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Why Japan successfully combats Covid-19 without enforcing a quarantine?

Author : Maksym Krylov

Source : Carnegie Moscow Center

The spread of coronavirus has not yet been reflected in Japanese statistics, not because of the malicious intent of the authorities, but because the virus does spread slowly, and the reasons do not depend on the government
10:39, 30 March 2020

Open source

The population of Japan began to cultivate misophobia (fear of infectious diseases) and practice social distance long before the current epidemic and does not need instructions from the authorities

One of the main attractions of modern Hiroshima is its trams. This is not about the trams themselves (they are the most ordinary), but rather about the fact that during their 107 history, they did not leave the depot for only three days in August 1945. The survivors of the atomic bombardment, burnt and crippled people still wandered around the ruins of the city, trying to find their loved ones, and employees of the Hiroshima Railways were already re-laying the rails and restoring power supply.

Through their efforts, the first tram set off on the Nishi – Tammatyo – Koima route on August 9, the day the second bomb fell on Nagasaki. Of course, there was no "economic" meaning in this. The tram went on rails for the sole purpose of becoming the first good news in destroyed Hiroshima. Demonstrate the victory of the ordinary over the extraordinary.

I was reminded of this story by my personal impressions of Tokyo from the era of the coronavirus. Unlike Paris, New York or London, trying to cope with the spread of the disease through total social distance, the largest metropolitan area of ​​the world still has no thoughts to cope with.

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Yes, there are fewer people on trains, there are no more crowds of schoolchildren in the black uniform on the sidewalks, and theatergoers like me have nowhere to go on Friday evening - the March season of kabuki is canceled, as well as all other mass events. For the rest, Tokyo lives a relatively normal life: cafe, as they should, the smell of coffee, companies of office proletarians of varying degrees of sobriety fall out of restaurants on the streets in the evenings, and children in parks seem to rave about nothing.

Unless this year, sakura blossomed earlier than usual, and toilet paper for some time was the only truly valuable paper, not subject to market fluctuations. Otherwise, the ordinary here is still calmly riding on the emergency, like a Hiroshima tram on the rails.

Today, Japan is the only G7 country where the Covid-19 pandemic has not yet caused serious problems. This looks especially strange if we take into account the local population density and the fact that the coronavirus began to spread here in mid-January, as well as the rather passive reaction of the authorities to its spread.

Facts and figures

Japanese statistics on coronavirus for weeks have left observers at a loss. The website of the Ministry of Health, Labor and Welfare of one of the most developed countries in the world gives official data on the spread of the infection with a fantastic delay: on Thursday evening there were numbers for Tuesday. By the way, the site itself leaves the impression that the development of web design in Japan stopped in the late Middle Ages, but there is nothing surprising in this - it really stopped there.

But that is not the point. So, according to the Ministry of Health, by 18:00 on March 24 in the 126 millionth Japan recorded 1,193 confirmed cases of Covid-19. By this indicator, it has already been beaten not only by such large countries as Israel, Denmark, and Norway but also by giant Luxembourg.

Mortality statistics are slightly less successful, but they still do not cause feelings of a catastrophe gaining momentum: by the evening of Tuesday, 43 people died from the coronavirus in Japan - significantly more than in same Norway, but much less than three- and four-digit numbers from large European countries.

The list of amazing statistical artifacts does not end there. Let’s take a look at the data on how many people with coronavirus were placed in the intensive care unit (ICU). Indeed, in the world oldest country, where an acute infection has the most severe impact on aged people, should cause a sharp increase in hospitalization rates in critical and critical condition. Right? No! By the evening of March 24th, there were only 57 people with Covid-19 in the ICU throughout Japan.

Let us not forget about the total number of PCR tests for coronavirus, since Japan also excelled here in its modesty. As of Tuesday, it tested 23,521 people, which is about 15 times less than neighboring South Korea.

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The temptation to write off relatively good statistics on the distribution of Covid-19 to insufficient testing volumes is very great, but one circumstance prevents the saying “they do a little testing, so they have a small number of the infected.” If an unrecognized epidemic raged in Japan, the ratio of the number of patients detected to the total number of tests carried out would be rather high. But this is not so: the Japanese indicator (slightly less than 6%) is really higher than the Korean one (about 2.5%), but not by much, and this difference can easily be explained by strict selection criteria for people who can pass the PCR test.

Until now, this test (with rare exceptions) has been available only to three categories of people: those who came from countries with a difficult epidemiological situation, who had close contact with at least one sick person, and those who had a temperature above 37.5 for four days and symptoms of acute respiratory disease. Obviously, such a sample is simply obliged to give more positive results in comparison with the mass tests practiced in South Korea, which almost everyone can pass without leaving the car.

These figures explain the passivity of the measures that the Japanese government and local governments have so far tried to limit the spread of the disease. While Western Europe knew the joys of hard quarantine, Japan was moving more in the opposite direction. For example, on March 19, the emergency regime announced in Hokkaido Prefecture on February 28 was canceled, and school holidays that began because of the coronavirus earlier than usual are expected to end already in the first decade of April. To the utmost, Japan tried to hold even the Olympics on time and in full.

So where did this amazing statistical well-being come from and how is it supported?

Independent reasons

The simplest possible explanation is that official Japanese statistics for one reason or another do not reflect the real situation. For example, one of the leaders of the opposition Constitutional Democratic Party and former Minister of Health of Japan, Akira Nagatsuma, recalls that in Japan, even without the coronavirus, about 90,000 people annually die from pneumonia of various etiologies (more than 200 a day).

Bloomberg

It is very difficult to establish whether Covid-19 is hiding in this array of deaths since pathological studies in Japan are extremely rare. This version has the right to life, although it has one serious drawback: crowded hospitals in Europe and the USA clearly demonstrate that the accelerated epidemic of coronavirus cannot be hidden – it becomes immediately noticeable. Wuhan’s attempts to do this, as you know, failed very quickly.

Most likely, the spread of Covid-19 has not yet been shown in statistics, not because of the malicious intent of the Japanese government trying to hide the true extent of the problem, but because the virus is indeed spreading slowly, and for reasons independent of the government. The point here, it seems, is that the population of Japan began to cultivate misophobia (an obsessive fear of infectious diseases) and practice social distance long before it became fashionable in other countries, and continues to do it now by itself, without any sanctions of the authorities.

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Let's start with misophobia. Anyone who has heard anything about Japan knows about the almost universal Japanese habit of wearing surgical masks. There are several reasons for this, but we will focus on the main thing:  it is not customary to take sick leave in Japan. Neither SARS nor the atomic bombing, which is clear from the story of Hiroshima trams, is not a good reason for not appearing at work here. This circumstance brought to life an exotic norm: if you have a fever, sneeze, and cough, you should definitely go to work, but you should wear a mask, so as not to infect others.

The first case of coronavirus was confirmed in Japan very early, on January 16, and since then the already high demand for masks has become a rush. Even today it is almost impossible to find them in any store, but now they are on almost all faces.

Even if masks do not help healthy people avoid coronavirus infection (there is no consensus among experts on this issue), they definitely prevent patients from spreading the infection to others: the mask takes on most of the secretions expunged by the sneezing and coughing person. An indirect argument in favor of the masks is the fact that the outbreak of influenza, standard for January - February in Japan, did not happen this year - thanks to the now total masking of the population.

The situation with social distancing is still more interesting. The greatest danger to society in the context of the coronavirus epidemic, apparently, is represented by people under the age of 35: they often tolerate the disease asymptomatically and therefore are almost ideal invisible carriers of infection. So these very people in Japan have long and very well isolated - both from those at risk of developing complications and from each other.

First, Japanese large cities where the epidemic is spreading faster, are much younger than smaller cities and towns, not to mention the countryside. People in megacities almost do not live in families consisting of several generations; moreover, the average young Japanese generally sees his older relatives in the province twice a year. This creates a kind of barrier that protects older Japanese from infection, and this barrier does not break even when the elderly require daily care: according to statistics, more than 50% of people over 65 receive it from spouses of the same age category, and not from children or grandchildren.

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Secondly, Japanese urban youth, in fact, are very lonely in themselves. At least 1.5% of people aged 15 to 39 years old are classified by the local statistics as “hikikomori” - not students and not working voluntary recluses who have not left their apartments for months and years. Those who nevertheless leave the apartments, as a rule, ply along the work-home route: the first takes them so much time and effort that all leisure comes down to sitting and lying in the second. With personal life, things are even worse: almost 70% of Japanese and almost 60% of Japanese women aged 18 to 34 are not romantically involved, and a quarter of men under the age of 50 are still single.

However, even married Japanese are not the most promising carriers for a virus that prefers to spread through close physical contact. The percentage of married and sexually active people in Japan is one of the lowest in the world, and the percentage of couples sleeping in different beds is one of the highest.

If we add to this the nods that replace shaking hands here, the disapproving attitude to expressing romantic feelings in public and the lack of a habit of visiting each other, the conclusion suggests itself: the coronavirus epidemic simply came across in Japan an even stronger epidemic of loneliness, which created for Covid- 19 very unfavorable environment for distribution.

Are come, but not gone

However, even if the assumptions described are true, this does not mean that Japan has a magical immunity to Covid-19. Apparently, while she was just lucky: millions of people cloaked in masks, for many of whom social distancing is a sad fact of life, and not a conscious choice, became extremely unpleasant news for the virus and slowed its spread. Slowed down, but did not stop. The Ides of March are come, aye, Caesar, did not gone.

The bad news for Japan is that a sluggish epidemic is creating a false sense of security among the authorities and society, which could lead to dire consequences. The first alarm bell rang on March 25, when Tokyo Prefecture reported a record number of new cases of coronavirus detected per day.

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The figure by European and American standards came out quite modest - only 41 people. But it is alarming here that the surge was preceded by a three-day weekend, which coincided in Tokyo with the peak of sakura blossom and warm sunny weather. The sad conclusions and not very favorable forecasts here beg for themselves.

The Tokyo authorities reacted instantly, although, as before, with restraint: Governor Yuriko Koike addressed the city on Wednesday evening, asking them not to leave their homes next weekend if possible. Will Japan, which has so far remained aloof from the global anti-flash mob, be able to limit itself in the fight against coronavirus by unhindered requests to its disguised lonely population and continue to demonstrate to the world the victory of the ordinary over the emergency? We will find out the answer to this question very soon.

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