Full-fledged discussion on reviewing Corona "Equivalent to type 2" to "type 5"? why now?

Discussions have begun to review the treatment of the novel coronavirus under the Infectious Diseases Act.

Currently, it is classified as "type 2", but it is expected that full-scale discussions will be held, including the possibility of lowering it to "type 5", which is the same as seasonal influenza.

What happens if you get a 5th grade?

While social restrictions are reduced, the burden of vaccination, medical expenses, etc. Will increase?

What is the outlook for future discussions?

Summarized in a Q&A format.

Q. What are "Type 2" and "Type 5" in the first place?

The Infectious Diseases Control Law categorizes viruses and bacteria into categories 1 to 5, in principle, according to the risk of aggravation and infectivity, and stipulates the measures that can be taken by national and local governments.

"Type 1" is classified as Ebola hemorrhagic fever, plague, etc. as infectious diseases with extremely high risk of life-threatening if caught.

"Type 2" includes "tuberculosis" and "severe acute respiratory syndrome = SARS", which have a high risk of becoming severe and are highly contagious. All costs will be covered by public funds.

In principle, hospitalized patients are accepted by designated medical institutions for infectious diseases, and doctors are required to report the outbreak of all infected patients to the public health center.

On the other hand, "type 5" includes "seasonal influenza" and "syphilis", and local governments cannot take measures to restrict employment or recommend hospitalization, and some medical expenses will be borne by the patient.

General medical institutions also accept inpatients, and doctors are required to report within seven days, and all patients are not required to be reported.

Q. Why are you discussing the review now?

At first, the characteristics of the new coronavirus were unknown, so it was classified as "corresponding to type 2." In addition to being able to take stricter measures than "Type 2", such as requesting self-restraint, we were able to make strong restrictions on behavior such as declaring a state of emergency.

In addition, as long as infection control measures are taken, it is now possible to accept patients in general hospital beds as designated by prefectures.

After that, the Omicron strain, which spread in the "6th wave" and the "7th wave," tended to have a lower rate of severe disease compared to the conventional strain, and the vaccination against the Omicron strain began. In addition to revising the period of medical treatment for patients, it was also simplified to grasp the total number of infected people, and measures at the border were relaxed.

Under these circumstances, the Ministry of Health, Labor and Welfare has added a provision to promptly consider the position of the new corona under the Infectious Diseases Law to the supplementary provisions of the revised Infectious Diseases Law, which was enacted on the 2nd of this month. He indicated a policy of full-fledged discussions for a review, including a reduction to .

They asked experts to verify the pathogenicity, infectivity, and possible mutations of the virus.

Q. What will happen if I downgrade to "Type 5"?

If it is classified as Category 5, in principle, it will be possible for general medical institutions to accept inpatients who are limited to designated medical institutions for infectious diseases.

In the future, if the infection spreads, it is expected that the tightness of hospital beds will be reduced, but medical institutions accepting new inpatients will be required to take measures to reduce the risk of infection within the hospital.

On the other hand, there are concerns that some medical institutions may not be able to actually accept patients due to insufficient infection control measures.

In addition, if it is reclassified to category 5, there are concerns that the costs of examinations and hospitalization, which are fully covered by public funds, will be borne by the patient, in principle, and the costs not covered by insurance will be borne by the patient.

In addition, it is also necessary to have the public understand that if they are infected, they will act to prevent the spread of infection, as they will not be able to restrict their behavior, such as recommending hospitalization and waiting for people who have had close contact with them.

Regarding this, Satoshi Kamamoto, executive director of the Japan Medical Association, said, "I'm opposed to drastically halting public funding of responses while we don't know what the future situation will be. points out.

Q. Has the “fatality rate” of the new corona decreased?

The ``mortality rate'', the ratio of those who died to the number of infected people, was 5.34% in the ``first wave'' from January 2020 when the infection was confirmed for the first time in Japan, but treatment methods for severe cases have progressed. In the "second wave" in the summer of that year, it was 0.93%.

After that, in the "third wave" from the beginning of 2021 last year, the rapid expansion was seen and the medical system was overwhelmed, so it rose again to 1.82%.

Furthermore, in the "fourth wave" of last spring, when the alpha strain, the first mutant virus confirmed in the UK, spread, the rate was 1.88%, but last summer, the "delta strain" spread, causing an even greater spread of infection, the "fifth wave." In the "Wave", the fatality rate was 0.32% due to the increase in the number of people who died, such as those who became seriously ill even among the relatively young generation, and the increase in the number of mild and asymptomatic infected people.

Then, the highly contagious Omicron strain spread, and after the "6th wave" from the beginning, the infection spread on a different scale than before, and the number of people who died increased, but the number of infected people increased. The increase in numbers was orders of magnitude greater and the fatality rate fell even further.

The fatality rate has dropped significantly to 0.17% in the 6th wave and 0.11% in the 7th wave this summer.

Experts say that the mainstream of infections has changed to the Omicron strain, and many people, especially the younger generation who do not have pre-existing illnesses, have mild symptoms, and the percentage of people who develop severe symptoms due to vaccination has decreased. It is said that it is in

However, although the fatality rate has decreased, the number of infected people has increased explosively, and the number of people who have died due to infection with the new corona has increased to more than 31,000, with the Omicron strain expanding the most this year. It has accounted for more than 60% of the people who have died from infection in the past three years.

Q.What kind of advice do you get from experts?

Experts say that when changing from "equivalent to type 2", it is necessary not only to reduce the "fatality rate" of the number of people infected with the new coronavirus who died, but also to consider the status of vaccines and therapeutic drugs and the mainstream mutations. The nature of the virus and its impact on medical care should be considered.

After sharing the direction of taking measures against corona while promoting socioeconomic activities, there are conditions to be able to treat corona as a "type 5" infectious disease, so to speak, as a disease. In an interview with NHK in July, Chairman Shigeru mentioned that vaccines should be widely vaccinated, there should be inexpensive and easily accessible therapeutic drugs, and that as many medical institutions as possible should treat infected people. rice field.

Looking at the current situation of these conditions, according to the website of the prime minister's official residence, the vaccination rate is 81.4% for the first vaccination and 80.4% for the second vaccination as of the 6th of this month. In addition to exceeding, 67.1% of them received the third vaccination.

However, only 22.1% of people have been vaccinated against the Omicron strain by the end of the year.

In addition, regarding therapeutic drugs, there are oral drugs that can be used in the mild stage, and "Lagebrio" developed by the American pharmaceutical giant "Merck" and "Lagebrio" developed by the American pharmaceutical giant "Merck" and prescribed for people who are at risk of becoming severe In addition to the use of "Pakilobid Pack" developed by "Pfizer", in November, "Zokoba", an oral drug from "Shionogi & Co., Ltd.", received emergency approval as the first drug that can be used even by people who are not at risk of becoming seriously ill. and prescribing has begun.

In addition, regarding the medical system, it is now possible for general medical institutions to treat patients with the new coronavirus after taking infection control measures, and each prefecture can provide corona treatment at local clinics. The number of medical institutions that can be examined is increasing, such as by publishing a list of medical institution names.

On the other hand, experts say that in addition to these conditions, future changes in the new coronavirus, which has repeatedly mutated, and changes in the status of immunity obtained by previous infections and vaccines, should be considered. is served.

In October this year, Professor Hitoshi Oshitani of Tohoku University and Professor Hiroshi Nishiura of Kyoto University submitted a document showing the future prospects to the Ministry of Health, Labor and Welfare's expert meeting, and in the future, a new Omicron stock that will replace "BA.5" It is possible that the rate of severe disease and fatality may increase again due to the rapid expansion of such mutations and the lack of vaccination rates, and the weakening of immunity from vaccines and natural infections, especially among the elderly. I was.

At a press conference after the Ministry of Health, Labor and Welfare's expert meeting held on November 30, chairman Takaji Wakita said, "Until now, coronavirus infections tended to aggravate respiratory diseases. , There are many complications of cardiovascular disease, and there is an opinion that it may be a circulatory disease, ”he said, pointing out the need to pay close attention to changes in the nature of the disease.

Q. What is the outlook for future discussions?

Regarding the discussion on revising the classification, the Ministry of Health, Labor and Welfare has not decided on a specific timing.

In the future, it is expected that specific considerations, such as how public funds should be borne, will be advanced based on the results of verification of pathogenicity by experts.

At the same time, it is expected that consideration will be given to what to do with the current free vaccinations.

When changing the classification to 5, it is necessary to revise the ministerial ordinance after consulting with the expert committee of the Ministry of Health, Labor and Welfare.

It is also possible to use public funds to pay for medical expenses, etc.

If a new classification is to be created, it will be necessary to revise the Infectious Diseases Act, which will require deliberation in the Diet.