Dr Shoji Yokobori did not mince his words when he described Japan's Covid-19 response as an "abject failure", even as he acknowledged the challenges in policymaking.

The 47-year-old chairman of the Nippon Medical School Hospital's emergency and critical care medicine department told The Straits Times that the Covid-19 crisis has been the greatest challenge in his two-decade-long medical career.

His hospital had to turn away patients during Japan's third wave of infections earlier this year. While the situation in Tokyo is still "manageable" amid the current fourth wave, Dr Yokobori fears that a drastic turn for the worse is around the corner.

"No matter how the government tries to frame it, the current state of emergency is really weak," he said, frustration bubbling under his temperate tone. This reply, to the question of whether the emergency has conveyed a sense of crisis to the public, came after seconds of contemplation with his eyes closed.

The ongoing measures cover Tokyo, Osaka, Kyoto and Hyogo, which have so far been the worst-hit in the fourth wave that is being driven by deadlier and more contagious mutant strains.

Yet, despite a sluggish campaign of vaccinations that would have slowed the spread of infections, Japan is still not resorting to lockdowns and circuit breakers like other nations have. Nor has it used stronger measures like those taken during the first state of emergency last year.

Prime Minister Yoshihide Suga described the ongoing 17-day decree, which began on April 25 and is due to end on May 11, as "short, intensive, focused and powerful".

This is the shortest emergency yet, and pundits speculate that the government wants to lessen any impact on the once-delayed Olympic Games, which are slated to begin on July 23. International Olympic Committee chief Thomas Bach will visit Japan later this month.

But Mr Suga chose a middle path in support of businesses, between the drastic measures in the first emergency that shut most shops and schools for 49 days, and the second 73-day emergency this year that kept everything open with few restrictions.

This time, food and beverage outlets in emergency areas are asked to observe an 8pm curfew and told not to serve alcohol, which has been blamed for boisterous late-night conversations without masks that lead to a spread of oral droplets, potentially causing infection.

Leisure facilities such as malls, bowling alleys, museums and cinemas that are larger than 1,000 sq m are requested to close. This, however, excludes most shops, with non-essential shops like luxury designer boutiques still open.

Schools are also kept open as they are deemed "low-risk". Still, several school clusters have emerged last week, including one in Yamagata in north-east Japan with 71 cases, and another in Hiroshima in the west with 35 cases.

The emergency was meant to curtail movement during the Golden Week stretch of holidays, but millions of travellers have gone ahead with their vacations. All Nippon Airways said bookings this year soared 7.5 times over the same holiday period last year.

"Japan really needs a reset in its thinking," Dr Yokobori said, warning that the mutant strains are a different beast. "The sense of crisis has not really sunk in with the public. It is an entirely different world outside the hospital."

COLLAPSE OF MEDICAL RESOURCES

Dr Yokobori fears that a medical breakdown in Tokyo, like that in Osaka, is near.

Osaka has had to seek reinforcements for nurses from elsewhere in the country. Its hospital bed occupancy is now at 98.3 per cent, prompting governors of Tokyo and Aichi to offer to take in seriously ill patients, transported by helicopter.

The bad news keeps on coming.

A study by Tokyo's Setagaya ward last week found that 30 per cent of asymptomatic patients carried a high virus load and were likely to be infectious without exhibiting any symptoms.

The feel-good Olympic torch relay has been sullied by the Covid-19 infections of eight employees, six of whom are in the south-western prefecture of Kagoshima where the relay passed through last week. All wore masks.

Japan logged 5,879 new cases yesterday as its overall tally crossed 600,000. It took less than a month for the tally to jump by 100,000 cases.

This was led by Osaka with 1,057 cases and Tokyo with 879.

Three prefectures reset their all-time high records yesterday - Hokkaido (326), Okayama (114) and Ishikawa (40) - while Fukuoka had its second-highest single-day tally yesterday with 417 cases.

There were 1,050 patients in severe condition nationwide yesterday - also an all-time high.

Dr Yokobori said that the challenges are being compounded by issues, like how the government's Covid-19 contact-tracing app Cocoa, which has seen a low take-up rate of just 20 per cent, failed to work for four months.

Yet, he recognises the difficulties in juggling public health concerns with the need to sustain livelihoods. The number of deaths by suicide last year, at 20,919, is higher than the country's number of Covid-19 deaths thus far, at 10,398.

Mr Tokuji Hirayama, 50, runs an izakaya, Nemuro Shokudo, in Shinbashi district that is popular with scores of salarymen for after-work drinks, and he fears the latest emergency might sound the death knell for his 15-year-old business.

"I worry about being able to meet my rent," he told The Straits Times, having exhausted a bank loan and let go of 10 of his 15 staff.

Grants have not been enough for medium-sized eateries like his 95-seater - Mr Hirayama laments how owners of smaller businesses have "just closed shop and gone on holiday" - though this was recently remedied through pegging support to the impact on profit.

But he said: "It has already been a year, and I cannot see a future."

The emergency was meant to curtail movement during the Golden Week stretch of holidays, but millions of travellers have gone ahead with their vacations. All Nippon Airways said bookings this year soared 7.5 times over the same holiday period last year.

"Japan really needs a reset in its thinking," Dr Shoji Yokobori of the Nippon Medical School Hospital said, warning that the mutant strains are a different beast. "The sense of crisis has not really sunk in with the public. It is an entirely different world outside the hospital."