An abrupt resurgence of the novel coronavirus has reignited criticism that Japan isn’t testing enough, and stirred debate over how stronger legal autonomy could empower municipal leaders to localize their countermeasures, prevent cluster infections and thus avoid further economic pain.
While the country is conducting more tests now than it was during the first outbreak — on some days double, on others quadruple the amount — it’s still lagging far behind most nations still ensnared in the pandemic. Some experts say active case surveillance and targeted testing, including those with no symptoms, is good but it’s not enough to detect community transmission. To get ahead of the contagion, they say, the country needs to “massively expand” its testing capacity.
Last week the central government’s coronavirus subcommittee put forward a list of reasons not to test low-risk, asymptomatic individuals, including the associated costs — labor, time and money — and the risk of a false positive.
“It’s important that we put everything on the table, and transparently examine both the merits and demerits of different testing strategies,” said Shigeru Omi, president of the Japan Community Health Care Organization and chair of the subcommittee.
“Finding asymptomatic patients is difficult and doing so wouldn’t necessarily prevent the virus from spreading, only provide us an understanding of where it is already.”
To prevent a cluster, experts have suggested Tokyo implement protective screening at nursing homes, hospitals, schools and other vulnerable places where physical contact is common, if not necessary, and prolonged closures need to be avoided.
“It's obvious that risk varies substantially by location, occupation, social environment and how people behave,” said Kenji Shibuya, director of the Institute of Population Health at King’s College London. “There's no reason to believe that infections are localized in Shinjuku.
“It's already in the community.”
Tokyo’s efforts to pre-emptively seek out clusters in such a manner, and even test asymptomatic individuals who may have merely been in close contact with someone who tested positive — as opposed to tracking down contact transmissions after the first case has been discovered — is a significant departure from its previous methodology.
Municipal leaders are responding to this outbreak in a different way than the central government did during the first wave earlier this year. In major urban centers, officials are refining their approach by conducting group tests and allocating financial support specifically to businesses suffering from cluster infections.
Many cases that have emerged in the capital since late June have been traced back to the Kabukicho and Ikebukuro districts located in Shinjuku and Toshima wards, respectively. The metropolitan government has been conducting group tests in those areas, specifically targeting staff and clients of host and hostess bars, maid cafes and other nightlife destinations.
Leading up to and during the first major outbreak in Japan — which peaked in early April, according to the government’s expert panel — the country focused on tracking down cluster infections and testing individuals already suspected of transmission. This time, Tokyo is conducting group tests directly where the infections emerged, and other prefectures are taking a similar approach.
Still, policymakers remain hesitant to greenlight expansive testing.
Since the onset of the pandemic, debate over the merits of different testing philosophies — how many people get tested and to what end — has been the symbolic fulcrum of a precarious balance between public opinion and bureaucratic lethargy, expectations and finite resources, human lives and economic recovery.
In theory, testing everyone would reveal how far and wide the virus has spread within the country. This would provide policymakers, health care professionals and experts the wherewithal to propose virus countermeasures informed by reality, not speculation.
In practice, however, officials are concerned that doing so would amass a wave of asymptomatic patients — many of whom don't necessarily need hospital treatment but would in some cases be hospitalized under Japan's stringent policies — that would prevent hospitals from providing treatment to patients with severe symptoms who really need it.
China has conducted more than 90 million tests, the U.S. about 48 million, Russia just over 25 million and India around 14 million.
Japan, according to its health ministry, has tested about 534,000 individuals.
When Tokyo reported 168 additional cases of COVID-19 on Monday, city officials said just over 4,100 polymerase chain reaction (PCR) tests had been conducted. In recent weeks, the metropolitan government receives and reports test results about three days after they were administered.
Shibuya believes lack of commitment and bureaucratic red-tape are the source of low testing in Japan, not technology or limited resources. Still, the central government remains reluctant to change course.
It’s undeniable the country has reported a significantly low number of fatalities. On Monday, the death toll surpassed 1,000.
In comparison, the U.S. has logged more than 140,000 deaths, Brazil over 80,000 and the United Kingdom around 45,000. Tens of thousands have lost their lives to the pandemic in Mexico, Italy, France, Spain, India, Iran, Peru and Russia.
Despite low testing and measures that at times seem tone deaf or contradictory — a thoroughly criticized plan to send two masks to every household in the country, or a government-funded campaign to promote domestic tourism during an ongoing pandemic, to name a few — Japan has avoided the kind of devastating outbreak occurring in other parts of the world.
Experts say delegating more power to prefectural governors and other municipal leaders would encourage a more localized approach that could eliminate the need for broad business closures and prevent the economy from sinking further into recession.
This could become reality after Chief Cabinet Secretary Yoshihide Suga said Sunday that “a new law is necessary” amid calls from prefectural governors for more power to fight the pandemic.
Earlier this month, unnamed government sources said the central government is weighing a package of law revisions to be submitted to the Diet no later than next year’s ordinary session, one of which would include the implementation of punishment for individuals who refuse to comply with social distancing measures or business closure requests.
But no country is out of the woods until a vaccine or effective treatment is developed and made available to the public.
During a budget meeting at the national Diet last week, Tatsuhiko Kodama, professor emeritus at the University of Tokyo’s Research Center for Advanced Science and Technology, warned lawmakers that Tokyo could become the epicenter of Japan’s next coronavirus wave if the government doesn’t take decisive action.
“A cluster and an epicenter are two very different things. If an epicenter forms, going to a music venue or riding the train will become dangerous,” Kodama pleaded. “If the government doesn’t take decisive action, by next month the situation could make us want to cover our eyes.”
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