathering eating other than family members.
- Let people know that in the current measures, the government will not implement measures such as
"lockdowns" (city blockades) and call for a calm response from the public (such as voluntary restraint
on non-essential travel across prefectures, such as unnecessary travels and homecoming , and avoid
rushing to shops and preventing hoarding).
② The government, led by the public relations officer, will disseminate information to the public in a
prompt and proactive manner by the website of the Prime Minister's Office by introducing links to the
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websites of relevant ministries and agencies, such as the Ministry of Health, Labour and Welfare, on the
Prime Minister's website, and by actively utilizing social networking services (SNS) and other media.
③ The government, in cooperation with private companies, will carefully disseminate information so that
sufficient information can reach the underserved population.
④ The Ministry of Health, Labour and Welfare will promptly release information on the status of
outbreaks of infectious diseases and the location and size of clusters.
⑤ The Ministry of Foreign Affairs will provide appropriate information and support to Japanese nationals
residing in each country in light of the fact that the infection is spreading throughout the world.
⑥ In addition to the information provided by quarantine stations, the Government will provide
appropriate information to returnees at companies and other business establishments that conduct business
overseas or stay overseas for a long period of time, as well as at universities and other institutions that have
many opportunities to study or travel abroad, so that they can make decisions and confirm whether or not
to travel to Japan and take necessary measures, such as requesting returnees to refrain from going outside
for two weeks.
⑦ The government will provide appropriate and prompt information to citizens, foreign residents, foreign
tourists, and foreign governments, which will lead to the prevention of the spread and countermeasures
against rumors in the country.
⑧ Local governments, in close cooperation with the government, should send messages and warnings to
residents through various means according to the infection situation in the area.
⑨ The Government will take measures based on the fact that the situation related to this novel coronavirus
infection was regarded as a “historical emergency” based on the Guidelines for the Management of
Administrative Documents (1st April, 2011, Approved by Prime Minister). Local governments will also
respond accordingly.
(2) Surveillance and Information Gathering
①Under the doctor's notification based on Article 12 of the Infectious Diseases Act, we will identify
patients with suspected symptoms and carry out tests that the doctor deems necessary.
② The Ministry of Health, Labour and Welfare will further strengthen the inspection systems of relevant
organizations such as local health laboratories and private inspection agencies in order to enable them to
conduct necessary inspections in the midst of the rapid spread of infection.
In addition, prefectures establish a conference body composed of relevant organizations such as medical
institutions, to understand and coordinate the implementation system for PCR and other inspections, and
utilize private inspection bodies.
③ Periodically publish the results of analysis of the number of people conducting PCRs and other tests,
the number of positive subjects, the positive rate by prefecture.
④ The Ministry of Health, Labour and Welfare will establish an effective use of the existing surveillance
system and an even more effective surveillance system in order to ascertain the prevalence of infectious
diseases in Japan, apart from the notification of doctors based on Article 12 of the Infectious Diseases Act.
When building the system, take care to avoid confusion in the field.
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⑤ The Ministry of Education, Culture, Sports, Science and Technology and the Ministry of Health,
Labour and Welfare will work to strengthen the understanding of outbreaks in schools.
⑥ The Government will continue to promote the development of simple testing kits for rapid diagnosis as
soon as possible.
(3) Pandemic Prevention
① The declaration of the state of emergency on April 7, 2020 was made for the purpose of further
accelerating the measures to date through the united efforts of the people, including the government, local
governments, medical personnel, experts, and businesses. By thoroughly addressing the reduction of
contact opportunities, it is possible to bring the situation under control, and we aim to reduce contact
opportunities by at least 70% and as much as 80% by promoting the following measures.
On the other hand, restrictions on people's freedoms and rights must be minimal in light of the provisions
of Article 5 of the Act. As a preventive measure, first of all, a request for cooperation should be made with
regard to self-restraint and the like based on Article 45, Paragraph 1 of the Act.
② Specified prefectures strongly request organizers to voluntarily refrain from holding events related to
the cluster and gatherings with "Three Cs" when there is a risk of a cluster occurring, based on Article 24,
Paragraph 9 of the Act and Article 45, Paragraph 2 of the Act.
In particular, the organizers are requested to take a cautious approach to large-scale nationwide events,
including cancellation or postponement of the event if risk management is not in place. In areas where
infection is on the rise and there are signs of overshooting, prompt action will be taken to request voluntary
refraining from going outdoors or holding events, with a specified duration of period. On the other hand, if
the infection begins to be contained, the request for voluntary restraint will be lifted from activities that
pose a low risk of infection spread.
③Based on Article 24, Paragraph 9 of the Act and Article 45, Paragraph 2 of the Act, the specified
prefectures request restrictions on the use of facilities that may lead to the spread of infection. In making
requests in these cases, the first step is to request cooperation in accordance with Article 24, paragraph 9 of
the Act, and if there is no justifiable reason for not responding, the second step is to make a request based
on Article 45, Paragraph 2, and then as the third step, make an instruction based on Article 45, Paragraph 3,
and publish these requests and instructions. The specified prefectures making these requests and
instructions shall consult with the Japanese Government to determine the effects.
④ When making a request based on Article 45, Paragraph 2 of the Act, designated prefectures shall
prepare necessary environment including their own staffing, so that the implementation status of the
request can be properly monitored.
⑤ All municipal authorities should ensure that people avoid the “Three Cs” and take appropriate measures
to reduce the number of clusters and reduce people’s contact opportunities based on the local coronavirus
infection situation and medical care provision system.
⑥ Municipal authorities, in cooperation with the Ministry of Health, Labour and Welfare and experts,
should conduct active epidemiological investigation, monitor the health of the individual person’s close
contacts and requests for the individual’s self-restraint on going out of their homes, and accurately
determine the scale number of coronavirus infection spread. For this reason, the health center system will
be strengthened.
⑦ Designated prefectures will take effective emergency measures according to the characteristics of their
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region. When taking emergency measures, specified prefectures shall take the minimum necessary in
accordance with Article 5 of the Act, and shall carefully explain and necessity of the measures to be taken
to the residents. In implementing emergency measures, specified prefectures shall share information
closely with the government task force under Article 20 of the Act. The Headquarters for Novel
Coronavirus Disease Control will coordinate with specified prefectures to make comprehensive
adjustments and, if necessary, seeking experts’ opinions.
⑧ Designated prefectures should inform residents, in cooperation with the Japanese government, that the
emergency measures taken in Japan are different from measures implemented in other countries such as
“lockdown” (city blockage) including prohibiting going out with penalties and blocking traffic between
cities. In addition, designated prefectures encourage the residents to take a calm approach to prevent
confusion, such as in buying up food, medicine, and other daily necessities.
⑨ Designated prefectures shall indicate the duration and applicable areas when making request to the
residents for the voluntary self-restraint in accordance with Article 45, Paragraph 1 of the Act. Based on
the opinions of the Advisory Committee on Basic Response Policy, Designated prefectures shall try to
control the spread by requesting people to self-restraint from going out for a certain period of time. It
should also indicate specific examples that are not subject to self-restraint, such as going to medical
institutions, shopping for food, medicine and other daily necessities, going to work when necessary,
exercising outdoors, taking a walk, and other things that are necessary for the maintenance of life.
⑩The specified prefectures shall encourage the residents to avoid the movement of people across
prefectures, such as unnecessary homecoming and travel, from the perspective of preventing the spread. In
particular, during the large holiday period, based on the provisions of Article 45, Paragraph 1 of the Act,
the specified prefectures request the residents to cooperate in refraining from unnecessary and urgent
movements across prefectures. In addition, if there is a risk that people will be concentrated in tourist
facilities in the area, we will ask the facility to take appropriate measures such as limiting the number of
visitors. As necessary, the government will make comprehensive adjustments regarding the voluntary
self-restraint of such unnecessary and urgent movements under the provisions of Article 20 of the Act.
⑪We strongly encourage people to refrain from going to red-light destricts and other down-town
establishments where it is already known large number of clusters have already occurred.
⑫Although going to work is excluded from requests for voluntary self-restraint, specified prefectures
should strongly promote remote working at first.
Even when commuting to work, we will promote initiatives to reduce social interaction with others, such
as staggered commuting and bicycle commuting, more vigorously than ever before. Designated public
institutions are formulating and implementing BCPs on measures to prevent spreading, and specified
prefectures are encouraged to further strengthen their efforts. In the workplace, employees are encouraged
to take measures to prevent infection (hand washing, cough etiquette, ventilation at workplaces,
self-restraint of employees with symptoms such as fever, videoconferencing to reduce employees traveling
on business trips), as well as encouraging them to take action to avoid “Three Cs.”
⑬Designated prefectures shall request business operators that perform services essential for ensuring the
stability of people’s life and economy to continue their services, based on the characteristics of the
business, while taking sufficient measures to prevent the spread of coronavirus infection. The business
shall take the necessary measures to avoid the “Three Cs.” Examples of business operators that perform
services essential for ensuring the stability of people’s life are provided in the appendix at the end.
⑭The government and specified prefectures shall endeavor to establish a consultation window for
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business operators, secure logistics system, and ensure the lifeline system in order to support the
businesses activities smoothly.
⑮Prefectures in metropolitan areas should take sufficient measures to prevent the spread, described above,
in order to avoid becoming the starting point of the nationwide and rapid spread. Even in other prefectures,
appropriate measures should be taken as they may spread nationwide and rapidly.
⑯The Japanese government and local government are urged to take necessary measures to prevent
infection so that the “Three Cs” will not be occurred, although restaurants are not subject to restrictions on
the use of their facilities.
For cafeterias, restaurants, coffee shops are urged to take the necessary measures to prevent infection and
avoid “Three Cs,” including careful attention to ventilation and proper spacing between people.
⑰The Japanese government will work with related organization to secure and train experts in cluster
measures.
⑱The Ministry of Health Labour and Welfare and prefectures governments, in cooperation with related
organizations, shall secure specialists and other personnel and dispatch them to the area, especially when
there are signs of spread of infection.
⑲The Japanese government and local governments will promptly work to strengthen the healthcare
system from the perspective of fundamentally strengthening measures to reduce clusters. In this regard,
prefecture government shall share information promptly with the municipalities within their jurisdiction
pursuant to Article 24 of the Act. Furthermore, prefectures shall endeavor to promptly share information
among them in order to contribute to the detection of clusters, and the government shall make
comprehensive coordination based on Article 20 of the Act when it is deemed necessary to implement
measures accurately and promptly. In addition, government will provide the necessary support so that the
prefectural governors can promptly reports to the Minister of Health, Labour and Welfare in accordance
with Article 12 of the Infectious Disease Act. In addition, the government, in cooperation with private
businesses, will establish a system to monitor the status of infection through SNS and other technologies.
⑳The Ministry of Education, Culture, Sports, Science and Technology (MEXT) will disseminate the
guiding principle regarding the implementation of temporary closure of schools, which were presented in
the revised “Guidelines for Implementation of Temporary closure of Absence in Response to New
Coronavirus Infections” on April 1st, and will provide additional information as necessary, in cooperation
with the Ministry of Health, Labour, and Welfare, based on the future spread of the infection and the views
of the experts committee. The prefectural government will instruct the school administrators on measures
against infectious diseases, such as health management, and promptly share information on the local
infection status and information on infected individuals from the school-related personnel.
㉑ The Ministry of Health, Labour and Welfare (MHLW) presents its policy on the reduction of childcare
and temporary closures of childcare centers and after-school children’s clubs. The policy it presents should
include how to reduce the provision of childcare and other services, such as asking parents who can to
refrain from sending their children to preschool. The policy should include measure sto secure childcare
for medical professionals and those who need to continue working in order to maintain the functioning of
society, and children of single parents who have difficulty taking time off from work in case of temporary
closing of preschool.
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㉒ The Government, in cooperation with relevant agencies, shall ensure that public transport and other
crowded facilities. to control infection.
㉓ Regarding border measures, the government will strengthen quarantine such as restricting immigration,
recommending suspension of travel, checking returnees and checking health, and restricting visas from the
perspective of preventing the influx of infected person into the country and the spread of the infection in
the country. The Ministry of Health, Labour and Welfare, in cooperation with relevant ministries and
agencies, will support the reduction of the workload of health centers and the strengthening of their
systems for health observation.
㉔ The Ministry of Land, Infrastructure, Transport and Tourism (MLIT) will, if necessary, make request
such as limiting the airports where aircraft arrives based on the situation of outbreaks of new coronavirus
infections in other countries.
㉕ If there is a shortage of facilities to be used for suspensions, the Ministry of Health, Labour and
Welfare (MHLW), if necessary, cooperates with relevant ministries and agencies while keeping in mind the
application of Article 29 of the Act. We will try to secure stop facilities by giving a careful explanation to
the managers of the facilities.
㉖Although there are some prefectures with a low number of infected people, there is a tendency for the
infection to spread nationwide. The prefectural governor shall judge the implementation as appropriate so
the local epidemic is suppressed, especially during the long holiday periods. Prefecture governors should
consider the impact of measures being considered and the fact that it is subject to an emergency declaration
for the purpose of minimizing the movement of people. The measures of ③⑫⑬ above are focused on
the prevention of spread of infection, while at the same time focusing on the situation of infection in the
region and economic and social conditions.
(4) Medical treatment, etc.
① The Ministry of Health, Labour and Welfare (MHLW), in cooperation with local public agencies and
related organizations, will secure a flexible medical care system for each region, depending on the situation
of infection spread, as following.
- Currently, outpatient medical care shall be provided to patients suspected of having coronavirus
infection with appropriate infection control through the Returnee and Contact Person Consultation
Center and the Returnee and Contact Person Outpatient Clinic.
- In addition, if a doctor’s decision is made to conduct a test and the patient is confirmed to be infected
with coronavirus, the patient would be recommended to be admitted to the designated medical
institution for infectious disease based on Article 10 of the Infectious Diseases Law and
implemented to prevent spread of the coronavirus and provide appropriate medical care to the
patient.
- In prefectural governments where there is a risk that the number of patients will increase and this
may hinder the provision of hospitalized medical care to critically ill, etc. in consultation with the
Ministry of Health, Labour and Welfare, the prefectures shall establish a system in which for
patients with mild illness who do not require inpatient treatment, shall be treated at home, and their
health condition shall be monitored remotely using telephones and other information and
communication devices, and medical treatment shall be provided using telephones and other
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information and communication devices when necessary by doctors.
- In the case of home treatment, if there is a risk of infection to the elderly or persons with underlying
health condition due to family structure, local governments should make arrangements to treat the
patient with mild illness at accommodated facilities or allowing family members living together with
the coronavirus patient to temporarily stay in a different place. Local governments shall make efforts
to secure temporary accommodation facilities, such as hotels, in advance, and the government shall
work closely with local governments to support the efforts of local governments.
- In areas where the number of patients is likely to increase and interfere with the provision of medical
care at outpatient treatment centers for returnees and contacted persons, the system of consultation
centers for returnees and contacted persons should be strengthened in response to the local infection
situation and demand for medical care, and the system for prompt outpatient treatment should be
developed by increasing the number of outpatient treatment centers for returnees and contacted
persons and securing dedicated personnel.
- In prefecture where there is a possibility that an increase in infection may exceed the limit of the
provision of medical care for outpatients and, governors should take necessary measures to let
general medical institution treat outpatient, in consultation with the Ministry of Health, Labour
and Welfare and take..
Under these circumstances, if the symptoms are mild, rest and recuperation at home should be considered,
because the risk of infection may be increased by consulting a medical institution easily due to anxiety
about infection. In principle, if the condition changes, consult with your physical doctor before visiting the
clinic.② The Ministry of Health, Labour and Welfare, in cooperation with local governments and related
organizations, will promote the securing of the medical care system, taking into consideration the
overshoot and the significant increase in the number of infected persons in the future and, if necessary,
taking into consideration the requests for medical care, etc. based on Article 31 of the Act. In addition to
dividing the role of local medical institutions as follows.
- For example, while sharing the roles of regional medical institutions, such as designating medical
institutions to specialize in receiving patients with coronavirus infection, consider the use of
tuberculosis beds and general beds of general medical institutions. Ensure that beds are available to
accommodate inpatients during peak periods.
- Securing a manufacturing system for pharmaceutical products, medical devices and medical materials
that support the medical provision system, ensuring a system that can promptly and smoothly, the
medical care system under appropriate infection control should be developed by promptly securing
necessary medical equipment and materials, such as specialized medical personnel and ventilators,
and materials necessary for infection control.
- Medical institutions should consider postponing scheduled but non-urgent surgeries and
hospitalizations that may be postponed at the physician's discretion, if necessary, based on the BCP.
- To consider dispatching medical professionals to work at general medical institutions such as local
clinics.
- For example, cancer centers, dialysis medical institutions, and obstetrical medical institutions, where
people are more likely to become severely ill, should not provide outpatient medical care to those
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suspected of having coronavirus infection.
- Provide necessary support for the establishment of temporary clinics and hospital wards using beds
currently out of operation, and establishing temporary medical facilities based on Article 48 of the Act
by specific prefectures.
- In order to prepare for the occurrence of medical care system crunches and overshooting, a system to
accept patients over a wide area, including those that cross prefectural areas, should be devised.
③ The Ministry of Health, Labour and Welfare, in cooperation with local governments, shall disseminate
the following items in order to thoroughly prevent infections in medical institutions and facilities for the
elderly.
- To prevent medical caregivers from becoming a source of infection, medical institutions and facilities
for the elderly should avoid places where the "Three Cs" occurs. Medical caregivers should wear
masks when interacting with patients and facility users even if there are no symptoms, wash hands
and disinfect hands and fingers thoroughly, disinfect computers, elevators, and other items shared by
multiple workers on a regular basis, keep a certain distance from other workers, when they are eating
and drinking in cafeterias and filling stations without masks, and keep track of their daily physical
condition and wait at home if they feel even slightly unwell. Medical institutions and facilities for the
elderly should suspend visits to medical institutions and facilities for the elderly, etc., except in
emergencies, in order to prevent infection from visitors.
- Visits to medical institutions and facilities for the elderly, should be temporarily suspended to prevent
infection by visitors, except in emergency cases.
- In addition, to prevent infection from patients and facility users, consideration should be given to such
measures as suspending or restricting the temporary use of day-care services at facilities, restricting
inpatients and users from going out and staying out in order to prevent infection from patients and
users.
- If COVID-19 infection is suspected for hospitalized patients or users at medical institutions and
facilities for the elderly, immediately isolate the patient in the private room and implement infection
measures under the guidance of public health centers and implement standard preventive measures,
contact preventive measures, and droplet infection prevention measures.
④ The government and prefectures should give priority to securing personal protective equipment (PPE),
such as masks, for medical institutions that accept patients suspected of having coronavirus infection for
PCR testing or hospitalization.
⑤ Prefectures should cooperate with the public awareness of "3 Cs" and pay particular attention to the
spread of infection in medical institutions and facilities through further thoroughness of infection
prevention measures, including separation of the space between infected and non-infected persons. In
addition, particularly for medical care, facility workers, and inpatients that are suspected to be infected,
take proactive measures such as PCR tests.
⑥ The Ministry of Health, Labour and Welfare (MHLW) will also address the following issues from the
perspective of providing appropriate medical care and controlling infection.
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- In cooperation with the relevant ministries and agencies, the Ministry should establish a database to
enable a centralized and prompt understanding of the usage status of infectious disease beds in the
preparation for the occurrence of overshoot.
- In order to prevent infections in outpatient settings, cooperate with relevant organizations to ensure
that outpatient clinics, recommend the patients the use of facilities such as using holiday(a off day:
non-business hours) and night-time emergency care centers with appropriate routes of movement and
treatment by appointment should be promoted to prevent congestion in outpatient settings at medical
institutions, including general patients.
- From the perspective of preventing infection among pregnant and nursing mothers, in addition to
thorough infection control measures such as separation of movement lines at medical institutions,
efforts should be made, in cooperation with relevant organizations, to encourage early consultation
with pregnant and nursing mothers suspected of being infected, and to provide an environment in
which pregnant women can easily rest in consideration of their work.
- In cooperation with relevant organizations, continue to strengthen the development of medical
interpreters, so that foreign nationals can receive medical care appropriately.
- Accelerate the development of effective therapeutic drugs and vaccines in cooperation with related
ministries, agencies and institutions. In particular, clinical studies, clinical trials should be promptly
conducted to verify the efficacy of drugs that are used in other treatments and are expected to be
effective.
- Regarding health examinations and vaccinations based on laws and regulations, consideration should
be given to the timing, so that appropriate infection control measures will be taken.
⑦ The Government shall provide the necessary support to local governments, regarding the above.
(5) Economic and employment measures (The policies decided on March 28 stand)
The Government will prevent the spread of the coronavirus infection and, while carefully assessing the
impact of the coronavirus infection on the domestic and international economy and the lives of the people,
will flexibly implement necessary and sufficient economic and fiscal policies without hesitation, and will
take drastic measures to put the Japanese economy back on a solid growth path. In particular, the system
will maintain the employment and livelihoods of people working in various forms, including freelancers
who have been affected as economic activity has contracted due to the spread of the coronavirus, as well as
small and medium-sized businesses and private businesses and establish a system to continue to engage in
business.
(6) Other important considerations
1) Considerations for human rights
① Government will take measures that is considerate of the human rights of the patients, those infected
and workers involved in the policies.
② Government will take measures regarding the reception of children and students, who have temporarily
returned to Japan from abroad. It will also work to prevent the incidence of bullying etc.
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③ Government and relevant organisations will ensure the freedom and rights of the people will be
minimally disturbed upon the policy implementation. They will ensure the impact on women and disabled
people to be fully considered.
④ Government will ensure correct information distribution to the people. This is to protect healthcare
workers involved in the actions against the Novel Coronavirus from misinformation and rumours.
⑤ Government and local governments will take actions to protect the mental health of people during
social isolation and prevent the domestic violence and abuse within homes. They will also provide suitable
support for the local town/village/city’s measures for supporting elderlies living alone and those with
disabilities who is in need of care.
2) Provision of Supplies
① Upon requests from people and local governments, government will request smooth production and
provision of masks, PPE, disinfectants and food to the relevant manufacturers. Furthermore, government
will secure sufficient supply of masks , PPE, ventilators etc under its responsibility for the purpose of
preventing infection spread. Government will request urgent transportation under article 54, and sales
under article 55 as required. For example, masks will be purchased by the government for the purpose of
distribution to necessary healthcare and care facilities as a priority, and in the areas where infection
prevention policies are required the most.
② Government will apply Act on Emergency Measures for Stabilization of National Life (article no.121,
1973), article 26, paragraph 1 to ban resale of masks and call to the consumers and businesses for calm
actions to refrain from extensive stocking of masks, in order to ensure enough supplies of masks and
disinfectants etc. Furthermore, government will act to distribute reusable cloth masks.
③ Government will, in case of the prolongation of the event, will make effort to ensure the supply of
masks and medical supplies and medications. This includes antibiotics and medical devices required for
healthcare. It will consider domestic production of those supplies.
3) Advancing cooperation with relevant organisations
① Government will strengthen the co-directional communication with relevant organisations, including
local governments, to ensure timely delivery of strategic decisions and understand the situation on site.
② Government will hear opinions from the stakeholders including local public authorities regarding the
policy promotion,.
③ Municipal authorities will ensure that not only health service bureau and crisis management beureau,
but all division cooperate to implement its policies.
④ Government will closely work with the international communities to collect information on the
measures from WHO and other countries and regions. Also, it will actively share expertise obtained in
Japan with relevant organisations such as WHO and other counties and regions. This is to apply the
expertise for the future strategies and contribute as a country impacted by the novel Coronavirus.
⑤ Government will act to promote policies for novel Coronavirus through supporting researches
including basic medical sciences, clinical researches and social medical sciences including epidemiological
studies.
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⑥ Specified prefectures will provide necessary support for neighbouring prefectures, when requested, to
take actions prompted by the declaration of the state of emergency.
⑦ Designated prefectures, in the event of state of emergency, will discuss with Novel Coronavirus
Response Headquarters and swiftly share information. Head of the Headquarters will make adjustment
with prefectures based on specialist advices, so that they could swiftly act to implement state of emergency
measures.
⑧ When the state of emergency measures are activated, governors of designated prefectures and head of
designated public organizations shall report the measures and its justification to the Head of the Novel
Coronavirus Response Headquarters. Heads of municipalities and designated local public organizations
shall report to the governors of their prefectures. Heads of designated public organizations will report to
the supervisory public authorities on their actions and justifications. Head of Novel Coronavirus Response
Headquarters will report to the parliament. Governors of the designated prefectures and designated public
organizations shall report to the head of the Novel Coronavirus Response Headquarters regarding the
reported measures and its justifications.
4) Maintaining social function
① The national and local governments , national and local designated public organizations will act to
prevent infections among their staff. They shall make strategies in advance so that works can be carried on
without a delay in the unfortunate event of infection or suspected infection among their staff. confirmation
of being close contacts with infectedTeleworks and online meetings shall especially be promoted.
② Municipalities, designated national and local public organizations, shall minimise the impact on the
people's lives and economy by sustaining the electricity, gas, water, public transport, communication and
finance businesses.
③ Government will offer necessary support for designated public organizations for them to continue their
operation.
④ Businesses that undertake works necessary to maintain the safety of the people’s lives and economy are
requested to endeavour to continue the works, in order to keep stability in the people’s lives and economy.
⑤ Government will make efforts to understand the level of service provided by businesses and to obtain
understanding of the people if required.
⑥ Government will, in order to prevent troubles at airports, ports and healthcare facilities, carry out
security and policing activities.
⑦ Police will prevent the various crimes that exploit the situation, and strengthen its alertness.
5) Actions after declaration of the state of emergency
Government will distribute information as appropriate to the public and stakeholders following the
declaration and especially in the period until May 6. The information should be based on regular analysis
and evaluation of the state of infection and strategy implementation from the regular communication with
designated prefectures and basic policies advisory committee.
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Following a withdrawal of the state of emergency, it will continue to be alert and analyse situation of the
pandemic in the country. It will strive to implement even more effective measures based on the knowledge
obtained.
6) Other issues
① Government will implemented measures based on acts other than National Emergency Act, as required.
② The decisions on whether the condition of state of emergency are met will be made after a
comprehensive assessment. The assessment is based on the situation abroad, state of of healthcare
provision in Japan, with the number of positive cases with unknown contact source and frequency of
clusters. The head of Novel Coronavirus Response Headquarters will consult the the basic policies
advisory committee to determine the possibility of significant impact on people's lives and economy.
③ Government will, in case either of changes of basic strategies, continuation, or cessation of state of
emergency, act flexibly with careful consideration of new scientific opinion, situation of the pandemic,
actual measure implementation, and opinions of basic policies advisory committee.
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(Appendix)
Businesses that are requested to continue their activity during the state of emergency.
With due respect and efforts to avoid the "3Cs", continuation is requested for the following businesses.
1. Maintaining Medical System
・We request the continuation of all business by medical professionalsnot only for treatment of COVID-19
infections, but also for other severe diseases.
・Medical professionals include hospitals, pharmacies, and other manufacturing and service industries
related to all the supplies and services necessary for treatment of patients including importing,
manufacturing and sales of pharmaceuticals and medical equipment, blood collection for blood donations,
and providing meals to inpatients.
2. Continuing to protect those in need
・We request the continuation of all life support businesses for people who need assistance, especially the
elderly and the people with disabilities, including housing and support for them .
・Life support businesses include all manufacturing and service industries related to the goods and services
necessary for the lives of the elderly and the people with disability, such as management of facilities for
nursing care and for people with disability, as well as providing meals to residents of the facilities.
3. Securing stable lives of the public
・We request the continuation of all concerned businesses which provide essential services for those who
stay at home to lead necessary minimum lives.
(1) Infrastructure (electricity, gas, oil, petrochemical, LP gas, water and sewage, telecommunications and
data centers, etc.)
(2) Food and beverage supply (agriculture, forestry, fishery, importing, manufacturing, processing,
distribution, and online shopping of food and beverage, etc.)
(3) Supply of daily necessities (importing, manufacturing, processing, distribution and online shopping of
household goods, etc.)
(4) Canteens, restaurants, coffee shops, home delivery and take-out, retailers of daily necessities
(department stores, supermarkets, convenience stores, drugstores, hardware stores etc.)
(5) Maintenance of household(plumber, electrician, etc.)
(6) Services related to daily necessities (hotel and accommodation, public bath, barber shop and
hairdressers’ salons, laundry, veterinary, etc.)
(7) Waste disposal services (collection, transportation, and disposal of waste, etc.)
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(8) Ceremonial affairs (operators engaged in cremation and post-mortem treatment of bodies)
(9) Media (TV, radio, newspapers, internet related business, etc.)
(10) Services for individuals (webcast, remote education, facilities and services related to maintenance of
the internet environment, maintenance services of private vehicles, etc.)
4. Maintaining the stability of the society
・With a view to maintaining the stability of the society, we request the continuation of the businesses, at
their minimum level, who provide essential services to maintain corporate activities during the period of a
state of emergency.
(1) Financial services (banks, credit banks and credit unions, securities, insurance, credit cards, and other
settlement services etc.)
(2) Logistics and transportation services (railways, buses, taxis, trucks, maritime transportation and port
management, aviation and airport management, postal services, etc.)
(3) Maintenance of manufacturing and service industries necessary for national defense (aircraft,
submarines, etc.)
(4) Services necessary to maintain corporate activities and security (maintenance and security of building,
etc.)
(5) Social infrastructure necessary for safety and security (management of public goods such as of rivers
and roads, public works, waste disposal, hazardous goods management based on respective law, etc.)
(6) Administrative services (police, fire fighting, other administrative services)
(7) Childcare services (daycare centers, etc.)
5. Others
Among medical and manufacturing industries, we request the continuation of the following business
operators in consideration of infection prevention: businesses whose production lines are difficult to
suspend due to the characteristics of the equipment (such as blast furnaces and semiconductor factories);
and operators who produce essentials (including important items in supply chains) for protection of the
people who need medical care and support, as well as for maintenance of social infrastructure. We also
request the continuation of the business operators who sustain medical care, the lives of the people, and
maintenance of the national economy.