As countries worldwide take steps such as vaccination campaigns to combat the COVID-19 pandemic, academia is actively promoting the timely sharing of scientific information across borders. As an international academic journal, Global Health & Medicine (GHM) has quickly accepted COVID-19-related papers and published results of series of studies since the beginning of 2020. In particular, the "First Special Issue on COVID-19" (April 2020) and the "Second Special Issue on COVID-19" (April 2021) included a wide range of articles presenting frontline data on the COVID-19 response in Japan, China, the United States, Italy, the United Kingdom, West Africa, and other various countries and areas worldwide. This "Third Special Issue on COVID-19" (April 2022) features the practical experiences of front-line clinicians, researchers, and other healthcare professionals from Japan and it presents updated data on i) national policy, ii) research, iii) clinical practice, and iv) the vaccination campaign. Our hope is that the rapid publication and sharing of information will help, in any way possible way, in the global fight against COVID-19.
Tokyo Metropolitan Area is the most populous metropolitan area in the world. While cities around the world are struggling to cope with COVID-19, the number of new positives and deaths in Tokyo has so far been relatively contained compared to other large metropolitan areas. In Japan, infection control measures do not prohibit people from moving around during a COVID-19 outbreak. However, people are not only refraining from travel and social activities at the request of the government, but are also using their own judgment to avoid risk based on information about the infectious disease. This plays an extremely important role in Japan’s infection control measures. Expectations are high in Japan for maintaining the health care system and minimizing deaths. It is necessary to steadily respond to these expectations while normalizing social functions.
The increasing number of COVID-19 cases has placed pressure on medical facilities. Against this backdrop, the Tokyo Metropolitan Government established a facility for mild and asymptomatic COVID-19 cases by using existing hotels. These kinds of facilities were established in several countries, and represented a spectrum from hotel-like to hospital-like care. In this article, we focused on implementation and related strategies for establishing such a facility in Tokyo as implementation research, while ensuring patient and staff safety. This facility had three functions: care, isolation, and buffering. For the implementation strategy, we used several strategies from the Expert Recommendations for Implementing Change (ERIC) to implement functions similar to an ordinary hospital, but using fewer inputs. This experience can be applied to other resource-limited settings such as that in less developed countries.
Two years have passed since the confirmation of the first case of coronavirus disease (COVID-19) in Japan. The aim of this article was to review the public health responses to COVID-19 in Japan. As of January 31, 2022, COVID-19-positive cases have cumulatively totaled 2,669,638 and deaths cases have cumulatively totaled 18,784. To deter COVID-19 transmission in the community, the government declared a state of emergency to minimize the impact on people's livelihoods and the economy. The prefectural (province) governor of an area under a "State of Emergency" may request special action to prevent the spread of infection among residents. A nationwide campaign, Avoid the "3 Cs" (Closed spaces, Crowded spaces, and Close-contact settings), has been widely acknowledged to have controlled infection in high-risk areas. In Japan, COVID-19 vaccines were supplied by Pfizer, Moderna, and AstraZeneca. Pfizer's vaccine received regulatory approval in Japan in February 2021, and Moderna and AstraZeneca's did so in May 2021. Public health centers (PHCs) under the jurisdiction of local governments are responsible for conducting Polymerase Chain Reaction (PCR) testing, coordinating the treatment of COVID-19-positive patients, and identifying persons in close contact with COVID-19 patients through an epidemiological study of each positive case. These public health responses have been implemented based on the assessment of the impact of each variant and support from a government panel of experts. Further studies may be need to be conducted develop more flexible and efficient public health responses.
Even after recovering from coronavirus disease 2019 (COVID-19), patients can experience prolonged complaints, referred to as "long COVID". Similar to reports in Caucasians, a follow-up study in Japan revealed that fatigue, dyspnea, cough, anosmia/dysgeusia, and dyssomnia are common symptoms. Although the precise mode of long COVID remains elusive, multiple etiologies such as direct organ damage by infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), autoimmunity, prolonged inflammatory reactions, and psychiatric impairment seem to be involved. Notably, SARS-CoV-2 is neurotropic, and viral RNA and proteins are continuously detectable in multiple organs, including the brain. Viral proteins exert a number of different toxic effects on cells, suggesting that persistent infection is a key element for understanding long COVID. Here, we first reviewed the current status of long COVID in Japan, and then summarized literature that help us understand the molecular background of the symptoms. Finally, we discuss the feasibility of vaccination as a treatment for patients with long COVID.
Acute kidney injury (AKI) is defined as an increase in serum creatinine within 48 h or 1 week, or a decrease in urine output within 6-24 h. Continuous renal replacement therapy (CRRT) plays an important role in patients with severe AKI. In addition to direct cytotoxicity caused by the severe acute respiratory syndrome coronavirus 2, patients with coronavirus disease (COVID-19) experience endothelial cell damage, increased thrombogenic inflammation, and impaired immune responses. It has been reported that the more severe the case, the greater overproduction of cytokines and the more advanced the multiorgan failure. The kidney is widely recognized as one of the primary target organs; and COVID-19 positive AKI has been reported to have a greater rate of subsequent decline in renal function than COVID-19 negative AKI. Blood purification therapy has been used to prevent or alleviate organ damage in patients with moderate-to-severe COVID-19. Cytokine regulation is one of the primary therapeutic goals for these patients. Even with the widespread use of vaccines and antibody therapy, a certain percentage of patients develop moderate-to-severe diseases.
The COVID-19 pandemic is continuing to have drastic consequences for patients, healthcare workers, and the health system. Its cardiovascular implications have been well described in previous studies, but original reports from Japan are sparse. Validating overseas findings in the Japanese clinical settings is crucial to improve local COVID-19 care and to clarify the pandemic's impacts in the country. This review of available literature demonstrates that in Japanese patients and clinical settings too, there is a close relationship between COVID-19 and the cardiovascular system including cardiovascular complications. On the contrary, secondary effects on cardiovascular practice including service disruptions, telemedicine, and epidemiological changes in Japan have been relatively small.
The aim of this study is to clarify changes in the circumstances of cancer diagnoses during the COVID-19 pandemic in Tokyo, Japan, estimated from [18F]-2-fluoro-2-deoxy-D-glucose (FDG) -positron emission tomography/computed tomography (PET/CT) for cancer patients. Cancer diagnosis in pandemic status (PANS) was evaluated by retrospective review of the findings of FDG-PET/CT examinations performed between 11 March 2020 and 28 December 2021 for initial staging and restaging for malignancy. Evaluation of cancer diagnosis in pre-pandemic status (pPANS) was conducted similarly in FDG-PET/CT examinations performed between 4 January 2018 and 10 March 2020. Of these, patients with malignant lymphoma (ML), lung cancer, esophageal cancer, and colorectal cancer who had a pathologically proven diagnosis or clinical diagnosis following therapy of the disease were selected for analysis. Initial cancer staging was determined by the diagnostic report of FDG-PET/CT. Change in cancer stage and in the number of FDG-PET/CT examinations performed was evaluated between pPANS and PANS, and according to term of the pandemic and vaccination status. The COVID-19 epidemic influenced the number of cancer patients who underwent FDG-PET/CT. There was a marked decrease in the number of cancer patients receiving FDG-PET/CT in Terms 1-3 (March 2020 to February 2021), but it recovered in Terms 4-6 (March 2021 to December 2021). There was no significant difference between PANS and pPANS in terms of the initial stage of cancer, but Stage IV ML and Stage II esophageal cancer were more frequent in PANS. Initial staging of ML, lung cancer, and esophageal cancer revealed more advanced cancer stages in Terms 4-6 compared with Terms 1-3. The number of patients receiving FDG-PET/CT in Tokyo was influenced by the COVID-19 epidemic. Staging based on FDG-PET/CT shifted to more advanced cancer stage during the pandemic compared with pre-pandemic.
Emergency physicians perform endotracheal intubations for patients with COVID-19. However, the trends in the intubation for COVID-19 patients in terms of success rate, complications, personal protective equipment (PPE) information, barrier enclosure use, and its transition have not been established. We conducted a retrospective study of COVID-19 cases that required tracheal intubation at four hospitals in the Tokyo metropolitan area between January 2020 and August 2021. The overall intubation success rate, operator experience, and infection control methods were investigated. We then compared the early and late phases of the pandemic for a period of 8 months each. A total of 211 cases met the inclusion criteria, and 133 were eligible for analysis. The intubation success rate increased from 85% to 94% from early to late phase, although the percentage of intubations performed by emergency medicine residents increased significantly in the late phase (p = 0.03). The percentage of light PPE use significantly increased from 65% to 91% from early to late phase (p < 0.01), whereas the percentage of barrier enclosure use significantly decreased from 26% to 0% (p < 0.01). Furthermore, the infection prevention methods during intubation became more simplified from early to late phase.
During the surge of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) delta variant, our institution operated an intensive care unit (ICU) for patients with severe COVID-19. The study aim was to determine the survival rate and treatment outcomes of patients with severe COVID-19 treated in the ICU during the surge. A total of 23 consecutive patients with severe COVID-19 were admitted to the ICU between August 5 and October 6, 2021. Patients received multidrug therapy consisting of remdesivir, tocilizumab, heparin, and methylprednisolone. The patients were divided into two groups based on the ordinal scale (OS): a non-invasive oxygen therapy (OS-6) group, and an invasive oxygen therapy (OS-7) group. There were 13 (57%) and 10 (43%) patients in the OS-7 and OS-6 groups, respectively. All patients were unvaccinated. Sixteen patients (70%) were male. The median age was 53 years; the median body mass index (BMI) was 30.3 kg/m2; and the median P/F ratio on admission was 96. The 30-day survival rate was 69% and was significantly poorer in the OS-7 group (54%) than in the OS-6 group (89%; p = 0.05). The prevalence of obesity (p = 0.05) and the Sequential Organ Failure Assessment (SOFA) score on admission (p < 0.01) were significantly higher in the OS-7 group. Seven patients in the OS-7 group (54%) developed bacteremia. A low P/F ratio on admission was a significant unfavorable prognostic factor (hazard ratio: 10.9; p = 0.03). The survival rate was poor, especially in patients requiring invasive oxygen therapy. More measures are needed to improve the treatment outcomes of patients with severe COVID 19.
The Japanese government implemented a large-scale vaccination policy against the coronavirus disease 2019 (COVID-19) pandemic, primarily using messenger RNA vaccines in 2021. Its hallmark was prioritized vaccination for the elderly after healthcare workers in a short period of time. Vaccination for the elderly, vulnerable to infection and severe disease, was carried out rapidly in approximately 4 months since April 2021. We evaluated the impact of Japan's vaccination policy against COVID-19 during the pandemic, with a particular focus on how prioritized vaccination for the elderly affected the pandemic. We observed a remarkable decrease in the number of infections, cluster events in long-term care facilities, and severe disease among the elderly during the fifth wave (August 2021) despite rising incidence of infections in the overall population. In conclusion, we think that prioritized vaccination for the elderly was efficacious in preventing infections and severe COVID-19 among the elderly during the fifth wave in Japan.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant has spread rapidly worldwide. We report the clinical characteristics and threshold cycle (Ct) values of the first 11 patients infected with the SARS-CoV-2 Omicron variant in Japan. All patients were younger returnees from abroad; 10 patients had received two doses of vaccine. Estimated Ct values for the 11 patients were 6.0 (95% confidence interval [CI] 4.2-7.3) days for > 30, 10.6 (95% CI 9.5-11.9) days for > 35, 15.1 (95% CI 13.6-17.6) days for > 40, and 19.7 (95% CI 17.3-23.7)days for > 45. Our results provide important insights for indicators of infection control.
Newly developed anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) drugs are being rapidly approved in countries worldwide. These new drugs are being approved after testing with a limited number of cases, and in real-world clinical practice, unknown and potentially serious adverse events that could not be detected in clinical trials may emerge. Accordingly, in the event of an adverse drug reaction for which a causal relationship with these new drugs cannot be ruled out, it is vital to promptly report the details of the case to the regulatory authorities. To date, through close cooperation between physicians and pharmacists, we have reported four cases of adverse drug reactions for which a causal relationship to anti-SARS-CoV-2 drugs cannot be ruled out. Herein, we introduce safety measures taken by pharmacists when using these new drugs in the hospital, and a system for reporting to the regulatory authorities when adverse events occur.
To investigate adverse reactions and attitudes toward the vaccine during the first month after mRNA1273 vaccination in a larger sample including younger men and women in Japan, we distributed a 1-month postvaccination questionnaire using a Google form to 8,566 people who received a second dose of mRNA-1273 at Okayama University. The response rate was about 40.2% (3,447 responses), the sex ratio was about the same, and 73.3 % (2,528 respondents) were students in their twenties or younger. Poisson regression with robust variance was performed to calculate the prevalence ratio of each symptom by different attributes. The most common adverse reactions after the second vaccine dose were local pain (80.4%), fever (85.1%), malaise (82.0%), headache (64.0%), and chills (57.4%). Approximately 99% of respondents reported that their adverse reactions resolved within 1 week. Over 80% of respondents were satisfied with their vaccination (87.2%), expressed interest in receiving the third vaccination (83.3%), and would recommend vaccination to their loved ones (80.2%). However, among them, 22.0% (757 respondents) would recommend and 28.4% (980 respondents) also stated that they would consider the type of vaccine in these decisions.
Although ten vaccines against novel coronavirus infection (COVID-19) have been placed on the World Health Organization (WHO)’s emergency use list, no vaccine has been developed by Japanese pharmaceutical companies. As of March 2022, 10 billion doses of vaccines have been administered worldwide 2 years after the infection was declared a pandemic by the WHO. Japan lacks a system for approval of pharmaceuticals at the stage of presumed efficacy in emergencies, such as the COVID-19 pandemic. The absence of such an emergency approval mechanism is believed to have been a stumbling block to the rapid availability of urgently needed drugs. Further promotion of vaccine development in Japan will require comprehensive improvement of investment in the vaccine field, which is critically lacking from a long-term perspective.