Tokyo Gov. Yuriko Koike on Tuesday announced a revision to the city’s guidelines on monitoring the ongoing spread of the novel coronavirus, putting more weight on the city’s health care system capacity when deciding to implement business closure requests and other virus countermeasures should they need to be restored.

The original guidelines put forward in May focused on new and untraceable cases measured on a weekly basis, as well as the number of COVID-19 patients in the city’s hospitals. The new guidelines will continue to reference case numbers but will shift the emphasis to whether hospitals are capable of accepting more patients. But it does not present numerical thresholds in those categories.

Specifically, the updated guideline will focus on seven criteria:

  1. The number of new patients.
  2. The number of new patients with an unknown infection route and its growth rate.
  3. The positivity rate of COVID-19 testing.
  4. The number of hospitalized patients.
  5. The number of phone calls made to a designated Tokyo Fire Department number consulting about a fever.
  6. The number of instances that it took more than 20 minutes to be taken to a hospital by ambulance, or five or more hospitals denied a request to accommodate a patient.
  7. The number of patients in serious condition.

Infectious disease experts then analyze the situation on a weekly basis and the Tokyo Metropolitan Government will decide what measures to take.

The guideline will be put on trial starting Wednesday and be implemented in full scale as soon as possible.

“At this point, our health care system is sound and although the situation is quite different from late March when the number of new patients soared rapidly, we need to stay vigilant over the number in the future,” Koike said during a task force meeting.

“Based on the new course of action, we’ll be monitoring the state of infection as well as the health care system. Additionally, while we exercise necessary precaution, we’ll be aiming both to prevent the disease from spreading and to keep socioeconomic activities moving.”

In May, Koike said she would consider reissuing business closure requests if the weekly average of new cases exceeds 50, more than half were untraceable or new cases increased in comparison to the week prior.

When the city’s plan was first announced in May, experts said the guidelines — which can prompt the metropolitan government to issue a Tokyo Alert, an alarm system that would attempt to warn residents through television broadcasts and illuminating major landmarks in red — are at best vague and most likely superficial.

On Tuesday, Tokyo reported 54 additional cases of coronavirus infection, with the weekly average of daily new cases at 55.1, half of which were untraceable.

The shift in monitoring criteria comes after a weeklong surge in new cases, a significant portion of which are emerging among young people in their 20s and 30s. A growing number of infections can be traced back to clusters in host and hostess clubs and other nightlife destinations.

Younger COVID-19 patients are more likely to be asymptomatic or have mild symptoms, which means they can be isolated at hotels and other designated facilities instead of being hospitalized. As of Monday, 272 COVID-19 patients were hospitalized for every 1,000 beds, and 12 patients with severe symptoms were hospitalized per 100 beds available.

The city’s decision to put forward new guidelines could be seen as an appropriate response to the ever-changing nature of this mercurial virus. But the approaching gubernatorial election on Sunday — in which Koike is seeking re-election — is drawing accusations that the city is loosening monitoring guidelines to placate voters.

But Koike already has an advantage in the election and doesn’t need this to win, said Kenneth McElwain, a professor at the University of Tokyo’s Institute of Social Sciences.

“The guidelines were unrealistic to begin with,” he said. “The governor’s only choice, at this point, was to move the goal posts.”

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