Underestimation of COVID-19 cases in Japan: an analysis of RT-PCR testing for COVID-19 among 47 prefectures in Japan

Journal article


Sawano, Toyoaki, Kotera, Y., Ozaki, Akihiko, Murayama, Anju, Tanimoto, Tetsuya, Sah, Ranjit and Wang, Jiwei 2020. Underestimation of COVID-19 cases in Japan: an analysis of RT-PCR testing for COVID-19 among 47 prefectures in Japan. QJM: An International Journal of Medicine. https://doi.org/10.1093/qjmed/hcaa209
AuthorsSawano, Toyoaki, Kotera, Y., Ozaki, Akihiko, Murayama, Anju, Tanimoto, Tetsuya, Sah, Ranjit and Wang, Jiwei
Abstract

Under the unique Japanese policy to restrict reverse transcriptase-polymerase chain reaction (RT-PCR) testing against severe acute respiratory syndrome coronavirus 2, a nationwide number of its confirmed cases and mortality remains to be low. Yet the information is lacking on geographical differences of these measures and their associated factors. Evaluation of prefecture-based geographical differences and associated predictors for the incidence and number of RT-PCR tests for COVID-19. Cross-sectional study using regression and correlation analysis. We retrieved domestic laboratory-confirmed cases, deaths, and the number of RT-PCR testing for COVID-19 from January 15 to April 6, 2020 in 47 prefectures in Japan, using publicly-available data by the Ministry of Health, Labour and Welfare. We did descriptive analyses of these three measures and identified significant predictors for the incidence and RT-PCR testing through multiple regression analyses and correlates with the number of deaths through correlation analysis. The median prefectural-level incidence and number of RT-PCR testing per 100,000 population were 1.14 and 38.6, respectively. Multiple regression analyses revealed that significant predictors for the incidence were prefectural-level population (p < 0.001) and the number of RT-PCR testing (p = 0.03); and those for RT-PCR testing were the incidence (p = 0.025), available beds (p = 0.045) and cluster infections (p = 0.034). Considering bidirectional association between the incidence and RT-PCR testing, there may have been an underdiagnosed population for the infection. The restraint policy for RT-PCR testing should be revisited to meet the increasing demand under the COVID-19 epidemic.

Keywordspublic health; Epidemiology; emergency medicine
Year2020
JournalQJM: An International Journal of Medicine
PublisherOxford University Press
ISSN1460-2725
1460-2393
Digital Object Identifier (DOI)https://doi.org/10.1093/qjmed/hcaa209
Web address (URL)http://hdl.handle.net/10545/624958
hdl:10545/624958
Publication dates19 Jun 2020
Publication process dates
Deposited07 Jul 2020, 14:50
AcceptedJun 2020
ContributorsFukushima Medical University, Japan, University of Derby, Tohoku University, Japan, Medical Governance Research Institute, Minato-ku, Tokyo, Japan, National Public Health Laboratory, Kathmandu, Nepal and Fudan University, Shanghai, China
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Kotera, Y., Adhikari, Prateek and Van Gordon, William 2017. Relationship between types of work motivation and worker profile in UK hospitality workers. Global Academic Excellence.
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