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Vulnerabilities in Japan’s testing regime for the novel coronavirus became apparent during a government-declared state of emergency over the COVID-19 epidemic in April and May.

During the period, many people were forced to wait for much-needed polymerase chain reaction tests.

Three months after the emergency declaration on April 7, reviews suggest that the shortage of tests was caused by a lack of crisis management awareness, as the government considered the explosive spread of the virus in other countries to be unrelated to Japan.

While the government met the goal of securing a PCR testing capacity of 20,000 tests a day immediately before the lifting of its state of emergency in late May, experts say that a capacity for at least 100,000 tests per day will be necessary to respond to a possible second wave of infections.

“Discussions to urge an expansion of testing capacity did not gain momentum,” Shigeru Omi, then-deputy chairman of a government-appointed expert panel on the coronavirus, said while reflecting on Japan’s epidemic response at a news conference on May 4.

Japan’s PCR testing capacity as of mid-February, when infections began spreading in the country, stood at only several hundred tests per day. Although the capacity has now been increased to some 30,000 daily tests, partly through the use of private-sector testing companies, Japan still lags behind other countries on its testing regime.

The number of PCR tests per 1,000 population as of the end of June stood at 97 for the United States, 89 for Italy, 70 for Singapore and 24 for South Korea. For Japan, the figure was five.

The expert panel noted that public health institutes around Japan have not been adequately equipped to test patients in their prefectures, presumably because the country had no cases during the 2003 outbreak of SARS, or severe acute respiratory syndrome, unlike Singapore and South Korea.

In June 2010, an expert panel of the health ministry proposed a boost to testing regimes, including PCR tests, at public health institutes after the novel influenza epidemic, but the proposal did not lead to improvements.

“(Japan) thought SARS was an issue unrelated to it,” Showa University visiting professor Yoshihito Niki, an infectious disease expert, said. “The novel influenza was not highly virulent, so measures were not taken during ordinary times.”

“As the accuracy of antigen tests has not been sufficiently verified, we must use PCR tests in principle, and at least 100,000 tests per day are necessary,” he added.

Niki also said a second wave of infections could be larger than the first, as in the case of the Spanish flu, which began in 1918.

“Some 200,000 to 300,000 tests must be secured so that we can respond to a second wave that may be two or three times larger,” he said.

Public health institutes are already approaching full capacity in their testing, so universities are expected to play a key role in future increases in tests.

Tokyo Medical and Dental University used its research-use PCR kit to establish a system capable of administering 300 tests per week, and started using it in April. The tests, however, are aimed mainly at preventing the in-hospital spread of the virus, and are only administered to medical professionals.

“If the second wave is large, we can envision accepting test samples from the central government and the Tokyo Metropolitan Government,” Shuji Toda, a professor of laboratory testing at the university, said.

But Toda added that unique expertise such as for infection prevention measures is necessary in conducting tests, and that accepting testing requests from outside is difficult due to a shortage of manpower.

“Private-sector companies have helped increase testing capacity, but we don’t know how much it will grow from the current 30,000 daily tests, and we have not set a target,” a health ministry representative said.

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