New cases of COVID-19 are rising again around the nation, but local governments and health officials may be better prepared after learning harsh lessons from the sixth wave of infections.

The spread of the Omicron variant of the novel coronavirus overwhelmed public health centers and hampered testing procedures.

These centers are considered the backbones of “early detection and isolation,” particularly in rural areas.

Local governments have streamlined or outsourced work related to the virus, including monitoring the health of COVID-19 patients. And the central government has given instructions to increase production of testing kits.

But some local governments say there are limits on how far they can adjust their systems.

In Shizuoka city, the number of daily new infections has increased to levels seen before COVID-19 pre-emergency measures were lifted around the country on March 21.

On one night after normal working hours in mid-March, before the anti-virus measures were dropped, six officials at Shizuoka city’s public health center were on phones with COVID-19 patients discussing their symptoms.

A 28-year-old official was talking to man in his 50s who was found infected with the virus on the morning of that day.

She asked the patient if he had a sore throat and told him that she would ask questions that do not require a lengthy answer.

The official normally works in another department, but on this day she was supporting her colleagues in their task of contacting COVID-19 patients over the phone.

The eightysomething mother of the man in his 50s had also been infected. The two lived together.

The official spent 20 minutes determining the health conditions and medical histories of their family members. During this 20-minute period, the public health office received a continuous stream of reports on other COVID-19 patients.

During the sixth wave, each center official called more than 20 COVID-19 patients every day until 10 p.m. But even then, they could not contact all the people who were infected.

The Shiozuka health center has since outsourced 30 percent of the health monitoring task to external medical institutions. It also reduced the number of calls it makes to asymptomatic COVID-19 patients.

However, its officials still have to visit COVID-19 patients who don’t answer the center’s calls.

“Public health nurses can’t abandon COVID-19 patients,” Kazunari Tanaka, director of the Shizuoka city public health center, said. “We can’t simplify our work anymore.”

During the sixth wave, public health centers across Japan had already increased their workforces and outsourced some of the work, but they were still extremely busy.

Public health centers in the greater Tokyo metropolitan area streamlined pandemic-related tasks to ease their workload before centers in other areas did so.

At the end of January, centers in Kanagawa Prefecture significantly simplified procedures to observe the health conditions of younger COVID-19 patients.

Centers in Tokyo restricted their monitoring of COVID-19 patients to those aged 50 and older.

The central government followed that trend in February by telling local authorities that they could limit their health monitoring to certain COVID-19 patients.

But rural areas, particularly those with aging populations and fewer hospital beds for COVID-19 patients, face difficulties in streamlining or simplifying their operations. Their public health centers play more important roles than those in urban areas in the early prevention of the spread of the novel coronavirus.

The public health center in Tottori city doubled the number of staff members from the fifth wave to the sixth wave. It continued its task of tracking down people who had come in close contact with COVID-19 patients.

A Tottori official said they must never simplify the process of contact tracing and early prevention.

Ehime Prefecture Governor Tokihiro Nakamura said on March 17 that his prefecture will not adopt the central government’s recommendation that businesses no longer need to identify workers who have come in “close contact” with an infected individual in their companies.

Nakamura said at a news conference that his prefecture still needs help from businesses because of its higher proportion of elderly people and lack of medical resources compared with urban areas.

He added that a sudden surge in COVID-19 cases could lead to the collapse of medical services in Ehime Prefecture.

Another problem highlighted in the sixth wave was a lack of testing kits for COVID-19.

Kita Shinagawa Fuji clinic, a private clinic in Tokyo’s Shinagawa Ward, nearly exhausted its supply of qualitative antigen test kits in late January. Its supplier told the clinic that it had no more kits available.

The central government in mid-January decided that dining together in large groups would be acceptable if all guests tested negative for COVID-19. That decision further increased demand for the test kits.

In addition, “close contact” people could have their self-isolation period at home reduced if they produce a negative test result.

The shortage of testing kits was further aggravated by Prime Minister Fumio Kishida’s policy that started in December to allow asymptomatic people to take free tests to ease their anxiety on whether they had caught the virus.

The health ministry at the end of January instructed wholesalers to prioritize medical institutions as buyers of the test kits.

As a result, pharmacies across the country suffered from shortage of testing kits until February.

The government has decided to secure a total of 350 million kits over the next six months.

The free testing will continue until the end of June, an extension from the initial government deadline of end of March.

However, experts say the government would need to review this policy if the virus spreads again.

(This article was written by Kai Ichino and Yuki Edamatsu.)