Japan has extended a coronavirus state of emergency in Tokyo and other areas by 20 days, with infections still not slowing as it prepares to host the Olympics in just over 50 days.

Cases remain high and medical systems in Osaka, the hardest-hit area in western Japan, are still overburdened, prime minister Yoshihide Suga said in announcing the decision.

The state of emergency in the capital and eight other metropolitan areas was scheduled to end on Monday, but hospitals in some areas are still overflowing with Covid-19 patients and serious cases have recently hit new highs.

The 20-day extension covers nine areas ranging from Hokkaido in the north to Fukuoka in the south. A 10th area, the southern island prefecture of Okinawa, is already under emergency status until June 20.

Olympic organisers must decide at about that time whether to allow any fans at all, after overseas spectators were banned months ago.

A plan to prioritise vaccinations for Japanese athletes is expected to begin around then, according to media reports.

The president of the organising committee hinted on Friday that even local fans may be barred from venues.

“We would like to make a decision as soon as possible (on fans), but after the state of emergency is lifted we will assess,” Seiko Hashimoto said.

“There are many people who are saying that for the Olympic Games we have to run without spectators, although other sports are accepting spectators,” she added. “So we need to keep that in mind. We need to avoid that the local medical services are affected. We need to take those things into consideration before agreeing on the spectator count.”

The Olympics are scheduled to start on July 23 after a one-year postponement due to the pandemic, and worries about new variants and Japan’s slow vaccination rollout have triggered calls from the public, medical experts and even a sponsor to cancel the Games.

Experts have warned the variants are infecting more people, leaving them seriously ill and flooding hospitals.

Japan has lagged on vaccinations due to bureaucratic and planning missteps and shortages. Only 2.3% of the population has been fully vaccinated, and the current phase targeting older adults is not scheduled to finish before the Games start.

Mr Suga and his government remain determined to host the Olympics. The International Olympic Committee has also said the Games will go ahead even if host city Tokyo is under emergency measures.

Japan has reported about 730,000 coronavirus cases and more than 12,700 deaths.