How does the impact of the COVID-19 state of emergency change? An analysis of preventive behaviors and mental health using panel data in Japan.

This study applies the difference-in-difference method on panel data collected from internet surveys to investigate changes in the preventive behaviors and mental health of individuals as influenced by the COVID-19 state of emergency declaration between March and June 2020. The key findings are: (1) The declaration led people to exhibit preventive behaviors but also generated negative emotions; (2) Such behaviors persisted even after deregulation of the state of emergency; (3) Making the declaration early (vs. late) had a larger effect on preventive behavior, with the gap between residents' behaviors for areas that made early vs. late declarations persisting after the deregulation; and (4) The effects on mental health diminished during the state of emergency and disappeared after its deregulation.

The Impact of the COVID-19 Pandemic on Physician Visits in Japan.

Background: Emerging from the coronavirus disease 2019 (COVID-19) scenario, fears of social distancing and contagion have led to a decline in the number of physician visits in Japan, placing severe financial strain on most hospitals and clinics. In this context, this study examined the impact of the spread of COVID-19 on the utilization of outpatient services. Methods: This study used monthly data drawn from the monthly statistics report of the social insurance medical fee payment fund in Japan and estimated fixed-effects models. Results: The results showed that the decline in the number of physician visits because of the first state of emergency declaration in Japan was greater than that caused by COVID-19's spread during the same period. However, there was a decline in the impact of the declaration over time. After the second state of emergency declaration, the decline in the number of physician visits caused by the spread reduced by almost half. The nationwide preschool closure under the declaration of the first state of emergency also adversely impacted the number of physician visits. The reduced healthcare per capita costs of preschool children were greater among prefectures taking specific precautions. The results showed non-negligible regional differences in physician visits of preschool children during the sample period. Conclusions: The findings imply that we should not overestimate the negative impacts of the state of emergency declaration without lockdown on physician visits. To restore the number of physician visits to its pre-pandemic level, it is crucial to facilitate a smooth transition of COVID-19 patients between hospitals and an effective compensation program for hospitals with COVID-19 patients.

An assessment of self-reported COVID-19 related symptoms of 227,898 users of a social networking service in Japan: Has the regional risk changed after the declaration of the state of emergency?

BACKGROUND: In the absence of widespread testing, symptomatic monitoring efforts may allow for understanding the epidemiological situation of the spread of coronavirus disease 2019 (COVID-19) in Japan. We obtained data from a social networking service (SNS) messaging application that monitors self-reported COVID-19 related symptoms in real time in Fukuoka Prefecture, Japan. We aimed at not only understanding the epidemiological situation of COVID-19 in the prefecture, but also highlighting the usefulness of symptomatic monitoring approaches that rely on self-reporting using SNS during a pandemic, and informing the assessment of Japan's emergency declaration over COVID-19. METHODS: We analysed symptoms data (fever over 37.5° and a strong feeling of weariness or shortness of breath), reported voluntarily via SNS chatbot by 227,898 residents of Fukuoka Prefecture during March 27 to May 3, 2020, including April 7, when a state of emergency was declared. We estimated the spatial correlation coefficient between the number of the self-reported cases of COVID-19 related symptoms and the number of PCR confirmed COVID-19 cases in the period (obtained from the prefecture website); and estimated the empirical Bayes age- and sex-standardised incidence ratio (EBSIR) of the symptoms in the period, compared before and after the declaration. The number of symptom cases was weighted by age and sex to reflect the regional population distribution according to the 2015 national census. FINDINGS: Of the participants, 3.47% reported symptoms. There was a strong spatial correlation of 0.847 (p < 0.001) at municipality level between the weighted number of self-reported symptoms and the number of COVID-19 cases for both symptoms. The EBSIR at post-code level was not likely to change remarkably before and after the declaration of the emergency, but the gap in EBSIR between high-risk and low-risk areas appeared to have increased after the declaration. INTERPRETATION: While caution is necessary as the data was limited to SNS users, the self-reported COVID-19 related symptoms considered in the study had high epidemiological evaluation ability. In addition, though based on visual assessment, after the declaration of the emergency, regional containment of the infection risk might have strengthened to some extent. SNS, which can provide a high level of real-time, voluntary symptom data collection, can be used to assess the epidemiology of a pandemic, as well as to assist in policy assessments such as emergency declarations. FUNDING: The present work was supported in part by a grant from the Ministry of Health, Labour and Welfare of Japan (H29-Gantaisaku-ippan-009).