Large-scale epidemiological monitoring of the COVID-19 epidemic in Tokyo

Daisuke Yoneoka, Yuta Tanoue, Takayuki Kawashima, Shuhei Nomura, Shoi Shi, Akifumi Eguchi, Keisuke Ejima, Toshibumi Taniguchi, Haruka Sakamoto, Hiroyuki Kunishima, Stuart Gilmour, Hiroshi Nishiura, Hiroaki Miyata

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)


Background: On April 7, 2020, the Japanese government declared a state of emergency regarding the novel coronavirus (COVID-19). Given the nation-wide spread of the coronavirus in major Japanese cities and the rapid increase in the number of cases with untraceable infection routes, large-scale monitoring for capturing the current epidemiological situation of COVID-19 in Japan is urgently required. Methods: A chatbot-based healthcare system named COOPERA (COvid-19: Operation for Personalized Empowerment to Render smart prevention And AN care seeking) was developed to surveil the Japanese epidemiological situation in real-time. COOPERA asked questions regarding personal information, location, preventive actions, COVID-19 related symptoms and their residence. Empirical Bayes estimates of the age-sex-standardized incidence rate and disease mapping approach using scan statistics were utilized to identify the geographical distribution of the symptoms in Tokyo and their spatial correlation r with the identified COVID-19 cases. Findings: We analyzed 353,010 participants from Tokyo recruited from 27th March to 6th April 2020. The mean (SD) age of participants was 42.7 (12.3), and 63.4%, 36.4% or 0.2% were female, male, or others, respectively. 95.6% of participants had no subjective symptoms. We identified several geographical clusters with high spatial correlation (r = 0.9), especially in downtown areas in central Tokyo such as Shibuya and Shinjuku. Interpretation: With the global spread of COVID-19, medical resources are being depleted. A new system to monitor the epidemiological situation, COOPERA, can provide insights to assist political decision to tackle the epidemic. In addition, given that Japan has not had a strong lockdown policy to weaken the spread of the infection, our result would be useful for preparing for the second wave in other countries during the next flu season without a strong lockdown. 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).

Original languageEnglish
Article number100016
JournalThe Lancet Regional Health - Western Pacific
Publication statusPublished - 2020 Oct

ASJC Scopus subject areas

  • Internal Medicine
  • Pediatrics, Perinatology, and Child Health
  • Health Policy
  • Obstetrics and Gynaecology
  • Public Health, Environmental and Occupational Health
  • Geriatrics and Gerontology
  • Psychiatry and Mental health
  • Infectious Diseases


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