Japan could suffer more than 400,000 deaths from coronavirus if the country does not follow social distancing rules and other measures, according to a dire projection released by its health ministry on Wednesday.

Research commissioned by the government and carried out by Hokkaido University found that in a worst-case scenario, Japan could see some 850,000 people fall seriously ill as a result of the Covid-19 outbreak.

The report projected that 420,000 of those would die, because the country’s health system would not have the numbers of intensive care units or ventilators to cope with so many seriously ill people.

Coronavirus cases have been shown to be particularly severe among older people, and Japan has the world’s oldest population. The country has avoided a total lockdown and Japanese companies have been slow to adapt to remote working protocols, prompting fears that the country has done too little, too late to respond to the pandemic.

The new projections should serve as a wake-up call for people to enforce social distancing more stringently, said Hokkaido University professor Hiroshi Nishiura, one of the leading experts advising the government on its coronavirus response. “We can stop the transmission if all of us change our activity and significantly reduce interactions,” he told the Associated Press.

Japan has had more than 8,800 cases of infection and 231 deaths, including about 700 positive cases from a cruise ship that was quarantined at a port near Tokyo earlier this year.

Tokyo has been particularly hard hit by the virus, with about a quarter of the country’s cases, and with more hospitals and even hotels taking in patients to maintain isolation. A panel of medical experts has warned that the healthcare system in the capital is on the brink of collapse.

Prime minister Shinzo Abe declared a state of emergency in Tokyo and six other districts on 7 April, and then extended it nationwide on Saturday.

But rather than enforce a lockdown, the government has merely requested citizens not to congregate in restaurants, bars and nightclubs, which remain open.

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Mr Abe said that in order for the emergency declaration to be lifted within a month, “social interactions must be reduced by 80 per cent, or at least 70 per cent”. “To achieve this, people’s further cooperation is needed,” he said.