Can PCR test prevent corona expansion?

"The infection route is blocked by the PCR test and the infection is thoroughly suppressed."

"Cospa is bad."

A large-scale PCR test plan for 730,000 people including asymptomatic residents launched by Hiroshima Prefecture.

Pros and cons were raised, and in the end, it was a trial implementation with the scale reduced to 1/100.

How can the inspection be done efficiently and effectively?

I followed the local government that continued to search.

(Hiroshima station, Jun Igarashi, Metropolitan area station, Naoki Iwamoto, Utsunomiya station, Ayumi Morita)

Unprecedented "all inspection"

In Hiroshima Prefecture, the infection spread rapidly in Hiroshima City from December last year.

At one point, he was forced to the brink of being designated as an "area that takes measures in accordance with the area subject to the state of emergency."

January 14th in such a situation.

Governor Hidehiko Yuzaki suddenly made an unexpected announcement.

"Intensive PCR testing will be conducted on all residents and workers in Naka Ward, Higashi Ward, Minami Ward, and Nishi Ward (in Hiroshima City) to block the source of infection." With

residents in the city center It is said that PCR tests will be conducted on an unprecedented scale in Japan for 730,000 workers.

Is it the first to argue inside the prefectural office?

However, despite announcing such a plan, he said that the specific method and schedule of the inspection were "under consideration".

As I proceeded with the interview, it became clear that opinions were divided even within the prefectural office.

Governor Yuzaki has been warming up the plan for some time, according to people familiar with the matter.

In fact, in May last year, when the first state of emergency was declared, he said:

"Ultimately, if we spread the test to the point where people who are interested can be tested immediately, the spread of infection can be prevented considerably. Even in the prefecture, we have a system that can test in thousands or tens of thousands a day. I want to make it. ”

However, some prefecture executives opposed the implementation from the viewpoint of the situation of infected people and the effectiveness of the test.

In the end, Yuzaki pushed up the plan.

I think this was the governor's "challenge first".

Yuzaki explained why he was particular about conducting large-scale inspections.

"We've been reducing outings and testing hospitals, and we've done a lot of active epidemiological investigations, but the infection has spread very rapidly, so large-scale testing is the only additional measure we can take. It was the way it remained. "

" It's done in the United States, South Korea, and elsewhere in the world, and it's done in China. In South Korea and China, it's been particularly effective in controlling infections. "

What is the test for improving infection?

January 19th, five days later.

Yuzaki finally revealed his thoughts on when to carry out a large-scale test.

"I'm still considering it, but I'd like to start it as early as possible, early in February. It will take about a month. In some cases, it may be about two months, but that's the assumption. it "

on the other hand, the infection status of the prefecture was going in the direction of improvement.

On this day, 24 people were found to be infected in the prefecture, which was about one-sixth of the peak.

When asked by reporters, "Is it necessary to test while the number of infected people in the prefecture is decreasing?", Yuzaki muddyed his words.

"If we can say that the infection has subsided, we need to make a separate decision,

but at this point

we are proceeding as planned."

Still, at this point, the plan is still twisting and twisting. I couldn't expect it.

Block the infection route

In response to the indication of the timing of the inspection, the prefecture decided to proceed with the work for implementation and at the same time to formulate a supplementary budget of 1 billion yen including the cost required for the inspection.

The rush in the prefectural office has increased, and one of the people concerned said, "We are preparing for the return on Saturday and Sunday."

And January 29, 15 days after the announcement.

Yuzaki has announced a basic plan for large-scale inspections.

The main content is that the PCR test, which collects saliva for several weeks from mid-February, is targeted at 730,000 residents and 730,000 people working in the four wards of the city, and the test fee is free. was.

In addition, a trial calculation of the effect of this test was also announced.

It is estimated that 280,000 people, which is 40% of the 730,000 people, will be tested, and up to 3900 infected people can be found, and the number of deaths will be reduced by up to 50 compared to the case without the test. did.

In addition, it is expected that economic damage due to self-restraint of business can be minimized and it is possible to avoid a decrease in prefectural income from 200 million yen to 400 million yen.

Yuzaki himself explained over a two-hour period based on dozens of materials displayed on the monitor.

And he emphasized the significance as follows.

"If the infection situation does not improve, it will affect medical care and the economy. I want to block the infection route from asymptomatic and mildly ill people and thoroughly suppress the infection."

“Cospa is bad”

There was dissent from the experts.

"In a nutshell, the cost performance is poor,"

said Takemasa Sakaguchi, a professor at Hiroshima University who is a member of the "Experts' Meeting" that advises the governor on measures against the prefecture's new corona.

"In Japan, where lockdown (city blockade) is not possible, even a single large-scale test has limited effect. Even if a huge budget is invested in the test, not many positive people can be found now. , Just when the number of infected people is decreasing, it may not be very effective. It is not something that is done all at once to people who are not at risk. "

Also attached in favor of the prefectural assembly

In addition, the prefectural assembly, which deliberates on the supplementary budget, also received a series of dissenting opinions.

"There is no convincing explanation as to whether the effect is commensurate with the large budget and personnel investment, as the decision is made by the departure from the deadline without careful consideration of the implementation method, effect, cost, etc. It is very doubtful whether the (infected person) is ready to accept it. ”(Kazunao Sato Prefectural

Assembly

) The

objection was also raised by Yuzaki's“ ruling party ”, the largest parliamentary group of the prefectural assembly.

"By carrying out on a large scale, or not to lead to unnecessary confusion. Not only the infection control of a period of time, or should not cast the budget measures that stood in the medium- and long-term field of view" (Morikawa IeTadashi prefectural assembly)

parliamentary group Some people said, "Why don't you decide for or against the majority vote?", And the opinions were so divided that the possibility that the budget proposal would be rejected was whispered.

However, Takashi Nakamoto, the chairman of the prefectural assembly and a major parliamentary group, admits, "This is the first test in Japan, and I can't tell until I actually try it. Hopefully, it may become a Hiroshima model." Taking a position changed completely.

Eventually, the largest parliamentary group was "agree" and the supplementary budget was passed and approved.

How about testing due to the decrease in infected people?

February 4th, when the budget was established.

Infection was revealed in 7 people in the prefecture, less than 10 people for the first time in about 2 months.

Is it really necessary to have a large-scale test while the infection situation is calm?

Such a voice was also getting stronger.

When asked, "Is there any change in the inspection schedule?" Yuzaki said, "I'm preparing now."

As mid-February, when the inspection was about to begin, was imminent, Yuzaki was forced to decide whether to carry out the inspection as planned.

Large-scale inspection is “pending”

February 8th, 4 days after the budget was established.

Things move a lot.

Yuzaki meets with Chair Nakamoto.

As a result of careful consideration, he conveyed the idea of ​​"holding" a large-scale inspection.

At a press conference on the 10th, it officially announced that it would "hold" the inspection of 730,000 people.

Instead, it announced that it will conduct a trial test on 8,000 people, including asymptomatic residents in some areas of Naka-ku, Hiroshima City, in preparation for a large-scale test.

One of the members of the prefectural assembly said that he should respond flexibly based on the infection situation when the plan was changed immediately after the budget was established.

On the other hand, another lawmaker criticized, "Because I voted in the parliament, it is a good idea to do it as it is. It is not a politician to change it."

Inspection applicants do not gather

February 19th.

Although there was a change in the plan, the inspection started.

First, it took three days for residents of 13 districts in Naka Ward.

When I was interviewing a person who had been inspected outside the inspection site after 10 am, my smartphone suddenly trembled.

I received an email from the prefecture.

The content was to change the subject of the inspection.

The inspection for residents was a reservation system in advance, but as of 9 am on the first day of the inspection, the number of reservations was only 1493 out of the maximum of 6000 people, so I hurriedly expanded the target to the entire ward. That's right.

Yuzaki explained this change as follows.

"I think that the number of people who want to be tested is decreasing due to the decrease in community-acquired infections. Based on the current reservation situation, we will expand the number of people who can be

tested

because we have the capacity to test and respond."

After this, it was also conducted for those who work at business establishments in Naka Ward.

Although 3335 people were inspected here, exceeding the expected 2000 people, the number of people for residents was only 3238 despite the expansion of the target, and the total number was 6573, which did not reach the originally planned 8000 people. It was.

Infection was confirmed in 4 residents, no workers, and a positive rate of 0.06%.

Yasutoshi Nishimura, the minister in charge of corona countermeasures, pointed out the need to consider effective inspections.

"(Confirmation of infection by inspection of residents) is 3200 people, which is 4 people, which is very inefficient. What kind of people will be asymptomatic in the future, including efforts like Hiroshima Prefecture? I would like experts to discuss how the test should be, whether to identify it in the form and prevent the re-spread of the infection. "

If you narrow down to nursing care facilities, etc.

How can the inspection be performed effectively?

Setagaya Ward, Tokyo, was the first to embark on a large-scale PCR test from October last year.

The subjects were those who wished to have no symptoms such as nursing care facilities and facilities for the disabled.

At that time, there were some skeptics about the effect.

However, Nobuto Hosaka, the ward mayor, said that he decided to carry out the examination because he thought that it was necessary to prevent the occurrence of clusters and the aggravation of patients in nursing care facilities where the risk of spreading infection was high.

"Last spring, I was shocked to see the news that hospitals were flooded with patients in Europe and many people died in the facility because medical staff could not come to the long-term care facility. There are more facilities than this. I thought about preventing this. ”The

inspections are“ regular inspections ”that inspect the desired nursing care facilities in order, and intensive and priority the facilities where infected people appear. It started with two "as-needed inspections" to inspect.

Initially, the ward assumes that 23,000 inspections will be conducted, and the actual inspections will be outsourced to the private sector.

The cost is expected to be fully borne by the government, and more than 400 million yen has been recorded.

The results began to come out immediately.

In October of last year, when the test was started, a total of 2 staff members were found to be positive at the two facilities, and in November, a total of 15 people were found to be positive, including staff and users of the special elderly nursing home. ..

All 15 were asymptomatic, and the person in charge of the facility seemed to be surprised, saying, "I can't believe it. I was focusing on infection control."

By February 28, Setagaya Ward had inspected a total of 13,239 people at a total of 731 facilities and found 99 infected people.

Introducing a new inspection method

From January, in order to increase the number of tests, we introduced a new test method called "pool method" in which multiple samples are mixed and tested.

For example, four samples are mixed into one and tested, and if the result is negative, all four are negative.

On the other hand, if a positive result is obtained, four samples are tested one by one to identify the infected person.

If the infection has not spread, the test time can be shortened compared to the conventional test, and the amount of reagents used can be reduced, so that the cost can be reduced.

The government has also issued a notice officially approving the "pool method".

With the introduction of the "pool method," Hosaka expects that the inspection will be even more effective.

"The number of people to be inspected has exceeded 10,000 even if we are doing our best. However, I think we are able to carry out effective examinations. By combining the pool method, we have a system that allows nursing care facilities to continue inspections on a regular basis. The goal is to make

Can you catch the signs of re-infection?

Some local governments have begun testing asymptomatic residents to find the beginning of a re-spread of the infection at an early stage.

In Tochigi prefecture, the number of infected people increased rapidly from the end of the year to the beginning of the year.

At one point, a state of emergency was declared, but the situation settled down and it was lifted on February 8.

In Tochigi Prefecture, where the number of infected people has decreased, testing for asymptomatic people aims to find potential viruses and lead to early countermeasures.

It is a response based on national policy.

Distribute test kits on the street

February 22.

The inspection has begun.

The inspection target is 600 people.

Half of them were surveyed by the younger generation, and 100 people were conducted at each of the three schools in Utsunomiya City.

The remaining 300 people were randomly and widely tested, so a test kit was distributed on the street.

The distribution location is not disclosed.

Suddenly, a banner was set up in a corner of Utsunomiya City in the afternoon, and the staff called out to the people who passed by.

"You can get a PCR test at no cost!"

How many people will cooperate with the first attempt in Japan?

After watching the situation for a while, people of various ages, such as office workers and nurses, stopped, sat down for about 10 minutes to receive explanations, and then received paper bags containing white boxes one after another. ..

The contents of the box are a container like a blue dropper or an invoice for mail, and the recipient returns to his home to collect saliva and sends the sample by mail.

The result will be notified to the installed application in 1 to 2 days.

If you are suspected of being positive, you will be contacted by the call center and will see a medical institution.

The country and prefecture were also groping, but during the three-day period, distribution began around noon every day, and in the evening all the test kits prepared were able to be distributed.

The high school student who received it said, "I think it's a great thing because unspecified people can be tested. I want you to improve these tests."

The personal information of the person who has undergone this test is not provided to the national or prefectural government, and the test is conducted only to understand the fact that "how many infected people are in which area".

The national and prefectural governments plan to continue to check the transition of the infection status by conducting PCR tests on asymptomatic people in Tochigi prefecture on a regular basis after March.

In the future, similar inspections will be conducted in other prefectures where the state of emergency has been lifted.

Regularly in high-risk areas

Shigeru Omi, chairman of the government subcommittee, points out that PCR tests for asymptomatic individuals are being conducted in various regions.

"Ideally, it's best to inspect everyone in the area more often than once, but in terms of capacity and efficiency, if you're going to try it, target it and do it as often as possible. It's a good thing to do. ”

“ It is very effective to regularly inspect high-risk areas such as facilities for the elderly not only once but several times. By doing it frequently, you can see the transition of the infection level. I understand the signs. "

Whereabouts of large-scale plans

Hiroshima Prefecture conducted a trial inspection of 6500 people.

The following steps were taken in preparation for the re-emergence of the infection.

In order to continuously monitor the infection status, a new free test was started for 500 citizens a day at the PCR center set up in the high-risk downtown area of ​​Hiroshima city.

Governor Yuzaki says that the inspection of 730,000 people, which was once shelved, will be carried out when the infection spreads again.

Will it move to a large-scale test again while the infection cannot be expected to converge?

Or do you take another step?

Yuzaki's judgment will be questioned.

(Honorific title omitted in the text)