Osaka Prefecture reported 884 new COVID-19 cases and 20 deaths on Tuesday, according to media reports, as Gov. Hirofumi Yoshimura said the spread of the deadly virus makes it increasingly “difficult” to avoid an extension of the state of emergency due to end May 11.

Neighboring Hyogo Prefecture confirmed 337 new cases, while Kyoto Prefecture confirmed 113 infections the same day. Much of the surge in the region may be due to the spread of COVID-19 variants.

Yoshimura said the virus was continuing to take a toll on the prefecture’s medical system and that available hospital beds were dwindling, adding that he would consult with the governors of Hyogo and Kyoto, both of which are also under the emergency declaration, NHK quoted him as saying.

A decision on an extension of the state of emergency covering the three prefectures and Tokyo could come as early as Thursday or Friday.

Meanwhile, Tokyo confirmed 609 new COVID-19 cases Tuesday. The figure was lower than the 708 cases confirmed on Monday. It was also less than the 828 infections reported a week ago on April 27, and came on the second-to-last day of the Golden Week holiday period.

The caseload in Tokyo boosted the seven-day average of new cases to 842.3, compared with 746.7 the week before.

People age 65 or over, who are at high risk of developing severe symptoms, accounted for 70 of Tuesday’s cases, while people in their 20s accounted for 148 infections. The number of severely ill patients under the metropolitan government’s criteria was the same as a day earlier at 65.

The number of severely ill COVID-19 patients has stoked concerns about the state of the country’s medical system, with the health ministry reporting a record 1,084 such patients nationwide as of Monday.

On Monday, Japan reported 4,469 new infections and 50 deaths linked to the virus, including 19 in Osaka Prefecture. Osaka reported 847 cases on Monday falling below 1,000 for the first time in seven days but hitting its second-highest level for a Monday.

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