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What began in late June as a COVID-19 rebound in Tokyo has escalated within weeks into a nationwide surge, forcing the central government to enact the country’s strictest measures in more than a dozen of its largest prefectures.

Prime Minister Yoshihide Suga on Tuesday expanded the country’s state of emergency from six to 13 prefectures, and extended it from the end of August until mid-September, as current measures fail to pacify an unprecedented surge in coronavirus cases.

While the central government has made efforts to bolster the health care system by streamlining the hospitalization of severely ill COVID-19 patients, pandemic fatigue and the waning influence of voluntary countermeasures are casting serious doubt on the country’s ability to fight back the current wave of new infections.

Effective Friday, the state of emergency will be expanded to Ibaraki, Tochigi, Gunma, Shizuoka, Kyoto, Hyogo and Fukuoka prefectures. The order, currently in place in Tokyo, Kanagawa, Chiba, Saitama, Osaka and Okinawa until the end of August, will remain active in all 13 prefectures until Sept. 12.

Quasi-emergency measures currently effective until Friday in 13 prefectures will be extended until mid-September and expanded to 10 additional prefectures: Miyagi, Toyama, Yamanashi, Gifu, Mie, Okayama, Hiroshima, Kagawa, Ehime and Kagoshima.

“The numbers make it clear that the virus is spreading faster by orders of magnitude,” Yasutoshi Nishimura, the minister leading the country’s coronavirus response, said Tuesday morning.

“The health care system is under heavy strain not only in the capital region but throughout the country as well,” he said. “Experts say the situation resembles a disaster and that savable lives will be lost if the situation continues to worsen.”

Just as Suga expanded and extended the country’s fourth state of emergency a week before the opening ceremony of the Olympic Games, the prime minister repeated the move one week before the beginning of the Paralympics, which are slated to kick off Aug. 24.

While there’s little evidence the Olympics contributed directly to the viral surge in and around Tokyo, critics said hosting the global sporting event during a state of emergency sent the wrong message to the public, thus damaging the effectiveness of the country’s already limited COVID-19 response.

On Monday, organizers announced that fans will not be allowed to attend events during the Paralympics.

Calls to cancel the Olympics have translated to the Paralympics, but organizers remain steadfast as ever in their efforts to host a “safe and secure” event.

As of Tuesday, 37.6% of the country has been fully vaccinated. Meanwhile, the delta variant — a more contagious version of the coronavirus — has in recent weeks been detected in up to 90% of new cases in several major cities.

Nationwide cases climbed steadily from June 21, when Japan reported more than 1,300 and a state of emergency was lifted in all but Okinawa, to the nearly 5,000 seen on July 21, just two days before the opening ceremony of the Olympic Games.

On Friday, the country saw a record-breaking 20,362 cases.

The number of severely ill patients nationwide reached 1,646 on Monday — another record — and hospitals are inundated to the point that experts and public officials say it is affecting other parts of the country’s health care apparatus.

Earlier this month, Suga announced the central government would, in principle, prioritize severe or high-risk patients by asking people experiencing mild or in some cases moderate symptoms to isolate at home.

His announcement was met with swift opposition, with many citing concerns that mild and moderate patients can suddenly and unexpectedly develop severe symptoms, and that asking them to isolate at home could delay potentially life-saving treatment.

Still, hospitals in densely populated areas are becoming further inundated with each passing day as the number of COVID-19 patients continues to soar. Meanwhile, medical personnel monitoring mild or asymptomatic patients isolating at temporary facilities — repurposed hotels — or treating patients isolating at home are under great strain.

The ongoing surge in new cases isn’t just overwhelming hospitals and quarantine facilities with new patients. It’s also forcing emergency first responders to deal with an unprecedented number of calls from individuals seeking hospitalization.

Over the past week, news has proliferated of infected individuals in the capital region who passed away while isolating at home, or were forced to find treatment outside the city after they couldn’t find a hospital willing to take them in.

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