Hiroyuki Noda

During the COVID-19 pandemic, while some countries succeeded in reducing their rate of death after SARS-CoV-2 infection via vaccination by the end of 2021, some of them also faced hospital capacity strain, leading to social anxiety about delays in the diagnosis and treatment of patients with other diseases. This essay presents an allegory to explain the situation during the COVID-19 pandemic. Through an allegory and Le Morte d’Arthur (Arthur’s Death), this essay indicates that “the scabbard of Excalibur” that we are looking for is an efficient and effective healthcare system that can diagnose patients who might become severely ill due to COVID-19 and to treat them without hospital capacity strain. In Le Morte d’Arthur, the scabbard of Excalibur was lost, and we have not been able to find any alternatives to end the COVID-19 pandemic. We can choose a future in which “the scabbard of Excalibur” exists, providing a different ending for the next pandemic.

漁獲量が大幅に減少しているキンメダイBeryx splendensの種苗生産を目指し，精子を冷蔵保存する溶液を開発した。塩濃度，pH等の条件を変えた種々の溶液に精子を懸濁し，一定期間冷蔵保存した精子の運動率を測定した。その結果，わずかに低張のNaCl溶液に低濃度のKClとCaCl₂，さらにグルコースとグリシンを加えたpH 7.5の溶液で長期の保存効果が得られ，最長81日間，運動能を保持したまま精子を冷蔵保存することができた。この溶液で24日間冷蔵保存した精子は受精能を保持していた。

Background: Aortic aneurysm rupture and acute aortic dissection are life‐threatening conditions and represent an ever‐growing public health challenge. Comprehensive epidemiologic investigations for their risk factors are scant. We aimed to investigate risk factors associated with mortality from aortic diseases through analysis of a community‐based Japanese cohort. Methods and Results: IPHS (Ibaraki Prefectural Health Study) comprises 95 723 participants who took part in municipal health checkups in 1993. Factors considered for analysis included age, sex, body mass index, blood pressure, serum lipids (high‐density lipoprotein [HDL] cholesterol, non‐HDL cholesterol, and triglycerides), diabetes, antihypertensive and lipid‐lowering drug use, and smoking and drinking habits. Cox proportional hazards models were applied to evaluate the associations between these variables and mortality from aortic diseases. During the median 26‐year follow‐up, 190 participants died of aortic aneurysm rupture, and 188 died of aortic dissection. An increased multivariable hazard ratio (HR) for mortality from total aortic diseases was observed for high systolic blood pressure (1.61 [1.00–2.59]), diastolic blood pressure (2.95 [1.95–4.48]), high non‐HDL cholesterol (1.63 [1.19–2.24]), low HDL cholesterol (1.86 [1.29–2.68]), and heavy (>20 cigarettes/day) smoking habit (2.46 [1.66–3.63]). A lower multivariable HR was observed for diabetes (0.50 [0.28–0.89]). Conclusions: Smoking habit, higher systolic blood pressure and diastolic blood pressure levels, higher non‐HDL, and lower HDL cholesterol levels were positively associated with mortality from total aortic diseases, whereas diabetes was inversely associated.

Aiming to evaluate a macro-level association of vaccination rate as well as booster vaccination rate with the number of confirmed COVID-19 cases in the United States and Japan, a cross-sectional study was conducted using data in each jurisdiction. Data on the total number of people who were fully vaccinated as of the end of December 2021, data on the total number of people who have received a booster dose as of the end of March 2022 and data on the cumulative number of confirmed COVID-19 cases were obtained from the website of the national governments. A generalized regression model was used to examine the association. This study showed that a higher vaccination rate was associated with a lower number of confirmed COVID-19 cases per year in 2021 for both the United States and Japan. The number of confirmed COVID-19 cases per 1000 population per year (95% confidence intervals) as a 1% increment of the vaccination rate was −0.74 (−1.29, −0.20), p = 0.007 for the United States and −1.48 (−1.95, −1.00), p < 0.0001 for Japan. A similar association was observed for the booster vaccination rate in 2022, although the association was attenuated in a multivariable model, particularly for the United States. This study provided macro-level evidence that vaccination may reduce the number of confirmed COVID-19 cases.

Aiming to identify the potentially reduced malaria cases by stagnation of international traffic after the COVID-19 pandemic, a longitudinal analysis of malaria cases as well as entries of Japanese and foreigners was conducted using data from 5 April 1999 to 30 September 2021 in Japan. Multivariable risk ratios were calculated with the Poison regression model as a predictive model of malaria cases by the number of entries for Japanese and foreigners. A generalized regression model was used to examine an association of time trend with entries for Japanese and foreigners using data before 2019, to estimate the potentially reduced number of entries after 2020. The potentially reduced number of malaria cases was estimated by the potentially reduced number of entries for Japanese and foreigners after 2020 using a multivariable Poison regression model. The multivariable risk ratio (95% confidence intervals) of malaria case numbers per 100,000 persons increment of entries per day was 3.41 (1.50–7.77) for Japanese and 1.47 (0.92–2.35) for foreigners. During 2020, a potential reduction of 28 (95% confidence limit: 22–34) malaria cases was estimated, which accounted for 58% (52–63%) of malaria cases in Japan. These finding suggest that the stagnation of international traffic during the COVID-19 pandemic reduced the number of malaria cases in Japan. This model may be helpful for countries without indigenous malaria to predict future trends of imported malaria cases.

Objective: To examine trends in effective medical treatment coverage for hypertension, diabetes and dyslipidaemia in Japan, using a metric to assess effective coverage of health interventions derived from a health system performance assessment framework. Methods: We obtained cross-sectional data for 96,863 individuals aged 40–74 years from the 15 annual Japanese National Health and Nutrition Surveys (2003–2017). We defined treatment need for hypertension, diabetes and dyslipidaemia as biomarkers equal to or greater than diagnostic thresholds or medication use. For individuals needing treatment, we conducted nearest-neighbour matching to estimate treatment effects and effective coverage, defined as the fraction of potential reductions in biomarkers actually achieved in treated individuals by medications. Results: The age-standardized prevalence of treatment need for hypertension, diabetes and dyslipidaemia remained around 40%, 7% and 33%, respectively, in 2003–2017. Average treatment effects for those treated in 2013–2017 were 14.8 mmHg (95% confidence interval: 14.2–15.4) for systolic blood pressure, 1.2 percentage points (0.8–1.6) for haemoglobin A1c and 57.9 mg/dl (56.6–59.2) for non-high-density lipoprotein cholesterol. Effective coverage significantly increased between 2003–2007 (hypertension: 48.4% [44.7–52.0], diabetes: 43.8% [35.7–51.8], dyslipidaemia: 86.3% [83.1–89.5]) and 2013–2017 (hypertension: 76.2% [74.2–78.2], diabetes: 74.7% [71.0–78.5], dyslipidaemia: 94.6% [93.3–95.9]). Conclusions: Effective coverage of medical treatment for metabolic risk factors has increased. Most of the potential reductions in non-high-density lipoprotein cholesterol have been achieved by statins. Further efforts are necessary to improve the effectiveness of antihypertensive and antidiabetic drugs.

In 2015, Japan created a unique governmental program to train experts in health emergencies called Infectious Disease Emergency Specialist (IDES). This is a concept paper to set out the goal and structure of the program, and to describe the achievement and the way forward to further contribute to global health security. The IDES program background, mission, structure, achievement, and future directions were reviewed and discussed by the IDES trainees, graduates, and program coordinators/supervisors. Since 2015, thirteen Japanese medical doctors have graduated from the program while five are currently in training. The IDES core competencies were identified in the context of a wide range of skillsets required for health emergencies. A large national and global network has been created through the training. Coordinated work with surge capacity of experts is of paramount importance to prepare for and respond to public health emergencies. The IDES program can be a good model to many other governments, and contribute to global health security.