We would like to announce that the following three administrative notifications regarding countermeasures against COVID-19 in schools issued by MEXT.

Contact:
The Office for a Professional Platform of Health and Hygiene Environment in Schools for Foreign Students provided by MEXT
TEL: 050-3187-8114 (a multilingual consultation service)
Email: hsfs@mediphone.jp

（Attachment）

Infection countermeasures in anticipation of concurrent
spread of COVID-19 and seasonal influenza

MEXT
Elementary and Secondary Education Bureau,
Health Education and Food Education (Shokuiku) Division

On October 13, a task force on developing countermeasures against the concurrent spread of COVID-19 and influenza was formed, and at its first meeting, the task force decided on its “Responses in preparation for the concurrent spread of COVID-19 and seasonal influenza”. In addition, on the same day, the Subcommittee on Novel Coronavirus Disease Control compiled its “Countermeasures against the Spread of Infection from the Fall.”

These countermeasures against the spread of COVID-19 are compiled to strengthen and prioritize the health care system and further clarify points of infection countermeasures, given the possibility of more cases of infection than this summer and the concern of a concurrent outbreak with seasonal influenza. We would like to ask you to refer these documents along with the following points which should be noted in particular regarding school operation, and to continue to make all efforts to take the necessary infection countermeasures to prevent the spread of infection while continuing school activities.

1. Countermeasures in preparation for the concurrent spread of COVID-19 and seasonal influenza

[Attachment 1-1, 1-2]

(1) The figure in attachment 1* shows the “Flow of Outpatient Consultation and Treatment under the Concurrent Spread of COVID-19 and Seasonal Influenza” depending on the risk of aggravated illness and symptoms, etc., with the assumption that numerous cases of febrile illness will arise due to the concurrent spread of COVID-19 and seasonal influenza. With this conceptual image as reference, concrete outpatient consultation and treatment methods have been decided in each region throughout Japan.

After confirmation of specific ways to handle cases of illness in collaboration with local health authorities (local government departments), we would like to ask that you thoroughly share information with the schools under your jurisdiction in advance regarding responses in cases of the occurrence of persons complaining of fever and other symptoms in schools. （Attachment）

(2) In particular, recent administrative notification has requested that consideration be given concerning the receiving of COVID-related certificates from medical institutions or public health centers. Besides for COVID-19, in regard to seasonal influenza, in order to avoid overburdening health providers and authorities, please refrain from requiring persons who have fallen ill to receive certificates of test results issued by medical institutions or health authorities before or after the treatment period in order to return to their school.
Reference: “Measures for persons confirmed to be infected with COVID-19 and those in close contact with infected persons” (Administrative Notification dated August 1, 2022).
https://www.mext.go.jp/content/20220802-mxt_kouhou01-000004520_001.pdf

(3) Vaccinations are being promoted for the prevention of COVID-19 infections, onsets and the aggravation of illness. So as to enable children and parents to determine by themselves whether to be vaccinated or not, your cooperation is requested for publicizing information regarding the efficacy and possible side effects of vaccinations and locations/contacts for vaccination consultations.
Reference: “Points regarding the Implementation of Vaccinations for Infants and Children against COVID-19 Infections in Schools” (Administrative Notification dated September 6, 2022).
https://www.mext.go.jp/content/20220907-mxt_kouhou01-000004520_01.pdf

2. Countermeasures against the Spread of Infection from the Fall [Attachment 2]

The Subcommittee on Novel Coronavirus Disease Control has made the following recommendations:
○ Regarding infection countermeasures at schools, nursery schools, etc., to reduce the burden on children, schools, and public health centers and ensure as far as possible educational opportunities for children, schools need to implement effective, efficient, and concise countermeasures based on scientific knowledge and fact.
Specifically, since, compared with the elderly, children have a lower risk of developing serious COVID-19 symptoms, and frequent testing of children creates a great burden on both children and public health centers, strengthening infection prevention by testing is not realistic.

○ On the other hand, since it is expected that the concurrent increase in seasonal influenza cases will occur, countermeasures against seasonal influenza, to which children are particularly susceptible, should also be considered.

○ For that, the infection countermeasures taken up to now such as having students, teachers, and staff refrain from attending school if they feel ill, ensuring good ventilation within the school including for club activities, and so on should be further promoted based on lessons learned from increased COVID-19 outbreaks this past summer, advanced preventive measures, etc.
Specifically, schools should take thorough measures to:

• Have students refrain from attending school if they feel ill, particularly assuming that there will be a concurrent spread of seasonal influenza
• Have teachers and staff take days-off if they feel ill
• Ensure effective ventilation
• Develop countermeasures against infection when the wearing of masks is difficult

To date, successive administrative notifications based on the COVID-19 Infection Control Manuals and Guidelines for Schools (hereinafter, “Infection Control Manuals”) compiled by MEXT, recommendations compiled by the Subcommittee on Novel Coronavirus Disease Control issued in July 2022, etc. have requested that schools should thoroughly implement basic countermeasures against infection. Specifically:

• Teachers, students, etc. should have their health continuously monitored on a daily basis, and if they are ill or unwell, they should refrain from attending or going to school.
• Schools should ensure that teachers, students etc. avoid the “Three Cs” (closed spaces, crowded places, and close-contact settings), keep appropriate distance from each other, wear masks, and observe hand hygiene by frequent hand washing, and that rooms are
  well-ventilated.
  Based on these recommendations mentioned above, in anticipation of the concurrent spread of COVID-19 and seasonal influenza, we ask that all schools consider and thoroughly carry out all necessary infection countermeasures.

Reference: “The revised Basic Policies for Novel Coronavirus Disease Control” (Administrative Notification dated July 15, 2022)
https://www.mext.go.jp/content/20220719-mxt_kouhou01-000004520_01.pdf

Reference: “Thorough Ventilation to Prevent the Spread of COVID-19 and its Effective Implementation” (Administrative Notification dated September 2, 2022)
https://www.mext.go.jp/content/20220902-mxt_kouhou01-000004520_01.pdf

In particular, regarding ventilation, as referred to in “Effective Ventilation to Prevent the Spread of Infection” (recommendation from the Subcommittee on Novel Coronavirus Disease Control issued on July 14, 2022) and the current recommendation, in order to revent the spread of COVID-19, schools should use instruments for measuring carbon dioxide concentration to maintain the level of carbon dioxide concentration at less than 1,000 ppm. Based on the Infection Control Manuals, “Practical Examples of Infection ountermeasures at Schools” (issued by the Japan Society of School Health in March, 2022), etc., adequate ventilation should be ensured depending on situations and locations, including classrooms, gymnasiums, changing rooms, buses used for commuting, etc.

As in specified in the recent recommendation and the materials (Reference Material 7) provided by MEXT for the Subcommittee on Novel Coronavirus Disease Control, we would like you to refer practical examples in each region, such as dispatching ventilation experts to schools, holding seminars on “Improving COVID-19 Countermeasures”, monitoring carbon dioxide concentration levels in classrooms, and confirmation of the effects of ventilation and effective ventilation methods. Also please use as reference the “Survey Results on the Installation of Ventilation Equipment in Public Schools,” conducted by MEXT.

Particularly in the coming season, since the temperature will drop in not only cold areas but also other areas, it is expected to become difficult to maintain constant ventilation by leaving windows open. It will thus be important for schools to ensure as much as possible adequate ventilation by devising supplementary measures for ventilation such as introducing air circulators, air cleaners with HEPA filters, etc.

In addition, examples of the introduction of mechanical ventilation equipment at nursery schools and welfare facilities for the elderly are shown in Reference Material 6 from the Subcommittee on Novel Coronavirus Disease Control. In order to ensure the required ventilation, high-performance ventilation equipment (total heat exchangers) is very effective, and depending on the situation of the school facilities, the installation of such equipment should also be positively considered.

Reference: Subcommittee on Novel Coronavirus Disease Control (19th meeting)
- Reference Material 6 Reference material on ventilation
- Reference Material 7 Reference material on ensuring ventilation in schools
https://www.cas.go.jp/jp/seisaku/ful/taisakusuisin.html

The “Support for Infection Countermeasures in Schools Project” is providing support for the installation of carbon dioxide concentration monitoring instrument, air circulators, air cleaners with HEPA filters, etc.
<･･･>
Please consider utilizing these support measures.

*Attachment 1 shows outline of outpatient consultations and treatment in response to the concurrent spread of COVID-19 and seasonal influenza, which is summarized below. The figure shows a standard model; changes may arise according to the circumstances in each region (health care provision system, infection situation, etc.).

[Patients at high risk of severe symptoms and infected children younger than elementary school age]
The elderly, persons with underlying diseases, pregnant women, and elementary school children or younger who show symptoms promptly make appointments to have COVID-19 or influenza examinations at fever outpatient clinics or primary care physicians.

- In case of positive results of COVID-19 examinations
The attending physician prescribes COVID-19 treatment medication for persons deemed to be at high risk of serious illness. For other patients, the physician prescribes antipyretic medication, etc. at his/her discretion.

- In case of positive results of influenza examinations
The physician prescribes anti-influenza drug (within 48 hours of onset of fever) for persons deemed in need of medication.

- In case of negative results of both COVID-19 and influenza examinations
The physician prescribes treatment according to judgment of symptoms/causes of illness.

[For other patients]
For sufferers other than those described above, they should at first conduct a selfexamination using a COVID-19 test kit (pharmaceutically approved). However, should symptoms persist and worsen, they should promptly receive a telephone or online consultation or visit a fever outpatient clinic or primary care physician.

- In case of positive results of COVID-19 examinations
The patient registers at a health follow-up center and recuperates at home (if the patient’s condition worsens, he/she should promptly contact the health monitoring center and receive a telephone or online consultation or receive an examination at a fever outpatient clinic.)

- In case of negative results of COVID-19 examinations
If there is an influenza epidemic in the sufferer’s region, in cases where there is the possibility of infection in a facility or at home, and the person shows characteristic symptoms (acute fever, muscle pain), there is a high likelihood that the person has contracted influenza. If the person wishes a consultation, he/she receives a telephone or online consultation in the region provided by the prefecture or receives an examination by a primary care physician. The physician prescribes an anti-influenza drug (within 48 hours of onset of fever) or other treatment depending on the physician’s judgment of the symptoms/causes. If the person does not want to receive a consultation, he/she should recuperate at home (if the person’s condition worsens, he/she should promptly receive a telephone or online consultation or visit a primary care physician for an examination).