Another State of Emergency is Possible: What the Coronavirus Subcommittee Hesitated with and How they Made Their Decision | Discuss Japan - COVID-19
Society  Nov. 11, 2020

Another State of Emergency is Possible: What the Coronavirus Subcommittee Hesitated with and How they Made Their Decision

Omi Shigeru, Chairman of the New Coronavirus Infectious Diseases Control


Dr. Omi Shigeru (71), Chairman of the New Coronavirus Infectious Diseases Control Subcommittee, revealed in Bungeishunju (July 2020) that he was influenced by author Kobayashi Hideo’s Mushi no Seishin (The Spirit of Unselfishness) when he was younger.
The following opinion is found in an essay by Kobayashi that was presented in the 1960s.
“People who succeed as doers are seen as people who push through themselves and strongly assert themselves, but on the contrary, there is actually a kind of unselfishness among them.” (Hideo Kobayashi Complete Works, Volume 12, Shinchosha)
Dr. Omi, who served as the vice chair of the Expert Meeting until June, took responsibility for controlling infections while also making the economy work as the Chairman of the Subcommittee from July, as the spread of infections approached a new phase.
Soon after its inauguration, the Subcommittee gained attention for its responses to the Go To Travel campaign and the Tokyo Problem, where the number of newly infected people had rapidly increased. Bungeishunju spoke again about his determination with COVID-19 measures as a “doer.”

Dr. Omi Shigeru

Viruses are not visible to the naked eye and they propagate through people. The ways viruses spread change while being influenced by the actual day to day movements of groups of people. For COVID-19 measures, this is why it is necessary to quickly understand and respond to people’s behavioral patterns and the state of infections.

In February 2020, experts in infectious diseases assembled and the Novel Coronavirus Expert Meeting (hereafter the Expert Meeting) was inaugurated. As a member of this Meeting, I started thinking about COVID-19 measures. But from April through May, both before and after the state of emergency, we began to hear concerns from many directions about how our measures were biased toward preventing the spread of infections and that there was not enough consideration for economic society.

Find a way for these two conflicting positions of infection prevention and economic measures to exist. From this request, the New Coronavirus Infectious Diseases Control Subcommittee (hereafter the Subcommittee) was formed with experts from each area. This was a different stage than with the former Expert Meeting, and, having been appointed as Chairman, I felt a different role and importance to the responsibility than from before.

Humans simplify complicated matters, and at times, we have a tendency to look at things in a black and white manner. However, the changes in the daily state of infections are not something that can be clearly seen, and they actually present a complex picture.

To carry out COVID-19 measures, all we can do is warily observe the state of infections that becomes clear each day, be willing at times to flexibly distance ourselves from knowledge that we rely on, even for experts, and slowly search for a variety of possibilities. Trying to balance both COVID-19 measures and the economy is like trying to find an extremely narrow alleyway.

Two Types of Community-acquired Infections

Compared to the Expert Meeting, which was composed of twelve members mostly in the public health sector, including virology and epidemiology, the Subcommittee, which was inaugurated in July, was made up of eighteen people, adding economists, governors, labor leaders, and representatives from various positions.

The first Subcommittee was held on Monday, July 6. In the week prior, there had already been five conservative days of more than 100 newly infected people in Tokyo and from the second half of the week of July 6, there were four consecutive days of more than 200 newly infected people, and this was the situation when the Subcommittee began.

It was a situation that demanded careful consideration as experts into how to analyze the state of infections and how to convey this as risk communication.

One of the reasons for this was that collected data on infected persons was incomplete and there were many people where the route of infection was unclear. The reason that the data was incomplete was because of the limited relationship between prefectures and ordinance-designated cities, in addition to the fact that rules for handling personal information differed for each local government.

There were more than a few infected persons who did not talk about their past actions in relation to restaurants and bars that involved entertaining (night spots). There are even cases where public health nurses have asked about the truth while passionately persuading the infected persons that they won’t tell anyone. There is some difficulty here, as publicly releasing this information may break down the relationship of trust.

When the term “community-acquired infection” is used among the general public, we find that there is some variance to how this term is perceived.

Dividing how the term is interpreted into two broad categories, the first is about spread, like 40% of the population being infected. This can be said to be the state of infections spreading on the surface from an unspecified large number to a further unspecified large number in a given area.

The other meaning of community-acquired infection is the state of infections connected by lines, with workers and customers becoming infected at night spots, infecting their friends and family, and then those family members further spreading infections at hospital when going to visit family members who are there. The Subcommittee’s common understanding is that currently, this is close to reality.

It was reported that the positivity rate at a PCR testing site in Shinjuku in June was over 30%, but this is only data related to night spots. At the same site, the positivity rate was 3.7% for employed adults and 3.8% for students. There is a trend that people who are concerned about infection risks go to the site, and we see that the positivity rate is surely no higher than these numbers among the general community where there are many who are not concerned about infection.

The Distinction Between Day of Reporting and Day of Onset

One thing that began in earnest in July was a redefining of the increases and decreases in the number of infected persons with day of onset of symptoms based on epidemiological studies, rather than on the day the infection was reported from public health centers to Tokyo.

With day of reporting, there is a variance between how many days pass from the onset of symptoms until getting tested and a lag occurs between what is reported and the actual situation when delays occur with work at testing centers and public health centers. We decided to look at increases and decreases based on day of onset of infections to eliminate these errors that occurred artificially.

The graph of the state of infections for each area based on day of onset, which emerged from the third Subcommittee on July 22, shows trends that are more moderate than any of those based on day of reporting. Even if we dared to make predictions with careful assumptions for the days immediately preceding for which data hadn’t come in yet, the trends didn’t change.

Even if we look at the breakdown by age of infected persons, while the ratio of people 60 and older who are more likely to become seriously ill is increasing, it was at 8.9% by July 21, which is a different situation from what it was during the peak in April when it was close to 30%.

From this, we offered an evaluation as a general consensus among members at the Subcommittee on July 22, saying that while it had not reached an explosive level of spread, infections were still steadily spreading.

Worst-Case Scenario

However, if you were to say that there isn’t a worst-case scenario where we would re-declare a state of emergency like the one declared by the government in April, I would say you’re wrong. I emphasized the following point at the end of the proposal to the government on that day.

“In preparation for an explosive spread of infections or when infections continue to spread, we will consider the various options for alternative measures, combinations of these measures, and indicators related to these decisions as soon as possible.”

Certainly, there is no upward trend or explosive spread currently. However, if infections gradually increase matching current trends, the number of serious cases will also increase, and fears of a collapse of the medical care system will arise. It is necessary to constantly be aware of this scenario.

If medical care ceases to function, it will become impossible to treat serious cases, and it will become impossible to avoid a sudden increase in deaths, similar to what the U.S. and Italy experienced. I repeated this at the same time as the state of emergency on April 7.

As of the 27th, of the 2,400 hospital beds secured by Tokyo, there were 1,269 people actually hospitalized in those beds, and of those hospitalized for being seriously ill with COVID-19, there were 19 people out of 100 beds. If you focus only on the situation at hand, then there is plenty of room to spare.

But comparing this with the beginning of July, beds have started filling up, and at this rate, the hospitals and hotel facilities for those with minimal symptoms will surely fill up.

Pressing the button to raise the emergency response level. I am acutely aware that this scenario is possible. If I could verbalize it, I would say that we are at a point now where if we were only thinking about COVID-19 measures, then it would be fine to go ahead and press that button.

For days from the following day after it was suggested, we discussed indicators for this decision and measures that anticipated this worst-case scenario.

Of course, abruptly switching to these measures would surprise residents, so in order to alleviate that, it is surely necessary to announce a few days in advance that we will be raising the level if we reach a certain point.

The previous state of emergency was issued on April 4. Discussions were continued among experts for about a week before this, but there was a sharp increase in the number of serious cases. For this reason, there wasn’t any time to announce to residents beforehand that we would declare the state of emergency if we reached a certain state.

This time, prefectures are preparing plans to secure hospital beds. Rather than just analyzing the state of infections, these plans may place greater value on the urgency of medical resources, with ratio of senior citizens among hospitalizations, ratio of beds occupied with severe cases, and more.

Will we do the same thing as the state of emergency in April, and will we implement some measures without warning? In any case, creating countermeasures that are prepared for the worst-case scenario is a major task for the Subcommittee.

“Go To” Trouble

The government announced that the Go To Travel promotion, which was set to start in August, would be launched ahead of schedule on July 22. As concerns were raised against this decision, the pros and cons of this decision came to be discussed even with the Subcommittee on July 16.
However, the government suddenly decided to exclude travel to and from Tokyo on that day, and the Subcommittee, which met that night, ended up discussing the Tokyo exclusion, and we approved it. Harsh criticism was raised of the approval, saying it was a confirmation of the government’s decision, and there was dissatisfaction even among the Subcommittee, saying that a decision had already been made before consulting the experts.

A few days before the Subcommittee met on the 16th, the government listened to the opinions of experts on infectious diseases and other fields and was advised to decide after analyzing the state of infections more and having proper discussions. They were told they ought to look at the situation a little more.

However, right before the Subcommittee met, the government decided to implement the promotion from the 22nd while excluding Tokyo, and so they didn’t take the advice.

At the Subcommittee meeting, a question was raised in relation to the Tokyo exclusion from one of the members about excluding Osaka as well, but I don’t think there were any opposing views from members about excluding Tokyo.

As my role was to coordinate and understanding that it was something the government had already decided and that our time for discussions was limited, I stated that we had to draw the line somewhere, and so we discussed the Tokyo exclusion and decided to approve of it as the Subcommittee.

I want to talk about the reason behind coming to this decision.

I’m repeating myself, but the Subcommittee started from an awareness that perhaps many residents hoped for a path that would allow us to make both goals a reality: preventing the failure of the medical system while moving the economy. How do you consider the topic of travel when searching for this narrow path? We thought that we couldn’t fulfill our responsibilities if we didn’t show grounded intentions, even if they weren’t perfect.

According to the epidemiological information that has become clear over the past six months, COVID-19 transmission generally occurs when people gather in situations with the “3Cs” (closed spaces, crowded places and close-contact settings) plus loud voices, such as night spots, live music clubs, small theaters, etc.

There hasn’t been a single case reported as of right now where someone was infected while on a high speed train or in an airplane. In other words, we believe that as long as you don’t go to places with the “3Cs + loud voices” at your destination, then travel itself won’t spread infections.

At the same time, the number of newly infected persons has increased nationwide since the beginning of July. In Tokyo, we have continued to have days of more than 100 infections per day and we surpassed 200 from July 9th. We have come to share in the awareness that Tokyo has become the starting point for infections nationwide, with infections especially spreading out from night spots.

God Only Knows

When interviewed at the Japan National Press Club on June 24th, a document called On the Concept of an Expert Advisory Body for the Next Wave was announced jointly by members as a sort of graduation thesis for the Expert Meeting. We reorganized ourselves in a way to share roles, with experts offering advice and the government deciding on policy using the advice as reference.

With the inauguration of the Subcommittee, there was the notion that the government would first listen to the advice of the experts, so it was natural that there was some dissatisfaction from experts regarding the decisions for the Go To Travel promotion. I also wanted the government to make their decision after discussions by the Subcommittee. However, the experts ought to also realize that in all cases, it is the government that must decide policies and bear the responsibility for those policies.

When we found out that the lifting of the state of emergency, which was supposed to happen on May 28th, was going to be moved forward to the 25th, the experts and myself expressed concern that this was too early, but even then, the government remained firm in their decision to lift it early.

It is always a possibility for a government to make a comprehensive decision and not take the advice of experts who have adopted an opinion. Understanding this, I think it is important for experts to state what they believe to the government and to politicians without hesitation.

I think that the idea of drawing a line somewhere even in uncertain situations is very important with COVID-19 measures against this unknown virus.

No matter the government or the expert, there is no perfect score in handling an unknown virus. Only God knows the actual state of infections. We also want to know this actual state, but in reality, it is very difficult to know, and we make decisions while wavering after repeated discussion.

As we discuss COVID-19 measures, counter opinions often emerge from experts, saying that, as there is not enough evidence for that decision, we can’t say anything about it. People from the Ministry of Health, Labour, and Welfare often say this. However, there are more than a few cases where even if there is probable data, it isn’t perfect as evidence. But if we do not make recommendations because we say the evidence isn’t perfect, then the practical operations of the economy and society can’t move forward. We can’t just be like critics and say we don’t know because there is no evidence. Apparently this is something that I have the habit of saying often, and I sometimes hear others saying, “Dr. Omi said it again,” with a hint of disgust.

20 Years in Manila

Evidence is important in science, but for COVID-19 measures, there are times when waiting for the evidence will be too late. Experts ought to value evidence, but my job as coordinator is to decide in a certain way with limited information. I think that the methods of this job are connected to my past, which seems to have been driven by chance.

I was unable to take the entrance exam for the University of Tokyo as the Yasuda Auditorium Dispute (a conflict in University of Tokyo) occurred in my third year in high school, so planning to be a diplomat, I chose to enter the law department at Keio University where I continued on to university. However, at that time, personal principles and positions were emphasized, and there was the strong notion that national government officials were tools of authority. I worried that maybe the dream I had was an occupation that I shouldn’t pursue.

Actually, at that time I encountered Kobayashi Hideo’s Mushi no Seishin (The Spirit of Unselfishness), which I talked about before.

At the time, I was shocked by, and at the same time admired, these words: “Doers that clearly know that to put something into action is to suppress the consciousness are extremely rare and can be thought of as the most charming of doers.” Later, I decided to become a doctor, left Keio University, and worked hard to enter Jichi Medical University as a first year student again.

I then came to work as the WHO Regional Director for the Western Pacific in Manila, Philippines for 20 years from 1990 when I was 40, after serving in an office for the former Ministry of Health and Welfare and as a hospital doctor in the Izu Seven Islands (Izu Islands) for nine years. So if I hadn’t had my experiences in Manila, I might not be standing on the frontlines against COVID-19 here now.

A Deeply Ingrained Cheekiness

I was the person in charge of polio eradication in the Asia-Pacific region for the first decade at the WHO, and was the Regional Director during my second decade there. I was consistently in management. One of the big projects during my time as the Regional Director was the response to SARS which struck Asia in 2003. From February of that year, information on the outbreak in Guangdong Province, China came in but the Chinese government officially maintained the stance that there was no problem.

Using an international conference held in Hong Kong as an excuse, I negotiated face to face with the Chinese Minister of Health, and asked for the public release of information and that they allow an investigation committee in, but the negotiations remained unsettled.

And on April 2, the WHO announced advice against traveling to the Guangdong Province and Hong Kong. I was worried, as this was harmful to the Chinese economy, but soon after this announcement, China finally changed their policy to release information.

Negotiations with a foreign political power are full of tension, but I had a sense of purpose at the same time.

My method for doing a job where I decide in a certain way like I said before is a feeling that I have cultivated through many experiences of racing through tense emergency situations where progress can’t be made with ordinary methods.

I get the feeling sometimes that people around me wonder if I should be saying certain things to the Minister. It has become a bit of an excuse, but even that is surely because of the cheekiness that came to be ingrained in me from my work at the WHO.

I myself, as well as the Subcommittee, may make mistakes in the future. However, as experts, we will continue to convey our decisions each time to the government without hesitation. If there is criticism, we will listen, and if there are mistakes, we will correct them. I want to put my heart into action so that we can reduce the number of severely ill patients and deceased, even if only by one, and so that we can put a damper on the spread of infections, even if only a single day sooner.

Translated from “Kinkyujitai ‘sai-sengen’ wa ariuru: Korona-bunkakai wa nanini mayoi, do handan shitaka (Another State of Emergency is Possible: What the Coronavirus Subcommittee Hesitated with and How they Made Their Decision),” Bungeishunju, September 2020, pp. 116-123. (Courtesy of Bungeishunju, Ltd.) [November 2020]


Related article:



  • Dr. Omi Shigeru
  • New Coronavirus Infectious Diseases Control
  • Subcommittee
  • Kobayashi Hideo
  • Mushi no Seishin (The Spirit of Unselfishness)
  • Expert Meeting
  • Go To Travel
  • Tokyo Problem
  • COVID-19
  • community-acquired infection
  • state of emergency