Public Relations Magazine for NCGM

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National Center for
Global Health and Medicine

Special
Issue
No. 3

February 2023
Special Issue
No.3

Office of Public Relations

NCGM Fights against COVID-19– Lessons Learned (3rd Edition) –Minister of Health, Labour and Welfare Katsunobu Kato visited the specified
infectious disease ward (August 2022).

In front of the Emergency Department (around 8:30 a.m. in early August 2022)

NCGM staff checking flow lines and infection control measures within the
TOKYO2020 PCR test area (August 2021).

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Special Issue February 2023

Foreword

The NCGM COVID-19 Task Force and Organization
Chairman (Hospital Director)

Norihiro Kokudo, President
National Center for Global Health and Medicine

Vice Chairmen- Deputy Hospital Director- Director, Disease Control andPrevention Center- Director, Department of Emergency
Medicine & Critical Care
- Nursing Director- Secretary General, General
Administrative Department

Members of the Task Force- Hospital Management and Planning
Board- Heads of departments- Manager, Clinical Laboratory
Department- Persons/individuals appointed by the
ChairmanCommittee for the Severe and Seriously Ill

Committee for the Moderately Ill◎ Director, Department ofEmergency Medicine &Critical Care
○ Head, Intensive Care
Department○ Head, Department ofEmergency Medicine &Critical Care

◎ Deputy Hospital Director(in charge of patient
examination/care)○ Administering physicianof the 5F West ward
○ Chief Physician, Divisionof Preparedness andEmerging Infections

Infection Control Team
◎ Director, Disease Control andPrevention Center○ Deputy Manager, the Infection
Control Team

Committee for the Fever Clinic

Committee for the Surgical Division◎ Director, Disease Control
and Prevention Center○ Chief Physician,
Department of Infectious
Diseases◎ Deputy Hospital Director(in charge of surgeries)○ Director, Operation
Management Department

Feel the NCGM Special Issue February 2023
Table of Contents/The NCGM COVID-19 Task Force and Organization 
Foreword 
1. Overview of NCGM History in Response to Various Health Issues and Our Multifaceted Role 
2. Treatment and Nursing of COVID-19 Patients and Suspected Patients 
3. How We Fought against COVID-19 Pandemic at Our Emergency Department 
4. Health Checkups and Tests Conducted on Returnees on Chartered Flights from Wuhan5. Cruise Ships: Diamond Princess and Costa Atlantica 
6. Development Research of COVID-19 Therapies Led by NCGM 
7. From COVID-19 Registry JAPAN (COVIREGI-JP) to REBIND 
8. Releasing of Academic Achievements 
9. Policy Recommendations 
10. Responses to COVID-19 Outbreak in Hospitals/Facilities 
11. The Fever Clinic and the Community-Based “Shinjuku Model” System 
12. International Cooperation and Joint International Research 
13. Experience in Providing Medical Support to Temporary Medical Facilities 
14. Measures for the Tokyo 2020 Olympic and Paralympic Games 
15. In Closing: Preparing for the Post-COVID-19 Era 

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The National Center for Global Health and Medicine (NCGM) is a national center primarily committed to infection
control. Our staff members have strived, as a team, to tackle the novel coronavirus disease 2019 (COVID-19) since thebeginning of the pandemic. In late January 2020, we carried out physical examinations and PCR testing of Wuhan
returnees. In the succeeding month of February, some staff members boarded the cruise ship anchored in Yokohama
to cooperate in addressing the COVID-19 cluster among its passengers. Affected passengers included a few severecases, and we started providing them intensive care while struggling to find effective ways to control this unknown
virus. We also started the compassionate use of an antiviral agent remdesivir, and engaged in joint research with the U.S.
National Institutes of Health (NIH) to establish the evidence for the efficacy of remdesivir. Additionally, we promptly
published the examination data from 11 initial cases, their treatment methods, and clinical courses on our website andin paper, which were actively utilized by the institutions nationwide that were then treating COVID-19 patients.
Reflecting back on the NCGM’s long history of over 150 years, we have responded to numerous pandemics in thepast, starting with the Spanish flu in 1919, SARS in 2003, swine flu in 2009, Dengue fever in 2014, and the Ebola
hemorrhagic fever outbreaks in 2014, 2018, and 2019. We have always been fully trained and prepared for suchcrises as one of the four medical institutions in Japan designated for treatment of specific infectious diseases, having
a total of four beds available for this treatment (the highest number of beds out of all four institutions). I am reallyproud of our staff members who have swiftly responded to the current pandemic and have then been battling against
COVID-19 with a firm sense of mission.
Subsequently, we have extended our activities in the treatment/research and international medical cooperation in
responding to COVID-19 including the development of new therapeutic drugs, convalescent plasma therapy, advanced
medical care for critically ill patients, the establishment of COVID-19 Registry Japan (COVIREGI-JP), REpository of Data
and Biospecimen of INfectious Disease (RIBIND), fever clinic, and the Shinjuku City COVID-19 Testing Center, support
for the mildly ill patients accommodated in hotels, vaccination for government VIPs, operation of the clinic for close
contacts at the athlete's village of the Tokyo 2020 Olympic and Paralympic Games, and support for infection control in
the Philippines and Papua New Guinea.
Since the beginning of the pandemic, we felt a need for organizational research and development to contain the
spread of this unknown disease, and we launched the Novel Coronavirus Infection Academic Advisory Board inearly February 2020. This Board covered a wide range of fields related to COVID-19, including its treatment, testing,pathophysiology, and epidemiology, and aided in the development of research protocols, coordinated with the IRB,
and managed and advised through the course of trials. More than 135 projects have been undertaken, and 321
papers have already been published in academic journals. This booklet is a record of the NCGM activities mentioned
above to address the COVID-19 pandemic. Currently, we are taking a step forward into the post-pandemic world
where we balance infection control and social activities. We at NCGM will continue to strive as a team to confront
this challenging infectious disease. Through this booklet, I would like to express my respect and gratitude to all of thehealthcare providers and the NCGM staff who are fighting against COVID-19.
In the Cabinet meeting of June 2022, the policy decision was made on the integration of NCGM and the National
Institute of Infectious Diseases (NIID) after FY2025. While the details of this integration are not yet determined at thismoment, NCGM will continue to fulfill our mission as a research and development agency based on national strategies,
succeeding our history and tradition of activities from Meiji, Taisho, Showa, Heisei eras to Raiwa era, and responding
accurately to the demands of the times.
February 2023

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Special Issue February 2023

Overview of NCGM History in Response to Various Health Issues and Our Multifaceted Role

1

Teiji Takei, Director-General, Bureau of Strategic Planning, NCGM

Health issues that NCGM confronted in the past

Spanish flu

The Daigo Fukuryu Maru
Incident

Health checkups and tests for returnees from Wuhan
Cruise ships
Measures for the Tokyo 2020 Olympic and Paralympic Games

Yellow fever

Democratic Republic ofCongo

September 11 attacks

Hostage crisis at Japanese
Ambassador's residence in Peru

COVID-19

Dengue fever

SARS

Care at the time of
returning home for
Mr. Shoichi Yokoi and
Mr. Hiroo Onoda, former
Japanese soldiers

A/H1N1swine flu

Mpox

Ebola hemorrhagic fever
West Africa

MERS
Ebola hemorrhagic fever

Great Hanshin-Awaji Earthquake

Democratic Republic of the Congo

Floods in Pakistan

Indonesia forest fires

Great East Japan Earthquake

Global epidemic/pandemic of infectious diseases
Infectious disease emergencies overseas
Health emergencies of Japanese and others living abroad
Health emergencies due to disasters

For refugees, Japanese residing overseas, and health emergencies caused by disasters, NCGM provides support by accepting patients anddispatching medical staff.
In addition to the illustration above, NCGM has provided assistance to refugees and Japanese residing overseas by dispatching medical staff toa Cambodian refugee camp in 1979, to the International Refugee Assistance Center (Shinagawa) to accept Indochina refugees in 1983, and toa Japanese hostage crisis in Kirghiz in 1999.
For health emergencies caused by disasters, NCGM dispatched medical staff in response to the damages caused by the tornado and flood in
Bangladesh in 1998, the earthquake in northwestern Turkey in 1999, the great earthquake off the coast of Sumatra and Indian Ocean tsunami
in 2005, and the cyclone in Myanmar in 2008.

COVID-19 Responses by NCGM
The one and only medical institution capable of undertaking
a multifaceted role in public health and medical treatment

1919

Providing info/advising the
National and Tokyo
Metropolitan
Governments

1954

Development oftreatment methods
Novel drugs,
convalescent plasma
therapy, and vaccines
Development of
diagnostic tests
Antibody/antigen tests
Severity prediction
methods

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Quarantine
Response to
COVID clusters

1972

1996

Functions as
general hospital
Treatment ofmoderate andsevere cases
Vaccination

2003
Community healthcare
PCR testing center
Management of hotels
for mild cases

Epidemiology
Genome analysis
Patient registry2009

Ever since the establishment of the Army Temporary Hospital(currently NCGM) in 1868, we have always played a pivotal role in
2014
2018
responding to health issues in Japan.
We still have the preserved
medical records of numerous patients that were treated over 100
years ago at the Tokyo Daiichi Eiju Hospital during the Spanish flu
pandemic in 1918-1920.
The accumulation of our experience within this century in
confronting emerging/re-emerging infectious diseases such as
SARS, A/H1N1 swine flu, MERS, Ebola hemorrhagic fever, andDengue fever are being put to use in our current COVID-19
response. NCGM will continue to serve as a general hospitaloffering advanced medical care to patients with various diseases
including infections, and as a medical institution capable of
2020
2023
undertaking a multifaceted role inpublic health and medical
treatment by providing advice and information to the government
policy-makers, conducting quarantine and responding to COVID-19
clusters. We will be committed to promoting research anddevelopment of treatment methods, novel drugs, and vaccines,
developing diagnostic tests and severity prediction methods,
conducting epidemiological studies, performing genome analysis,
creating a patient registry, and taking part in the local healthcare
cooperation, international cooperation, research and education.

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Special Issue February 2023

Treatment and Nursing of COVID-19 Patients and Suspected Patients
Norio Ohmagari, Director, Disease Control and Prevention Center (DCC), Center Hospital, NCGM
Tatsuya Okamoto, Head, Intensive Care Department, Center Hospital, NCGM
Masayuki Hojo, Head, Department of Respiratory Medicine, Center Hospital, NCGM

Yuki Hirota, Manager, 13th Floor Ward, Center Hospital, NCGM
Shiho Kubota, Deputy Manager, Infection Control Team, Center Hospital, NCGM
Kumi Horii, Deputy Manager, Infection Control Team, Center Hospital, NCGM

From the initial response to the present approach to the “unknown infectious disease”
At NCGM, the first COVID-19 patient was from among the patientsconsulting with the Department of Infectious Disease in late
January 2020. Since then, we have treated numerous patients. We
also performed COVID-19 screening tests with PCR and provided
medical care to the patients who tested positive and arrived inJapan on the flights from Wuhan, China chartered by the Japanese
government on January 29, 2020.
We initially possessed limited knowledge about the clinical featuresand natural course of this disease, and its treatment. Thus, we
treated the patients having respiratory failure with lopinavir/
ritonavir, of which in vitro activity against SARS-CoV-2 had been
confirmed by applying our experience and expertise. In February,
many critically ill patients were identified among the patients
aboard the cruise ship, Diamond Princess, anchored at YokohamaPort. In order to treat these patients, we ordered the antiviral drug
remdesivir from Gilead Science, Inc. in the U.S.A. and started its
compassionate use on the patients. In the same month, we started
preparing for global clinical trials of remdesivir in collaboration with
the U.S. National Institutes of Health (NIH), and the investigatorinitiated clinical trials were launched on March 25, 2020.
Meanwhile, we also continued to treat the patients with lopinavir/
ritonavir, of which in vitro activity against SARS-CoV-2 had been
confirmed by previous findings.
Four different clinical trials were conducted over about one year,
and the results demonstrated that the efficacy of remdesivir
was significantly higher compared to that of placebo, and thatthe efficacy of remdesivir in combination with baricitinib wassignificantly higher compared to that of remdesivir alone. Basedmainly on these data, remdesivir and baricitinib were approved inJapan for treating COVID-19 and have become clinically available.
We also participated in a global clinical trial of hyperimmune
intravenous immunoglobulin (IVIG), and conducted a multicenter
randomized comparative trial to evaluate the efficacy of
ciclesonide. While the expected efficacy was not demonstrated ineither of the investigated drugs, it is important to conduct clinical
trials expeditiously to find effective drugs to cope with emergency
situations. In this sense, we think we have played a prominent rolein Japan.
Aside from the patients who disembarked from the Diamond
Princess, from February to March 2020, many patients having
a travel history to Wuhan visited our outpatient department
and were diagnosed with COVID-19. We began to observe a
pronounced rise in the number of COVID-19 patients who had notapparently traveled to Wuhan in March. Simultaneously, criticalcases, mainly involving elderly patients, began to be identified.
Correspondingly, the number of COVID-19 inpatients increased.
In spite of the nationwide state of emergency declared by theJapanese government on April 7, 2020, as many as 48 patients,
including eight patients on ventilators, were admitted to our
Hospital at the same time in the following week.
After late April, the number of newly admitted patients gradually
decreased, and consequently the total number of inpatients
gradually decreased. However, the number of patients began toincrease again after ending the state of emergency, leading to theso-called “second wave” of the pandemic. In this outbreak, as
opposed to the outbreak from March to May, fewer patients werein critically ill condition - probably because there were fewer elderly
patients - and most of the affected people were young adults intheir 20s to 30s who acquired the infection mainly in downtown
areas. Therefore, the Japanese government did not declare a stateof emergency during the second wave.
The Japanese government then strived to enhance the economic
activity while trying to prevent COVID-19 transmission. However,this was not an easy task. The number of new COVID-19-positive
cases remained high in autumn, and began to increase in Tokyo
with the decrease in temperature in December 2020. With rapid
increase in the number of new cases, the “third wave” set in at
the end of December. Under these circumstances, we also began
to accept many moderately to severely affected patients. The
Japanese government declared its second state of emergency inJanuary 2021. During the third wave of the pandemic in Tokyo
involving more elderly patients and most moderate to severe cases,
many medical institutions struggled to accept these patients. Even

after February, clusters of COVID-19 cases were identified one after
another in elderly facilities and medical institutions, slowing thedecrease in the number of new positive cases and severe cases. The
situation finally settled in March, when long-awaited vaccination
started for the NCGM staff members. With the cooperation ofmany staff members from various departments, vaccination was
conducted smoothly and swiftly. The former Prime Minister Suga
also came to NCGM to be vaccinated.
In the summer of 2021, the fourth wave of the pandemic reachedJapan, and the Japanese government declared its third state of
emergency. We at the Center Hospital of NCGM renovated theHigh Care Unit (HCU) to accept COVID-19 patients in severe
condition. In this outbreak, the number of critically ill patientsreached a record high, many of which were people in their
40s to 60s.
From November to December 2021, the Omicron variant began to
be detected in Japan, mainly in people arriving from abroad.
NCGM conducted an investigational study in cooperation with the
National Institute of Infectious Diseases (NIID) and reported theclinical features of the patients affected by the Omicron variant
and the dynamics of the virus. This study helped the Japanese
government take measures.
From January to February 2022, the sixth wave of the pandemic
reached Japan. This was an even larger wave especially affecting
elderly people, who often suffered from debilitating conditions
leading to hospitalization. Consequently, many people diedthroughout Japan. Meanwhile, the number of patients with severe
respiratory failure decreased. This was probably owing to theincreased vaccination rate.
In July 2022, the seventh wave of the pandemic occurred in Japan.
As in the sixth outbreak, this wave also witnessed many elderly
people being affected, suffering from debilitating conditions, andhospitalized. Additionally, children and young people with lower
risks also suffered from poor eating and laryngeal stenosis due tosevere sore throat; and increasing number of patients admitted forother emergency conditions such as trauma and cerebrovasculardisease were confirmed as SARS-CoV-2 positive at the admission
screening. This changed the composition of inpatients.
Furthermore, there was such a situation that as many as 140 staff
members in our Hospital took leave from work at the same time.
Possibly because the infection with the Omicron variant tended tocause mild symptoms that were often hardly noticeable, the staff
and inpatients were affected one after another and thus we had a
hard time dealing with them. Like this, the nosocomial cluster andabsence of the staff greatly affected the hospital operation.
(Norio Ohmagari)

Clinical cases were quickly reported to provide the information on the “unknown infectious disease” to healthcare
providers nationwide

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Special Issue February 2023

The HCU designated for COVID-19 patients in severe condition, which was operated as the second ICU

Treatment of critically ill COVID-19 patients in the ICU/HCU
To meet the social demands as a medical institution designated fortreatment of specific infectious diseases, the policy to centralize thetreatment of critically ill patients at the High Care Unit (HCU) was
determined. The HCU was then renovated to depressurize south
half of the floor all together, including open beds, to enable thehealthcare providers to treat many patients after wearing PPE once.
On February 15, 2021 in the late third wave of the pandemic, we
opened our HCU with seven beds for patients in severe condition,and treated four intubated patients including long-term ECMO
cases until the closure of the unit at the end of March, 2021.
In the fourth wave of the pandemic from April to July 2021, there
were no severe cases admitted to the ICU or HCU, whereas in thefifth wave (with the Delta variant) the HCU opened for the second
time on August 5, 2021. At that time, the staff of the ICU treatedthe patients at the HCU in a closed system. With two dedicated
ICU specialists, the HCU was operated as the second designated
ICU with almost all beds occupied from September, treating 15
intubated patients including two ECMO cases until the closure in
October, 2021.
Figure 2 shows the changes in the number of intubated patientsby unit from the cruise ship cluster in February 2020 to the fifth

Figure 1
Change in the numberof intubated patientswith COVID-19(up to Oct. 2021)

Capacity enhancement for the sixth wave of the pandemic

pandemic wave in August 2021. We accepted 57 intubated patientsin approximately one and a half year until the end of October
2021, of which the mortality was 39%; ECMO was used for ninepatients, of which mortality was 56% (Figure 1). The mortality
increased over time, reaching high at 60% in the fifth wave of
the pandemic. The proportion of patients with severe obesity also
increased, amounting to 73% of the COVID-19 patients in the fifth
wave. Looking into the affected people by age, the proportion ofelderly people aged 60 and older was higher from the first wave
to the third wave of the pandemic, whereas half of the affected
people were in their 50s in the fifth wave of the pandemic.
(Figure 2)

Displacement of the Delta variant (fifth wave) by the
Omicron variant (sixth wave)
When the Delta variant became dominant and the number ofaffected patients reached its peak in August 2021, NCGM took the
initiative to save lives of people in their prime, who have become
critically ill before receiving vaccination, striving to alleviate thestress on the collapsing emergency medical care system. At thattime, our Emergency Department (ED) accepted long-waiting
ambulance patients exceeding our maximum capacity at night or
on holidays, started initial treatment immediately, and transported
them to nearby medical institutions accepting COVID-19 patientsduring the daytime for consecutive days.

After the sixth wave of the pandemic (with the Omicron variant)in January 2022, patients with acute respiratory distress syndrome(ARDS) associated with COVID-19 were no longer seen, and postoperative patients tested positive with PCR and patients withmedical diseases requiring intensive care are being accepted at the
depressurized room of the ICU. As I myself have never experienced
a situation where 60% of patients die, I keenly felt the threat of
the Delta variant.
(Tatsuya Okamoto)In the sixth wave of the pandemic in which the Omicron variant
emerged, we also treated many patients in moderate to severe
conditions. Their clinical features greatly differed from previous
cases; many of those who died were very elderly people
hospitalized after developing dehydration due to high fever,disturbance of consciousness, and aspiration pneumonia, andthose who survived required long-term rehabilitation for disuse
syndrome even after their recovery from the acute phase. As
an exit strategy to continuously accept new patients, NCGM
strengthened cooperation with nearby hospitals, which actively

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Response to the seventh wave of the pandemic (Julyto September 2022)
We experienced the seventh wave of the pandemic with the
Omicron variant under the government policy of “placing no
additional restrictions on socioeconomic activities.” As in manyother medical institutions, a considerable number of healthcare
providers in NCGM were affected during the spread of theinfection, and outbreaks occurred in general wards. Like in thesixth wave of the pandemic, there were less people with severe
symptoms and few “severe cases” requiring respiratory care withthe ventilator or ECMO, while many elderly people intolerantof invasive intensive care died, which was similar to the excess
mortality in influenza epidemics. All staff of NCGM have been
continuously making efforts to avoid infection, or to not transmit
the virus to colleagues and patients even if infected, and are now
overcoming several weeks of tense situation.
(Masayuki Hojo)

Accepting COVID-19 patients in general wards
The sixth wave of the COVID-19 pandemic started from December
17, 2021. The cases surged fiercely and our Hospital had to accept
many patients.

Figure 2
Clinical features of
the intubated patientswith COVID-19

accepted the patients surviving the acute phase.
Additionally, we continued dispatching our physicians to themunicipal hospitals in Tokyo accepting large number of elderly
patients with increased risk for severe COVID-19, providing medical
cooperation to meet the needs of those hospitals.

About a month later, on January 28, 2022, it became difficult
to accept the COVID-19 patients only in the specified ward, andour ward (general single room ward) also started to accept thepatients. Of 41 beds in our ward, 21 were reserved for COVID-19
patients and 20 for non-COVID-19 patients; we thus paid theutmost attention to prevent the infection from spreading among
the non-COVID-19 patients.
As we have accepted the COVID-19 patients in our ward fourtimes from the second wave to the fifth wave of the pandemic,
we could prepare necessary supplies smoothly; however, the staff
accepting those patients were not easily prepared. Now the ward
staff mutually reconfirm proper PPE donning/doffing each time
before accepting the patients. And we perform N95 mask fitting
tests to ensure a close facial fit. Furthermore, after accepting the
COVID-19 patients, we check ourselves in the mirror placed at the

PPE donning area before
entering a patient’s room.
There are photos at thedoffing area showing how
to remove PPE properly. As
the steps to remove PPE
must be strictly observed, we
make sure to reconfirm themevery time, not considering
them easy because “weStaff checking proper PPE donninghave done it several times.”
Additionally, we performzoning of contaminated andclean areas, and mutuallyreconfirm if all the staff understand the zoning properly and cancare patients without bringing contaminated items in the clean
area. We also train nurses in their first year so that both patientsand nurses can stay safe and secure.
We separate the rooms for non-COVID-19 and COVID-19 patients9

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Figure 1
Measure to prevent
infection when using
the lobby

Special Issue February 2023

using partitions placed in the hallway. While the COVID-19 patientsare isolated in their rooms, the non-COVID-19 patients may
go out of their rooms for examinations and rehabilitations. We
therefore provide sufficient explanation and ask for cooperation
to the non-COVID-19 patients to not go across the partitions. We
also precisely determine the patient transportation path so that
infectious and non-infectious patients never come into contact.
So far, no infection clusters have occurred in our ward, and we areconfident that we are caring for the COVID-19 patients with a highlevel of awareness.
In the seventh wave of the pandemic, we have been accepting
the COVID-19 patients since July 25, 2022. Even in this highly
infectious wave, we are maintaining secure care as before. We willcontinue to care for infectious patients confidently in cooperation
with colleagues.
(Yuki Hirota)

Well equipped withdisinfecting wipes andgloves to prevent infection

To prevent nosocomial infection
Bed management
Until after the fifth wave of the pandemic, many patients often
became severely ill and required treatment with the ventilator
or extracorporeal membrane oxygenator (ECMO), and thus werepurposed part of our HCU into a COVID-19 care unit to treat
critically ill patients. Before opening the unit, we reconfirmed PPE
donning/doffing of the staff and performed zoning in cooperation
with the deputy manager nurse of the HCU.
Before the Delta variant surge in the fifth wave, inpatients ingeneral wards have never developed the infection; however, after
the appearance of the Omicron variant in the sixth wave, increasing
number of inpatients and healthcare providers in the generalwards tested COVID-19 positive. After the subvariant BA.5 became
dominant, the number of affected people further increased.
When any of the hospital staff or inpatients tested positive, theward manager prepared a list of people closely contacting theinfectious person from two days before onset, based on which the
Infection Control Team (ICT) identified those applicable to close
contacts and provided instructions for PCR test and follow-up. The
close contact person in hospital is defined as a patient staying inthe same room with an infected patient; a person who has had
conversation with an infected person for more than 15 minutes
without both or either one wearing a mask; and a person who
have long contacted an infected person for more than 30 minutes
even if both wearing a mask.
The nurses providing patient care are frequently in contact
with the patients; therefore, if they are infected, they precisely
confirm the details and time of care to determine patients closelycontacting them very carefully. If the infected nurse has been onnight duty during the potentially infectious period, care should

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be taken for the nap room used. As the nap room users may staywithout wearing a mask and given that it is a completely close theroom without sufficient ventilation, we check the order of use by
the infected person and the time between uses by next users todetermine if there are close contacts.
When an inpatient has become a close contact person, we
provided care to the patient under single room or cohort isolation,or coordinated bed control with the manager nurse to request thetransfer of the patient to a single room of other ward dependingon the situation.
As of September 2022, the Japanese government determines thelifting of restrictions on movement for close contacts after the sixthday; however, as we have experienced that many cases tested
positive on the sixth day, we maintain the previous definition of
7-day isolation and lift the isolation immediately after confirming anegative PCR result on the seventh day.

Until the emergence of the Omicron wave,
universal mask wearing has been advocated;
however, masking in a private space such as asingle room and inside a curtain in a large roomhas been determined at the discretion of eachpatient and not strongly requested. However, after the increase ininfected healthcare providers with the emergence of the Omicron
variant in the sixth wave, we made sure that the patients shouldwear a mask when healthcare providers enter their room toprevent them from becoming close contacts, and that healthcare
providers should put a mask on the patients who cannot it wearby themselves before starting care. Additionally, we made it
mandatory for healthcare providers to wear an N95 mask and theface shield during the meal assistance and oral care of the patients
removing a mask. These efforts led to the decrease in patients andhealthcare providers identified as close contacts.
Measures for the staff
In the sixth wave of the pandemic with the Omicron variant, thenumber of infected staff increased, and the staff unable to work
also surged because their family member has been infected or has
become a close contact, which made it difficult to secure certain
number of staff. Similarly in Japan, there was a concern about
securing healthcare staff. Then the secretariat of the COVID-19
Measure Promotion Division of the Ministry of Health, Labour andWelfare (MHLW) announced the notification titled “Measures toconfirmed rapid spread of COVID-19” (dated January 5, 2022
[partly revised on January 14, 2022]). Given this notification, theself-quarantine period for those who closely contacted the patients
infected with the Omicron variant was shortened from 14 days to
10 days, and the period was lifted on the seventh day if tested PCR
negative on the sixth day. Along with this change, we provided
outpatient PCR tests at the Department of Infectious Diseases if thestaff in our Hospital has become sick or close contacts. However,●Move couches to secure alarge space in the lobby.

●

Keep patients apart as muchas possible, accommodating at
most 6–7 patients.

●

Restrict the traffic of people in
the area as shown in the photowhen there are many patients.

this did not solve the problem of the staff shortage because it took
several days for the staff’s family members who became sick andvisited a local doctor to obtain PCR results and increasing numberof the family members could not receive PCR tests immediately
after being identified as close contacts due to the lack ofsymptoms.
Then, in order to secure the staff, we coordinated with thephysician of the Department of Infectious Diseases, the manager
nurse, and the Pediatric Department to ensure consultation of thesick family members of the staff, and also established a system incooperation with the executive members and the Administrative
Department of the Hospital to provide PCR tests to the family
members of the staff identified as close contacts. This resulted insmooth testing and shortened the self-quarantine period for thestaff.
After the sixth wave of the pandemic, the self-quarantine period
for essential workers identified as close contacts had beenshortened or changed several times, and each time the ICT
examined how to deal with close contacts in the Hospital based on
the infection status within the Hospital and reference publications.
We also revised manuals in a timely manner, developing an easyto-understand flow to deal with the staff who became sick or
those identified as close contacts (Figure 2. Flow to deal with thestaff identified as close contacts), and made them known to theentire staff.
(Shiho Kubota, Kumi Horii)

Figure 2 Flow to deal with the staff identified as close contacts

Reponses to COVID-19 outbreak
When multiple infection cases were found in the same ward, we
checked the status with the ward staff and examined the cause of
the spread of infection and the countermeasure.
Consequently, it was found as a cause that patients had been
watching TV in the ward lobby or taking meals while sitting closely
to each other. We then took a countermeasure of placing thechairs and wheelchairs one meter (or two meters if possible) apartin the same direction so that patients keep a distance from others
without facing each other while watching TV in the lobby, andmade it standardized and known to all staff (Figure 1. Measure toprevent infection when using the lobby).

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Special Issue February 2023

How We Fought against COVID-19 Pandemic at Our Emergency Department

3

Akio Kimura, Director, Department of Emergency Medicine and Critical Care, Center Hospital, NCGM
Ryo Sasaki, Head, Department of Emergency Medicine and Critical Care, Center Hospital, NCGM
Kentaro Kobayashi, Chief Physician, Department of Emergency Medicine and Critical Care,
Center Hospital, NCGM
Figure 1 Check list

In the clinical practice for COVID-19 at our Emergency Department(ED), the crucial task was not just to provide initial management forsuspected patients but to identify severity (triage) and isolate thosepatients to prevent them from becoming a source of nosocomial
infection in addition to the safety of healthcare providers.

almost half of patients required emergency hospitalization weresuspected or confirmed COVID-19 patients, suggesting that agreater part of the clinical practices at the ED was performed under
the alert for COVID-19. Later, it became possible to use rapid
PCR results and to stop unnecessary precautions after confirming

Checklist for COVID-19

Surgical masks must be provided to all patients!!
[Social history in suspected COVID-19 infections]
Fever over 37.5°C (99.5°F)
Respiratory symptoms, cold symptoms
Loss of sense of taste and/or smell
Close contact with a COVID-19 patient
Fever and respiratory symptoms of individuals in thesame household
Overseas travel history in past 2 weeks
Contact with returnees from oversea countries
Attendance of mass gathering events in past 2 weeks
Visit to city center/nightlife district

As a measure to prevent infection in the ED, we made it mandatory
to wear the mask for all patients against droplet transmission.
Healthcare providers must strictly observe standard precautions
for droplet and contact transmissions, and wear N95 masks andgoggles at all times during the initial management at the ED toprevent aerosol exposure (Photo 2). In crowded ED situations,however, donning and doffing such equipment was timeconsuming.
With the spread of community transmission, we had to treat
all patients with fever and respiratory symptoms brought byambulances as suspected patients, and thus had to respondconfronting as if we had a considerable number of COVID-19
patients. To select highly suspicious patients, we started screening
all patients brought to the ED using a checklist shown in Figure 1,
which included questions about the history of overseas travels andclose contacts, fever and symptoms of respiratory system, etc.

Photo 1 Entrance to the ED. The
negative pressure room is locatedto the right of the entrance.

Figure 2 shows the change in the number of non-COVID-19
patients receiving normal emergency care, suspected COVID-19
patients, and confirmed COVID-19 patients brought by ambulances
to our ED per week during the “first wave” of the pandemic. Fromlate March 2020, when community transmission of COVID-19 wasprevalent, the number of potentially infectious patients admitted
to the ED increased rapidly, and in the week from April 19 to 25,

Number of inpatients
who underwent normal
emergency care

120

Number of inpatients suspectedof a COVID-19 infection

0
3

100
1
2

36

4
0
2

0
0
0

0
2

0

1

1

10

13

8

3
20

60

5

25

23

88

84
73

79

In the “seventh wave” of the pandemic (around August 2022),
the number of COVID-19 patients more than doubled due tothe strengthening of viral transmission. The suspected COVID-19
patients also rapidly increased and consequently our ED wasovercrowded. In spite of such circumstances, we continued to treat
as many patients as possible, providing screening including rapid
antigen test and estimating urgency of patients after arrival, inside
an ambulance, but outside the Hospital.

32

22

3

0

0

17

1

20

22

68

68

2

32

Photo 2 All healthcare providers at the ED wore N95 masks and goggles
at all times.

17

25

28
85

76
62

20

4

0
15

1
3

99

40

1

2

80

66

63

53

46

55

49

65

71

80

75

73

81

/1
-2

22/

26
1/

2/
8
2/
92/
1
2/
16 5
-2
/2
2/
23 2
-2
/2
9
3/
13/
7
3/
83/
1
3/
15 4
-3
/2
3/
22 1
-3
/2
8
3/
29
-4
/4
4/
54/
1
4/
12 1
-4
/1
4/
19 8
-4
/2
5
4/
26
-5
/2
5/
35/
5/
10 9
-5
/1
5/
17 6
-5
/2
5/
24 3
-5
/3
0
5/
31
-6
/6
6/
76/
1
6/
14 3
-6
/2
6/
21 0
-6
/2
7
6/
28
-7
/4

34

0

12

Number of inpatients
confirmed with COVID-19
0

In the “second wave” of the pandemic in mid-June 2020, thenumber of COVID-19 clusters increased among night-time workers
in the hot spots such as Kabuki-town, Tokyo, and new questions
were added to the above-mentioned screening checklist asking
about occasions to visit nightlife districts. In those days, rapid
antigen tests became available, which greatly improved theinfection screening accuracy. In the “third” and “fourth" waves ofthe pandemic, there were no significant changes in our practices
at the ED; however, in the “fifth wave” with the Delta variant(around August 2021), increasing number of young patientsrequired intensive care and many hospitals were overcrowded in
accepting patients in severe condition. Our ED was overwhelmedwith critically ill patients waiting for vacant beds, and had toaccommodate two patients in a single room (Photo 4).
In the “sixth wave” of the pandemic (around December 2021),
the number of severe COVID-19 cases greatly decreased due tothe displacement by the Omicron variant. However, number ofless severe patients were remarkably increased and considerable
number of beds were required for COVID-19 patients at each local
area, resultingly beds for non-COVID-19 emergency patients went
short, causing nationwide confusion in emergency medical system.

Figure 2 Change in the number of admitted patients in the first wave of the pandemic in 2020
140

their infection status, which gradually reduced the burdens on the
ED staffs against infection. The outbreaks repeatedly surged andsubsided subsequently, and every case required different measuresat the ED depending on the characteristics of each waves.

Photo 3 Negative pressure room. Patients suspected with COVID-19
have been basically treated in the negative pressure room installed in the
ED. If the room is occupied, other two rooms are available for isolation
purposes.

Photo 4 (Monitor screen of the ED) Single rooms for COVID-19 patientsat the ED each accommodating two patients13

Feel the NCGM

4

Special Issue February 2023

Health Checkups and Tests Conducted on Returnees on Chartered Flights from Wuhan
Satoshi Kutsuna, Former Chief Physician, Division of Preparedness and Emerging Infections, Disease
Control and Prevention Center (DCC), Center Hospital, NCGM
Takeo Kawamata, Former Special Advisor to the President, NCGM

On January 23, 2020, the Chinese government imposed a lockdown
in Wuhan and its nearby cities, trapping many Japanese and theirfamilies who were unable to travel back to Japan. The Japanese
government evacuated a total of 829 nationals on chartered flightsfrom January 29 (the first flight) to
February 17 (the fifth flight).
NCGM responded to the government’s urgent request to conduct
health checkups and PCR tests on returnees. It was a mission
carried out under a critical situation, in which the WHO declareda Public Health Emergency of International Concern (PHEIC) on
January 30.
Individuals detected with fever at the Haneda Airport quarantine
were directly taken to a hospital, and other returnees weretransported to NCGM on five to seven buses. First, temperatures
were taken and questionnaires were filled out on the bus. After
disembarking, returnees were checked in at the entrance of theconference room (auditorium) and received medical consultation bya physician. Those with symptoms were taken to the Department
of Infectious Diseases, and those suspected of infection were
hospitalized. Those who were asymptomatic underwent blood
tests and PCR nasopharyngeal swab tests. Rice balls, bread,and tea were distributed, and they were taken on the bus toaccommodations provided by the government.

Buses carrying returnees on the first chartered flight from Wuhan
arrives at NCGM

NCGM staff awaiting the arrival of Wuhan returnees at the site of healthcheckup and PCR testing

NCGM staff in protective clothing, awaiting the arrival of Wuhan returnees

Returnees receiving health checkups

Returnees undergoing PCR nasopharyngeal swab tests

mission topped 356 within an approximate span of five days (107physicians, 115 nurses, 24 clinical technicians, and 110 clerical staff).
Of the 793 returnees who received PCR tests at NCGM, eighttested positive (Refer to the table below). Here, a striking new fact
was discovered in our country, that positive cases were seen inasymptomatic individuals. This had a huge impact on the public. It
was the beginning of our challenge against the novel COVID-19.

Many of the returnees included small children under age six andChinese speakers, requiring attentive care, such as help frompediatric specialists, provision of nursing rooms and rest areas, andmedical interpreters. The number of NCGM staff involved in this14

FlightDate of arrival

Nnumber of returnees

Tested cases at NCGM

1

Thursday,January 29

206

199

2

Thursday,January 30

210

197

3

Friday,January 31

150

140

4

Friday,February 7

198

194

5

Monday,February 17

65

63

PCR testing results(Positive/Negative)(Positive)

3(Negative) 196(Positive)

2(Negative) 195(Positive)

2(Negative) 138(Positive)

1(Negative) 193(Positive)

0(Negative)

63

A staff meeting held on the initial day after caring for returnees on the first chartered flight from Wuhan

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Feel the NCGM

5Special Issue February 2023

Cruise Ships: Diamond Princess and Costa Atlantica
Hajime Inoue, Former Director-General, Bureau of Strategic Planning, NCGM

A major spread of COVID-19 was seen on board the Diamond
Princess cruise ship, which docked in Yokohama on February
3, 2020. We were faced with an unprecedented challenge
of isolating, quarantining, and providing medical care toapproximately 3,700 passengers and crews, with limited clinicalknowledge of this disease.

The Diamond Princess
docked in Yokohama Port

Furthermore, a crew boarded on the Costa Atlantica cruise ship
docked in Nagasaki Port was confirmed with COVID-19 on April
20. Making use of the Diamond Princess experience, NCGM
dispatched staff to Nagasaki in an effort to contain the virus.

NCGM dispatched a team of medical providers including physicians
and nurses to the Diamond Princess, and accepted many severelyill patients for treatment. This was done in response to a request
made by MHLW taking command of the situation. From early
March until late April, an on-land quarantine of the captain andcrew members totaling near 240 took place at the dormitory of
the National Tax College in Wako City, Saitama Prefecture. Thismission was commanded by NCGM specialists who supervised
a diverse team of professionals gathered from around the world
for support.
Inside the captain’s cabin. Meeting held every evening at 9:00 PM with the captain.
Captain Gennaro Arma (seated second from the left)
Gaku Hashimoto, former State Minister of Health, Labour and Welfare(seated third from the right)
Hanako Jimi, former Parliamentary Vice-Minister of Health, Labour and Welfare(seated second from the right)

On-Land Quarantine of Diamond Princess Crew Members Conducted by a Multinational TeamAn NCGM staff boarding the Costa Atlantica
docked in Nagasaki Port, in response to a request
for quarantine (Hajime Inoue)

Wako

NCGM
On-land quarantine check-in

Taken in front of a message board filled with wordsof gratitude from the captain and crew members who
underwent quarantine

Commemorative photo taken of multinational team members after completionof quarantine inspection

Yokohama
Quarantine team members of the Diamond Princess crew
Meeting held every day by quarantine team members

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6Special Issue February 2023

Development Research of COVID-19 Therapies Led by NCGM
Hiroaki Mitsuya, Director-General, Research Institute, NCGM
Yukihito Ishizaka, Vice Director-General, Research Institute, NCGM
Yoshihiro Kawaoka, Director, Research Center for Global Viral Diseases, NCGM
Katsushi Tokunaga, Director, Genome Medical Science Project-Toyama, Research Institute, NCGM

Wataru Sugiura, Director-General, Center for Clinical Sciences, NCGM
Daisuke Tokita, Director, Department of Clinical Research Promotion, Center for Clinical Sciences, NCGM
Shinichiro Morioka, Deputy Chief Medical Director, Disease Control and Prevention Center, Center Hospital, NCGM

Research of COVID-19 by the NCGM Research Institute (NCGMRI)
To develop therapeutic and prophylactic agents for COVID-19,
we need to establish an animal model that has similar symptoms
to those seen in humans. The Research Center for Global Viral
Diseases of the NCGMRI has shown that a hamster infectedwith SARS-CoV-2 (Figure 1) exhibits symptoms such as severe
pneumonia, which is seen in humans.1) Currently, hamsters areused worldwide as the most useful animal model to investigate thecharacteristics of SARS-CoV-2.

Figure 1
Scanning electron microscopy image of SARS-CoV-2, thecausative virus of COVID-19 (viruses are colored in blue).
Diameter: 80–220 nm (1 nm = 10-9 m)

Since the start of the pandemic caused by SARS-CoV-2, various
variant viruses have emerged, for which the Research Center for
Global Viral Diseases is leading the world in investigating thecharacteristics of these variants and the effects of therapeutic
agents on them. We demonstrated that the Omicron variant,which emerged at the end of 2021 and is still prevalent, wasless lung proliferative and pathogenic than previously prevalentvariants.2,3) We also investigated therapeutic agents (monoclonal
antibodies and antiviral agents) developed to combat SARS-CoV-2
and identified which ones were retained efficacy against Omicron
variants.4,5)
The world-leading research by the Research Center for Global Viral
Diseases does not just help select appropriate therapeutic agentsfor COVID-19 in medical settings, but also provides essential riskassessment information about the variants, which administrative
agencies can use to develop and implement countermeasuresagainst COVID-19.

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As mentioned above, while monoclonal antibodies are currently
used as specific drugs for COVID-19, it is crucial to prepare a
monoclonal antibody with a wide variety of neutralizing activities
against emerging virus variants for antibody therapy to continue tobe effective.
By using peripheral blood cells of the COVID-19 patients visiting
NCGM, the Department of Intractable Diseases of the NCGMRI
succeeded in cloning a number of complete human monoclonal
antibodies that bind to the spike proteins on the surface of theviruses.6) The clone EV053286 exerts antiviral activity against all
virus variants analyzed in a neutralization assay using Vero E6 cells(wild variant, Alpha variant, Delta variant, Beta variant, Gamma
variant, Kappa variant, and Omicron subvariants BA.1, BA.2,
BA.4, and BA.5). It also neutralized escape variants for which
the antibody cocktail developed by Regeneron is ineffective, andsuppresses infection in the experiment using a mouse. Currently it
is being investigated for clinical use, and this kind of methodology
is expected to be effective for potential new variants.
The Department of Refractory Viral Diseases of the NCGMRI isdeveloping therapeutic agents targeting the proteolytic enzyme of
SARS-CoV-2 (main protease; M pro ). M pro is an essential enzyme forreplication of SARS-CoV-2, and its composition (amino acidsequence) is similar in many coronaviruses at high level.
Of note, M pro is hardly mutated even if SARS-CoV-2 mutation
occurs on the spike protein of the virus and allows it to become an
escape variant, and is thus considered a suitable target in thedevelopment of a therapeutic agent for COVID-19. The
Department of Refractory Viral Diseases identified candidate
therapeutic agents such as GRL-24205h , which specifically bind to
the active site of M pro (where proteolysis occurs) and potently
inhibit the activity.7,8)
Based on the X-ray crystallographic features of an experimental
anti-SARS-CoV-2 compound, GRL-24205h , complexed with M pro ,the Department also continued redesigning and organic synthesis(optimization) to synthesize an orally available low molecularweight compound TKB-245 (Figure 2), which is about hundreds oftimes more potent than currently used remdesivir, molnupiravir, or
nirmatrelvir that had been developed during the early pandemic.
Compounds such as TKB-245 and TKB-248 have been confirmed
to inhibit the infectivity/proliferation of all investigated SARS-CoV-2
variants equally and potently in vitro, and upon oral administration
to a mouse model 9). The Department of Refractory Viral Diseases
is advancing clinical application of these compounds.
(Hiroaki Mitsuya Yukihito Ishizaka Yoshihiro Kawaoka)

TKB-245

TKB-248

Figure 2
X-ray crystal structure of the proteolytic enzyme essential for SARS-CoV-2 infection and proliferation (M pro ). Two M pro molecules polymerize(dimerize) to acquire proteolytic function (left). The M pro inhibitor specifically binds to the active site of the enzyme that processes immatureviral proteins through proteolysis to produce mature viral proteins, and eventually inhibits transmission and proliferation of the virus. The X-ray
crystallographic analysis shows the potent M pro inhibitors TKB-245 and TKB-248 binding to the “cavity” of the enzyme’s active site.
References
1) Imai M and Kawaoka Y et al. Proc Natl Acad Sci USA 2020
2) Halfmann and Kawaoka Y et al. Nature 2022
3) Uraki R and Kawaoka Y et al. Nature 2022
4) Takashita E and Kawaoka Y et al. N Engl J Med 2022
5) Uraki R and Kawaoka Y et al. Nat Microbiol 2022
6) Ueno M and Ishizaka Y et al. Antiv Res 2022
7) Hattori SI and Mitsuya et al. mBio 2020
8) Hattori SI and Mitsuya H et al. Nat Commun 2021
9) Higashi-Kuwata N and Mitsuya H et al. Nat Commun 2023

COVID-19 human genome research
The Genome Medical Science Project of the NCGMRI is conducting
research and analysis on two topics related to host (human)
genome. One is the exploration of genetic factors involved insevere cases of COVID-19. We have already published three papers
in international journals, including the results of the genomewide association study using samples obtained from the patientsat the NCGM Hospitals, the results from participating in global
joint researches, and the results of detailed analysis targeting
human leukocyte antigen (HLA) complex especially important for
immune system. The other is the exploration of a genetic factor
affecting the level of antibodies produced by the COVID-19 vaccine
and attenuation of the antibody response. We have publishedthe results of detailed analysis of HLA complex as a promising
candidate genetic factor in an international journal.
We believe it will be important to conduct association analyses
using data of both mutation of pathogen COVID-19 genome anddiversity of host human genome.
(Katsushi Tokunaga)

Short-read and long-read genome sequencers used for genome analyses

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Special Issue February 2023

Clinical studies and trials led by or jointly conducted by NCGM
NCGM has so far conducted various development researches of
COVID-19 therapies. We initially conducted specified clinical trials
and investigator-initiated clinical trials of antiviral agents, and are
currently engaged in vaccine development (Figure 1). We are alsoplanning several studies on antibody preparations and vaccines.

Ongoing specified clinical trials
1. Exploratory single-arm study to evaluate the safety andimmunogenicity of KD-414 as a booster vaccine for SARSCoV-2 in healthy adults [KAPIVARA study] (Investigator:

Figure1 Study plans to develop drugs and vaccines for emerging/re-emerging infectious diseases in NCGM (January 2020 - August 2022)

Mugen Ujiie)
October 22, 2021 - in follow-up
A single-center specified clinical trial to evaluate the safety andimmunogenicity of the inactivated vaccine KD-414 as a booster
in healthy adults who received two mRNA vaccinations for

SARS-CoV-2.1) The primary endpoint is the immunogenicity
after booster vaccination of KD-414 compared with that after
vaccination of mRNA vaccine.
2. Randomized controlled trial of convalescent plasma
therapy [COVIPLA-RCT] (Investigator: Sho Saito)
February 24, 2021 - Completed enrollment in December
2021
A two-arm, randomized, open-label, multicenter specified
clinical trial to evaluate the efficacy of convalescent plasma
therapy for COVID-19.2) Given the approval of the antibody
cocktail therapy Ronapreve® (generic name: casirivimab[genetical recombination]/imdevimab [genetical recombination]),the enrollment was completed in December 2021.
3. PMX specified clinical trial [X-code trial](Investigator: Shinyu Izumi)
September 28, 2020 - Completed enrollment in March2022 (in analysis)
A multicenter specified clinical trial to evaluate the efficacy
and safety of a blood purification therapy (PMX therapy) for
moderate to severe COVID-19.3)
Ongoing investigator-initiated clinical trials jointly
conducted by NCGM
1. Adrenomedullin AMP-2-COVID2 trial (Led by University ofMiyazaki; NCGM investigator: Norio Ohmagari)
June 24, 2021 – in progress
Adrenomedullin is a circulatory adjusting peptide which exhibits
anti-inflammatory effect. It is expected to prevent patients withmoderate pneumonia from becoming severe.
2. Adrenomedullin AMP-2-COVID trial (Led by University ofMiyazaki; NCGM investigator: Norio Ohmagari)
November 2, 2020 - March 1, 2022
This trial started with the expectation to prevent critically illpatients on a ventilator from aggravation and completed
enrollment.
3. Ephedra Herb extract (Led by Kitasato University; NCGM
investigator: Norio Ohmagari)
March 30, 2021 - January 7, 2022
An exploratory Phase I/II trial to evaluate the efficacy and safetyof Ephedrine alkaloids-free Ephedra Herb extract in patients inthe early stage of infection.

Blue indicates clinical trials led by NCGM; green indicates clinical trials led by other institutions

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Figure 1
The number of days after COVID-19 onset
or diagnosis and the proportion of patientswith any prolonging symptoms

Special Issue February 2023

Proportion (%)

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Specified clinical trials/investigator-initiated clinical
trials led by NCGM (completed)
1. Specified clinical trial of ciclesonide [RACCO trial](Investigator: Haruhito Sugiyama
March 27, 2020 - Completed enrollment on September 17,
2020
An exploratory Phase II trial was initiated by NCGM in 22
facilities in Japan and 90 subjects were enrolled.4) Sincesignificant exacerbation of pneumonia was seen in theciclesonide inhalation group, NCGM announced not torecommend the use of this agent in the press release on
December 23, 2020.
2. Compassionate use of remdesivir (RDV) (Investigator:
Norio Ohmagari)5)Given the offer of compassionate use of RDV from the Embassyof the United States to the Chief Medical and Global Health
Officer of MHLW, three critically ill patients admitted to NCGM
received RDV for the first time in Japan.
3. Adaptive COVID-19 Treatment Trial-1 (ACTT-1)[NCTO4280705; Domestic COVRA-1 trial in Japan](Investigator: Norio Ohmagari)6)
February 21, 2020 – May 21, 2020
ACTT-1 was a placebo-controlled, double-blind, two-arm trial
to evaluate the efficacy and safety of RDV in moderate to severe
hospitalized adult patients. Given the results of this trial, RDV
was approved on May 7.
4. ACTT-2 [NCTO4401579; Domestic COVRA-2 trial in Japan](Investigator: Norio Ohmagari)7)
May 26, 2020 - July 31, 2020
ACTT-2 was a double-blind, two-arm trial to evaluate the
combination of RDV and baricitinib tablet compared to the
combination of RDV and placebo tablet in moderate to severe
hospitalized adult patients. Baricitinib was approved as thethird therapeutic agent for COVID-19, following remdesivir anddexamethasone.
5. ACTT-3 [NCTO4492475; Domestic COVRA-3 trial in Japan](Investigator: Norio Ohmagari)8)
July 30, 2020 - December 21, 2020
ACTT-3 was a double-blind, 2-arm trial to evaluate the efficacy
of RDV in combination with interferon β1a by comparing
RDV + subcutaneous interferon β1a and RDV + subcutaneousplacebo.

22

6. ACTT-4 [NCTO4640168; Domestic COVRA-4 trial in Japan](Investigator: Norio Ohmagari)9)
December 18, 2020 - August 2, 2021
ACTT-4 was a double-blind, two-arm trial to evaluate theefficacy of RDV in combination with dexamethasone comparedwith RDV in combination with subcutaneous baricitinib.
7. Inpatient Treatment with Anti-Coronavirus
Immunoglobulin (ITAC) clinical trial (NCTO4546581;
Investigator: Norio Ohmagari)10)
October 15, 2020 - October 12, 2021
ITAC trial was a randomized, double-blind, placebo-controlled
two-arm trial of hyperimmune intravenous immunoglobulin(hIVIG) compared with placebo, led by the NIH and theInternational Network for Strategic Initiatives in Global HIV Trials(INSIGHT)
Sponsor-initiated clinical trials
NCGM is proactively involved in sponsor-initiated clinical trials
for the development of therapies. So far, NCGM has participatedin clinical trials of therapeutic agents, including molnupiravir(Lagevrio®), nirmatrelvir/ritonavir (Paxlovid®), and enrolled many
subjects. These trials are still ongoing.
(As of September 2022) (Wataru Sugiura)

References
1) Terayama Y, et al. Life (Basel). 2022 Jun 27;12(7):966.
2) Tomita N, et al. Life (Basel). 2022 Jun 8;12(6):856.
3) Terada-Hirashima J, et al. JMIR Res Protoc. 2022 Sep 1.
4) Terada-Hirashima J, et al. JMIR Res Protoc. 2020 Dec 31;9(12):e23830.
5) GreinJ,et al. N Engl J Med 2020;382(24):2327-2336
6) Beigel JH N Engl J Med 2020;383(19):1813-1826
7) Andre C.Kalil N Engl J Med 2021;384:795-807
8) Andre C.Kalil Lancet.2021;9:1365-1376
9) Cameron R Wolfe Lancet.2022;10: 888–899
10) The ITAC (INSIGHT 013) Study Group Lancet 2022; 399: 530–540

Studies on the post-COVID-19
conditions(Post-acute sequelae of COVID-19)
Introduction
It is now known that there are symptoms that are prolonged inpatients who contracted COVID-19 (PASC: post-acute sequelae
of COVID-19) from around July 2020. In order to provide accurate
information on PASC, the Disease Control and Prevention Center(DCC) of NCGM has conducted five surveys since August 2020
with the cooperation of patients affected by COVID-19. This
allowed us to determine the epidemiology of PASC, identificationof risk factors for symptom appearance and prolongation, impact
on quality of life and social productivity, and association with
antibody titers, humoral factors, and genome.
Epidemiological data reports on the post-acutesequelae of COVID-19
In April 2021, we conducted a questionnaire survey of patients
who participated in the COVID-19 convalescent plasma therapy
screening at the Center Hospital of NCGM from February 2020
to March 2021. Of the 526 participants, 457 responded to thequestionnaire (response rate 86.9%). The median age of the
responders was 47 years; 50.5% were female, and 84.4% were
patients with mild disease.1)
Symptoms of COVID-19 were classified as follows: (1) Acutesymptoms (symptoms that resolve within one month): fever,headache, decreased appetite, arthralgia, sore throat, myalgia,
diarrhea, and sputum; (2) Acute to prolonged symptoms(symptoms that prolong beyond one month): fatigue, dysosmia
of taste, dysosmia of smell, cough, and dyspnea; and (3) Postacute symptoms (symptoms that appear after recovery):alopecia, decreased concentration, memory impairment, anddepression. Symptoms that appear after recovery: alopecia, poor
concentration, memory impairment, and depression.
Figure 1 shows the number of days since onset or diagnosis andthe percentage of patients with some residual symptoms. Some
symptoms were still present in 120 patients (26.3%) at six months
and in 40 patients (8.8%) at 12 months after COVID-19 onset or
diagnosis.

Symptoms
Any symptoms

Days

Post-acute sequelae of the Omicron variant
Telephone interviews were conducted with 128 patients infectedwith Omicron strain who were admitted to the Center Hospitalof NCGM between December 2021 and February 2022, and53 patients responded regarding sequelae after recovery. The
frequency of post-acute sequelae of Omicron strain was comparedamong 502 persons diagnosed with COVID-19 before the Omicronstrain emerged, after matching age, gender, presence or absenceof obesity, and vaccination history. The results showed that 5.6%of the Omicron group had at least one sequelae, compared to55.6% of the target group (p=0.003) 3). This indicates that the
Omicron strain tended to have fewer sequelae than the earlier
strains.
Future approach
As of September 2022, the clinical features, pathology, andtherapy of PASC have not been established. The DCC will continue
its efforts to provide accurate information to patients sufferingfrom the PASC, and to elucidate the clinical features and discovereffective therapeutic agents.
(Shinichiro Morioka)

References
1) Miyazato, Y, et al, Factors associated with development andpersistence of post-COVID conditions: A cross-sectional study. J InfectChemother, 2022. 28(9): p. 1242-1248.
2) Tsuzuki, S, et al, Impact of long-COVID on health-related quality of life inJapanese COVID-19 patients. Health Qual Life Outcomes,
2022. 20(1): p. 125.
3) Morioka, S, et al, Post COVID-19 condition of the Omicron variant of
SARS-CoV-2. J Infect Chemother, 2022. 28(11): p. 1546-1551.

Next, we analyzed the risk of occurrence and prolongation of
fatigue, taste and smell disorders, and hair loss. Compared tomen, women were more likely to experience fatigue, taste andsmell disorders, and alopecia, and more likely to have prolonged
taste disorders. In addition to being female, younger and thinnerindividuals were more likely to develop taste and smell disorders.
It was also found that patients with some PASC had a lower
quality of life compared to those without PASC2), and this could
lead to a decrease in productivity in society.

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7

Special Issue February 2023

From COVID-19 Registry JAPAN (COVIREGI- JP) to REBIND
Nobuaki Matstunaga, Chief, Division of Clinical Surveillance, AMR Clinical Reference Center, Center Hospital, NCGM
Norio Ohmagari, Director, Disease Control and Prevention Center (DCC), Center Hospital, NCGM
Kazuo Izumi, Director, Department of Research Resource, Center for Clinical Sciences, NCGM
Wataru Sugiura, Director-General, Center for Clinical Sciences, NCGM

COVID-19 REGISTRY JAPAN (COVIREGI-JP)
Introduction
It has been two and a half years since the identification ofpneumonia clusters due to novel coronavirus in Wuhan, China
in December 2019. COVID-19 keeps changing in clinicalmanifestations, clinical course, severity, case fatality rate, etc. overtime under the influence of the spread of variants. To comprehend
this information in real time and directly return the data to publichealth and clinical settings, we have initiated a registry study of
COVID-19 hospitalization cases since March 2020 (COVIREGI-JP)(https://covid-registry.ncgm.go.jp/) (Figure 1).
Overview of the registry study
This is an observational study that has been initiated with the
MHLW Grant-in-Aid for Scientific Research (Title: Development ofclinical therapy for critically ill patients with COVID-19; Principal
investigator: Norio Ohmagari, NCGM) and is currently under
the operation of the REpository of Data and Biospecimen of
INfectious Disease (RIBIND) described later. The case reports aredeveloped focusing on the basic information, demographic data,epidemiological data, clinical data regarding hospitalization andtreatment, and infectiological data, and are revised according to
the changes in the situation. The number of cases registered was
10,000 in October 2020 and 40,000 in May 2021, and data ofover 70,000 cases have been accumulated as of September 2022.
Achievement of the registry study
Aside from obtaining academic results, we promptly analyze thecollected data and provided outcomes to relevant administrations
and municipalities. We also returned the outcomes to participating

Figure 2

due to serious COVID-19 pneumonia decreased with the increasein proportion of people receiving third and fourth vaccination. As
this report does not include statistical investigation, further study
will be necessary. (Figure 4)
We have been providing our study conference materials to theTokyo Novel Coronavirus Response Headquarters. Our study
provided an opportunity to start the study on the epidemiological
data of COVID-19 in Tokyo in 2021. We are sharing the data,
including epidemiological characteristics, rate of medication use
and respiratory support therapy, and severity of COVID-19 patientsin Tokyo, with the cohort of the participating institutions in Tokyo.

institutions with a view to advance the study in a multi-facetedmanner. Our current achievements are shown below.
Dashboard
In March 2021, we established the “Dashboard” that facilitatedvisual browsing of the registered cases. The Dashboard is a tool
to show the registered data with easy-to-understand tables andgraphs. This allows high level overview of the change in thenumber of critically ill patients, age and gender composition,
symptoms, comorbidities, medication, respiratory support therapy,
smoking status, etc. It also enables the users
to specify the relevant areas and periods todisplay the case data within the ranges.

Period can be specified

The composition, symptoms, and treatment of inpatientscan be seen at a glance.

24

Figure 3 Symposium

Figure 1 Website

The proportion of critically ill patients in those admitted ineach wave of the pandemic can be confirmed.

Prefecture can be specified

Figure 4 Cases of death from COVID-19 analyzed by the COVID-19
Advisory Board of MHLWThe “visually perceptible” data of the
COVID-19 inpatients is available for anyone
including the general public and healthcare
providers (https://covid-registry.ncgm.go.jp/
dashboard/) (Figure 2).
Academic publications
We share the registered data with theinstitutions registering information to help
them understand their current status andprepare statistical reports. We also provide
opportunities for the institutions to researchnation-wide data if they submit an application
for data use and a study plan, and obtainapproval by the peer review committee.
As of September 2022, 110 data from single
facilities and 50 data from multiple facilities
are made available. And we have reported 29
papers.

To broadly provide findings from the studies utilizing the registrydata, the “COVIREGI Study Report Symposium” is held periodically,
mainly focusing on the reporting of study outcomes. (Figure 3)
In the third Symposium held on July 26, 2022, the Secretariat
presented the comparison of the outbreak with the Delta andOmicron variants using the Dashboard. Despite the fact that thepatients admitted during the Delta outbreak were primarily intheir 30s to 50s and those during the Omicron outbreak were in
their 70s and older, the proportion of patients who eventuallyused respiratory support therapy with oxygen or steroid therapy
decreased in the Omicron outbreak. This suggested the effect ofvaccination status.
The summary of study outcomes is updated timely on the website
to facilitate information disclosure to the general public andhealthcare providers.

To obtain further findings from epidemiological studies, we needto share data with participating institutions to analyze the factors
associated with exacerbation and death from various aspects,
promote cross-sectional and longitudinal studies concerning
efficacy of medication and association with lifestyle, and evaluate
long-term prognosis, which will contribute to academic andpolitical achievements.
(Nobuaki Matstunaga)

Providing information to administrations andmunicipalities
Parallel to preparing academic papers, we provide information toadministrations and municipalities in a timely manner to reflect ourstudy in the national policy. Here we will introduce a part of ourachievements.
In the COVID-19 Advisory Board of MHLW held on September
7, 2022, the cases of death from COVID-19 were analyzed given
the increased number of deaths from the disease since July 2022.
In the comparison of death cases between the fifth and the sixth
to seventh wave of the pandemic, the rates of ventilator/nasal
high flow use and steroids prescription were lower in the sixth toseventh wave. Additionally, 90% of the cases required oxygenin both the waves. In comparison to the sixth wave, the rates ofventilator/nasal high flow use and steroids prescription further
decreased in the number of deaths in the seventh wave. It was
assumed that the proportion of patients with respiratory failure

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Special Issue February 2023

Samples from 1327 cases have been collected including those transferred from other studies

REpository of Data and Biospecimen of INfectious Disease (REBIND)
Introduction

The coronavirus disease 2019 (COVID-19) has rapidly spread over
the world to become a pandemic, and the pathogen, SARS-CoV-2,
is still causing frequent worldwide spread and convergence while
mutating repeatedly. To promptly respond to future emerging/reemerging infectious diseases including COVID-19, it is essential tocollect broad range of clinical data quickly like COVIREGI-JP, andto collect biological samples for immediate use by researchers.
Therefore, MHLW determined to collect medical information andbiological samples of emerging/re-emerging infectious diseases
including COVID-19 to establish a pubic repository that can beused for research and development. The REpository of Data andBiospecimen of INfectious Disease (REBIND) was thus launched in
2021 under the operation of MHLW.

Figure 1 Operation

Purpose and concept
The purpose of the REBIND is to establish a system that enables
rapid collection and provision for use of the clinical data andsamples of all emerging/re-emerging infectious diseases.
To promote the use in research and development, the REBIND
is also available to the third parties in Japan not involved in thecollection of clinical data or samples. Therefore, written consents
have been obtained from the sources regarding the use inacademic researches and product developments of companies,
and the use for human and pathogen genome data analyses.
Additionally, the terms of use specify that the outcomes of the useof such data/samples belong to the user, securing the rights of theusers. Moreover, the REBIND management do not use the data/
samples maintained at the REBIND in principle to secure fairness
and transparency, except in cases necessary for operation orrequested from the government for infection control.
Operation
Based on the Article 56-39 (3) of the Act on the Prevention of
Infectious Diseases and Medical Care for Patients with Infectious

Diseases (Act No. 114 of October 2, 1998), NCGM
is entrusted by MHLW and operates the REBIND
jointly with the National Institute of Infectious
Diseases, which is the “facility” of MHLW, under
the cooperation of Tohoku University, Tohoku
Medical Megabank Organization, the Institute ofMedical Science of the University of Tokyo, andFigure 2 Progress (as of September 2022)
the University of Tokyo Hospital (Figure 1). The
Steering Committee to discuss the operation policies
and the Use Review Committee to accept medical
information and samples and review applications
and the data pertaining to the human whole-genome analysis andfor data/sample provision are also established with participation ofvirus whole-genome analysis obtained from the collected samples
third parties as members.
are available for use in principle. All samples, except for those forlong-term storage, are available for use in principle.
In principle, medical institutions involved in the treatment of
infectious diseases in Japan are responsible for the collection of
Progressdata and samples as collaborating research organizations specified
The collection of data and samples for the REBIND was started
in the “Ethical Guidelines for Medical and Biological Researchby NCGM in October 2021, and then by 14 medical institutions
Involving Human Subjects” (those not conducting research based
nationwide in FY2021, including all designated medical institutions
on research plans but only collecting samples and data from thefor specified infectious diseases. In FY2022, the participation ofresearch targets and providing them to research institutions).
medical institutions, mainly designated medical institutions forClass I infectious diseases, will be further promoted.
The COVIREGI-JP has been operated under administration costs of
the REBIND since 2021 when the REBIND was launched. However,All the data and samples collected for the REBIND so far are fromas the COVIREGI-JP is an opt-out registry study and the procedure
inpatients with COVID-19. As of September 2022, 486 cases
for use is different from that for the REBIND, it is operated in thehave been registered at the medical institutions participating in
way before launch of the REBIND.
the REBIND, and samples from 1327 cases have been collected,
including those transferred from other studies (Figure 2). As theData and samples handled
clinical data is or will be obtained for each sample, all samples will
The REBIND currently includes COVID-19 as a target disease. It
be maintained with relevant data.
plans to add mpox and pediatric hepatitis as target diseases in
FY2022.
For the use of these data and samples, as of September 2022,
small number of applications are to be accepted on a trial basis,
The medical information on COVID-19 is collected using electronic
and the general applications will be accepted after the trial
data capture (EDC) for the same items as those in the COVID-19
operation.
registry study COVIREGI-JP. Other data collection methods arealso being introduced, such as semiautomatic collection from
Lastly, we would like to express our sincere gratitude to theelectronic health records and receipt processing systems, aiming topatients, their families, and healthcare providers who havesave labor and improve data accuracy in medical institutions. The
been taking care of COVID-19 patients for their cooperation
samples being collected at this moment are blood, nasopharyngeal
with the COVIREGI-JP and the REBIND, and appreciate theirswab, and saliva for COVID-19, and the blood samples are used
continued support.
to prepare plasma, DNA, and peripheral blood mononuclear cells(Kazuo Izumi)(PBMCs), and nasopharyngeal swab and saliva samples to isolate
viruses. Other samples such as stools will be added in the future.
The data and samples collected for other research will also be
accepted after the review by the REBIND Use Review Committee.
For the data and samples maintained at the REBIND, third parties inJapan can apply for the use. The data and samples of REBIND will
be available to such parties after the approval of the research plan
to use them by the Ethical Review Board and approval of use by
the REBIND Use Review Committee. All the collected clinical data26

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8Special Issue February 2023

Releasing of Academic Achievements
Peipei Song, Chief, Division of Global Health & Medicine, Center for Clinical Sciences, NCGM
Wataru Sugiura, Director-General, Center for Clinical Sciences, NCGM
Yasuhide Yamada, Director, Medical Research Department, Bureau of Strategic Planning, NCGM

achievements with the topic "Response to COVID-19: Sharing
Academic Findings", and Japanese abstracts are summarized byfield (Figure 1).
In addition, Japanese abstracts and bibliographic information
are also available on the NCGM website for published articles
in which NCGM staff are the first or corresponding authors(Figure 2). Many papers on important topics are summarized,
including gender differences in risk of severe diseases, antibody
titer after vaccination and smoking/drinking habits, predictorsof silent hypoxia, prolonged symptoms after COVID-19 illness,characterization of Omicron/BA.2 mutant strains, prediction ofsevere condition by interferon-lambda 3 (IFN λ3), and effects ofvaccination on the elderly.

The Meeting of NCGM COVID-19 Academic Advisory Board / Publication Committee held on October 25, 2022.

The ”NCGM Novel Coronavirus Infection Academic Advisory
Board” (Current Chair: Wataru Sugiura, Director of the Centerfor Clinical Sciences) was established on February 7, 2020 for the
purpose of consolidating research and development information on
COVID-19, utilizing limited resources within NCGM, and exploring
possibilities for cross-organizational support. The Advisory Board
is comprised of executive members from NCGM, including thePresident, the staff from the Center Hospital, Research Institute,
Center for Clinical Sciences, and Bureau of International Health
Cooperation, and 64 meetings have been held so far. New
research proposals are registered with the Committee at the
beginning of the project, and the progress of ongoing research
proposals is updated as needed to capture the evolving status of
COVID-19 research and development. To date, 136 projects havebeen registered.
Apart from the Academic Advisory Board, the “NCGM COVID-19
Publication Committee” was established in March 2020 tosupport the publication of papers from NCGM in a strategic andtimely manner. The committee has met 41 times so far, with the
President, center executives and researchers attending to share
updates on the COVID-19 papers and discuss ways to advancethe timely dissemination of academic information in response to
the pandemic. To date, 296 academic papers on COVID-19 with
NCGM staff as authors have been published. Of these, 281 papers(116 in clinical research, 29 in basic research, 66 in epidemiologicalresearch, and 70 in global health research) published by July
2022 are collected and published as a collection of research

Since the outbreak of COVID-19, many articles containing the latest
research findings have been published on Global Health & Medicine(https://www.globalhealthmedicine.com) – an international, openaccess, peer-reviewed journal, published by NCGM. In particular,
the three issues of “GHM Special Topic: COVID-19” (April 2020,
Vol.2, No.2; April 2021, Vol.3, No.2; April 2022, Vol.4, No.2)(Figure 3, A-C) collected a range of articles describing COVID-19
based on frontline data from Japan, China, the United States, Italy,
the United Kingdom, and other counties and areas worldwide. To
date, 87 articles including 59 from NCGM have been published,
and a dedicated website on COVID-19 has also been created(https://www.globalhealthmedicine.com/site/topics.html).
(C)

Figure 2 COVID-19 related papers are available
on the NCGM website.
https://www.ncgm.go.jp/covid19/academicpaper.htm

In addition, as the journal is included in PMC (PubMed Central,a free full-text archive of biomedical and life sciences journal
literature at the U.S. National Institutes of Health's National Libraryof Medicine), all published article are available on PubMed/PMC,with the goal of creating a global information network for the
publication of high-quality original research.
Moreover, NCGM launched the second international academic
journal – GHM Open (Print ISSN 2436-293X, Online ISSN 24362956; https://www.ghmopen.com) – in August 2021, with thegoal of creating a network to share global health informationand findings from basic science and clinical science for use inpractice. To date, 8 papers on COVID-19 have been published in
GHM Open. NCGM will continue to communicate its response
experience and research findings on COVID-19 through scientificpapers, SNS and websites as a shared asset for humanity.
(Data as of September 2022)

(D)

(B)
(A)

Figure 1 (A) Cover page of the collection of research achievements and (B) changes in the number of publications for papers
related to COVID-19 with NCGM staff as authors.
(A)

(B)

Figure 3 Three issues of “GHM Special Topic: COVID-19” published in (A) April 2020, (B) April 2021, (C) April 2022, and (D) the latest
issue published in October 2022.

28

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9Special Issue February 2023

Policy Recommendations
Norio Ohmagari, Director, Disease Control and Prevention Center (DCC), Center Hospital, NCGM

Medical institutions and the administration must work in unison tohandle the COVID-19 pandemic. We at NCGM have contributed tovarious cases from administrative issues to policy recommendations.
Our staff members were dispatched to support MHLW in their
mission to address the issues on the Diamond Princess which
had anchored in Yokohama Port in February 2020. Also, we
supported the members of the United States Public Health Service
Commissioned Corps, a subordinate body of the Department
of Health and Human Services (HHS) that visited Japan to help
American citizens on the cruise ship return to their home country.
Their mission was to assess the situation of American COVID-19
patients who were critically ill and hospitalized in Japan andsupport them and their family. NCGM helped the team collaborate
with Japanese medical institutions in providing care to the patientsand their families (Photo 1).
Due to these circumstances, an unapproved drug remdesivir was
decided to be subject to compassionate use not only to criticallyill American patients but also Japanese and other international
COVID-19 patients. It was administered to nine patients in Japan.
In order to develop necessary drugs for COVID-19 treatment
speedily, we started preparing for global clinical trials of remdesivir
in collaboration with the U.S. NIH, which was commissioned by
MHLW, and launched the investigator-initiated clinical trials on
March 25, 2020 (Photo 2). We also established the COVID-19
registry COVIREGI-JP, in which 689 institutions participated and72,758 cases were registered as of September 26, 2022. Following
that, we established the REpository of Data and Biospecimenof INfectious Disease (RIBIND) in April 2021. The REBIND is a

Photo 1 Commemorative photo taken on the day before departure of the UnitedStates Public Health Service Commissioned Corps.

Photo 2 Taken with two doctors who visited us
from the U.S. NIH for the meeting of global
clinical trials.

30

repository of patient data and samples that collects the clinicaldata and clinical samples from patients with emerging/re-emerging
infectious diseases for centralized management and for thepromotion of development and research inside and outside Japanas a “preparation” to combat COVID-19 and future emerging/reemerging infectious diseases. The REBIND has been commissioned
to NCGM by MHLW as part of the measures against emerging/re-emerging infectious diseases and is operated jointly with the
National Institute of Infectious Diseases (NIID).
NCGM has been playing an active part in the treatment of
COVID-19 in Tokyo. Especially in the seventh wave of the pandemic
in the summer of 2022, we treated many COVID-19 patients at our
Hospital. During the COVID-19 outbreaks, the entire emergency
care system in Tokyo came under increasing strain, and in many
hospitals the malfunction due to nosocomial infection, etc. led tolimited capacity to accept ambulances. Under such circumstances,the Emergency Department of NCGM accepted many ambulances.
There were many cases where ambulances carrying COVID-19
patients had difficulty in finding an available hospital, and we
accepted many of them at the same time and treated the patientsin the car.
Since February 2020, we have dispatched our staff members to theExpert Meeting on Novel Coronavirus Disease Control convened
by MHLW, where they provide advice and made proposals to thegovernment from the standpoint of medical experts engaged in
the treatment of COVID-19. We have also dispatched our staff
members to the Novel Coronavirus Infection Monitoring Meeting
held by the Tokyo Metropolitan Government to attend as advisers
for the Government’s measures against COVID-19, assessing the
spread of COVID-19 and the status of medical institutions weekly
and providing advice on the measures (Photo 3). Additionally, we
dispatched our staff as members of the Development Committee
for “Coronavirus Disease 2019 (COVID-19) Treatment Guidelines”
and “Coronavirus Disease 2019 (COVID-19) Pathogen Testing
Guidelines,” and contributed to the establishment of national
treatment guidelines. Our executive members have frequently
communicated with the staff from the Cabinet Secretariat,
MHLW and the Tokyo Metropolitan
Government and shared the COVID-19
status information, and we have provided
frank opinions regarding the medical caresystem from the viewpoint of staff in thefield. On August 23, 2022, the Ministerof MHLW, Mr. Kato, visited NCGM andhad a meeting, where we reported
detailed current status in medical settingsand exchanged frank opinions for
improvement of the medical care system.

Photo 3 Press conference with the Tokyo Governor
Yuriko Koike.

10

Responses to COVID-19 Outbreakin Hospitals/Facilities
Yumiko Fujitomo, Chief, Information and Education Division, AMR Clinical Reference Center,
Center Hospital, NCGM

The AMR Clinical Reference Center has continued its activities aspart of the Infection Control Team of Tokyo Center for Infectious
Disease Control and Prevention (iCDC) to help hospitals andelderly facilities in Tokyo deal with the COVID-19 outbreak. We as
infection control specialists assist in the specialized tasks involvedin epidemiological studies and nosocomial infection control in
the respective hospitals/facilities in response to the requests frommunicipalities, and have provided assistance in 52 outbreak cases (in47 hospitals and five facilities) from July 2021 to August 2022. We
have been acting to aid early termination of the outbreaks, and tohelp create a foundation for voluntary and continuous updating of
measures in preparation
for future COVID-19
outbreaks. Many of thehospitals/facilities haveenhanced their ordinary
measures against

Preventive measure with zoning

COVID-19 and have become capable to respond to the patients on
their own according to our advice during the assistance period.
In the autumn of 2021, we visited four Tokyo metropolitan schools(special schools, junior high and high schools) to provide infection
control education. This has taken place upon request of the Tokyo
Metropolitan Board of Education as part of the measures toprevent infection clusters in metropolitan schools. We discussedwith the teachers how to prevent infections in various settings at
the schools where many students stay.
Insights gained from our mission are utilized for education of
the staff in Tokyo metropolitan hospitals and health centers, andare being reflected in the establishment of a new system andpreparation for outbreaks expected in healthcare institutions.

Infection control education at a Tokyo metropolitan
schoolAdvice on ventilation was also given

Infection control education is vital for healthcare providers to work safely. Implementing basic measures in a constant and continuous manner is the key.

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Special Issue February 2023

The Fever Clinic and the CommunityBased “Shinjuku Model” System

11

Makoto Tokuhara, Former Director, Division of Regional Medical Liaison and Public Relations,Center Hospital, NCGM
Photo 1 Katsunobu Kato, Minister of Health, Labour and Welfare (frontrow, 3rd from the right) inspects the “Shinjuku Model”(April 23, 2020)

Negative

Positive rate

18 9
0 0

22 19
17
0 2 0

28
0

0

3
0

2
1

23 19 20 27
0

3

3

1

3

6
8

1

63 66
59

67

46 51

22 22 72
15 14 13
1
1

66
49

36

32

17 16
3 0 1 2

47

46

54

35
7
3

41
24

43

29 28
4
4

8
8

24

33
17 16

Seibo
LiaisonWorsening of condition

Tokyo Metropolitan
Government Bed
Management

HotelsLow severity

Positive

Negative

Result not yet in/submitted for retesting

40%
0

250

210

0

215

150

101
97

100

59

85

69

37

54

51

50

60

59

46 41 80

156

107

68

74

107

185
146

148

136

0

66

79
40 43 34 49

79
44

48

47

69

0

10%
0%

154
123
134
109

135

92
81

58

40
44
56
42
66 37 28 38 28 33 17 14 21 30 21 17 20
53 48
67
45 50
32 29 32 35
39
36
32 37
51
34 44
28
4 4 1 2 2 5 5 0 1 0 0 1 3 0 3 0 2 3 2 1 3 4 7 3 2 2 1 5 11 7 9 8 12 7 5 8 8 9 12 11 18 26 15

49

0

20%

0

0

0

168

30%
0

1

200

50

50%

0

0

Positive rate

34

15 10
15
12 11 9 13 11 12
6 6
2 3•Shinjuku City
Medical Assoc.
•Shinjuku City
Pharmaceutical
Patient Care Assoc.
•Shinjuku City Office

Rest at home

83
56 48

58

33 39

40

4/
2
4/ 7
2
4/ 8
30
5/
1
5/
6
5/
7
5/
5/ 8
11
5/
1
5/ 2
1
5/ 3
14
5/
1
5/ 5
1
5/ 8
1
5/ 9
2
5/ 0
21
5/
2
5/ 2
2
5/ 5
2
5/ 6
2
5/ 7
28
5/
29
6/
1
6/
2
6/
3
6/
4
6/
5
6/
8
6/
6/ 9
10
6/
1
6/ 1
1
6/ 2
15
6/
1
6/ 6
1
6/ 7
1
6/ 8
1
6/ 9
22
6/
2
6/ 3
2
6/ 4
2
6/ 5
2
6/ 6
29
6/
30
7/
1
7/
2
7/
3
7/
6
7/
7
7/
8
7/
7/ 9
10
7/
1
7/ 3
1
7/ 4
15
7/
1
7/ 6
1
7/ 7
2
7/ 0
2
7/ 1
22
7/
2
7/ 7
2
7/ 8
2
7/ 9
3
7/ 0
31

54
46

66

Ohkubomoderate severity

positive results

300

Number of patients

81

0%

121

PCR + Sat O2

JCHO Tokyo
YamateJCHO Tokyo
Shinjuku

Source: The Shinjuku City press conference on April 15, 2020

50%

10%
66

Keio University

Cooperation
Shinjuku City
COVID-19 PCR
Testing Center
Shinjuku City Public(located in the
Health Office
Low toNCGM)
Notification ofGraph 2 : Transition patient numbers at Shinjuku City COVID-19 Testing Center (2020)

20%
76

NCGM
Tokyo Women’s
Medical University
Tokyo Medical
University

SevereNCGM coordinates
securing of hospital beds

MedicalQuestionnaire*Required tests andmedications

30%

36

Hospitals

Hospital bed management

Condition improves

Clinics such as
ReferralShinjuku City Medical
Association engage intelephone andface-to-faceconsultation

A medical system for speedy
testing and appropriate care forpatients’ symptoms in addition tothe outpatient clinic for returnees
and close contact persons

Commissioned by Shinjuku City to NCGM and conducted incooperation with Shinjuku City Medical Association andother bodies

Dispatch of staff

40%

3/
9
3/
10
3/
11
3/
12
3/
13
3/
14
3/
15
3/
16
3/
17
3/
18
3/
19
3/
20
3/
21
3/
22
3/
23
3/
24
3/
25
3/
26
3/
27
3/
28
3/
29
3/
30
3/
31
4/
1
4/
2
4/
3
4/
4
4/
5
4/
6
4/
7
4/
8
4/
9
4/
10
4/
11
4/
12
4/
13
4/
14
4/
15
4/
16
4/
17
4/
18
4/
19
4/
20
4/
21
4/
22
4/
23
4/
24
4/
25
4/
26

Number of patients32• Shinjuku City
Medical Association• Hospitals and clinics*Numbers between March 9 and April 26, 2020 include PCR testing of
emergency medical care patients, outpatients and inpatients

Graph 1 : Transition of outpatient fever clinic consultations
Positive

Shinjuku Model Medical Care
System flowchart

It has been about one year since the initiation of the “Shinjuku
Model” system. During the third wave of the pandemic, the daily
number of COVID-19-positive cases exceeded 2,000 in Tokyo,
causing difficulty in the control of hospital beds. Under suchcircumstances, the “Shinjuku Model” system greatly contributed
to the facilitation of functional bed control, enabling hospital
admission of new patients soon after the discharge of recovered
patients, and admission of patients depending on the severityof their symptoms, through close communication between the
personnel in charge in each core hospital and those in the Public
Health Office.

The “Shinjuku Model” is based on two major strategies of setting
up a PCR Testing Center and of assisting in the management of
hospital beds for COVID-19 patients. The purpose of the system isto enable smooth and efficient PCR testing by establishing a PCR
Testing Center to which patients could be referred by local clinics
and medical offices if so required. Another function of the system
was to assist in securing a sufficient number of hospital beds
required by the City’s Public Health Office, by coordinating efforts

COVID-19 Shinjuku Model Medical Care System• PCR Testing Center established at NCGM by commission from Shinjuku City
• Clinics such as Shinjuku City Medical Association refer patients to the PCR
Testing Center• Hospitals in the City coordinate efforts to secure hospital beds
• Shinjuku City Medical Association cooperates in the care of patientsrecuperating at home

Shinjuku City commissioned NCGM to establish the “Shinjuku
City COVID-19 PCR Testing Center” within the Hospital (Photo 1,2). This was an unprecedented undertaking for NCGM, and were
faced with many obstacles, but with the cooperation of the various
departments, the Testing Center was able to commence operations
on April 27. The launch of the Testing Center was only madepossible by the knowledge and experience we gained through our
involvement in the medical crises of the charter plane returnees
from Wuhan, the passengers of the Diamond Princess cruise ship,
and our outpatient fever clinic. The Testing Center is staffed solely
by those working within Shinjuku municipality, with doctors,
nurses, clinical laboratory technicians, and clerical workers from
Shinjuku’s seven core hospitals as well as doctors of the Shinjuku
City Medical Association. The Testing Center was set up to
enable the testing of 200 people on weekdays between 9:00 and
11:00 AM, but in actuality we conducted testing for almost 300
patients on some days (Graph 2). The operation of the “Shinjuku
City COVID-19 PCR Testing Center” was started by Shinjuku
City in August 2020 and was relocated onto the compound of
Shinjuku Public Health Office. Core hospitals are cooperating in its
operation, and NCGM is also continuing to perform testing.

During a meeting between the President, the Hospital Director
and other top-level NCGM officials, the creation of a COVID-19
response network was proposed, connecting the Shinjuku
municipality office, Shinjuku Medical Association, and core
hospitals in Shinjuku City. We were able to garner support fromthe Shinjuku City Medical Association President Seiichi Hirasawa
and the directors of seven core hospitals in Shinjuku City (Yuko
Kitagawa of Keio University Hospital, Tamotsu Miki of Tokyo
Medical University Hospital, Kazunari Tanabe of Tokyo Women’s
Medical University Hospital, Nobuo Sekine of JCHO Tokyo Shinjuku
Medical Center, Tetsu Yano of JCHO Tokyo Yamate Medical
Center, Toshihiko Tujii of Ohkubo Hospital, and Tatsu Nakazawa of
Seibo Hospital).
On April 11, we met with Shinjuku Mayor Kenichi Yoshizumi topresent our proposal of the “Shinjuku Model” COVID-19 Medical
Care System (Chart 1).

140
130
120
110
100
90
80
70
60
50
40
30
20
10
0

Chart 1

Condition improves

between the seven core hospitals in the municipality.
Mayor Yoshizumi made the bold decision to go forward with our“Shinjuku Model” proposal, and the plan was announced at apress conference on April 15 held by the Shinjuku City Mayor, thePresident of the Shinjuku City Medical Association, and thePresident of NCGM.

Condition becomes severe

The spread of COVID-19 infections gave rise to serious problems
concerning the need for widespread PCR testing and securing asufficient number of hospital beds. NCGM started an outpatient
fever clinic on March 9, 2020, establishing a system of PCR testingfor patients with referrals from other medical institutions or who
were residents of Shinjuku City. However, by April the number ofpatients visiting the outpatient fever clinic grew to more than 100
per day, overwhelming its capacity, since doctors were required to
conduct medical consultations, perform various medical tests, andprescribe medications in addition to PCR testing. Furthermore, theincreased workload strained the staff of the Hospital’s Department
of Infectious Diseases which managed the outpatient fever clinic,
leading to concerns that the care of severely ill patients would
suffer (Graph 1).

Photo 2 “Shinjuku City COVID-19 PCR Testing Center” launched in
the NCGM Center Hospital grounds by commission from Shinjuku City

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12Special Issue February 2023

International Cooperation and Joint International Research
Azusa Iwamoto, Director, Division of Global Networking, Department of Global Network and Partnership,
Bureau of International Health Cooperation, NCGM
Motoyuki Tsuboi, Division of Global Health Policy and Research, Department of Health Planning andManagement, Bureau of International Health Cooperation, NCGM

Support for foreign
residents in JapanThe COVID-19 pandemic revealed the
difficult situations of foreigners living inJapan, who are likely to be marginalized.
The Bureau of International Health
Cooperation of NCGM participates in'Migrants' Neighbor Network & Action(MINNA)' together with 'Our SDGs Task
Force for Foreigners', 'Services for Healthin Asian African Regions (SHARE)', and
The Institute of Developing Economies',to promote improvement of access tohealth-related information and services
for foreign residents in Japan.

Takeshi Nishijima, Division of Global Health Programs Department of Health Planning and Management, Bureau ofInternational Health Cooperation, NCGM
Tatsuo Iiyama, Director, Department of International Trial (DIT), Center for Clinical Sciences, NCGM
Masato Ichikawa, Manager, Public Relations Section, Department of International Trial (DIT), Center for Clinical Sciences, NCGM

the Omicron variant was about to occur.
Under such circumstances, I contributed to implementation ofsurveillance activities for COVID-19 response and provided various
technical/strategic supports to strengthening the surveillancesystem at the COVID-19 control center of the country during the
dispatch period, based on the experience of being engaged in
multiple control measures against COVID-19 in Japan, including

analyses of epidemiological situation of COVID-19 on the cruise
ship (Glob Health Med. 2020;2:102-106) and at airports/ports(Clin Infect Dis. 2022;74:1614-1622), and in collaboration with the
National Department of Health while considering sustainability inthe resource-limited settings.
(Motoyuki Tsuboi)

COVID-19 response by WHO Regional Office for the Western PacificPhoto 1 Responding to telephone consultation from foreign residents with the NPO staff at the COVID-19
Vaccination Information Center for International Citizen(COVIC)

We have been engaged in the following
activities:(1) Dissemination of health information necessary for foreign
residents (by posting messages on the huge SNS Facebook page
managed by Vietnamese living in Japan [No. of reach: 300,000],
and conducting online questionnaire survey on the impact of
COVID-19)(2) Creation of a pathway for foreign residents in difficult situations
to access necessary healthcare services (establishment of'COVID-19 Vaccination Information Center for International
Citizen (COVIC)' to help them obtain vaccination vouchers bytelephone consultation [Photo 1])(3) Exploration to find ways to solve social, economic, and culturalissues that affect the health of foreign residents (ex: seminarseries to promote collaboration among administration,

consultation services for foreigners, public health centers,
occupational health staff, etc.)(4) Collaboration with the initiatives inside and outside Japan that
support foreigners and other vulnerable populations(e.g: publication of 'Health Handbook for Vietnamese Workers
in Japan' in cooperation with International Organization for
Migration Vietnam).
Looking ahead to the post-COVID-19 world, we will continue ourefforts to further reinforce cooperative relationship with various
partners, including foreigner communities, and tackle issues facedby foreigners and other vulnerable populations.
(Azusa Iwamoto)I have been appointed as a technical officer for antimicrobial
resistance at WHO Regional Office for the Western Pacific in
Manila, the Philippines, and appointed as a member of the WPROCOVID-19 Incident Management Support Team to be in chargeof clinical management, infection prevention and control, andresearch and science to provide support to WHO country offices
and Member States.
We take this pandemic as an opportunity to support developmentof long-term health system strengthening, especially at subnational
level, to prepare for the forthcoming outbreak of infectious
diseases.
One of our support is the reinforcement of oxygen supply systemin the Member States. Based on the situation and demands of each
Member State and from the viewpoint of long-term usefulness,

we support supplying pressure swing adsorption (PSA) oxygen
generators to 11 countries to prepare for future outbreaks of
COVID-19 and other respiratory diseases.
With support from the Disease Control and Prevention Center(DCC), WHO held meetings with the governments of Mongolia,
Laos, and Cambodia with the goal of improving their medical
systems to adjust their care pathway to cope with COVID-19
pandemic.
The DCC shared the information on Japan’s response to theoutbreak with the Omicron variant so that Member States canlearn from Japan’s experience.
(Takeshi Nishijima)Strengthening COVID-19 surveillance in Papua New Guinea
From December 2021 to March 2022, I was involved in on-site
activities in Papua New Guinea as an epidemiology consultant
for the World Health Organization (WHO) COVID-19 IncidentManagement Team through the Global Outbreak Alert andResponse Network (GOARN), an international framework
established by WHO to promptly dispatch and operate infection
control teams in times of global crises due to infectious diseases.
At that time in Papua New Guinea, the third wave of the COVID-19
pandemic with the Delta variant ended and the fourth wave with

Photo 2 Dr. Tsuboi discussing strengthening the surveillancesystem with the local staff.

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Photo 3 WHO-organized teleconferences which invited the Disease Control and Prevention Center (DCC)
and the governments of Mongolia, Laos, and Cambodia

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Special Issue February 2023

13
Joint International Research Projects

Photo1 Online international meeting of the WHO R&D Blueprint

Cooperating with other countries in the research and development of medical products to combat COVID-19
Researchers and industrial companies around the world havebeen committed to develop diagnostic tools, treatments, andvaccines to tackle the COVID-19 pandemic. Humanity has neverwitnessed such an unprecedented number of research anddevelopment projects for a single infectious disease being carriedout simultaneously throughout the world. NCGM has been
involved in international medical cooperation for 30 years, and isproviding global cooperation to the current pandemic by carryingout research and development activities.
In relation to the current pandemic, the Department ofInternational Trials of the NCGM Center for Clinical Sciences,which conducts overseas clinical trials and clinical research,
participated in international initiatives such as the WHO R&D
Blueprint, the Global Health Security Initiative (GHSI), and the
Global Research Collaboration for Infectious Disease Preparedness(GloPID-R). We also provided cooperation and assistance to morethan 40 countries/areas in securing evidences and complying withregulations for provision of technical services such as medicationand laboratory tests (Photo 1: Online international meeting of
the WHO R&D Blueprint). We promote clinical trials of drugs andvaccines, and clinical performance tests of diagnostic equipment
while complying with international laws and regulations, andprovide academic and technical assistance to establish clinical trial
platforms in each country (Photo 2: Clinical trial in Thailand).

Although a number of vaccines and therapies have beendeveloped aiming for the containment of the pandemic by 2022,
the development and research is still ongoing to respond to theemergence of variant strains, and repeated increase and decreaseof patients requiring treatment across the world.
At the end of 2021, the ARO Alliance for ASEAN & East Asia
(ARISE), an Asian platform to promote prompt clinical developmentin global emergency situations including the current pandemic,
was established primarily by NCGM (Photo 3: Signing ceremonyof ARISE). Promoting international development and researchwith various Asian institutions participating in the ARISE andcooperating with Western groups as a representative group from
Asia, we are advancing our activities to ensure delivery of necessary
vaccines and diagnostic treatments to healthcare providers in thefield.
As long as globalization and international travel continue toaccelerate, there will always be a risk of infection by viruses andother pathogens spreading across the borders. To counter thesethreats common to all humankind, a global response is required.
As a research institution with a mission to promote international
medical cooperation, we will continue to work in collaboration withinstitutions inside and outside Japan to develop diagnostic tools,
therapies, and vaccines to overcome the COVID-19 pandemic.
(Tatsuo Iiyama, Masato Ichikawa)Experience in Providing Medical Support toTemporary Medical Facilities
Nobuaki Inoue, Director, Division of Human Capacity Building, Department of Human Resource
Development, Bureau of International Health Cooperation, NCGM

1. Summary of activities
From February 21 to April 20, 2022, we implemented supportive
activities at two temporary medical facilities.
Recovery accommodation facility with enhanced medical
function (February 21 to February 28, 2022)
We were stationed in a hotel that has been newly designated asa quarantine facility to accept high-risk patients and pregnant
patients with COVID-19 in mild condition. A physician was
stationed at the facility during daytime to primarily provide
care to high-risk patients in mild condition when they needed
examination and transportation. Beds equipped with monitors,
oxygen concentrators, and ECG monitors were placed in the
hotel lobby, and we treated the patients in cooperation with thenurses dispatched from all over Japan and staff from the Tokyo
Metropolitan Government.
Facility dedicated for the medical care of elderly patients(March 1 to April 20, 2022)
After March 2022, we were dispatched to the facility dedicatedfor the care of elderly patients. The facility opened at the endof February as a temporary medical facility under the special
measures law, and it accepted patients from elderly facilities who
tested positive and treated those patients for whom we could
deal with supplemental oxygen, infusion, antibiotics, antiviraldrugs, etc. We also directly accepted dialysis patients and elderly
patients emergently transported to the facility. The facility initially
had approximately 50 beds, and then increased its capacity toaccommodate approximately 120 beds.

We provided a wide range of medical assistance, including
the health check at admission, giving instructions for healthmanagement during admission based on the patients’ underlying
diseases, and response to the newly emergent symptoms,
exacerbation, and falls during admission.
2. Looking back the activities
We had a chance to work at the medical facilities newly establishedby the Tokyo Metropolitan Government to respond to the medical
demands due to increased number of infected people. While inthe surge of people requiring medical care and lack of attending
physicians, we believe we have been able to render some help.
We especially thought that our activities, which have beenpromoted in close communication with other staff concerned, tofind feasible solution with limited medical resources in the placewith insufficient medical supply system were applicable to medical
settings in low- and middle-income countries where the Bureau ofInternational Health Cooperation is mainly engaged in their duties.
Meanwhile, we had difficulties while performing our duties in thefacility, which was not originally used as a medical institution, at
almost the same level as we do in a hospital. We do not know
when we will experience similar situations again, but we consider
we need to discipline and train ourselves for future emergencies.
(Nobuaki Inoue)

Entrance of the Yellow zone in the facility dedicated forthe medical care of elderly patients. Partitions
were placed to prevent people coming and goingfrom contacting.
Photo 3 Signing ceremony of ARISE
Photo 2 Clinical trial in Thailand

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Beds placed in the recovery accommodation facility with enhanced medical function

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14

Special Issue February 2023

Measures for the Tokyo 2020 Olympic
and Paralympic Games
Yasunori Ichimura, Division of Global Health Policy and Research, Department of Health Planningand Management, Bureau of International Health Cooperation, NCGM
Toyomitsu Tamura, Director, Division of Public Relations and Communications, Department of
Human Resouce Development, Bureau of International Health Cooperation, NCGM

Support to the Tokyo 2020 Infectious Disease
Control Centre (IDCC)
Upon request from the Tokyo Organizing Committee of the
Olympic and Paralympic Games, the Bureau of International Health
Cooperation of NCGM supported the IDCC for public healthsurveillance. Five physicians experienced in managing surveillancedata and working for the government/relevant agencies took
responsibility in rotation, contributing to this work of a total of 69
person-days for 65 days from July 6 to September 8, 2021.
Our primary duty was the support for a daily report of public healthsurveillance including syndromic surveillance and environmental
surveillance, and we helped organize and standardize the method
to collect the necessary data on the report items, which wereshared every day among the relevant organizations before, during,
and after the Olympic and Paralympic Games, and also helped
prepare the report. Additionally, we gathered data on COVID-19
cases among the authorized persons of the Games, checked thepeople who reported the symptoms among athletes and listed
persons requiring action, and made as required summaries of theresults of screening tests, and COVID-19 cases. Moreover, weorganized data on relevant tests and surveillance. This information
was reported to the supervising team of the IDCC properly tofacilitate subsequent responses.
Through the practical experience in information management ofdiseases in the global event of the Olympic and Paralympic Gamesin the face of the spread of COVID-19, we had an opportunity toreview responses to health emergency management on infectious
diseases inside and outside Japan.
(Yasunori Ichimura)

15

In Closing:
Preparing for the Post-COVID-19 Era
Teiji Takei, Director-General, Bureau of Strategic Planning, NCGM

Contribution to enhance infection control measures at the athlete’svillage of the Tokyo 2020 Olympic and Paralympic Games
NCGM contributed to the establishment and management of the
PCR test area of COVID-19 for the athletes who were identified
as close contacts in the athlete's village of the Tokyo 2020
Olympic and Paralympic Games. We provided PCR tests withnasopharyngeal swab to the athletes for 14 consecutive days perperson in this area.
NCGM dispatched the staff from the Bureau of International
Health Cooperation and the National College of Nursing, Japan tothe athlete's village for 53 days. The total number of dispatchedstaff was 275, including 58 medical doctors, 97 nurses, and 120
administrative staff.
In this test area, the following seven tasks were primarily
performed:(1) Establishment and operation of the test system (infection
control, patient registration, management of test results,
preparation of emergency procedures, etc.)(2) Test implementation (reception, sample collection, guidance,
environmental maintenance, etc.)(3) Technical support (training of sample collection, etc.)(4) Equipment management (placement and replenishment ofequipment and materials, etc.)(5) Simple statistical analysis (reporting of results, descriptive
statistics, etc.)(6) Language support (interpretation in English, French, Spanish,etc.)(7) Administrative procedures (arrangement of village entry
procedures, etc.)
As a result, we dealt with a large number of samples andcontributed to the enhancement of infection control measureswith the staff of the Olympic and Paralympic Games. These
activities were highly evaluated, for which we received a certificate
of appreciation from Seiko Hashimoto, the President of the Tokyo
2020 Organizing Committee.
(Toyomitsu Tamura)

Photo 2 Certificate of appreciation from President Seiko
Hashimoto to the NCGM President Norihiro Kokudo.

Despite the fact that all the countries in the world have been
making substantive efforts to end the COVID-19 pandemic
for more than three years, future prospects still remain
uncertain. Even if this pandemic comes to an end, there is no
end to the ongoing battle between humans and emerging/re-emerging infectious diseases. Just in the past two decadesof this century, we have witnessed numerous emerging/reemerging diseases around the globe; SARS, H5N1 highly
pathogenic avian influenza, the A/H1N1 swine flu, MERS,
Ebola hemorrhagic fever, Zika fever, and now COVID-19.
These diseases have threatened our lives and caused socialand economic turmoil.
In the post-COVID-19 era, we must build back effective
healthcare and social systems to fight against the threats ofemerging/re-emerging diseases to prepare for next
infectious disease crisis. NCGM is committed to playing apivotal role in continuously protecting human lives and society
from emerging/re-emerging infectious diseases, based on an
academic foundation in fields broadly ranging frombasic medical science to highly advanced medical care andsocial medicine.

Blue Impulse's flight celebrating the Tokyo 2020 Paralympic
Games opening ceremony on August 24, 2021. The phototaken from the 16th floor of the Center Hospital of NCGM
looking in the direction of Yoyogi.

Photo 1 PPE donning/doffing training in the test area of the athlete's village.

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Special Issue February 2023

Acknowledgements
We are going into the fourth year since NCGM has started the treatment andresearch of COVID-19. After July 2021 when we issued the second edition of
the Feel the NCGM Special Issue, we repeatedly experienced the big waves of
COVID-19 pandemic in Japan, including the fifth, sixth, seventh and eighth
outbreaks. In the fifth wave of the pandemic with the Delta variant, many patients
became critically ill, whereas the patients were mostly in mild to moderateconditions during the sixth through eighth waves in which the Omicron variant
was dominant. Meanwhile, in the seventh and eighth waves, the number of deaths
increased due to increased total number of COVID-19 patients, and as of February 1,
2023, the cumulative number of deaths from COVID-19 exceeded 68,000.
In the meantime, NCGM actively promoted activities such as research on "longCOVID" and infection control in the Tokyo 2020 Olympic and Paralympic Games.
We would like to express our deepest gratitude to everyone who contributed andcontinue to support NCGM to date.
Due to the surge in COVID-19 cases, the Center Hospital of NCGM partially limited
healthcare services, and either prohibited or restricted visitors. Kohnodai Hospitalof NCGM also restricted visitors. We thank all our patients and their families forunderstanding and cooperating with us.
NCGM will continue to work in unity to confront COVID-19 to save lives of affectedpatients and help them recover as soon as possible. We greatly appreciate yourcontinued support.
All staff at NCGM

Planning/issuing

Bureau of Strategic Planning, National Center for Global Health and Medicine
1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan

TEL +81-3-3202-7181

https://www.ncgm.go.jp

Printed in Japan