Japan to downgrade COVID-19 to flu level in spring

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Government push for COVID status change

Three years after Japan confirmed its first case of coronavirus infection, Prime Minister Kishida Fumio said on January 20 that it would move forward with a plan to make major changes to its pandemic response in the spring. Central to this plan is downgrading COVID-19’s legal status as an infectious disease, placing it on the same level as the seasonal flu. An expert panel advising the health ministry will discuss steps toward this reclassification. Proposed measures include easing measures on mask-wearing.

The government sees a relaxing of COVID-related restrictions as crucial to reinvigorating the economy and social activity. Infections have been declining in recent weeks, and compared to the early days of the Omicron variant, the fatality rate and number of people developing severe symptoms have also decreased.

At the end of last year, the government asked a panel of experts to start discussing the reclassification of the coronavirus. The panel had taken a cautious stance amid concerns about the healthcare system. Authorities were divided on how to implement the changes.

Dropping from Category 2 to 5

COVID-19 is now ranked at a level roughly equivalent to category two, the second most severe level in Japan’s classification system under the infectious disease control law. This level allows authorities to take strict measures to prevent the spread of the disease, including urging people to limit their movements.

Lowering COVID-19 to the lowest-rank category five -- the same as the seasonal flu -- would allow more medical institutions to accept coronavirus patients. It also means people would no longer be requested to limit their activities. But it also means patients would have to pay for tests, medical treatment, hospital stays and vaccinations -- presently, all covered by public funds.

Four focal points of reclassification

The health ministry has outlined four key themes for consideration before reclassifying categories. The following is an overview of the expert commentary on these themes.

1. Legal powers and funding for treatment

A level roughly equivalent to category two grants authorities the legal power to recommend hospitalization or take steps to ensure it. They can also ask patients and their close contacts to refrain from outings. Tests, hospitalization and medical treatments for outpatients are all covered by public funds.

One member of the expert panel raised concern that fewer people would seek medical help if they are required to cover a part of those expenses. As a result, any changes should be done in phases. Another said patients should cover the cost when downgrading the category, since it would remove the legal assumption that the government had intervened in individual treatments to prevent infections.

The government is considering continuing public funds for the time being.

2. Health delivery system

Japan's government currently offers subsidies to medical institutions that secure beds for COVID patients and, in principle, coordinating hospitalizations. The aim is to ensure prompt admission for patients who require it. The government also subsidizes fever clinics that offer COVID-19 treatment and tests, and covers fees for hospitalization and outpatient care.

One expert on the panel said subsidies for preventing infections should remain in place to encourage medical institutions to accept COVID patients. They said the government should continue coordinating hospitalizations and offering subsidies to secure hospital beds.

And because medical resources differ by region, the expert recommended introducing the new measures at a pace that ensures there are hospitals ready to accept COVID patients in each region.

3. Monitoring patients and variants

The experts also discussed tracking the spread of the coronavirus. Doctors are responsible for reporting infections. The procedure has been simplified since the start of the pandemic, and doctors are now only required to submit detailed reports on older or high-risk patients. The central and local governments are responsible for monitoring the emergence of variants.

The panel discussed switching to a “fixed-point” observation system of the kind currently used to track seasonal influenza. That means extrapolating the data from designated hospitals across Japan.

One member stressed the importance of coordination between central and local governments in any changes made to monitoring COVID-19, to maintain a clear understanding of infection rates and detect new variants.

4. Basic anti-infection measures

The government currently asks people to carry out basic anti-infection measures, including wearing masks, washing and sanitizing hands. They ask people to avoid the “Three Cs” -- closed spaces, crowding and close contact -- while ensuring adequate ventilation. Medical institutions and nursing homes for the elderly have adopted measures to avoid cluster infections. Under the category change, the government is considering easing masking measures.

The experts believe that infections will continue, so sustainable anti-infection measures need to be in place. They said masks are used not only to protect the wearer, but also to stop infections of other people. They advised against easing anti-infection measures at medical institutions, caregiving or nursing homes.

Further discussion by expert panel

The expert panel will continue discussing what healthcare services will be needed under the reclassification, and to what extent the government should cover medical costs. It will also study anti-infection measures, including whether to keep its recommendation that people wear masks indoors.

The vaccination system is also under review. Vaccines for COVID-19 are currently provided free of charge under the Preventive Vaccination Law. The health ministry is consulting with experts on whether to continue covering this cost after March, 2023 when the free vaccine period is due to end.

This information is accurate as of January 25, 2023.