新型コロナウイルス感染症（COVID-19）の現状と対策

With concerns of a simultaneous COVID-19 and influenza pandemic in the winter of 2022, preparations were being made for the upcoming tightening of inpatient and outpatient care.
The mRNA vaccine, which was expected to be the trump card to converge the pandemic of COVID-19, has been shown high efficacy comparable to natural immunity by inducing humoral and cellular immunity.
m-RNA vaccination has shown strong efficacy in preventing exacerbation.
However, in the early stages of the COVID-19 epidemic, severe respiratory failure was seen in unvaccinated groups of 40s and 50s, and sometimes even in the group of 30s, severe pathology requiring intensive care management and high-level ventilator management had been essential for the treatments. As a result, the medical field has quickly tightened up and has been dealing with the situation with a sense of crisis. With repeated mutation, it is becoming increasingly understood that vaccination alone is not enough to converge the pandemic.
In addition, the infectivity of the virus has increased greatly, and even if patients are promptly isolated from the first symptomatic patient, a high percentage of patients in the same space will be infected, making it extremely difficult to control infection in hospitals and elderly care facilities.
Given these current conditions, it will be extremely difficult to control pandemics worldwide. However, as the rate of severe illness and mortality declines, a shift to category 5 infectious diseases is being discussed.
There have been multiple evidence for the efficacy of universal masks from the early stages of the COVID-19 epidemic until recently. A recent report showed that in areas where the mask wearing requirement was discontinued, there was an increase of 44.9 cases per 1,000 people infected in the following 15 weeks to people in schools that continued to wear masks, which resulted corresponds to about 30% of all new infection cases that occurred in the targeted areas for this study during this period. It is very important to continue to be aware of the need to prevent the spread of infection by wearing masks and taking precautions against droplet infection on an individual basis for those who are symptomatic. After that, new items such as partitions and vinyl curtains have been introduced, as well as new eating habits.
There have been scattered outbreaks of various infectious diseases, especially influenza every year, but we have never requested such many infection control measures for frontline healthcare workers and staff.
Probably in the future, it will be necessary to review the infection control measures in order to recreate the mid to long-term plan that has been taken at the Infection Control Department, at the University of Tokushima Hospital. The three important items to prevent COVID-19 infection are : ⑴ how to detect symptomatic patients as soon as possible, ⑵ aerosol generation techniques and wearing the N95 during cough symptom treatment, and ⑶ thorough health observation prior to admission.
However, these items were of fundamental importance in preventing outbreaks of many respiratory infections, including tuberculosis, even before the COVID-19 epidemic.
Based on our experience with cluster interventions in medical care insurance facilities and my own hospital, It is safe to consider that this new type of coronavirus infection is a category 5 infection that is no longer overly feared, although it is a pathogen that can be transmitted at high rates if certain conditions are met.
If a patient in the same room has COVID-19 and an aerosol generating procedure is performed, there is a high rate of infection in the same room. In facilities where cooperation is difficult to obtain because of dementia and so on, preventing clusters is even more difficult.
However, patients with adaptions for hospitalization should be accepted by many medical institutions as class 5 infectious diseases. If patients with non-adaption for hospitalization should be observed at each facility with the infection control measures. And then the situation should be landed back to normal as soon as possible. It must be important to fully share practical knowledge and infection control techniques that have been cultivated through know how among administrative agencies, health centers, and medical facilities.