Life in isolation has lasted longer than expected for the millions in Japan who remain patiently homebound, alone or with family, in the name of fighting the novel coronavirus.
For many, the most pressing question is when the state of emergency slated to expire on Wednesday will actually be lifted. Prime Minister Shinzo Abe reportedly told the Liberal Democratic Party’s secretary-general, Toshihiro Nikai, that he plans to extend the measure, and the government is thought to be considering lengthening it by about a month.
Even if the declaration is lifted, the threat of a second wave will persist after society reopens and it could take months, if not years, for a vaccine to be developed and mass produced.
But even amid the uncertainty, policymakers are starting to understand what precautions need to be taken before emergency restrictions are lifted.
Earlier this month, the World Health Organization said any government looking to ease measures must meet six conditions: 1) Transmission of the disease is under control; 2) health care providers can “detect, test, isolate and treat every case and trace every contact”; 3) the risk of clusters in vulnerable places like hospitals and nursing homes has been minimized; 4) preventive measures are in place at schools, offices and other essential places; 5) the risk of importing new cases is being well managed; and 6) the public is “fully educated, engaged and empowered to adjust to the new norm.”
The government’s expert coronavirus panel, meanwhile, has proposed three similar criteria for lifting the state of emergency: The number of infections must be falling; 80 percent reduction in human contact has been achieved; and medical facilities must be able to provide adequate treatment for COVID-19 patients.
As it stands, whether Japan satisfies those criteria is debatable.
In most parts of the country, new cases are declining and human contact has been reduced considerably, though still short of the government’s goal.
According to the health ministry, the rate of infection fell all the way from 12 percent on April 7 — when Abe declared the emergency — to 1.5 percent on Sunday.
According to NTT Docomo, data gathered using cell phone towers showed that movement near Tokyo’s Shinjuku, Shibuya and Roppongi stations declined on most days by more than 60 percent — and sometimes 80 percent — since the declaration was made.
But Tokyo officials also say grocery stores, shopping areas and public parks have been attracting bigger crowds since the emergency was declared.
It is on the panel’s third criteria, however, where Japan could be seen as failing.
Tokyo has been struggling to secure beds for COVID-19 patients, and hospitals have been operating at or beyond capacity for nearly a month. At the beginning of April, the Tokyo Metropolitan Government began transporting patients with mild or no symptoms of the disease caused by the virus directly to empty hotels to lighten the burden on medical facilities.
In-hospital infections are also causing difficulties.
Fatalities at Eiju General Hospital in Taito Ward account for nearly a third of all reported deaths in Tokyo, and Bokutoh Hospital in Sumida Ward has reported 40 positive cases among patients and staff in less than two weeks.
These outbreaks have incapacitated cardiology wards, neonatal intensive care units, emergency rooms and other critical facilities in a handful of hospitals — several of which were designated by the city to receive coronavirus patients. In each case, large numbers of doctors, nurses and other staffers were ordered to quarantine themselves at home for at least two weeks.
Since ending the emergency prematurely or abruptly could trigger a second explosive surge in infections, experts say countermeasures need to be peeled back gradually and in progressive stages.
Without steps to prevent people from returning to their previous lifestyles, lifting the state of emergency unconditionally could also be dangerous.
Workers and students may have no choice but to return to their offices and classrooms lest they become unemployed or fail courses, small and midsize companies might risk bankruptcy in the absence of government subsidies if they don’t immediately resume business, and people itching to get outside after weeks of self-isolation would — understandably — leap at the chance to reunite with friends and family.
Germany has begun lifting restrictions that were put in place more than a month ago. A decentralized political system allows its 16 federal states to independently implement and repeal social distancing measures. As parts of the country begin to loosen these measures, the world will be watching carefully to see if the contagion will dissipate or bounce back.
In the United States, the debate has become heavily politicized, resulting in literal street showdowns between medical professionals and citizens over reopening the economy despite a steady increase in infections.
To prevent the virus from re-emerging, it’s become clear that the world needs to be under some form of “lockdown” for a long time — maybe even years.
In a report published earlier this month, researchers from Harvard University warned that COVID-19 could enter a long-term cycle, re-emerging in annual, biennial or sporadic patterns over the next five years.
The researchers projected that social distancing measures may be necessary until 2022 to mitigate recurrent outbreaks following the initial wave, and that a resurgence could occur as late as 2024.
Even after the state of emergency is lifted in Japan, experts agree that more testing is crucial to permanently contain the virus.
So far, the government’s strategy has been to focus on testing individuals already suspected of being infected. When the novel coronavirus reached Japan’s shores nearly four months ago, it gradually tried to tighten border controls. After the contagion began to surface in small groups, the government then focused on chasing clusters, testing people with obvious signs of infection and hospitalizing the positive cases. It then began easing off that policy for mild patients to stop overwhelming the hospitals.
That strategy is no longer working in Tokyo and Osaka, said Kentaro Iwata, a professor in infectious diseases at the Kobe University Graduate School of Medicine.
“Japan needs a change of strategy but this shift is not happening immediately,” he said. “There was tremendous delay in dealing with this problem.”
The government needs to start focusing on aggressive contact tracing and proactively testing people to better gauge the extent of the outbreak, Iwata said.
Residents can’t be expected to respond appropriately without an accurate grasp of the situation, and that can only be provided by aggressive testing, said Kenneth McElwain, a professor at the University of Tokyo’s Institute of Social Sciences.
Behavior will be guided by what the public perceives to be the actual number of infections — as opposed to what the government is reporting — and further testing, McElwain said, coupled with comprehensive contact tracing, may be the only way to bridge that gap.
“Returning to normal requires that people believe that other people are not sick,” he said. “That requires confidence that people who may be sick have been tested.”