Projecting a second wave of COVID-19 in Japan with variable interventions in high-risk settings

An initial set of interventions, including the closure of host and hostess clubs and voluntary limitation of non-household contact, probably greatly contributed to reducing the disease incidence of coronavirus disease (COVID-19) in Japan, but this approach must eventually be replaced by a more sustainable strategy. To characterize such a possible exit strategy from the restrictive guidelines, we quantified the next-generation matrix, accounting for high- and low-risk transmission settings. This matrix was used to project the future incidence in Tokyo and Osaka after the state of emergency is lifted, presenting multiple 'post-emergency' scenarios with different levels of restriction. The effective reproduction numbers (R) for the increasing phase, the transition phase and the state-of-emergency phase in the first wave of the disease were estimated as 1.78 (95% credible interval (CrI): 1.73-1.82), 0.74 (95% CrI: 0.71-0.78) and 0.63 (95% CrI: 0.61-0.65), respectively, in Tokyo and as 1.58 (95% CrI: 1.51-1.64), 1.20 (95% CrI: 1.15-1.25) and 0.48 (95% CrI: 0.44-0.51), respectively, in Osaka. Projections showed that a 50% decrease in the high-risk transmission is required to keep R less than 1 in both locations-a level necessary to maintain control of the epidemic and minimize the risk of resurgence.