The 2020 summer Olympic and Paralympic Games in Tokyo were postponed to July–September 2021 due to the coronavirus disease 2019 (COVID-19) pandemic. While COVID-19 has emerged as a monumental health threat for mass gathering events, heat illness must be acknowledged as a potentially large health threat for maintaining health services. We examined the number of COVID-19 admissions and the Tokyo rule for emergency medical care, in Tokyo, from March to September 2020, and investigated the weekly number of emergency transportations due to heat illness and weekly averages of the daily maximum Wet Bulb Globe Temperature (WBGT) in Tokyo in the summer (2016–2020). The peak of emergency transportations due to heat illness overlapped the resurgence of COVID-19 in 2020, and an increase of heat illness patients and WBGT has been observed. Respect for robust science is critical for the decision-making process of mass gathering events during the pandemic, and science-based countermeasures and implementations for COVID-19 will be warranted. Without urgent reconsiderations and sufficient countermeasures, the double burden of COVID-19 and heat-related illnesses in Tokyo will overwhelm the healthcare provision system, and maintaining essential health services will be challenging during the 2021 summer Olympic and Paralympic Games.

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted essential health services. Simultaneously, it has created opportunities for citizens to raise awareness of personal hygiene, mask wearing, and other preventive measures. This brief report aims to clarify the epidemiological trends of measles and rubella in Japan and to explore future challenges for controlling these diseases during and after the COVID-19 pandemic. Although Japan eliminated measles in 2015, the number of measles patients has gradually increased since then, and reached 744 in 2019. In the 2010s, Japan experienced two large rubella epidemics, and the majority of the patients were reported in Tokyo and other metropolitan areas. While the transmission of measles and rubella seems to be suppressed during the COVID-19 pandemic, closing the gap in routine childhood vaccination will be challenging in any country. Moreover, supplementary immunization campaigns for adults have also been disrupted, and they must be invigorated. While the pandemic has a devastating effect on a global scale, it should be utilized as a good opportunity to regain faith in vaccines, implement an evidence-based vaccination policy, and strengthen international cooperation.

INTRODUCTION Most studies use the prevalence of current smoking as an indicator to quantify the burden of smoking. However, length and intensity of smoking, as well as time since cessation for former smokers are also known to impact smoking-related health risks. The aim of this study was to quantify and compare the burden of smoking across the European Union (EU) using a range of smoking burden indicators. METHODS We conducted a cross-sectional analysis using data from the March 2017 Eurobarometer 87.1 (n=27901, people aged ≥15 years) in 28 European Union Member States (EU MS) and the Tobacco Control Scale. We defined five indicators of smoking burden including the prevalence of current and ever smoking, length of smoking, pack-years, and discounted pack-years, and ranked EU MS by each indicator. Two-level linear and logistic regressions were performed to assess the association between these indicators and sociodemographic and tobacco policy factors. RESULTS Wide variations across the EU countries were observed in all smoking burden indicators. While some MS ranked consistently high (e.g. Greece, France) or consistently low (e.g. Ireland, United Kingdom) in all indicators, we found substantial discrepancies in ranking depending on the indicator used for MS such as Malta, Denmark, Finland and the Netherlands. All indicators of smoking burden were lower among women and respondents without financial difficulties; however, the magnitude of those inequalities varied two-fold among the different indicators. CONCLUSIONS Using a range of smoking burden indicators can be more informative than relying on prevalence alone. Our analysis highlights the limitations of relying solely on prevalence of current smoking to estimate the burden of smoking and the potential value of more nuanced indicators. We recommend that multiple and more nuanced indicators that consider former smokers, intensity and duration of smoking should be utilized to monitor tobacco use and evaluate tobacco control policies.

The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of health emergency and disaster risk management (EDRM) to reduce the risks and impacts of infectious disease outbreaks. We investigated Japan’s response to the COVID-19 pandemic, focusing on changes made to the current health EDRM. Findings from document analysis and semi-structured interviews with six experts were integrated to provide insights into Japan’s health EDRM to improve outcomes in future health emergencies. Relevant information was extracted from COVID-19 policy documents published by the Japanese government, and the interviews validated and expanded on the data already collected. Challenges faced in the country’s response to COVID-19 and the changes made to the health EDRM framework are summarised. Findings were grouped into human resource topics (including essential health EDRM positions and safety of personnel), health service delivery topics (including public health and hospital primary care services), and logistical topics (including vaccination, personal protective equipment, patient transport, and telecommunications). These responses to the pandemic could serve as an example of good practice for other countries developing strategies for future health emergencies and disasters.

BACKGROUND Continuing to smoke tobacco products by tuberculosis (TB) patients and people living with HIV (PLHIV) leads to adverse TB and HIV treatment outcomes, respectively. There are few estimates of tobacco use among patients with TB and PLHIV in countries in the Middle East region where the burden of TB and HIV is also low but highly variable. OBJECTIVE The aim of this study was to determine the prevalence of current tobacco smoking among patients with TB and PLHIV In Jordan and to assess the association between socio-demographic characteristics and current smoking. METHODS We analysed data from the knowledge, attitude, and practice survey conducted in Jordan in 2021. In this survey information about current tobacco smoking was collected from 452 Patients with TB and 152 PLHIV. The data collected on current smoking also included products and frequency of smoking. Multivariable logistic regression was used to assess the sociodemographic characteristics that were independently associated with current smoking. RESULTS The prevalence of current tobacco smoking among patients with TB and PLHIV were 43.8% and 67.8 %, respectively. Cigarettes are the most commonly used tobacco products. The prevalence of current tobacco use was higher among males (71%) when compared to females (22%), those aged >18 years (45%) when compared with those less than 18 years (22%), Jordanians (53%), Syrians (48%) and Palestinians (45%) when compared to people from other nationalities (21%), those experiencing financial difficulties (56%) when compared to those without financial difficulties (33%) and among those employed (47%) than in those unemployed (41%). The prevalence of current tobacco use among PLHIV were higher in males (76%) when compared to females (31%) and those with financial difficulties (73%) when compared to those without financial difficulty (59%). CONCLUSIONS Nearly half of the patients with TB and PLHIV in Jordan were current tobacco smokers. There is an urgent need to introduce/strengthen smoking cessation services under the TB and HIV control programmes in the country.