Despite not being on lockdown, why has Japan been able to keep coronavirus infection and fatality numbers so low?

You may have seen a recent article by Bloomberg News that was titled, “A Coronavirus Explosion Was Expected in Japan. Where Is It?”. In truth, besides the outbreak on the Diamond Princess cruise ship–which many say was not handled well–Japan hasn’t seen as large an outbreak of the highly contagious disease as many had feared, despite the country’s capital being one of the world’s most densely populated cities.

According to Reuters it’s been two months since the first confirmed case of COVID-19 in Japan, and as of March 22 there were only a little more than 1,000 confirmed cases, not counting the cruise ship. Some measures have been taken to curb the spread, like the closing of popular tourist attractions and canceling of concerts, but otherwise business is as usual in the country. So what’s Japan doing that other countries aren’t (even Japanese rockstar Yoshiki wants to know)?

The Bloomberg article cites several contrarian theories–including that Japan is under-reporting numbers for the sake of preserving the Olympics, or that it’s because the country hasn’t been testing as much as it should. Japanese users, in response to Bloomberg‘s article, had their own theories:

“Fukushima’s radiation probably killed the virus.”

“Because people in Japan can get advanced medical care immediately.”

“Because they follow rules, already have high hygiene levels, already frequently wear face masks etc etc etc”

“I’m in Kyoto, Japan. The reason why they are least-affected it’s because they are not testing! It’s very hard to get tested unless you are very sick, apparently Olympics is more important: (”

“Could it be because Japanese almost never shake hands and rarely hug?”

But one Twitter user, @tsukuru_ouu, claims to know the answers, though admittedly we don’t know for sure if they’re qualified to give them. In response to Bloomberg’s article, @tsukuru_ouu posted a series of tweets delineating the importance of Japan’s focus on outbreak clusters rather than individual cases.

@tsukuru_ouu wrote their explanation as a hypothetical dialogue between Bloomberg News and Japan:

“Bloomberg: Japan’s not doing enough polymerase chain reaction (PCR) testing for the virus. There should be many more cases of infected individuals. Japan: Exactly. We’re aiming to keep our medical system from crashing as well as decreasing the number of deaths. We aren’t interested in knowing the exact number of infections. Bloomberg: Huh? Japan: There are probably several times as many infected individuals, but their symptoms are mild, so we aren’t worrying about them. Bloomberg: You’re not worried about them? Japan: What we’re really interested in is the trends in the number of cases, how they increase and decrease. Right now we seem to be looking at a decrease. Bloomberg: How convenient. Japan: Just look at how Hokkaido is lifting its state of emergency, and the schools around the country are going to open back up on schedule.”

▼ The first graph represents the number of patients who began to experience symptoms between January 1 and March 19, and the bottom graph represents the number of patients whose symptoms weren’t linked to COVID-19.

“Bloomberg: You can’t stop infections without testing everyone. Japan: We’re focused on cluster outbreaks. The virus doesn’t spread without them. Bloomberg: Cluster outbreaks? Japan: Everybody in Japan knows how the virus spreads and is working to avoid spreading it. If a cluster is found, the people involved in it are tested. Bloomberg: But if you don’t know how many people are infected, you don’t know how much the virus has spread. Japan: We know from the number of deaths. Bloomberg: But if a person dies without being testing then they won’t be counted in the number of deaths related to COVID-19. Japan: Generally there aren’t any patients who contract pneumonia from COVID-19 and die without being tested.

Bloomberg: But you’re not testing very often. Japan: We may not be doing much PCR testing, but we’re doing plenty of CT scans. If it’s a very serious case of pneumonia, we’ll do multiple scans. Then if we aren’t sure if it’s a result of the virus, then we will without fail do PCR testing. Bloomberg: Without fail? Japan: The number of deaths is a reliable way to track the virus. Right now it’s only at 33. I’m not saying we should be proud, but we are trying to keep tragedy at bay. Bloomberg: B-but…PCR testing…”

So essentially, this is what @tsukuru_ouu believes is happening: Japan’s is using polymerase chain reaction (PCR) testing–the most commonly used type of testing for the virus–only for those involved in a cluster outbreak. Rather than spending resources and time on everyone who exhibits symptoms, Japanese officials have been targeting the sources of the outbreaks. When someone has become ill with pneumonia–which is the most common deadly result of COVID-19– they’re tested, and if the results come back positive, then the people who have been around them are tested too, and those people confirmed are quarantined until the contagious period has safely ended.

Furthermore, according to The Straits Times, the Japanese government’s chief policy in regards to suspected COVID-19 cases is that those experiencing flu-like symptoms should stay home and self-quarantine, only venturing out to seek medical help if they experience a high fever. This has also, undoubtedly, helped keep the virus from spreading widely throughout the country.

Though the number of infected continues to increase in Japan, the number of deaths still seem to be well-contained compared to other countries. In the end it may be true that the actual infection rates are higher than they appear, but we can take heart from the fact that very few people are dying as a result of the virus, as @tsukuru_ouu suggests.

Still, places where many people gather and live, like concerts and elderly care centers, seem to be the source of many cluster outbreaks in Japan, which might mean that the ever-crowded Tokyo will need to go on lockdown for a short while, to stem the spread. But even if your city or country is not imposing strict measures, it might be best to avoid large gatherings and refrain from visiting your elderly relatives and friends for a while, until all of this blows over. And of course, don’t forget to wash your hands!

Sources: Twitter/@tsukuru_ouu via Togetter, Bloomberg News, Reuters, The Straits Times

Top image: Pakutaso

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