**2. Literature review**

Infectious diseases are often prevalent after a natural disaster [8]. In particular, there are many cases of infectious diseases occurring in shelters [9–11].

The spread of infectious diseases involves multiple factors. First, stress due to major changes in the living environment [12], food shortages, and unsanitary environments increase the risk of infection [8]. Next, although an unspecified number of people live together in shelters, it has been clarified that infection is spreading in shelters where the usable area per person is small and dense [13]. In addition, disasters can paralyze medical institutions and damage healthcare workers, so inadequate provision of medical care compared to normal times contributes to the spread of infection [12].

In the Great East Japan Earthquake, there were many acute respiratory and gastrointestinal symptoms [9]. During the Kumamoto earthquake, norovirus-induced infectious gastroenteritis was prevalent [10].

The epidemic of infectious diseases after the occurrence of a natural disaster is not limited to Japan.

For example, the 2004 Sumatra earthquake and tsunami caused aspiration pneumonia, skin and wound infections [14], the 2005 hurricane Katrina spread norovirus infections in shelters [11], and the 2010 Haiti earthquake caused a cholera outbreak [15].

It is necessary to take appropriate measures against the epidemic of such infectious diseases. During the Great East Japan Earthquake, an infectious disease control team [12] and Japan Medical Association Team (JMAT) from a nearby university hospital were dispatched to shelters [16]. At the time of the Kumamoto earthquake, Kagoshima Prefecture JMAT was also dispatched, and public health activities including infectious disease control were carried out along with medical care for the victims [17]. Activities from the early stage of 5 days after the disaster are attributed to the good relationship between the medical association and the local government before the disaster and the communication function using the Web [17]. Thanks to these activities, the effects of the infection are said to have been relatively small [18].

The main activities of these organizations are the provision of medical care and surveillance of infectious diseases. As medical needs change over time, the content and scale of medical care provided by various organizations changes [19]. Early after the disaster, disaster medicine is provided, but gradually shifts to support for daily medical care in the disaster area, and the proportion of nurses decreases and the proportion of

#### *A Report of the Survey on Shelter Management under COVID-19 in Japanese Local Governments DOI: http://dx.doi.org/10.5772/intechopen.98493*

doctors increases [20]. Since conventional surveillance systems may not function or limited resources may be available in the early stages after the disaster, it is necessary to consider a system that efficiently collects infectious disease information from the early stages of the disaster [9]. In addition to relying on people with specialized knowledge, shelter operators, mainly local governments, also need basic knowledge [21] and understanding of pathogens [22] to improve the environment of shelters.

However, according to a survey conducted by Kudo et al., about 60% of local governments have prepared infection control manuals, and it cannot be said that a sufficient system is in place to prevent the spread of infectious diseases. In addition, 75% said they had insufficient knowledge about infectious diseases, and only 3% said they had sufficient knowledge [23].

As described above, infectious diseases have become prevalent in shelters after the occurrence of natural disasters, and many studies have analyzed individual cases and are considering countermeasures. However, they do not consider COVID-19 that is currently prevalent. In addition, this is a study on cases of infectious diseases that occur after natural disasters and their countermeasures, which is different from the case where natural disasters occur while infectious diseases are spreading as they are now. In order to implement effective countermeasures against COVID-19, it is necessary to understand disaster countermeasures that incorporate infectious disease countermeasures by local governments.

Therefore, the purposes of this study are i) to clarify the current status of proactive measures for shelter operation under COVID-19, and ii) to clarify the actual state and issues of shelter operation in COVID-19. These results are useful in considering countermeasures against the occurrence of natural disasters and shelter management under COVID-19.
