Covid-19 in JAPAN
The Japanese Government: Clinging to the Tokyo Olympics
The Truth about the “Japan Miracle”
Reported by TAKI YURIKO
Translated by John and Deborah SAXON
Introduction
The coronavirus continues to find the weakest link in each country’s defenses. Japan’s weakest link was that the Abe administration, which proudly wore its “longest tenured” badge and boasted that it was the strongest of all administrations, could not switch to crisis mode when confronted with this emergency.
Each country’s leaders have determined their own country’s fate by how they responded to this crisis. Leaders who used the expertise of scientists and doctors succeeded in finding quick resolutions. Then there are countries like Japan, which prefer the “let the leaders themselves make the choices” style of governance, which still cannot stop the rise in infections. Not surprisingly, almost all East Asian countries have the coronavirus under control, leaving only Japan behind.
This summer, the Olympics and Paralympics were to be held in Tokyo and broadcast worldwide in real time. The coronavirus arrived with the Japanese actually in high spirits, as the Olympic countdown had just begun.
The Olympics would have revitalized the Japanese economy, even if only temporarily. News coverage would have focused domestic eyes solely on the Olympics and diverted them away from Fukushima’s problems, such as the steady generation of radioactively contaminated water, which continues unabated. The government can also suppress unfavorable news. Used together, these two tools would put the Abe administration in a very favorable light. Postponing the Olympics by one year gained them yet another advantage, as both the general election and the LDP presidential election are scheduled for the autumn just after the Olympics finish. There is no doubt that Prime Minister Abe planned to win both elections and prolong his administration with the citizenry still bathing in a post-Olympic afterglow.
All of this makes me think that the Abe administration’s overarching purpose behind its response to the coronavirus had little to do with scientific knowledge, and everything to do with ensuring that the Tokyo Olympic Games would go smoothly.
1-How the coronavirus spread in Japan
The first incident began when a large number of Chinese tourists arrived in Japan around the end of January to celebrate the Chinese New Year. Infections were soon confirmed in bus drivers, guides, and souvenir shop clerks who came in contact with the tourists as they visited Tokyo, Kyoto, Hokkaido, and other areas.
The next incident was on February 7, when the Grand Class cruise ship Diamond Princess (British flag, American company operated) berthed at the port of Yokohama. The infection had started with a passenger from Hong Kong, spreading throughout the ship by the time it arrived in Yokohama. Out of humanitarian concern the Japanese government immediately supplied food and medical care to all passengers. Since there were no facilities to medically handle all 3711 passengers and crew right at the dock, Japan quarantined all except the PCR-positive passengers and crew within the ship. But the increase of secondary infections on board focused worldwide criticism on the incident. Eventually, there were a total of 712 infections and 13 deaths. After everyone who had entered hospital treatment recovered, the Japanese government granted those still on board permission to disembark. Everyone then flew back to their home countries. Unfortunately, infections appeared among some of the Japanese who had cared for the tourists.
In both incidents, the virus came from China, carried by Chinese tourists, making it easy to positively identify the sources of the infections. With subsequent contact tracing, any further spread of the virus was held in check.
A new problem appeared in March, when the infection began to spread rapidly in Europe, not long after its appearance in Asia. Asymptomatic Japanese who were either living or traveling abroad began returning to Japan, making contact tracing impossible. Both groups brought the virus back from Europe and caused a larger number of secondary and tertiary infections. This European strain had evolved from the Chinese strain of the virus and had grown powerful.
The method of isolating infection clusters discovered by contact tracing had reached its limits. At this point Japan needed to match other countries’ methods by expanding its PCR testing to include potentially infected individuals, then by identifying and quarantining those that tested positive.
2- Why the Japanese government’s count of infections is so low
A smoothly held Olympics was likely the Abe administration’s top priority. So after the spread of the infection had begun, they wanted to at least make it appear as if the number of infections were low. To that end, testing fewer people would naturally yield fewer detected infections, so one cannot help but think that the small number of PCR tests conducted might have been intentional.
First, Abe classified Covid-19 as a “designated infectious disease,” to which I agree – the problems came after. Next, the Abe administration restricted PCR testing to government-administrated testing, effectively bypassing doctors and making the nation’s public health centers the sole arbiters of whether a test should be administered. The national research institutes and their local agencies held a monopoly on those tests, choosing to limit potential candidates for testing to returnees from abroad and close contacts of infected individuals. Even more restrictively, potentially infected individuals in cities could only be tested if they “had a fever of greater than 37.5 degrees Celsius for at least 4 days.” As a result, gradually more and more individuals either died before even being allowed to apply for testing, or had successfully applied for testing but were already seriously ill by the time the examination results came back. Despite a series of criticisms from doctors in the field, the government said “The research institutes only have the older types of testing devices, which are all manually operated, so the testing itself takes time. In addition, there are not enough specialized laboratory technicians nor is there enough testing equipment to turn the test results around quickly. Furthermore, if infections spike, hospitals will be jammed,” justifying the paucity of PCR tests with this lineup of reasons that aren’t reasons. Even though the above regulations have been somewhat relaxed so that Japan now administers close to 10,000 tests daily, that number still pales in comparison with overseas countries.
Concerned with this situation, professors at national universities implored the government: “We offer you our automated testing equipment that we use for our usual research, as it works equally well for PCR testing. Make use of it, and let us assist with the testing process as well. 200,000 tests daily could be possible.” But the Abe did not accept the offer of assistance.
As is well known, Prime Minister Abe demanded that the Olympics be postponed a year, rather than cancelled, and as ever Japan’s number of PCR tests continues to be extremely small.
Japan tests only 1.8 persons per thousand, the second lowest among the 36 OECD member countries. The lowest is Mexico with 0.4 people per thousand.
The Japanese government’s policy of not conducting extensive testing makes it difficult to accurately determine the number of people infected with Covid-19.
3-How was Japan, without any lockdown, able to shrink the number of infected people only by requesting self-restraint?
Prefectural governors, experts, and doctors could see a crisis coming in the ever-increasing number of infected people despite the government’s controlling the number of PCR tests, and they urged the Abe administration to take action. After it was decided to postpone the Olympics, the government reluctantly issued a nationwide “request” for self-restraint to begin on April 7th and lasting through the end of May. This request was not a penalty-provisioned “State of Emergency Declaration,” nor did this request have any enforcement behind it. Even then, this directive was lifted early on May 25th despite the voices of experts advocating for the directive to “remain in place another two weeks.”
The directive consisted of the following: “We ask that everyone refrain from leaving home for any nonessential or nonurgent reasons. Please avoid crowded areas or enclosed spaces.” In addition to schools, from elementary through university, which were already closed, workers were “asked” not to commute but instead to do their jobs remotely as much as possible. Except for places like drug stores and grocery stores, the Abe administration “requested” that all other types of business be closed – movie theaters, theaters, museums, public facilities, restaurants, and other places where people gather. However, the government would not provide any compensation for the resulting leaves of absence and other hardships.
Even though most other countries’ lockdowns differed from these unenforcible requests, close to 90% of all Japanese obeyed them. Other countries called it, “The Japanese Miracle.”
The first reason it came about was that citizens listened carefully to working doctors in the media take turns explaining Covid-19 directly to the people – changes in daily routine to protect oneself, such as how to wear a mask, how to wash the hands and fingers carefully, how to gargle, how to disinfect doorknobs, dining tables, etc., all in detail. They warned of the “3Cs” (crowds, closed spaces, close contact) where clusters are more likely to develop, and they alerted us to take care against the dangers as well.
In addition, another reason I would offer is a characteristic peculiar to Japanese people: societal peer pressure. For instance, as stores continued to be out of masks, we made and wore hand-sewn masks in order to comply. Anyone going out without a mask is now met with icy stares that serve as compliance enforcement. However, it went too far when some self-styled “self-restraint police” appeared. Pushing compliance enforcement with unjust acts, they plastered posters saying “CLOSE YOUR STORE!” on the front of noncompliant pubs, bars, and pachinko parlors, and they monitored cars with out-of-prefecture plates and uploaded them to SNS.
In any case, the number of symptomatic Covid-19 infected individuals decreased sharply during this time of “self-restraint.”
4- Reasons for Japanese Covid-19 Patients’ High Recovery Rate and Low Mortality Rate
Japan has relatively few doctors per capita. Maintaining this trend are the facts that a) not only can Japan’s medical colleges take only so many students each year, but I also believe that b) death from overwork has actually become a problem for doctors in Japan due to their long working hours. Japan has 2.4 doctors/1000 people (32/ 36 OECD member countries, 158th / 215 countries of the world).
As of Sep 20, 2020, worldwide:
Number of those infected: 30,900,000
Number of those recovered: 21,100,000 Recovery rate 68%
Number of deaths: 959,000 Mortality rate 3.1%
As of Sep 20, 2020 in Japan:
Number of those infected: 77,762
Number of those recovered: 70,231 Recovery rate 90%
Number of deaths:1499 Mortality rate 1.9%
Diamond Princess:
Number of those infected: 712 (there were 40 passengers whose infection status was unknown when they returned home via a flight chartered from the United States)
This may not be an apt comparison, but…
Number of those recovered: 649 Recovery rate 91%
Number of deaths: 13 Mortality rate 1.8%
Japan’s small number of PCR examinations renders any “infected persons” comparison with other countries meaningless. However, recovery rate and mortality rate do have some meaning here. Obviously, Japan’s high recovery rate and low mortality rate are notable. Moreover, since asymptomatic infected individuals as well as close contacts of infected individuals are excluded from testing in Japan (testing being reserved mainly for moderately and severely ill patients), one might even say these are outstanding percentages.
Such results illustrate how the few doctors we have are giving their all, despite the dearth of N95 masks and other protective clothing and well as the extra hours they are working over and above their usual overloaded work schedule.
One behind-the-scenes factor pushing up the high recovery rate (thereby reducing the mortality rate) is that Covid-19 was categorized by the Japanese medical establishment as a “designated infectious disease,” a category instituted in 1999. Treatment for Covid-19 is therefore 100% publicly funded. Even when advanced medical care such as ECMO is used during the time that a patient tests positive, the patient burden is zero. Even with multiple “wait-and-see” days of hospitalization following a negative test, Japan’s universal health care system has a 60-year history of guaranteeing a fee of no more than 30% of the cost for treatment of any general illness.
5-Problems for the future
During the “period of self-restraint,” everyone thought the government would be planning the revamping of the medical system with more nurses, more N95 masks to prevent infections, more protective clothing, and so on, but such expectations were dashed.
・It has become harder to manage the private hospitals and clinics that accept patients with Covid-19. Taxes are levied to support national and public hospitals when they show a loss, but for private hospitals there is no subsidy assistance. Nevertheless, since the national and public hospitals have run out of beds, private hospitals are being asked to accept Covid-19 patients anyway.
According to the All Japan Hospital Association, accepting so many Covid-19 patients has forced hospitals to accept fewer patients for general treatment. In addition, high costs of care continue to rise due to the extra facilities, equipment and labor required for treating Covid-19 patients. Out of 339 private hospitals, almost 80% showed a loss. In particular, 90% of those in Tokyo showed a loss. Estimates indicate that just one month will see debts exceeding hundreds of millions of yen. Helping hospitals recover the cost of this extra medical care should be a pressing concern for the government, but only a meager budget has been set aside to do so.
・During this time of “self-restraint,” among the benefits that the Abe administration instituted for individuals impacted by Covid-19 were two cloth masks per person, insufficient in size and material to prevent infection, and 100,000 yen of assistance. Renters losing income due to forced leave received three months rent, and those laid off by their companies received 60% of the average wage. The upper corporate benefit limit for businesses was 2 million yen, while the maximum benefit limit for sole proprietors was 1 million yen. Individual aides furloughed due to elementary school closures received a maximum benefit of 8330 yen per day, while parents and freelance caregivers received a maximum of 4,100 yen per day. No repayments were required for the above benefits. Outside of these provisions, however, banks only made taking out loans easier, effectively saying, “Crisis or no crisis, make your payments on time.” The lockdowns for Germany and the UK came with assistance commensurate with such a lockdown, but by comparison Japan’s lockdown benefits are quite inadequate. Even worse, the benefits application process is complicated, and it usually takes some time before the benefits arrive. As a result, some businesses are forced into bankruptcy before they are actually paid.
When the second wave comes, compensation for leaves of absence will be trifling, and even if another self-restraint request is issued, there is some doubt as to whether the people will obey as before.
・The business community also is requesting that the government avoid another nationwide self-restraint by expanding PCR testing to detect and isolate all infected persons as soon as possible.
(Note: 1USD=106yen)
6-Government interest and reality
The Japanese government had already set aside a large budget for a previously agreed contract with a pharmaceutical research company in the United Kingdom and the United States to obtain Covid-19 vaccines. The Abe administration wanted to secure enough of them to vaccinate every Japanese before the Tokyo Olympics next year.
However, I do not expect it. Vaccines for neither SARS nor MERS have yet been developed. Furthermore, the main Chinese and European (which evolved from the Chinese) strains of COVID-19 appear to have already developed into 5000 distinct strains as of May, and they continue to evolve. Even if the vaccine is completed, I can’t believe that it would be effective against the strain of Covid-19 that will be present at that time.
Making the PCR tests easy to get and free for all so that social activities can be safe would be much appreciated. Even if all symptoms disappear, the most realistic future scenario is a new daily routine in which we test ourselves before meeting someone, hanging a timestamped “negative test” certificate tag from our head.
Unfortunately, for the time being, we must be careful not to become infected, and asymptomatic carriers must be careful not to infect others. But the ends toward which we must work is an equal society in which anyone in the world who becomes sick, not from just the coronavirus but from anything, can receive free medical care.
7-Other
Countries will be judged by whether they have made it a priority to invest in the medical care of their people. In order to broadly reduce medical expenses, the Abe administration has reduced the number of beds per hospital, and by consolidation reduced the number of hospitals nationwide. In addition, it has relied on imports of N95 medical masks and disinfected protective gear from overseas countries such as China. It keeps saying that there is not enough PCR testing equipment, but in actual fact a small Japanese company had already received a five-year upfront investment from France for such machines and has already commercialized the product. Now they are very active in coronavirus-struck France. Together, all the latest Japanese-made fully automated testing machinery could provide 200,000 PCR tests per day. It was reported that the French ambassador delivered this company an official letter of appreciation from the country of France. However, the Japanese government has not granted permission for this machinery to be distributed domestically, so it is not being used in Japan.
Recent international affairs can be viewed through a Covid-19 pandemic lens. When Japan was suffering under a shortage of store masks, the Taiwanese government, its strong leadership having already appropriately handled its Covid-19 problem, donated two million Taiwan-made surgical masks, further stating that they were ready for export. The Korean government, a political rival of Japan’s, also formally offered Korean-made simple PCR test kits. But Prime Minister Abe would not act to import either of them, perhaps worried that he might be seen as having mismanaged the crisis.
However, more of us Japanese citizens are thinking more about what an ideal leader should be like, and by extension what an ideal society and civilization should look like in this new Covid-19 world. I hope it will be a time of change for a better world.
Postscript: A new Prime Minister, Mr. Suga, took office in Japan while this article was being written. Mr. Abe took a mid-term retirement due to illness, but as the previous administration’s chief cabinet secretary has been retained, Prime Minister Suga has carried on with all of Mr. Abe’s previous initiatives. To promote next year’s Olympics, the new administration is putting all of its efforts into emphasizing “how energized Japan is,” drawing up a budget to subsidize trips, dining out, etc. Named the “GO TO TRAVEL, GO TO EAT, GO TO EVENT, GO TO SHOPPING” campaign, coupons of up to 50% are issued by the government. However, doctors are worried about the spread of infection that will result from the “GO TO” campaign. The one promoting this campaign, which accomplishes the exact opposite of infection prevention, in the name of revitalizing the economy, is of course Prime Minister Suga himself.
It will be natural for the new Suga administration, which succeeded the most recent Abe administration, to use the Olympics to try to win next year’s national elections and presidential elections to solidify their political position.
However, it must not be forgotten that holding to this aggressive policy forces our medical care system into collapse at the cost of many Japanese lives.