Mar 18 2020
*This page is based on the message issued on March 9, 2020 in Japanese and has been modified in accordance with the up-to-date situation.
The novel coronavirus infectious disease (COVID-19) emerged in China in 2019, and the infection is spreading to many countries including Japan. I ask the students, faculty and staff of Niigata University to cooperate to the current measures with prudence and accurate information for your own safety and the future of Japan.
The feature of the virus infection is as stated in the opinion issued by the Expert Meeting on the Coronavirus Disease Control established by the Ministry of Health, Labour and Welfare ("Expert Meeting") on March 2, 2020:
In that regard, please understand that the Expert Meeting is encouraging younger generations around Japan to avoid crowded space with poor ventilation. This is important to minimize your own risk of infection, and also to prevent yourself from becoming a spreader and infecting others. Moving out from the area of residence at this time can increase the risk of infection and spread the disease nationwide.
There are two points to consider about the risk of infection by COVID-19:
Considering the above, I would like you to implement the following:
Current containment measures are likely to continue through the month of March, and we are expecting that the effect of these measures that started in late February may become apparent from the middle of March. On the other hand, the government may declare a state of emergency if the virus continues to spread. Further control may be implemented in such a case. The worst-case scenario is for COVID-19 to become a severe pandemic. Either way, we will continue to implement the current measures during March unless there is a significant change in circumstances. We intend to present our policy for April onwards by the end of March.
I assume that many of you, particularly the students, are wondering how they should spend their days under various restraints. Remember that opportunities will present itself at time of crisis, and take this time as a rare opportunity to reassess things that were considered to be normal, in society and in your life. I hope you can spend your time productively.
You can access various news on the internet, and it includes many fake news. Some of the media argument seems biased. I would like the students, staffs and faculty of Niigata University to consider the facts yourself, and act calmly. You should not be unnecessarily anxious, and do not instigate panic or have bias against others.
Supplement: I would like to share the necessary knowledge on the novel coronavirus (COVID-19), and accurate information on the measures currently being implemented with the students, staffs and faculty members. With advice from the faculty of Medical and Dental Sciences, I have put together basic information, infection control measures, current national policy, and the significance of the response by Niigata University, noting that readers will vary from liberal arts to science majors. I would suggest each one of you read the parts where you feel necessary.
Viruses are small particles consisting of a nucleic acid molecule (DNA or RNA) encased in protein and sometimes with a fatty envelope. Its size is about 100nm (1/10,000 of 1mm), which is too small to see with a light microscope. Viruses cannot reproduce on their own, but can replicate by infecting (parasitizing) host cells, using host cell enzymes and cellular mechanism to replicate. Viral diseases are induced from damage of the cells in our body by the virus infections.
There are many types of viruses, with different names. Influenza infection is caused by the influenza virus, norovirus infection is caused by the norovirus, coronavirus infection is caused by the coronavirus. Different viruses have different places in our body (host cell) that they tend to infect and reproduce in. For example, norovirus tend to infect stomach and intestinal cells, causing acute gastroenteritis. Coronavirus tends to infect and reproduce in the throat, respiratory tract and lung cells, causing coughs, sore throat and pneumonia.
COVID-19 is a viral infection first recognized in Wuhan, Hubei Province, People's Republic of China in December 2019, and spread mainly in China and now to other countries around the world.
In Japan, the first case of COVID-19 was detected on January 15, 2020 from a patient with pneumonia who had traveled to Wuhan. In general, viral infection is specific to certain animal, and those infecting humans and other animals tend to differ. Coronavirus is the same, and there were six known strains of coronavirus infecting humans, based on the genetic sequence. Of these, four comprise 10-15% of the cause of common cold, with only mild symptoms such as coughing and sore throat. The remaining two are the severe acute respiratory syndrome (SARS) which occurred in 2002, and Middle East respiratory syndrome (MERS) which occurred from 2012 mainly in the Middle East. COVID-19 is a new type of coronavirus that has a different genetic sequence from these six strains of viruses.
Generally, viruses that infect animals do not infect humans. However, in rare cases, viruses are transmitted from animals to humans (zoonosis). In such a case, the virus is normally not transmitted from an infected person to another person. However, a change in the viral genetic sequence may create a new variant virus that can be transmitted from human to humans. The origin of COVID-19 is yet to be known, however, it has been pointed out that the genetic sequence is similar to the bat coronavirus among the animal origin coronaviruses.
COVID-19 is a respiratory infection similar to the general coronavirus (so-called viral cold). Therefore, droplet infection and contact infection are possible.
Airborne infection is not considered to have occurred (infection caused by small aerosol particles). However, COVID-19 is known to cause infection of multiple persons if there is an infected person among a large number of people in a poorly ventilated small indoor space, where the group continue to speak in a close distance, even without coughing or sneezing ("cluster infection," see below). This is why indoor circle activities, concerts and exercising in a gymnasium has become an issue.
Many people infected with COVID-19 has an asymptomatic period of 3 to 14 days before showing signs of infections such as fever and respiratory symptoms (sore throat and coughing). Many patients experience fever of 37-38 °C for about a week, accompanied with general fatigue. It seems that symptoms are milder than influenza but continue longer.
The symptoms differ by age, but overall, about 80% of patients have mild symptoms and recover in about a week. If this is the case, no special treatment is required, and resting at home should be sufficient. Resting at home while being careful not to infect family members and people close is effective in avoiding transmission to other people.
On the other hand, if your fever continues for longer than 4 days to a week, breathing becomes difficult, or the coughs get worse, pneumonia is suspected and the Consultation Center for Corona Virus or other facilities should be contacted. In Niigata City, the Niigata City Healthcare Center should be contacted by telephone (025-212-8194). They will refer you to a hospital.
Another feature of COVID-19 is that senior citizens and people with pre-existing diseases tend to suffer severe symptoms. In contrast to the mortality rate for individuals aged 10 to 49 being only about 0.2%, it increases sharply to 1.3%, 3.6%, 8.0%, and 14.8%, for those in their 50s, 60s, 70s, and 80s, respectively.
Following information has also been revealed from recent research:
There are no specific remedy or therapeutic agents for COVID-19 at present. So, it is important to prevent infection by following the general preventive measures. COVID-19 is transmitted by droplet transmission and contact transmission like the regular coronavirus, so the following points must be noted:
Hand washing: Thorough hand washing is essential, to avoid infection of mucous membrane of eyes and mouth from fingers contaminated with the virus. Virus attached to the handrails for stairwell, escalators, straps and doorknobs are said to possibly remain alive for at least several hours. In this regard, thorough hand washing after returning home is an effective preventative measure.
Wearing masks: Wearing masks when you have coughs is effective to prevent contamination of others with droplets in case you are a carrier. If you cough or sneeze without a mask, do not cover your mouth with your hands. Instead, it is important to cough into your elbow (coughing etiquette). On the other hand, for healthy individuals to wear a mask may be meaningful in avoiding droplets, but you should note that inhaling of droplets cannot be completely avoided with regular masks.
In addition to these basic preventative measures, you should be very careful about avoiding droplets when having conversations or meals in close distance in an indoor space.
Analysis of COVID-19 cases in Japan has identified cluster infection phenomenon. Cluster refers to a small group infection. It refers to a sharp increase in infection when a carrier is present in a poorly ventilated crowded space. On this topic, the opinion by the Expert Meeting issued on March 2nd is very important.
Following is a summary:
For this reason, the Expert Meeting is encouraging younger generations around Japan to avoid crowded space with poor ventilation.
There are two points to consider about COVID-19:
Outbreak or endemic: Group infection in a community or certain small geographic area. Spread of seasonal influenza falls into this category.
Epidemic: Sudden increase in infections exceeding the expected level in a specific region or group is called an epidemic, and it may spread beyond region or country. In the past, the severe acute respiratory syndrome (SARS) infection fell into this category.
Pandemic (international and out of control): Simultaneous occurrence and spread of infections in multiple countries or continent. The largest pandemic was the Spanish flu between 1918 and 1919, and WHO declared a pandemic for H1NI Influenza in 2009. A pandemic will cause disruption to global economy, and will be beyond the limit of medical treatment.
Based on expert opinion, current COVID-19 is deemed to be reaching the critical point where it is becoming a pandemic from an epidemic. This is why the actions taken in countries where the infection is increasing, i.e., South Korea, Italy, Iran, Japan, and now European countries are gathering attention.
The Japanese government announced the Basic Policy concerning the Novel Coronavirus Infection on February 25, 2020. Many people may be wondering about the timing.
In general, government action against new infections occurring abroad can be categorized into three phases: (1) prevention of entry into Japan; (2) prevention of spread of infection in Japan if entry could not be prevented; and (3) prevention of severe cases in case the infection spreads further.
COVID-19 infection started in China, and the first measure taken was to prevent its entry into Japan. Whether the measure was successful will be left to analysis in the future. Isolation of Diamond Princess was a measure taken at this stage. However, despite measures to prevent entry, patients with unknown infection route started to appear sporadically in multiple areas of Japan from the end of January, and the number of patients in Japan excluding those aboard Diamond Princess exceeded one hundred on February 21st. At this point, the measures entered the second stage of preventing spread of infections, and to resolve the situation quickly.
However, COVID-19 is an unknown viral infection, and a remedy is yet to be developed. What must be done now is to control the increase in the number of cases and the speed of the spread to the extent possible. The timing is important for containing the epidemic to the extent possible and creating time to prepare medical framework that can respond to carriers and severely affected patients.
Rigorous measures to prevent individual infection and strategies to prevent cluster infection have been introduced from these perspectives. COVID-19 is an infection that has never been experienced, so an effective measure is hard to determine, and expert opinions are divided. It will take some time to gather medical evidence, so we may have to rely on past experience. There is a record related to the Spanish influenza pandemic (1918-1919) that mortality was lower in some regions of the US where school closure and cancellation of meetings and events were enforced compared to regions that did not take such measures. The current closure of schools and cancellation of gathering events are not expected to work unless they are implemented across board. Moving out from the area of residence can increase the risk of your infection, and spread of the disease nationwide. Therefore, it is very important for you not to travel. This is not a matter of avoiding infection for yourself. It is a matter for the whole nation, and it begs the prudence of the citizens.
Some of you might think that such response is overreacting for Niigata City where the number of infections is very limited. However, among the countries that the WHO is expressing concerns over the spread of infection, i.e., Korea, Italy, Iran, Japan and now in European countries, Japan is the only country where the spread is slow at the moment. This is believed to be due to the attention paid by the Japanese public on COVID-19, with encouragement on wearing masks, washing hands, and cancellation of events. From this perspective, I am hopeful that further spread of infection could be prevented by implementing through measures at this stage. We are at a very critical point, so I appreciate your understanding about the cancellation of the graduation ceremony and voluntary ban on meetings.
Current enclosure measures are likely to continue through the month of March. We expect that the effect of these measures may become apparent from the middle of March. On the other hand, the government may declare a state of emergency if the virus continues to spread. Further control may be implemented in such a case. The worst case scenario is for COVID-19 to become a severe pandemic. Either way, we will continue to implement the current measures during March unless there is significant change in circumstances. We intend to present our policy for April onwards by the end of March.
I assume that many of the students are wondering how they should spend their days with the ban on circle activities and meetings, as well as restrictions on indoor parties, and request to prevent movement out from the area of residence and traveling. Remember that opportunities will present itself at time of crisis, and take this time as a rare opportunity to reassess things that were considered to be normal, in society and in your life. I hope you can spend your time productively. It may feel limiting, but your freedom has not been taken away. You should try to look at it as making a small change to behavior to protect your freedom. Gathering in groups is not the purpose of life; this may be a good opportunity to ponder on the preciousness of normal life.
You may have had topics that you wanted to learn and think deeply at the university. Perhaps you can spend your time reading. Large group gathering is banned, but it could be a wonderful opportunity for you to spend relaxed time with family, following the basic rules of infection prevention. You could also try new things, like cooking or painting. If you take a casual stroll in a quiet park near home, you may feel the sign of spring, or discover something new.
When you start working after graduation, a peaceful break like this will be hard to come by. I would like you to maximize your intellectual curiosity, and create an enriching experience even in a limited physical space.
*Please also refer to the following websites:
USHIKI Tatsuo, MD, PhD
President
