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Message from the Mayor about measures to prepare for the 6th wave of COVID-19(2021.11.26 Mayor’s Press Conference)

Last updated date:2021/11/26

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I will now talk about COVID-19 prevention measures in preparation for the sixth wave. Today I will cover vaccination boosters, the preparation of a genomic sequencing system, and strengthening the medical system.

First I will talk about booster shots. This graph shows the projected number of people to receive booster shots in January of next year, as well as the numbers expected for March and April. The graph is based on the number of people for whom eight months will have passed since their second shot and will serve as our general target. Going forward, we would like to move the schedule forward, especially for nursing care facilities, but the current timeline for the moment is based simply on eight months passing since the last shot.

As for the vaccination system, we have prepared a variety of options, as Yokohama has a very large number of people eligible for vaccination. Throughout the city, Pfizer was provided at 1600 medical facilities and 33 mass vaccination centers, while Moderna was provided at the Hammerhead large-scale vaccination center as well as through other opportunities such as workplace vaccinations and Self Defense Force large-scale vaccinations.

We plan to strengthen the individual vaccination system for booster shots by increasing the number of medical facilities from 1600 to 1900. This is out of consideration for the future after the third shots are administered. Although a third booster shot will provide strengthened immunity, it is likely that this immunity will not last forever. Although we still do not know how frequently boosters will be required, it is likely that we may need a booster each year.

If this ends up being the case, we believe that it is better to treat vaccinations like influenza shots, and provide a vaccination system that utilizes clinics and medical facilities by strengthening individual vaccinations. Although group vaccinations, including those conducted at mass and large-scale vaccination centers, are listed, even if we increase the number of shots administered per week or day, group vaccinations are not especially efficient. This is why we will focus on increasing individual vaccinations at medical facilities.

The details regarding workplace vaccinations should be determined going forward, and the national government has not announced whether they will open the Self Defense Force vaccination centers again.
Based on this vaccination system, we will start accepting reservations. Like last time, reservations will generally be required. Reservations at both medical facilities and centers can be made online using the reservation website or by calling the reservation center. Based on our experience with reservations for first and second shots, we know that it is crucial to improve the system and make it easier for everyone to find a slot and make a reservation.

Regarding vaccination slots, in May through August of this year, it was difficult for people to find open slots through the reservation system. The City will coordinate with each vaccination venue to confirm openings, and provide this information online in a manner that is comprehensive and easy to view.

Although it would be nice to rebuild the system from scratch, the same system is being used by several local governments, so this feature will instead be added to the existing system. Since there are certain parts of the system that cannot be changed, we will make sure that this new feature is as easy to use as possible, and coordinate openings while sharing the information online.

Furthermore, we will increase the number of reservations available on the reservation site. For people who do not have access to the internet, phone reservations will still be available, and we will also increase the number of support staff at each ward office to make reservations on your behalf. Currently, there are two staff members in each ward, or 36 total, but we plan to increase the total to 90, or five for each ward. Through this initiative, we hope that we can encourage people to have online reservations made on their behalf.

In this way, we will increase the number of reservation slots, provide support to get an online reservation, and make it easier to see where reservations are available in the first place in order to make the reservation site and system easier to use for everyone.

Next, please allow me to share my own opinion on the booster shots. Currently, there is some debate about the time period to wait between shots. First, the most important thing is to maintain regular medical care while treating COVID-19 patients. Decreasing the number of patients with severe symptoms from COVID-19 is one way to maintain regular medical care. Patients with severe symptoms require more time in hospitals, and as the number of severe symptom patients increases, there is a risk that it will interfere with treating patients with other conditions such as cancer or heart disease. In order to prevent an increase in patients with severe symptoms, it is important to prevent the disease from spreading to high-risk people. The first high-risk group that comes to mind is older adults.

There is a variety of data that shows that older adults have a higher risk of developing severe symptoms from COVID-19. There are now many older adults for whom six months have passed since their last shot, and recent data shows that there is a trend where the older a person is, the more likely it is for their immunity to decrease six months after their second shot.

For example, research such as a recent article released by Levin et al., as well as a study of 100 people which I was previously involved in at Yokohama City University, allows us to see the extent to which immunity is changing after six months. Looking at this data, you can see that the older a person is, the larger decline in their antibody levels.

In other words, the older a person is, the easier it is for their immunity to decline after vaccination, and therefore the risk of infection increases. Naturally, there is some variability in immunity levels, so it is difficult to make an overarching statement, but looking at averages, you can see a trend of immunity decreasing and infection becoming more likely after six months from a variety of sources.

Nursing care facilities face an especially high risk of multiple people getting infected. At this time, over 100 clusters have been confirmed at nursing care facilities in Yokohama. We are concerned about the possibility of several clusters occurring, allowing the virus to spread to older adults, some of whom will develop severe symptoms and therefore increase the number of patients with severe symptoms.

It is medically approved for people to receive their third booster shot as soon as six months after their second shot. On the other hand, the national government has taken the stance that the time period between the second and third shots may be reduced to six months in exceptional circumstances. It is possible that the definition of these “exceptional circumstances” will be confirmed in the coming days, but we believe that the government will recognize nursing care facilities as part of this exception and allow local governments to shorten the period to six months at their own discretion.

Next I will talk about the preparation of a genomic sequencing system. Although the number of cases is low at the moment, we must remain cautious going forward, as there is a possibility that a new strong variant will emerge and spread throughout the population. We must remain cautious of new variants, and it is crucial to prepare a system that can detect new variants at an early stage. On this front, the national government requested that local governments strengthen their genomic sequencing systems, and Yokohama has prepared its own system.

Planning for the system originally started around the beginning of October, as we believed that this type of monitoring is necessary. We prepared a system to collect samples from patients, analyze the entire genome from the sample, and look for indications of variants in early October out of the belief that each local government should conduct this analysis independently. On October 25th, the national government issued a request for local governments to take the lead on strengthening their own genomic sequencing systems, and I saw that our actions were in accordance with the request. For the system, we plan to collaborate with Yokohama City University and the University of Tokyo Research Center for Advanced Science and Technology to conduct analysis. By collecting samples, sequencing the genomes, analyzing them to see if there are any signs of new variants, collecting data, and sharing it with the national and other local governments, we believe that we will be able to develop a better surveillance system.

Finally, I will explain our plans to continue strengthening the medical system. As I announced In September, we will open a COVID-19 hospital and secure more hospital beds. The hospital will finally open and start accepting patients on December 1st. The name of the facility is Yokohama Hajime Hospital. The former Oguchi Hospital, now known as Yokohama Hajime Hospital was opened specifically for COVID-19. There are currently 85 approved beds. Of those, we are planning to use 60 beds specifically for COVID-19 patients. If the number of cases increases in the future, we may consider using the remaining 25 beds, but for the moment we have secured 60.

Preparations began in mid-September. When I was appointed as mayor, the vaccination rollout was already moving along smoothly, and I saw that it was important to strengthen the system for treating patients with symptoms classified as mild or moderate I, so around that time I started discussions with the relevant departments to increase the number of beds specifically for COVID-19 patients. In those discussions, Yokohama Hajime Hospital arose as a candidate, and we began considerations. At the time, the hospital was closed, but after discussions with the medical corporation that operates the hospital and two months of preparations, we are finally ready to start accepting patients on December 1st.

The mission of this COVID-19 hospital is to conduct specialized treatment for high-risk patients with light or moderate I symptoms from an early stage, preventing them from developing severe symptoms. Treatments include Remdesivir, steroid treatments, antibody cocktails, and potentially oral medications if they are approved in the future. By providing treatment at an earlier stage, patients may stay in the hospital for shorter periods of time—for example, one night and two days for a patient with moderate I symptoms—meaning that the turnover time for hospital beds would be very quick. I believe that providing 60 of these hospital beds will make a big difference for COVID-19 patients.

The City of Yokohama, Designated Medical Corporate Foundation Jikeikai, and Yokohama City University have entered an agreement regarding the operation of the hospital. We are planning to receive certification as an important medical institution under the Kanagawa Model. Additionally, Yokohama City University will have a system to constantly dispatch doctors and nurses, while Yokohama’s Y-CERT will manage admissions. The hospital was not originally intended for infectious diseases, so we have prepared for the opening by consulting with infectious disease specialists for guidance on equipment and management, including zoning and what kind of devices to supply.

To finish up today’s presentation, this slide shows the current number of hospital beds. As of September 1st, 2021, there were 685 hospital beds for COVID-19 patients. Currently, including the Yokohama Hajime Hospital, in the three months since September we have managed to arrange agreements to secure beds specifically for COVID-19 if case numbers increase through discussion with several hospitals, bringing the total up to 826 beds. Currently, in anticipation of a sixth wave, the national government is calling for the number of hospital beds to be increased by 20%, and Yokohama has already reached that target.

However, in preparation for the future, since we do not know the extent to which cases may increase, we will continue to aim for a 25 or 30% increase. In order to achieve these targets, we will continue our endeavors to secure more hospital beds with the cooperation of local hospitals.

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