At the time of writing, Japan has just over 900 confirmed cases of coronavirus. That’s 900 cases recorded over a two-month period since the first person — a man who had traveled to Wuhan — was confirmed to have the disease while in a Japanese hospital between Jan. 10 and 15.
In Italy, the first case was recorded two weeks later than in Japan, on Jan. 23. Shortly after, 50,000 people were quarantined in a handful of towns in the Lombardy region. Then, it was the entire north. Now, the entire country is in quarantine, with over 40,000 confirmed cases and 3,600 dead.
In the U.S., New York has closed its bars and restaurants and California has imposed similarly wide-scale “shelter in place” restrictions on the movement of its people and the activities of its citizens.
Look around Tokyo now, and you’ll see no such scene has unfolded. Despite the cancellation of sports events, the closure of schools, and the shutting down of some, but not all, larger entertainment venues, much of Japan continues as normal. There is no quarantine and no enforced closures of bars or restaurants. Even clubs (easy places to get sick at the best of times) remain open.
If you want to eat ramen at 4 a.m., fine. If you get on the subway, you’ll see it slightly emptier, but still heaving. If you want to rent a car and drive from one end of the country and back again, do it — there’s nothing stopping you. Which means there’s very little stopping the spread of the disease either.
So why the difference? How has Japan seemingly escaped the spread of the coronavirus when other countries have suffered so badly?
When you look at the factors that have made the virus spread quickly and easily elsewhere, Japan meets all of the same criteria. It has close contact with China, where the disease originated. Its cities are vast and dense, people are crammed into small apartments and squeezed together on trains (more so than many other cities), and despite requests for people to stagger their commutes and attempt to telework, Tokyo, with its population of 38 million people, remains busy.
One reason that Italy has been hit so badly, according to the World Health Organization, is the age of its population: The country has the oldest average age in Europe, the second oldest in the world, and coronavirus disproportionately affects the elderly, whose immune systems may not be strong enough to stave off the pneumonia the virus causes. Here, Japan one-ups Italy, its population is the world’s oldest and is just as vulnerable.
A common factor behind the deaths recorded in China was smoking — those with already damaged lungs are more likely to succumb to pneumonia. Here again, Japan triumphs in its vulnerability — the government still owns 33 percent of Japan Tobacco and legislation toward smoking here is extremely lax. In 2017, Japan had the highest rate of male smoking among the G7 nations.
And it’s not like Japan has placed strict measures on its citizens to keep the disease under control. It has neither imposed the level of quarantine we saw in China to curb the outbreak, nor has it been strict with its travel restrictions. Most travelers can still visit Japan, and those from restricted countries aren’t banned entirely, they are just asked to voluntarily self-isolate for 14 days.
So again you have to ask why the difference? How is Japan reporting such low numbers?
The cynical answer points to the country’s low testing rates, that Japan has recorded such a low number of cases precisely because it isn’t testing. Of course, a question mark hangs over the Olympics and whether the government is attempting to keep confirmed cases low so that the games proceed as planned.
Unlike South Korea, where we are seeing rigorous testing, and despite World Health Organization advice to “test, test, test,” Japan has stuck to a policy of testing only those with extended visible symptoms or a history of direct contact with those who have tested positive, attempting to isolate small clusters before they grow. New tests that produce results in 10-15 minutes are becoming available, but even with the improved tech, under the current policy a test will only be administered in the most extreme circumstances, when people have had a fever for four days or more.
But if the government’s testing regime is a failure, surely we’d see evidence of the disease’s spread in other ways. Its presence would appear not as positive test results but in the guise of an overwhelmed health care system and overcrowded mortuaries. We have seen no such evidence.
Three trains of thought lead from here: conspiracy, good fortune and efficacy.
Conspiracy would suggest that there is a widespread cover up, that people are dying in their homes, untested and untreated, or being given false death records in hospital. It is, however, hard to believe that a nation’s worth of doctors would be, or could be, silent if the number of deaths we are seeing in Italy were occurring here. While an authoritarian government might dream of being able to control its population to that extent, the reality is unattainable; doctors would speak out to prevent deaths — we saw them speaking out in China, we’d see it here.
It is equally hard to get onboard the second train of thought: that Japan is simply fortunate. That the disease here just hasn’t spread in the way it has elsewhere due to a number of pre-existing conditions: relatively less social intimacy (bowing vs. shaking hands), an inclination to wear masks when sick that has existed since long before this coronavirus, already high rates of isolation amongst the elderly, and what little voluntary self-isolation and social distancing there is has meant that Japan is flattening its curve without a truly active attempt to.
Then there is the third option, that Japan’s “just enough” efforts, built upon those pre-existing conditions have simply worked. That targeted testing where needed has contained the disease where it has emerged; that early closure of mass events did do enough to prevent widespread contact of the infected with the healthy; and that decentralized efforts stemming from individuals and corporations (zero contact pizzas, everyone) have halted its spread without heavy-handed government directive. But “just enough” feels like an awfully precarious position to be in and without the coordinated efforts that have forced other populations to limit the spread of the virus, you have to ask: How long will the situation last?
The “critical” two-to-three week containment period proclaimed by Prime Minister Shinzo Abe at the end of February has now come to an end and some schools are set to reopen. If you head out to places like Tokyo’s Shinjuku Station or Shibuya Crossing, you’ll see them packed.
We’re now enjoying a three-day weekend, and it is the start of hanami (cherry blossoms viewing) season, which is typically marked by large picnics and parties beneath the trees. Already Shinjuku Gyoen, one of the capital’s largest parks, is busy with people taking pictures and swarming close between the nascent blossoms.
While official hanami events have been cancelled, the practice is so ingrained in the culture that it is hard to imagine people showing such restraint as to cancel picnics in their entirety.
If Japan’s not yet seen the worst of the disease, and studies suggest that it is yet to, will this be the catalyst?