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Japan may have no choice but to declare a state of emergency if the nationwide surge of COVID-19 infections isn’t subdued within three weeks, said Yasutoshi Nishimura, the Cabinet minister leading the country’s pandemic response, during a news conference Wednesday evening.

“The next three weeks are critical,” Nishimura said after a meeting of the government’s coronavirus subcommittee, adding that the declaration of a state of emergency will “enter the field of view” if the virus doesn’t show signs of abating during that period of time.

Top officials are beginning to sound the alarm as the virus continues to spread throughout the country, an upward trend they fear could overwhelm the health care system and prevent hospitals from providing basic medical treatment.

A sustained increase in new infections has already forced officials to roll back or suspend campaigns intended to reboot the economy through subsidies to the tourism and food industries.

Hokkaido was the first prefecture in Japan to declare a state of emergency — though it didn’t have a legal basis to do so — in late February, weeks before the central government declared an emergency in seven prefectures in early April. The order was extended nationwide 10 days later and lifted completely on May 25.

The revision of a pre-existing virus law allowed Prime Minister Shinzo Abe to make the declaration at the time. In Japan, however, instructions to self-isolate, practice social distancing, wear a mask or avoid unnecessary travel do not carry criminal penalties or monetary fines like in some other countries. Hence municipal governors can only request people stay indoors, or put forward what came to be known as a “soft” lockdown.

While the outbreak here pales in comparison to those seen in the United States, Brazil and much of Europe, the voluntary nature of the country’s COVID-19 measures has drawn criticism since the very beginning.

At the urging of both local governors and its own coronavirus subcommittee, the central government announced on Tuesday that Sapporo and Osaka will be temporarily excluded for three weeks as destinations for Go To Travel, the government’s ¥1.35 trillion domestic tourism campaign.

Residents of Sapporo and Osaka, however, are still able to use discounts afforded by the campaign to travel elsewhere.

Travel restrictions are warranted in areas deemed to have reached Stage 3 of the government coronavirus subcommittee’s four-tier system, which was implemented to monitor the situation in prefectures after the travel campaign kicked off in July.

Sapporo, Osaka, Nagoya and Tokyo’s 23 wards have already reached Stage 3, said Shigeru Omi, subcommittee chair and president of the Japan Community Healthcare Organization, on Wednesday.

Omi also said that, when suspending an area from the travel campaign, outbound trips to other places from that area should also be discouraged, not just inbound travel.

Aichi Gov. Hideaki Omura announced Thursday that restaurants in Nagoya’s nightlife district that serve alcohol will be asked to close by 9 p.m. for three weeks beginning Sunday.

Tokyo reported 481 additional cases of COVID-19 on Thursday, bringing the city’s total past 39,000 infections. The capital has reported 482 deaths.

During a meeting of the metropolitan government’s virus panel, experts warned that figures are climbing across the board, not just for new infections but also for asymptomatic cases, clusters, the city’s positive test rate, infections occurring among older people and the young, and the number of active severe cases.

“The number of people being tested, while significantly higher than it was before, has reached a plateau but new infections continue to grow rapidly,” said Norio Ohmagari, director of the Disease Control and Prevention Center, during a meeting at the Tokyo Metropolitan Government on Thursday. “If this trend continues, there is a real risk the health care system will be overwhelmed and hospitals won’t be able to provide basic medical treatment.”

Tokyo officials announced on Thursday that a repurposed hospital equipped with 100 beds specialized for COVID-19 patients will become operational on Dec. 16.

In contrast to the governors of Osaka and Hokkaido, Tokyo Gov. Yuriko Koike is reluctant to suspend national economic measures in the capital despite having to confront the country’s largest COVID-19 outbreak.

A day earlier, Koike announced that karaoke bars and food establishments that serve alcohol located within the city’s 23 wards and the western Tama region will be asked to close by 10 p.m. for three weeks beginning Saturday.

The capital also suspended “Motto Tokyo,” a localized travel subsidy program meant to supplement the central government’s campaign, and the Go To Eat campaign — a parallel program meant to assist businesses in the food industry — for roughly the same period of time.

On Saturday, Prime Minister Yoshihide Suga abruptly announced that areas experiencing the brunt of the nationwide surge will be removed from the travel campaign, and any decisions to do so will be made in close cooperation with municipal governors.

Asked whether Tokyo should be removed from Go To Travel on Wednesday, Koike pointed out that it’s a national program proposed, administered and funded by the central government.

The governor had announced just moments beforehand the temporary suspension of the Go To Eat campaign, also a national program.

In July, when the travel campaign took effect in all prefectures but Tokyo — which was in the midst of a surge in new infections — friction emerged between Suga — who was chief Cabinet secretary at the time — and Koike, who appeared to be blindsided by the capital’s exclusion.

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