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NYT: Japan’s Virus Success Has Puzzled the World. Is Its Luck Running Out?

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Japan’s Virus Success Has Puzzled the World. Is Its Luck Running Out?
The country has not widely tested. Its people are going about their lives, even crowding into clubs that had previous outbreaks. But now Japan is warning of the risk of rampant infection.

By Motoko Rich and Hisako Ueno
March 26, 2020
Source:https://www.nytimes.com/2020/03/26/world/asia/japan-coronavirus.html

TOKYO — Japan had only a few dozen confirmed coronavirus infections when the 30-something nurse with a slight sore throat boarded a bus to Osaka, the country’s third-largest city, to attend a Valentine’s weekend performance by pop bands at a music club.

Less than two weeks later, she tested positive for the virus, and the authorities swiftly alerted others who had been at the club. As more infections soon emerged from three other music venues in the city, officials tested concertgoers and their close contacts, and urged others to stay home. All told, 106 cases were linked to the clubs, and nine people are still hospitalized.

But less than a month after the nurse tested positive, the governor of Osaka declared the outbreak over.

Ever since the first coronavirus case was confirmed in Japan in mid-January, health officials have reassured the public that they have moved quickly to prevent the virus from raging out of control. At the same time, though, Japan has puzzled epidemiologists as it has avoided the grim situations in places like Italy and New York without draconian restrictions on movement, economically devastating lockdowns or even widespread testing.

The puzzle may be about to gain some clarity. On Thursday, Katsunobu Kato, Japan’s health minister, said he had informed Prime Minister Shinzo Abe that there was evidence that Japan was now at a high risk of rampant infection.

On Wednesday night, just a day after Japan and the International Olympic Committee agreed to delay the Tokyo Summer Games for a year because of the coronavirus pandemic, the governor of Tokyo, Yuriko Koike, warned citizens that the sprawling city of close to 14 million people was in a “critical phase before a possible infection explosion.”

Cases in Tokyo spiked this week, setting records for four days running — including an announcement of 47 cases on Thursday — as travelers returned from overseas. The limited testing for the virus has raised fears that many more are going undetected.

Ms. Koike implored the people of Tokyo to work from home, avoid unnecessary outings and stay inside over the weekend. On Thursday, governors from four neighboring prefectures also requested that residents refrain over the weekend from going outside for anything other than urgent needs.

“If we go without doing anything now,” Ms. Koike said, “the situation will worsen. I ask for everyone’s cooperation.”

The public so far has not taken such warnings seriously. Although schools have been closed for a month and the government has requested that large sports and cultural events be canceled or delayed, the rest of life has returned to normal. People have been riding crowded subways, congregating in parks to view the cherry blossoms, shopping, drinking and dining, comforted by Japan’s relatively low number of confirmed coronavirus cases and deaths.

Even at one of the Osaka clubs where the outbreak occurred earlier this month, a group of 40 young women attended a performance by a boy band on Wednesday, jumping and waving their hands in a small, unventilated space for close to two hours.

As other parts of the world fall into a spiral of infections, hospital overflows and deaths, Japan, a country of almost 127 million people, has reported only 1,300 cases and 45 deaths, with one of the slowest-progressing death rates in the world despite its aging population.

“It’s either they did something right,” said Dr. Peter Rabinowitz, co-director of the University of Washington MetaCenter for Pandemic Preparedness and Global Health Security, “or they didn’t, and we just don’t know about it yet.”

As Japan has seemed to pull off a feat of infection containment, it has presented an intriguing contrast to other countries in Asia, where the pandemic began. It did not put cities on lockdown, as China did. It has not deployed modern surveillance technology like a growing number of countries, including Singapore. Nor did it adopt the kind of wholesale testing that helped South Korea isolate and treat people before they could spread the disease.

While South Korea, with a population less than half the size of Japan’s, has conducted tests on close to 365,000 people, Japan has tested only about 25,000. Japan now has the capacity to conduct about 7,500 tests a day, but its daily average is closer to 1,200 or 1,300.

Dr. Tomoya Saito, director of the department of health crisis management at the National Institute of Public Health, said the limited testing was intentional. Those who are tested are referred by doctors, usually after patients have had fevers and other symptoms for two to four days. Japan’s current policy is to admit anyone who tests positive to a hospital, so officials want to avoid draining health care resources with less severe cases.

Dr. Saito said that part of Japan’s seeming resistance to infection may result from measures common in the culture, including frequent hand-washing and bowing instead of shaking hands. People are also much more likely to wear masks on trains and in public spaces. “It’s a kind of social distancing,” Dr. Saito said.

But Jeffrey Shaman, an epidemiologist at Columbia University and the senior author of a report that projected five to 10 undetected cases for every confirmed infection of the coronavirus based on data from China, said Japan’s approach was a “gamble.”

“The risk is that things may be brewing underneath the surface that you don’t recognize until it’s also a little bit too late,” Dr. Shaman said.

In Osaka, a report prepared for the health ministry this month projected that by early April, the city could have close to 3,400 infections, 227 of them serious. “It’s possible that provision of medical treatment to seriously ill patients may become difficult,” the report said.

On Wednesday, Osaka’s governor, Hirofumi Yoshimura, said he was working to secure an additional 600 beds in hospital isolation wards that could accommodate patients with the most severe infections.

Dr. Masaya Yamato, chief of infectious diseases at Rinku General Medical Center in Osaka, said the region was moving toward a model where coronavirus patients with mild symptoms could stay at home in order to save hospital beds for the seriously ill.

In Tokyo, there are only 100 beds designated to handle those with serious infectious diseases. On Wednesday, the city government pledged to secure 600 more.

The request by Tokyo’s governor to stay inside this weekend, Dr. Yamato said, may be too weak to defer a crisis.

“It’s better that Prime Minister Abe decisively declare a lockdown in Tokyo,” Dr. Yamato said. “The economic impact should not be a top priority. Tokyo should lock down for two to three weeks. Otherwise, Tokyo’s medical system could collapse.”

Mr. Abe’s administration has appointed a task force to determine whether he should declare a state of emergency, a measure that he said was unnecessary earlier this month.

For now, the public is largely unmoved. Although some grocery store shelves in Tokyo were cleared out on Wednesday night after the governor’s request, it was business as usual on Thursday.

Near Shinbashi Station in central Tokyo, men in black suits sat elbow to elbow at a counter in a restaurant offering a fried noodle lunch special for 500 yen, about $4.50. A long line formed outside a McDonald’s, and smokers crowded a small pen near the station entrance.

In Shinjuku Gyoen park in western Tokyo, where cherry blossoms were near peak bloom, a sign at the entrance informed visitors that, as part of antivirus efforts, picnic blankets and alcohol were banned. Security guards with megaphones wandered through groups of people who were taking photos with the flowers, warning them to wash their hands.

At a store not far from the park, Kazuhisa Haraguchi, 36, stood in a long line for a chance to buy a limited-edition pair of Nike Air Max sneakers.

Mr. Haraguchi said that he was worried about how the virus was spreading in the United States and Europe, but that he wasn’t too concerned about the situation in Japan.

“It’s scary, but it doesn’t seem like there’s much of it here right now,” he said. “If I die, at least I’ll die with my sneakers.”

Ben Dooley and Makiko Inoue contributed reporting from Tokyo, and Hiroko Masuike from Osaka, Japan.
 
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We can't judge based on the number alone.

Because it doesn't tell anything.


But if one person gets infected from the street...

Then we should be careful...

Perhaps coronavirus is already circulating on the street.

And waiting to just explode.
 
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Japanese has long been practicing social distancing before the virus.
 
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Sooner or later all of us may get the Coronavirus. Japan with high percentage of retired population is high risk as virus causes high death rate of old people.
 
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We can't judge based on the number alone.

Because it doesn't tell anything.


But if one person gets infected from the street...

Then we should be careful...

Perhaps coronavirus is already circulating on the street.

And waiting to just explode.
1.JPG
 
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I almost ignore Japan from the radar until several days ago.

But I always ask question whatever Japan's new cases are because of international arrival or domestic cases.


But around several days ago, I read a news saying around tens of people get infected after a gathering event.

That is the sign.
 
. . .
Japan are just lucky most who got it show just mild symptoms. But now here comes more showing more severe symptoms after infected.
 
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Japan PM Abe to declare state of emergency amid surge in virus infections
KYODO NEWS - 7 hours ago - 12:26
Source:https://english.kyodonews.net/news/...te-of-emergency-over-virus-govt-official.html

Prime Minister Shinzo Abe intends to declare a state of emergency over the coronavirus outbreak in Japan, a government official said Monday, as a recent surge in infections sweeps Tokyo and other major cities.

The declaration is expected on Tuesday, and will take effect Wednesday, according to an administration source. Once declared, prefectural governors will be able to tell the public to stay at home and request the closure of schools and other facilities.

Abe is required to specify which areas will be targeted and for how long. Major cities such as Tokyo and Osaka will likely be targeted, the government official added.

The declaration, under a recently amended law, will come as Japan seeks to contain a rapid increase in COVID-19 cases, which poses a significant risk to life and to the Japanese economy, the official said.

A growing number of cases in which transmission routes cannot be traced have raised the alarm. Abe has warned of an explosive surge if people let down their guard, having conceded that Japan was barely "holding the line" against the virus.

Pressure has been mounting for the declaration. Tokyo Gov. Yuriko Koike and Osaka Gov. Hirofumi Yoshimura had stepped up calls on Abe to make the declaration, while the Japan Medical Association has also sought the measure amid fears of a health care system collapse.

An emergency declaration, the first of its kind in Japan, would restrict individual rights, allowing prefectural governors to call for specific action to prevent the spread of the virus.

Even if a state of emergency is declared, citywide lockdowns, as seen in other countries hit hard by the coronavirus such as China and France, cannot be enforced under Japanese law. People will not be punished if they do not fall in line, neither can business activity be banned.

Abe cannot declare a state of emergency at his own discretion. He needs input from an advisory panel of experts in medicine and public health who will determine whether such a move is required.

Before formally declaring the state of emergency, the government is in principle required to inform parliament of its intention.

As of Sunday, the number of people with coronavirus in Japan stood at 4,563, including some 700 from the Diamond Princess cruise ship, with 104 deaths reported.

Tokyo confirmed 143 new infections Sunday, marking the city's highest rate of daily increase and taking the capital's total to 1,033.

To prevent the health care system from becoming overwhelmed and other widespread impacts, governors of areas subject to the declaration will be able to tell people to only go outside on essential errands such as grocery shopping, or if they are key workers in areas such as health care and public transport.

Governors can restrict the use -- and request temporary closure -- of places where large groups gather such as schools, social welfare facilities, theaters, music venues and sports stadiums.

In the event that hospitals become overrun and new ones need to be quickly set up, as has been the case elsewhere, such as in China and the United States, governors will be able to expropriate private land and buildings if rejected by their owners and users for no legitimate reason.

They can also requisition medical supplies and food from companies that refuse to sell them and punish those that hoard or do not comply. They can force firms to help transport emergency goods.

Abe gained the power to set in motion the process of establishing a state of emergency on March 13, when the Diet passed a revised version of a law enacted in response to the 2009 swine flu pandemic. The revision is effective for two years.

Recent requests by the prime minister for all schools to shut and for large sports and entertainment events to be canceled or postponed to prevent group transmission were made without the legal basis to enforce them.

One reason for the recent surge in infections is believed to be the importation of cases from abroad, prompting the government to implement an entry ban on foreign travelers that have recently been to one or more of 73 countries and regions.

Abe has promised the country's "boldest-ever" stimulus measures to help struggling households and businesses amid the virus epidemic, more than the 56.8 trillion yen ($522 billion) package rolled out during the 2008 global financial crisis.

The government is putting together the stimulus, which will include cash handouts to struggling households, with the possibility of a state of emergency declaration in mind. It may be finalized on Tuesday.

Economists expect Japan, already reeling from a consumption tax hike last October, to have fallen into recession during the January-March quarter due to the impact of the pandemic.
 
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5 out of G7 are topping the charts with infected numbers, Japan doesn't feel like to be left behind no more
 
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I heard Japan did a few tests. Maybe they wanted badly Olympics to starts in 2020.
^^
Who is the guy in your profile picture?
 
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Japan and Italy have one of the most aging populations on the planet. There is a fear of Japan turning into another Italy, although their discipline will come handy and help.
 
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