TOKYO — Japan has extended a coronavirus state of emergency in Tokyo and 18 other areas until the end of September as health care systems remain under severe strain.

Prime Minister Yoshihide Suga says serious cases remain high and are still overwhelming many hospitals. Despite the prolonged emergency, the largely voluntary measures have become less effective as the exhausted public increasingly ignores them.

The extension covers a period when Japan’s government is in transition. Suga has announced he is not running in a Sept. 29 race for his party’s leadership, and his successor in that race likely will be the next prime minister. His government has faced sharp criticism over its handling of the virus.

About 49% of people have completed inoculations, with the rate expected to exceed 60% by the end of September, Nishimura says.