Japan's state of emergency is coming to an end with new cases of coronavirus declining to just dozens. He got there despite largely ignoring the default playbook.
No restrictions were placed on resident movements, and businesses from restaurants to hair salons remained open. No high-tech apps were deployed to track people's movements. The country does not have a disease control center. And even when nations were urged to "test, test and test," Japan has conducted diagnostic tests on just 0.2% of its population, one of the lowest rates among developed countries.
However, the curve has flattened, with the death toll well below 1,000, one of the least among the developed nations of the Group of Seven. In its dense hub, cases have dropped to single digits most days. While the possibility of a second wave of more severe infection is always present, Japan has entered and is ready to emerge from its emergency in just weeks, with the status already lifted for most of the country and it will likely exit completely as soon as the Monday.
Analyzing how Japan defied the odds and contained the virus while ignoring the playbook used by other successful countries has become a national conversation. There is only one thing we agree on: that there was no silver bullet, no factor that made a difference.
"Just looking at the mortality figures, you can say that Japan was successful," said Mikihito Tanaka, a professor at Waseda University specializing in scientific communication., and a member of a public advisory group of experts on the virus. "But even the experts don't know the reason."
In a widely shared list they gathered 43 possible reasons cited in the media reports, ranging from a culture of wearing masks and a famously low obesity rate to the relatively early decision to close schools. Among the more outrageous suggestions is a claim that Japanese speakers emit fewer potentially virus-laden drops when speaking compared to other languages.
The experts consulted by Bloomberg news they also suggested a myriad of factors that contributed to the outcome, and none were able to point to a unique policy package that could be replicated in other countries.
However, these measures still offer long-term lessons for countries in the midst of the pandemic that may last for years.
An early population response to growing infections was essential. While the central government has been criticized for its slowness in taking policy action, experts praise the role of Japan's contact trackers, which took action after the first infections were discovered in January. The rapid response was made possible by one of Japan's built-in benefits: its public health centers, which in 2018 employed more than half of the 50,000 public health nurses experienced in infection tracking. In normal times, these nurses would be tracking more common infections like the flu and tuberculosis.
"It's very analogous, it's not an app-based system like Singapore's," said Kazuto Suzuki, a professor of public policy at Hokkaido University who has written about Japan's response. "But nevertheless, it has been very useful."
While Countries like the United States and the United Kingdom are starting to hire and train contact trackers as they try to reopen their economies, Japan has been tracking the movement of the disease since the first handful of cases were found. These local experts focused on dealing with so-called clusters, or groups of single-site infections, such as clubs or hospitals, to contain cases before they got out of control.
"A lot of people say we don't have a Center for Disease Control in Japan," said Yoko Tsukamoto, professor of infection control at Hokkaido University of Health Sciences, citing a frequent complaint about infection management in Japan. "But the public health center is a kind of local CDC."
The early response was also fueled by an unlikely event. Japan's battle against the virus first captured international attention with its highly criticized response to the Diamond Princess cruise ship in February, which caused hundreds of infections. However, the ship's experience is credited with providing Japanese experts with invaluable early data on how the virus spread, as well as catapulting it into public awareness.
Other countries still viewed the virus as a foreign problem, Tanaka said. But in Japan, international scrutiny of infections on board and the rate at which the virus spread throughout the ship raised awareness and recognition that the same thing can happen across the country, he said. "For Japan, it was like having a burning car right outside your house."
Although the lack of political leadership was criticized, that allowed doctors and medical experts to come to the fore, which is considered best practice for managing public health emergencies. "You could say that Japan has had an expert-led approach, unlike other countries," said Tanaka.
Experts are also credited with creating an easy-to-understand message to avoid what is known as the “Three C's,” that is, closed spaces, crowded spaces, and close contact environments, rather than staying away from others completely.
"Social distancing may work, but it doesn't really help to continue normal social life," said Suzuki of Hokkaido University. "The 'Three Cs' are a much more pragmatic and very effective approach, while having a similar effect."
Infectious disease experts also pointed to other determining factors, and Shigeru Omi, the deputy head of the expert group advising the Japanese government and former head of the WHO office for the Western Pacific, cited the health consciousness of the Japanese people. as possibly the most important factor.
The possibility has also been raised that the strain of the virus that is spreading in Japan may have been different, and less dangerous, than that faced by other nations.
Researchers at the Los Alamos National Laboratory in the United States studied the variants of the coronavirus in a database and found a strain of the virus that was spreading throughout Europe that had several mutations that distinguished it from the Asian version, according to a document published to Begginings of may. Although the study has not been peer-reviewed and has drawn some criticism, the findings point to the need to further study how the virus changes.
There are still big questions about the true extent of the spread of the pathogen. In April, a Tokyo hospital tested a handful of nontuberculous patients and found that about 7% had the coronavirus, demonstrating the danger of missing asymptomatic or mild carriers that could become the source of an outbreak. An antibody test on 500 people in the capital suggested that the true outbreak could be almost 20 times greater than the numbers that have been shown. Analog contact tracking is interrupted when the number of infections is high, and reports of people unable to undergo testing or even medical treatment for Covid-like symptoms peppered social media at the height of the outbreak.
And the fact is, Japan's response was less than perfect. While the total population is much smaller, Asian neighbors like Taiwan had only seven deaths confirmed by the virus, while Vietnam had none.
"Japan's response cannot be said to have been astonishing," said Norio Sugaya, visiting professor at Keio University School of Medicine in Tokyo and a member of a panel from the World Health Organization advising on influenza. pandemic. "If you look at the other Asian countries, they all had a death rate that was about 1/100 of the western countries."
While it is true that Japan has avoided the worst health outcome, the loose closure has not protected the country from the economic impact. Its economy, which is already grappling with the impact of a sales tax increase in October, officially went into recession in the first three months of the year. Economists have warned that the second quarter will be the worst on record, and the specter of deflation, which has haunted the economy for decades, looms once again. The number of tourists plunged by 99.9% in April, after the country closed its borders, holding back a booming industry that had promised to be a growth engine for years. As in other countries, bankruptcies have increased considerably.
Even with the end of the state of emergency in sight, authorities warn that life will not return to normal. When the number of cases decreased in early March, there was public optimism that the worst was over, only for the cases to increase again and the emergency declaration to be activated.
If a deadlier second wave follows, the risk factor in Japan, which has the world's oldest population, remains high. The country has quickly approved the remdesivir of Gilead Sciences Inc. and is now fighting to allow the use of the Avigan antiviral from Fujifilm Holdings Corp. that has not yet been tested. There are calls for the country to use the time it has purchased to shore up its tests and learn from its SARS and MERS neighbors.
Authorities have begun to talk about a phase when people "live with the virus", acknowledging that Japan's approach has no chance of eliminating the pathogen.
"We have to assume that the second wave could be much worse than the first and prepare for it," said Yoshihito Niki, professor of infectious diseases at Showa University School of Medicine. "If the next explosion of cases is worse, the medical system will collapse."
With information from Bloomberg
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