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Basic Policies for Novel Coronavirus Disease Control

March 28, 2020(Revised on April 16, 2020)

Decisions by the Headquarters for Novel Coronavirus Disease Control

The government of Japan recognizes that counter measures against the novel coronavirus infections are a

critical issue in terms of crisis management, and has made every effort to protect the lives of the people by

taking countermeasures at the water's edge, preventing the spread of the disease, and providing medical

care.

However, in Japan, there have been sporadic outbreaks in areas where the number of patients with

unknown routes of infection has been increasing, and the spread of infection has been observed in some

areas.

In light of this situation, on March 26, 2020, the Minister of Health, Labour and Welfare reported to the

Prime Minister that there was a high risk of the spread of the novel coronavirus infection based on Article

14 of The Act on Special Measures for Pandemic Influenza and New Infectious Diseases Preparedness and

Response (Act No. 31 of 2012; hereinafter referred to as the “Act”), which is applied by replacing the

terms of Article 1-2, paragraphs(1) and (2) of the Supplementary Provisions. On the same day, March 26,

2020, the Headquarters for Novel Coronavirus Disease Control based on Article 15, paragraph 1 of the Act

was established.

In order to protect the lives of the people, it is important to control the number of infected people and to

maintain the health care delivery system and social functions.

Based on this, the first step is to further promote the avoidance of the "Three Cs" and contain the outbreak

of the cluster (populations that have been found to be related to the patient, hereinafter referred to as "the

cluster") through active epidemiological surveys. It is important to contain the outbreak of the so-called

overshoot, an explosive spread of infection (hereinafter referred to as "overshoot") in order to prevent the

outbreak of the disease and to minimize the number of infected, seriously ill and dead.

In addition, it is important to control the rate of spread of infection as much as possible by combining the

avoidance of “Three Cs” with the reduction of human to human contact, such as through requests to refrain

from going outside in order to achieve the above containment and to prevent the collapse of the healthcare

delivery system.

At the same time, it is also necessary to prepare for a rapid increase in the number of infected cases in

Japan, and to establish the necessary systems for healthcare delivery, mainly for the seriously ill.

With respect to the novel coronavirus infection that has already been detected in Japan, as shown in the

following section, "1. Facts about the situation of the new coronavirus infection outbreak", it can be

comprehensively judged that

・The novel coronavirus tends to cause pneumonia at a considerably higher frequency than in the case of

seasonal influenza, and there is a risk of causing significant damage to the lives and health of the people.

・It is a situation that has a risk of having an enormous impact on the lives of the people and the national

economy due to the rapid spread of the disease throughout the country due to the large number of cases

with no identifiable route of infection and a rapid increase in the number of cases.

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On the basis of this, on April 7, 2020, the Head of the Novel Coronavirus Response Headquarters declared

a state of emergency under Article 32, paragraph 1 of the Act on Special Measures for Pandemic Influenza

and New Infectious Diseases Preparedness and Response.

The period during which emergency measures should be taken under the declaration is 29 days from April

7 to May 6, 2020. Areas where emergency measures should be taken are Saitama, Chiba, Tokyo,

Kanagawa, Osaka, Hyogo and Fukuoka Prefectures. Due to widespread COVID-19 infections similar to

the previously mentioned seven prefectures, as of April 16, 2020, a state of emergency declaration has been

additionally designated for the following prefectures: Hokkaido, Ibaraki, Ishikawa, Gifu, Aichi, and Kyoto.

In addition to the prefectures recently designated to be under a state of emergency, it was decided that all

prefectures would also be subject to emergency measures for the reasons stated on page 5 and beyond. The

period for implementing emergency measures in these areas are from April 16, 2020, to May 6, 2020. If the

emergency measures are deemed no longer necessary, the state of emergency will be released immediately

even within the period.

In light of the current situation of the novel coronavirus infection and the issues to date, the declaration of a

state of emergency requires the use of measures based on the law to prevent the spread of infection. Under

this declaration, the public, including the government, local governments, medical personnel, experts, and

businesses, should work together to avoid the infection of themselves and ensure that they do not infect

others by implementing basic infection prevention measures, such as refraining from leaving the house in

an emergency, and avoiding the "Three Cs" described below.

In order to implement effective measures comprehensively, reliably and swiftly, it is an urgent task to

strengthen the system for cluster measures and to secure the medical care delivery system, and we will

implement the necessary measures by implementing the existing measures with sufficient effectiveness,

and in particular by strongly requesting people to refrain from going out of the house on unnecessary and

urgent occasions, and by thoroughly reducing human-to-human contact.

If the people of Japan can work together to implement these measures, it is possible to bring the current

spread of infection under control. Specifically, people should avoid unnecessary and non-urgent outings,

“Three Cs”, and red-light districts and high risk night entertainments. Also, businesses need to cooperate to

reduce human-to-human contact by using telework, etc., in addition to reducing employee commuting by

40% based on the Business Continuity Plan (BCP).

If a rapid convergence can be successfully achieved in 30 days, it means we succeeded in reducing

contacts by 80% ,based on a mathematical model. Even under the state of emergency, the Government of

Japan will work to minimize the impact on social and economic functions, and will not take compulsory

measures such as "lockdown" (city blockade) that is being implemented in other countries.

In order to protect the lives of the people, this guideline accurately grasps the situation surrounding the

novel coronavirus infection, and the people including the government, local governments, medical

personnel, experts, and businesses work together to further promote countermeasures against the novel

coronavirus infection.

Since the novel coronavirus infection is an infectious disease with a different virus and pathology than the

novel influenza, the government will take immediate action in cooperation with the public, including local

governments, medical personnel, experts, and businesses, while listening to their opinions.

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1. Facts on current situation of the Novel Coronavirus infectious disease

In Japan, since January 15, 2020 when the first case was confirmed, a total of 7,964 infected cases and 119

deaths in 46 prefectures have been confirmed by April 14.. In particular, recently 61% of infected people

are those with unknown routes of transmission (situation up to April 13). This means that in addition to the

infection in specific places where clusters were identified, the risk of infection in daily life, which was

previously limited, has started to increase. Medical provision system is strained in some areas and

strengthening of the system is an urgent issue.

In the assessment by the specialists Meeting on the Novel Coronavirus Disease Control (hereinafter

referred to as the "Specialist Meeting"), an overshoot is not confirmed so far in Japan. However, cluster

infections have been reported one after another mainly in urban areas and the number of patients is

increasing rapidly.

Under such circumstances, some regions are facing a situation where the healthcare delivery system is

getting tight and it has been analyzed that strengthening the healthcare delivery system is an urgent issue.

In particular, from March 16 to April 1, the number of reported cases jumped from 817 to 2,299, with a

doubling time (the time required for the number of infections to double) of 4.0 days. The Specialist

Meeting pointed out the existence of clusters in establishments in downtown areas that provide services

involving human to human physical contact. This has become a major problem along with nosocomial

infections and infections in elderly people and welfare facilities. In addition, some specialists have

indicated that there is a risk of infection spreading from asymptomatic or unclear symptoms.

On the other hand, in terms of the situation overseas, the new coronavirus infection has spread to all

continents except Antarctica, and overshooting has been confirmed in Iran, Europe and in the United States.

Under these circumstances, from mid to late March of this year, there was an increase in the number of

individuals who appear to have been infected overseas and then entered Japan.

The share of infected persons entering from overseas among the total confirmed infections in the country

increased from 13% (March 11-March 18) to 29% (March 19-March 25), with a maximum of over 37% on

some days, but this has now been contained to a certain extent as a result of enhanced quarantine policy.

However, as for the country of origin, although the epidemic was initially concentrated in the People's

Republic of China, it is now expanding mainly in Europe and in the United States, reflecting the global

trend of imported infection cases.

Concerning the domestic medical provision system, Tokyo and Osaka prefectures, where the number of

infected people is rapidly increasing, have announced that patients with mild symptoms who do not need

hospitalization will be switched to treatment at accommodation facilities as there is a possibility that the

provision of inpatient medical care for severely ill patients may be affected.

In addition, Kanagawa Prefecture, which is adjacent to Tokyo and where the number of infected people

exceeds 500, is also planning to switch treatment of patients with mild symptons from inpatient medical

care to accommodation facilities. The medical care delivery system is beginning to appear stringent,

especially in metropolitan areas.

As of April 6, the cumulative number of infected people was 1,123 in Tokyo and 429 in Osaka, and the

doubling time in the past week was 5.0 days in Tokyo and 6.6 days in Osaka. Moreover, there is a risk of a

further surge in the number of infected people. In addition, the cumulative number of infected people in

neighboring prefectures, namely Saitama, Chiba, Kanagawa, Hyogo, and Kyoto, exceeded 100 respectively,

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with almost half of those infected have unknown routes of transmission in all prefectures except Kyoto.

Furthermore, the spread of infection was rapid in Fukuoka prefecture, where the cumulative number of

cases reported is over 100 with the doubling time of about 3 days, and the proportion of cases with

unknown routes of infection accounts for 70%.

As of April 14, the cumulative numbers of Coronavirus case reports were over 100 in Hokkaido, Ibaraki,

Ishikawa, Gifu, Aichi, and Kyoto. In Ibaraki, Ishikawa and Gifu, the doubling time in the most recent week

is less than 10 days, and the doubling time in the most recent week is less than 10 days in Hokkaido, Aichi

and Kyoto, excluding the effects of past epidemics in Hokkaido. In addition, in these prefectures, the ratio

of cases with unknown infection routes has reached nearly half in the last week. It is necessary to proceed

with prevention efforts in these 13 high risk prefectures hereafter collectively referred to as “the special

alert prefectures”.

Even in prefectures that have not been specified as the special alert prefectures, cluster may occur in urban

areas due to the movement of people. In such areas, the healthcare provision system may not be well

established, and if the infection spreads, there is a high possibility that healthcare will become

dysfunctional. Since the declaration of an emergency, many people have cooperated with the Japanese

Government in changing their behavior.

From the data observed on the movement of groups of people, it is necessary to request further cooperation

for changing the behavior of the people by expanding emergency measures nationwide. Looking at the

actual number of infected people, it can be considered that the infection has spread due to some loosening

of caution during mid-March to the consecutive holidays.

During this timeframe, citizens, local and national governments and other public and private organizations

should work together to prevent the spread of infection, especially during the long holiday period between

April 29 and May 6. All prefectures will work together to prevent the spread of infection. Therefore,

Japanese government has declared all prefectures to be areas where emergency measures should be

implemented.

Taking into consideration the fact that national and local governments, medical personnel, specialists, and

business people will unite in this effort to prevent the spread of infection, It is necessary to take appropriate

measures to prevent the spread of infection.

The following are the characteristics of the novel coronavirus infection:

- Although droplet infection and direct contact are considered to be the main route of infection in

general situation, there is a risk of spreading the infection even without symptoms such as coughing

or sneezing under certain circumstances such as conversing with many people at close range in an

enclosed space. The possibility of transmission from asymptomatic individuals has also been noted.

On the other hand, keeping distance between people (social distancing) has been shown to

significantly reduce the risk of infection.

- Given the commonality of the places where mass infections have occurred, there are three conditions

("Three Cs") when combined, the risk of spreading the infection is considered to be high in particular.

“Three Cs” are (1) closed spaces (enclosed spaces with poor ventilation), (2) crowded conditions

(where many people are densely packed), and (3) Close-contact settings (where conversations and

vocalizations take place within touching reach of each other).

In addition, risks are considered to be present in crowds and in close distance conversations,

especially in loud voices and singing.

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It has also been noted that there may be a risk of infection with exercise with vigorous exhalation and

exercise involving loud voices.

- At present, even in areas where infection is spreading, the spread of infection is mainly in clusters of

live music venues/ music pubs, sports gyms, medical institutions, and, more recently, down-town

establishment where customer and servicers comes in direct physical contacts, . The risk of infection

in daily life is limited, and it is not considered to be widespread in the city.

- According to the World Health Organization (WHO), the incubation period is currently estimated to

be 1-14 days (generally about 5 days), and the Ministry of Health, Labour and Welfare has decided to

monitor the health of persons in contact with concentrations for 14 days, based on the information on

the novel coronavirus infections

- When infected with the novel coronavirus, fever and respiratory symptoms often persist for about a

week, and many people complain of strong physical weariness (malaise).

- According to a report in China (published on March 9, 2020), the median length of hospitalization for

the novel coronavirus infections is 11 days, which is longer than the 3 days for seasonal influenza.

- It is reported that about 80% of the infected people are mildly ill and 80% of the infected people does

not infect others. In addition, it has been reported that many cases are cured, including hospitalized

cases.

- In terms of severity, it has been reported that there is a higher risk of death than seasonal influenza. A

report in China (published on February 28, 2020) reported a fatality rate of 2.3% in confirmed patients

and an 18.5% rate of moderate or higher pneumonia.

For seasonal influenza, the fatality rate was reported to be about 0.00016%-0.001%, the rate of

pneumonia was reported to be 1.1%-4.0%, and the ratio of excess deaths to the cumulative estimated

number of patients was reported to be about 0.1%.

Thus, the mortality and pneumonia rates in the novel coronavirus infections are likely to be

considerably higher than in seasonal influenza. In addition, it has been reported that the risk of serious

illness is particularly high among the elderly and those with underlying diseases, so it is important to

take measures against nosocomial infection in medical institutions and nursing homes. In the above

report in China, the percentage of deaths by age was 0.2% for those under 30 years of age, compared

to 6% for those over 60 years of age.

- In accordance with Article 12 of the Infectious Diseases Act, the average time from onset date to

report date was 9.0 days in patients reported by March 31, 2020.

- At present, there are no specific antiviral drugs or vaccines that have been confirmed to be effective,

and symptomatic therapy is the main treatment method. As there is no vaccine available at this time,

measures related to vaccination among those listed in the National Action Plan for Pandemic

Influenza and New Infectious Diseases are not included in this Basic Policies. On the other hand,

several candidate therapeutic agents have emerged from existing ones, and clinical observation

studies are underway.

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2. Overall Policies for Novel Coronavirus Disease Control

- The speed of spread of the infection will be controlled by the containment of clusters and reducing

opportunities for contact in each region through general policies, information provision, sharing, and

measures to prevent the spread of new coronavirus infection.

- We will make every effort to minimize the occurrence of serious illness and fatalities through

surveillance, information gathering, and the provision of appropriate medical care.

- Minimize the impact on social and economic functions through appropriate measures to prevent the

spread of the disease and economic and employment policies.

- These counter measures are not irreversible even when the number of infected people increases. For

example, If the containment of clusters and the reduction of contact opportunities were successful,

and the incidence of infected people in the area was reduced in the early stage, the strengthened

counter measures should be reversed as appropriate.

3. Key points in implementing measures against novel coronavirus disease

(1) Provision and sharing of information

① The government will inform the public accurate, easy-to-understand information and calls to the public

in response to changes in the situation, as described below, to promote awareness-raising that will

contribute to change in behaviour, and to take a calm response.

- Provide accurate information such as clinical information on outbreaks and patients' conditions.

- Provide epidemiological analysis information that is easy for the public to understand.

- Ensure basic infection control measures such as hand washing and coughing etiquette.

- Encourage taking leaves from work/absences from school andrefrain from going out in case of

experiencing illness such as a cold.

- Encourage to call medical institutions by phone in advance in order to receive consultation and reduce

the risk of infection.

- Disseminate in an easy-to-understand manner the "Guidelines for consultation and Examination of

Novel Coronavirus Infections" prepared by the Ministry of Health, Labour and Welfare.

- Call for no discrimination based on misunderstanding or prejudice against infected people, people in

close contact with infected people, medical institutions, medical personnel, and other people involved

in countermeasures.

- Avoid "Three Cs". In particular, in their daily lives and workplaces, they are urged to avoid talking in

crowds or in close distance, shouting or singing in a room full of people, and exercising in a way that

makes exhalation more intense.

Restaurants should avoid scenes with "Three Cs".

- Make employees and students aware of the importance of health management and infection control.

- Avoid mass gathering eating other than family members.

- Let people know that in the current measures, the government will not implement measures such as

"lockdowns" (city blockades) and call for a calm response from the public (such as voluntary restraint

on non-essential travel across prefectures, such as unnecessary travels and homecoming , and avoid

rushing to shops and preventing hoarding).

② The government, led by the public relations officer, will disseminate information to the public in a

prompt and proactive manner by the website of the Prime Minister's Office by introducing links to the

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websites of relevant ministries and agencies, such as the Ministry of Health, Labour and Welfare, on the

Prime Minister's website, and by actively utilizing social networking services (SNS) and other media.

③ The government, in cooperation with private companies, will carefully disseminate information so that

sufficient information can reach the underserved population.

④ The Ministry of Health, Labour and Welfare will promptly release information on the status of

outbreaks of infectious diseases and the location and size of clusters.

⑤ The Ministry of Foreign Affairs will provide appropriate information and support to Japanese nationals

residing in each country in light of the fact that the infection is spreading throughout the world.

⑥ In addition to the information provided by quarantine stations, the Government will provide

appropriate information to returnees at companies and other business establishments that conduct business

overseas or stay overseas for a long period of time, as well as at universities and other institutions that have

many opportunities to study or travel abroad, so that they can make decisions and confirm whether or not

to travel to Japan and take necessary measures, such as requesting returnees to refrain from going outside

for two weeks.

⑦ The government will provide appropriate and prompt information to citizens, foreign residents, foreign

tourists, and foreign governments, which will lead to the prevention of the spread and countermeasures

against rumors in the country.

⑧ Local governments, in close cooperation with the government, should send messages and warnings to

residents through various means according to the infection situation in the area.

⑨ The Government will take measures based on the fact that the situation related to this novel coronavirus

infection was regarded as a “historical emergency” based on the Guidelines for the Management of

Administrative Documents (1st April, 2011, Approved by Prime Minister). Local governments will also

respond accordingly.

(2) Surveillance and Information Gathering

①Under the doctor's notification based on Article 12 of the Infectious Diseases Act, we will identify

patients with suspected symptoms and carry out tests that the doctor deems necessary.

② The Ministry of Health, Labour and Welfare will further strengthen the inspection systems of relevant

organizations such as local health laboratories and private inspection agencies in order to enable them to

conduct necessary inspections in the midst of the rapid spread of infection.

In addition, prefectures establish a conference body composed of relevant organizations such as medical

institutions, to understand and coordinate the implementation system for PCR and other inspections, and

utilize private inspection bodies.

③ Periodically publish the results of analysis of the number of people conducting PCRs and other tests,

the number of positive subjects, the positive rate by prefecture.

④ The Ministry of Health, Labour and Welfare will establish an effective use of the existing surveillance

system and an even more effective surveillance system in order to ascertain the prevalence of infectious

diseases in Japan, apart from the notification of doctors based on Article 12 of the Infectious Diseases Act.

When building the system, take care to avoid confusion in the field.

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⑤ The Ministry of Education, Culture, Sports, Science and Technology and the Ministry of Health,

Labour and Welfare will work to strengthen the understanding of outbreaks in schools.

⑥ The Government will continue to promote the development of simple testing kits for rapid diagnosis as

soon as possible.

(3) Pandemic Prevention

① The declaration of the state of emergency on April 7, 2020 was made for the purpose of further

accelerating the measures to date through the united efforts of the people, including the government, local

governments, medical personnel, experts, and businesses. By thoroughly addressing the reduction of

contact opportunities, it is possible to bring the situation under control, and we aim to reduce contact

opportunities by at least 70% and as much as 80% by promoting the following measures.

On the other hand, restrictions on people's freedoms and rights must be minimal in light of the provisions

of Article 5 of the Act. As a preventive measure, first of all, a request for cooperation should be made with

regard to self-restraint and the like based on Article 45, Paragraph 1 of the Act.

② Specified prefectures strongly request organizers to voluntarily refrain from holding events related to

the cluster and gatherings with "Three Cs" when there is a risk of a cluster occurring, based on Article 24,

Paragraph 9 of the Act and Article 45, Paragraph 2 of the Act.

In particular, the organizers are requested to take a cautious approach to large-scale nationwide events,

including cancellation or postponement of the event if risk management is not in place. In areas where

infection is on the rise and there are signs of overshooting, prompt action will be taken to request voluntary

refraining from going outdoors or holding events, with a specified duration of period. On the other hand, if

the infection begins to be contained, the request for voluntary restraint will be lifted from activities that

pose a low risk of infection spread.

③Based on Article 24, Paragraph 9 of the Act and Article 45, Paragraph 2 of the Act, the specified

prefectures request restrictions on the use of facilities that may lead to the spread of infection. In making

requests in these cases, the first step is to request cooperation in accordance with Article 24, paragraph 9 of

the Act, and if there is no justifiable reason for not responding, the second step is to make a request based

on Article 45, Paragraph 2, and then as the third step, make an instruction based on Article 45, Paragraph 3,

and publish these requests and instructions. The specified prefectures making these requests and

instructions shall consult with the Japanese Government to determine the effects.

④ When making a request based on Article 45, Paragraph 2 of the Act, designated prefectures shall

prepare necessary environment including their own staffing, so that the implementation status of the

request can be properly monitored.

⑤ All municipal authorities should ensure that people avoid the “Three Cs” and take appropriate measures

to reduce the number of clusters and reduce people’s contact opportunities based on the local coronavirus

infection situation and medical care provision system.

⑥ Municipal authorities, in cooperation with the Ministry of Health, Labour and Welfare and experts,

should conduct active epidemiological investigation, monitor the health of the individual person’s close

contacts and requests for the individual’s self-restraint on going out of their homes, and accurately

determine the scale number of coronavirus infection spread. For this reason, the health center system will

be strengthened.

⑦ Designated prefectures will take effective emergency measures according to the characteristics of their

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region. When taking emergency measures, specified prefectures shall take the minimum necessary in

accordance with Article 5 of the Act, and shall carefully explain and necessity of the measures to be taken

to the residents. In implementing emergency measures, specified prefectures shall share information

closely with the government task force under Article 20 of the Act. The Headquarters for Novel

Coronavirus Disease Control will coordinate with specified prefectures to make comprehensive

adjustments and, if necessary, seeking experts’ opinions.

⑧ Designated prefectures should inform residents, in cooperation with the Japanese government, that the

emergency measures taken in Japan are different from measures implemented in other countries such as

“lockdown” (city blockage) including prohibiting going out with penalties and blocking traffic between

cities. In addition, designated prefectures encourage the residents to take a calm approach to prevent

confusion, such as in buying up food, medicine, and other daily necessities.

⑨ Designated prefectures shall indicate the duration and applicable areas when making request to the

residents for the voluntary self-restraint in accordance with Article 45, Paragraph 1 of the Act. Based on

the opinions of the Advisory Committee on Basic Response Policy, Designated prefectures shall try to

control the spread by requesting people to self-restraint from going out for a certain period of time. It

should also indicate specific examples that are not subject to self-restraint, such as going to medical

institutions, shopping for food, medicine and other daily necessities, going to work when necessary,

exercising outdoors, taking a walk, and other things that are necessary for the maintenance of life.

⑩The specified prefectures shall encourage the residents to avoid the movement of people across

prefectures, such as unnecessary homecoming and travel, from the perspective of preventing the spread. In

particular, during the large holiday period, based on the provisions of Article 45, Paragraph 1 of the Act,

the specified prefectures request the residents to cooperate in refraining from unnecessary and urgent

movements across prefectures. In addition, if there is a risk that people will be concentrated in tourist

facilities in the area, we will ask the facility to take appropriate measures such as limiting the number of

visitors. As necessary, the government will make comprehensive adjustments regarding the voluntary

self-restraint of such unnecessary and urgent movements under the provisions of Article 20 of the Act.

⑪We strongly encourage people to refrain from going to red-light destricts and other down-town

establishments where it is already known large number of clusters have already occurred.

⑫Although going to work is excluded from requests for voluntary self-restraint, specified prefectures

should strongly promote remote working at first.

Even when commuting to work, we will promote initiatives to reduce social interaction with others, such

as staggered commuting and bicycle commuting, more vigorously than ever before. Designated public

institutions are formulating and implementing BCPs on measures to prevent spreading, and specified

prefectures are encouraged to further strengthen their efforts. In the workplace, employees are encouraged

to take measures to prevent infection (hand washing, cough etiquette, ventilation at workplaces,

self-restraint of employees with symptoms such as fever, videoconferencing to reduce employees traveling

on business trips), as well as encouraging them to take action to avoid “Three Cs.”

⑬Designated prefectures shall request business operators that perform services essential for ensuring the

stability of people’s life and economy to continue their services, based on the characteristics of the

business, while taking sufficient measures to prevent the spread of coronavirus infection. The business

shall take the necessary measures to avoid the “Three Cs.” Examples of business operators that perform

services essential for ensuring the stability of people’s life are provided in the appendix at the end.

⑭The government and specified prefectures shall endeavor to establish a consultation window for

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business operators, secure logistics system, and ensure the lifeline system in order to support the

businesses activities smoothly.

⑮Prefectures in metropolitan areas should take sufficient measures to prevent the spread, described above,

in order to avoid becoming the starting point of the nationwide and rapid spread. Even in other prefectures,

appropriate measures should be taken as they may spread nationwide and rapidly.

⑯The Japanese government and local government are urged to take necessary measures to prevent

infection so that the “Three Cs” will not be occurred, although restaurants are not subject to restrictions on

the use of their facilities.

For cafeterias, restaurants, coffee shops are urged to take the necessary measures to prevent infection and

avoid “Three Cs,” including careful attention to ventilation and proper spacing between people.

⑰The Japanese government will work with related organization to secure and train experts in cluster

measures.

⑱The Ministry of Health Labour and Welfare and prefectures governments, in cooperation with related

organizations, shall secure specialists and other personnel and dispatch them to the area, especially when

there are signs of spread of infection.

⑲The Japanese government and local governments will promptly work to strengthen the healthcare

system from the perspective of fundamentally strengthening measures to reduce clusters. In this regard,

prefecture government shall share information promptly with the municipalities within their jurisdiction

pursuant to Article 24 of the Act. Furthermore, prefectures shall endeavor to promptly share information

among them in order to contribute to the detection of clusters, and the government shall make

comprehensive coordination based on Article 20 of the Act when it is deemed necessary to implement

measures accurately and promptly. In addition, government will provide the necessary support so that the

prefectural governors can promptly reports to the Minister of Health, Labour and Welfare in accordance

with Article 12 of the Infectious Disease Act. In addition, the government, in cooperation with private

businesses, will establish a system to monitor the status of infection through SNS and other technologies.

⑳The Ministry of Education, Culture, Sports, Science and Technology (MEXT) will disseminate the

guiding principle regarding the implementation of temporary closure of schools, which were presented in

the revised “Guidelines for Implementation of Temporary closure of Absence in Response to New

Coronavirus Infections” on April 1st, and will provide additional information as necessary, in cooperation

with the Ministry of Health, Labour, and Welfare, based on the future spread of the infection and the views

of the experts committee. The prefectural government will instruct the school administrators on measures

against infectious diseases, such as health management, and promptly share information on the local

infection status and information on infected individuals from the school-related personnel.

㉑ The Ministry of Health, Labour and Welfare (MHLW) presents its policy on the reduction of childcare

and temporary closures of childcare centers and after-school children’s clubs. The policy it presents should

include how to reduce the provision of childcare and other services, such as asking parents who can to

refrain from sending their children to preschool. The policy should include measure sto secure childcare

for medical professionals and those who need to continue working in order to maintain the functioning of

society, and children of single parents who have difficulty taking time off from work in case of temporary

closing of preschool.

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㉒ The Government, in cooperation with relevant agencies, shall ensure that public transport and other

crowded facilities. to control infection.

㉓ Regarding border measures, the government will strengthen quarantine such as restricting immigration,

recommending suspension of travel, checking returnees and checking health, and restricting visas from the

perspective of preventing the influx of infected person into the country and the spread of the infection in

the country. The Ministry of Health, Labour and Welfare, in cooperation with relevant ministries and

agencies, will support the reduction of the workload of health centers and the strengthening of their

systems for health observation.

㉔ The Ministry of Land, Infrastructure, Transport and Tourism (MLIT) will, if necessary, make request

such as limiting the airports where aircraft arrives based on the situation of outbreaks of new coronavirus

infections in other countries.

㉕ If there is a shortage of facilities to be used for suspensions, the Ministry of Health, Labour and

Welfare (MHLW), if necessary, cooperates with relevant ministries and agencies while keeping in mind the

application of Article 29 of the Act. We will try to secure stop facilities by giving a careful explanation to

the managers of the facilities.

㉖Although there are some prefectures with a low number of infected people, there is a tendency for the

infection to spread nationwide. The prefectural governor shall judge the implementation as appropriate so

the local epidemic is suppressed, especially during the long holiday periods. Prefecture governors should

consider the impact of measures being considered and the fact that it is subject to an emergency declaration

for the purpose of minimizing the movement of people. The measures of ③⑫⑬ above are focused on

the prevention of spread of infection, while at the same time focusing on the situation of infection in the

region and economic and social conditions.

(4) Medical treatment, etc.

① The Ministry of Health, Labour and Welfare (MHLW), in cooperation with local public agencies and

related organizations, will secure a flexible medical care system for each region, depending on the situation

of infection spread, as following.

- Currently, outpatient medical care shall be provided to patients suspected of having coronavirus

infection with appropriate infection control through the Returnee and Contact Person Consultation

Center and the Returnee and Contact Person Outpatient Clinic.

- In addition, if a doctor’s decision is made to conduct a test and the patient is confirmed to be infected

with coronavirus, the patient would be recommended to be admitted to the designated medical

institution for infectious disease based on Article 10 of the Infectious Diseases Law and

implemented to prevent spread of the coronavirus and provide appropriate medical care to the

patient.

- In prefectural governments where there is a risk that the number of patients will increase and this

may hinder the provision of hospitalized medical care to critically ill, etc. in consultation with the

Ministry of Health, Labour and Welfare, the prefectures shall establish a system in which for

patients with mild illness who do not require inpatient treatment, shall be treated at home, and their

health condition shall be monitored remotely using telephones and other information and

communication devices, and medical treatment shall be provided using telephones and other

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information and communication devices when necessary by doctors.

- In the case of home treatment, if there is a risk of infection to the elderly or persons with underlying

health condition due to family structure, local governments should make arrangements to treat the

patient with mild illness at accommodated facilities or allowing family members living together with

the coronavirus patient to temporarily stay in a different place. Local governments shall make efforts

to secure temporary accommodation facilities, such as hotels, in advance, and the government shall

work closely with local governments to support the efforts of local governments.

- In areas where the number of patients is likely to increase and interfere with the provision of medical

care at outpatient treatment centers for returnees and contacted persons, the system of consultation

centers for returnees and contacted persons should be strengthened in response to the local infection

situation and demand for medical care, and the system for prompt outpatient treatment should be

developed by increasing the number of outpatient treatment centers for returnees and contacted

persons and securing dedicated personnel.

- In prefecture where there is a possibility that an increase in infection may exceed the limit of the

provision of medical care for outpatients and, governors should take necessary measures to let

general medical institution treat outpatient, in consultation with the Ministry of Health, Labour

and Welfare and take..

Under these circumstances, if the symptoms are mild, rest and recuperation at home should be considered,

because the risk of infection may be increased by consulting a medical institution easily due to anxiety

about infection. In principle, if the condition changes, consult with your physical doctor before visiting the

clinic.② The Ministry of Health, Labour and Welfare, in cooperation with local governments and related

organizations, will promote the securing of the medical care system, taking into consideration the

overshoot and the significant increase in the number of infected persons in the future and, if necessary,

taking into consideration the requests for medical care, etc. based on Article 31 of the Act. In addition to

dividing the role of local medical institutions as follows.

- For example, while sharing the roles of regional medical institutions, such as designating medical

institutions to specialize in receiving patients with coronavirus infection, consider the use of

tuberculosis beds and general beds of general medical institutions. Ensure that beds are available to

accommodate inpatients during peak periods.

- Securing a manufacturing system for pharmaceutical products, medical devices and medical materials

that support the medical provision system, ensuring a system that can promptly and smoothly, the

medical care system under appropriate infection control should be developed by promptly securing

necessary medical equipment and materials, such as specialized medical personnel and ventilators,

and materials necessary for infection control.

- Medical institutions should consider postponing scheduled but non-urgent surgeries and

hospitalizations that may be postponed at the physician's discretion, if necessary, based on the BCP.

- To consider dispatching medical professionals to work at general medical institutions such as local

clinics.

- For example, cancer centers, dialysis medical institutions, and obstetrical medical institutions, where

people are more likely to become severely ill, should not provide outpatient medical care to those

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suspected of having coronavirus infection.

- Provide necessary support for the establishment of temporary clinics and hospital wards using beds

currently out of operation, and establishing temporary medical facilities based on Article 48 of the Act

by specific prefectures.

- In order to prepare for the occurrence of medical care system crunches and overshooting, a system to

accept patients over a wide area, including those that cross prefectural areas, should be devised.

③ The Ministry of Health, Labour and Welfare, in cooperation with local governments, shall disseminate

the following items in order to thoroughly prevent infections in medical institutions and facilities for the

elderly.

- To prevent medical caregivers from becoming a source of infection, medical institutions and facilities

for the elderly should avoid places where the "Three Cs" occurs. Medical caregivers should wear

masks when interacting with patients and facility users even if there are no symptoms, wash hands

and disinfect hands and fingers thoroughly, disinfect computers, elevators, and other items shared by

multiple workers on a regular basis, keep a certain distance from other workers, when they are eating

and drinking in cafeterias and filling stations without masks, and keep track of their daily physical

condition and wait at home if they feel even slightly unwell. Medical institutions and facilities for the

elderly should suspend visits to medical institutions and facilities for the elderly, etc., except in

emergencies, in order to prevent infection from visitors.

- Visits to medical institutions and facilities for the elderly, should be temporarily suspended to prevent

infection by visitors, except in emergency cases.

- In addition, to prevent infection from patients and facility users, consideration should be given to such

measures as suspending or restricting the temporary use of day-care services at facilities, restricting

inpatients and users from going out and staying out in order to prevent infection from patients and

users.

- If COVID-19 infection is suspected for hospitalized patients or users at medical institutions and

facilities for the elderly, immediately isolate the patient in the private room and implement infection

measures under the guidance of public health centers and implement standard preventive measures,

contact preventive measures, and droplet infection prevention measures.

④ The government and prefectures should give priority to securing personal protective equipment (PPE),

such as masks, for medical institutions that accept patients suspected of having coronavirus infection for

PCR testing or hospitalization.

⑤ Prefectures should cooperate with the public awareness of "3 Cs" and pay particular attention to the

spread of infection in medical institutions and facilities through further thoroughness of infection

prevention measures, including separation of the space between infected and non-infected persons. In

addition, particularly for medical care, facility workers, and inpatients that are suspected to be infected,

take proactive measures such as PCR tests.

⑥ The Ministry of Health, Labour and Welfare (MHLW) will also address the following issues from the

perspective of providing appropriate medical care and controlling infection.

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- In cooperation with the relevant ministries and agencies, the Ministry should establish a database to

enable a centralized and prompt understanding of the usage status of infectious disease beds in the

preparation for the occurrence of overshoot.

- In order to prevent infections in outpatient settings, cooperate with relevant organizations to ensure

that outpatient clinics, recommend the patients the use of facilities such as using holiday(a off day:

non-business hours) and night-time emergency care centers with appropriate routes of movement and

treatment by appointment should be promoted to prevent congestion in outpatient settings at medical

institutions, including general patients.

- From the perspective of preventing infection among pregnant and nursing mothers, in addition to

thorough infection control measures such as separation of movement lines at medical institutions,

efforts should be made, in cooperation with relevant organizations, to encourage early consultation

with pregnant and nursing mothers suspected of being infected, and to provide an environment in

which pregnant women can easily rest in consideration of their work.

- In cooperation with relevant organizations, continue to strengthen the development of medical

interpreters, so that foreign nationals can receive medical care appropriately.

- Accelerate the development of effective therapeutic drugs and vaccines in cooperation with related

ministries, agencies and institutions. In particular, clinical studies, clinical trials should be promptly

conducted to verify the efficacy of drugs that are used in other treatments and are expected to be

effective.

- Regarding health examinations and vaccinations based on laws and regulations, consideration should

be given to the timing, so that appropriate infection control measures will be taken.

⑦ The Government shall provide the necessary support to local governments, regarding the above.

(5) Economic and employment measures (The policies decided on March 28 stand)

The Government will prevent the spread of the coronavirus infection and, while carefully assessing the

impact of the coronavirus infection on the domestic and international economy and the lives of the people,

will flexibly implement necessary and sufficient economic and fiscal policies without hesitation, and will

take drastic measures to put the Japanese economy back on a solid growth path. In particular, the system

will maintain the employment and livelihoods of people working in various forms, including freelancers

who have been affected as economic activity has contracted due to the spread of the coronavirus, as well as

small and medium-sized businesses and private businesses and establish a system to continue to engage in

business.

(6) Other important considerations

1) Considerations for human rights

① Government will take measures that is considerate of the human rights of the patients, those infected

and workers involved in the policies.

② Government will take measures regarding the reception of children and students, who have temporarily

returned to Japan from abroad. It will also work to prevent the incidence of bullying etc.

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③ Government and relevant organisations will ensure the freedom and rights of the people will be

minimally disturbed upon the policy implementation. They will ensure the impact on women and disabled

people to be fully considered.

④ Government will ensure correct information distribution to the people. This is to protect healthcare

workers involved in the actions against the Novel Coronavirus from misinformation and rumours.

⑤ Government and local governments will take actions to protect the mental health of people during

social isolation and prevent the domestic violence and abuse within homes. They will also provide suitable

support for the local town/village/city’s measures for supporting elderlies living alone and those with

disabilities who is in need of care.

2) Provision of Supplies

① Upon requests from people and local governments, government will request smooth production and

provision of masks, PPE, disinfectants and food to the relevant manufacturers. Furthermore, government

will secure sufficient supply of masks , PPE, ventilators etc under its responsibility for the purpose of

preventing infection spread. Government will request urgent transportation under article 54, and sales

under article 55 as required. For example, masks will be purchased by the government for the purpose of

distribution to necessary healthcare and care facilities as a priority, and in the areas where infection

prevention policies are required the most.

② Government will apply Act on Emergency Measures for Stabilization of National Life (article no.121,

1973), article 26, paragraph 1 to ban resale of masks and call to the consumers and businesses for calm

actions to refrain from extensive stocking of masks, in order to ensure enough supplies of masks and

disinfectants etc. Furthermore, government will act to distribute reusable cloth masks.

③ Government will, in case of the prolongation of the event, will make effort to ensure the supply of

masks and medical supplies and medications. This includes antibiotics and medical devices required for

healthcare. It will consider domestic production of those supplies.

3) Advancing cooperation with relevant organisations

① Government will strengthen the co-directional communication with relevant organisations, including

local governments, to ensure timely delivery of strategic decisions and understand the situation on site.

② Government will hear opinions from the stakeholders including local public authorities regarding the

policy promotion,.

③ Municipal authorities will ensure that not only health service bureau and crisis management beureau,

but all division cooperate to implement its policies.

④ Government will closely work with the international communities to collect information on the

measures from WHO and other countries and regions. Also, it will actively share expertise obtained in

Japan with relevant organisations such as WHO and other counties and regions. This is to apply the

expertise for the future strategies and contribute as a country impacted by the novel Coronavirus.

⑤ Government will act to promote policies for novel Coronavirus through supporting researches

including basic medical sciences, clinical researches and social medical sciences including epidemiological

studies.

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⑥ Specified prefectures will provide necessary support for neighbouring prefectures, when requested, to

take actions prompted by the declaration of the state of emergency.

⑦ Designated prefectures, in the event of state of emergency, will discuss with Novel Coronavirus

Response Headquarters and swiftly share information. Head of the Headquarters will make adjustment

with prefectures based on specialist advices, so that they could swiftly act to implement state of emergency

measures.

⑧ When the state of emergency measures are activated, governors of designated prefectures and head of

designated public organizations shall report the measures and its justification to the Head of the Novel

Coronavirus Response Headquarters. Heads of municipalities and designated local public organizations

shall report to the governors of their prefectures. Heads of designated public organizations will report to

the supervisory public authorities on their actions and justifications. Head of Novel Coronavirus Response

Headquarters will report to the parliament. Governors of the designated prefectures and designated public

organizations shall report to the head of the Novel Coronavirus Response Headquarters regarding the

reported measures and its justifications.

4) Maintaining social function

① The national and local governments , national and local designated public organizations will act to

prevent infections among their staff. They shall make strategies in advance so that works can be carried on

without a delay in the unfortunate event of infection or suspected infection among their staff. confirmation

of being close contacts with infectedTeleworks and online meetings shall especially be promoted.

② Municipalities, designated national and local public organizations, shall minimise the impact on the

people's lives and economy by sustaining the electricity, gas, water, public transport, communication and

finance businesses.

③ Government will offer necessary support for designated public organizations for them to continue their

operation.

④ Businesses that undertake works necessary to maintain the safety of the people’s lives and economy are

requested to endeavour to continue the works, in order to keep stability in the people’s lives and economy.

⑤ Government will make efforts to understand the level of service provided by businesses and to obtain

understanding of the people if required.

⑥ Government will, in order to prevent troubles at airports, ports and healthcare facilities, carry out

security and policing activities.

⑦ Police will prevent the various crimes that exploit the situation, and strengthen its alertness.

5) Actions after declaration of the state of emergency

Government will distribute information as appropriate to the public and stakeholders following the

declaration and especially in the period until May 6. The information should be based on regular analysis

and evaluation of the state of infection and strategy implementation from the regular communication with

designated prefectures and basic policies advisory committee.

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Following a withdrawal of the state of emergency, it will continue to be alert and analyse situation of the

pandemic in the country. It will strive to implement even more effective measures based on the knowledge

obtained.

6) Other issues

① Government will implemented measures based on acts other than National Emergency Act, as required.

② The decisions on whether the condition of state of emergency are met will be made after a

comprehensive assessment. The assessment is based on the situation abroad, state of of healthcare

provision in Japan, with the number of positive cases with unknown contact source and frequency of

clusters. The head of Novel Coronavirus Response Headquarters will consult the the basic policies

advisory committee to determine the possibility of significant impact on people's lives and economy.

③ Government will, in case either of changes of basic strategies, continuation, or cessation of state of

emergency, act flexibly with careful consideration of new scientific opinion, situation of the pandemic,

actual measure implementation, and opinions of basic policies advisory committee.

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(Appendix)

Businesses that are requested to continue their activity during the state of emergency.

With due respect and efforts to avoid the "3Cs", continuation is requested for the following businesses.

1. Maintaining Medical System

・We request the continuation of all business by medical professionalsnot only for treatment of COVID-19

infections, but also for other severe diseases.

・Medical professionals include hospitals, pharmacies, and other manufacturing and service industries

related to all the supplies and services necessary for treatment of patients including importing,

manufacturing and sales of pharmaceuticals and medical equipment, blood collection for blood donations,

and providing meals to inpatients.

2. Continuing to protect those in need

・We request the continuation of all life support businesses for people who need assistance, especially the

elderly and the people with disabilities, including housing and support for them .

・Life support businesses include all manufacturing and service industries related to the goods and services

necessary for the lives of the elderly and the people with disability, such as management of facilities for

nursing care and for people with disability, as well as providing meals to residents of the facilities.

3. Securing stable lives of the public

・We request the continuation of all concerned businesses which provide essential services for those who

stay at home to lead necessary minimum lives.

(1) Infrastructure (electricity, gas, oil, petrochemical, LP gas, water and sewage, telecommunications and

data centers, etc.)

(2) Food and beverage supply (agriculture, forestry, fishery, importing, manufacturing, processing,

distribution, and online shopping of food and beverage, etc.)

(3) Supply of daily necessities (importing, manufacturing, processing, distribution and online shopping of

household goods, etc.)

(4) Canteens, restaurants, coffee shops, home delivery and take-out, retailers of daily necessities

(department stores, supermarkets, convenience stores, drugstores, hardware stores etc.)

(5) Maintenance of household(plumber, electrician, etc.)

(6) Services related to daily necessities (hotel and accommodation, public bath, barber shop and

hairdressers’ salons, laundry, veterinary, etc.)

(7) Waste disposal services (collection, transportation, and disposal of waste, etc.)

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(8) Ceremonial affairs (operators engaged in cremation and post-mortem treatment of bodies)

(9) Media (TV, radio, newspapers, internet related business, etc.)

(10) Services for individuals (webcast, remote education, facilities and services related to maintenance of

the internet environment, maintenance services of private vehicles, etc.)

4. Maintaining the stability of the society

・With a view to maintaining the stability of the society, we request the continuation of the businesses, at

their minimum level, who provide essential services to maintain corporate activities during the period of a

state of emergency.

(1) Financial services (banks, credit banks and credit unions, securities, insurance, credit cards, and other

settlement services etc.)

(2) Logistics and transportation services (railways, buses, taxis, trucks, maritime transportation and port

management, aviation and airport management, postal services, etc.)

(3) Maintenance of manufacturing and service industries necessary for national defense (aircraft,

submarines, etc.)

(4) Services necessary to maintain corporate activities and security (maintenance and security of building,

etc.)

(5) Social infrastructure necessary for safety and security (management of public goods such as of rivers

and roads, public works, waste disposal, hazardous goods management based on respective law, etc.)

(6) Administrative services (police, fire fighting, other administrative services)

(7) Childcare services (daycare centers, etc.)

5. Others

Among medical and manufacturing industries, we request the continuation of the following business

operators in consideration of infection prevention: businesses whose production lines are difficult to

suspend due to the characteristics of the equipment (such as blast furnaces and semiconductor factories);

and operators who produce essentials (including important items in supply chains) for protection of the

people who need medical care and support, as well as for maintenance of social infrastructure. We also

request the continuation of the business operators who sustain medical care, the lives of the people, and

maintenance of the national economy.