Commentary / Japan | Opinion

Japan's response to COVID-19: A preliminary assessment

by Glen S. Fukushima

Contributing writer

In the four months since the new coronavirus spread from China to become a global pandemic infecting over 3 million individuals and resulting in more than 200,000 deaths, each country has responded to the crisis in its own way, reflecting that society’s politics, economy, institutions, health care system, culture and values.

Because we are still in the midst of the pandemic, it is too early to conclude which countries have been the most effective in managing the crisis. But at this point, public health experts agree that Taiwan, South Korea, New Zealand, Australia and Germany have been among the more successful in containing the virus. Singapore and Hong Kong were considered relatively successful at first, but the positive early results were brought into question by subsequent relapses.

When measured based on the number of deaths per 1 million population, the countries that have suffered the most include Spain (548 per million), Italy (481), the United Kingdom (423), France (386), Sweden (283), and the United States (213). Comparable data for the more successful cases are as follows: Taiwan (0.3), Hong Kong (0.5), Singapore (three), Japan (four), Australia (four), New Zealand (four), South Korea (five) and Germany (83).

The case of Japan

Japan received worldwide criticism in February because of its handling of the COVID-19 infections on the passenger cruise ship Diamond Princess that was docked at Yokohama. It was eventually reported that 712 of the 3,711 people on board, or 19.2 percent, were infected by the virus. In an interview on Feb. 17, Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said: “So, the [Japanese] quarantine process failed. I mean, I’d like to sugarcoat it and try to be diplomatic about it, but it failed. I mean, there were people getting infected on that ship. So something went awry.” This assessment was echoed by many public health experts both in Japan and abroad.

The lessons learned from the Diamond Princess experience and the scrutiny and criticism that resulted were among the factors that compelled Japanese authorities by March to take stronger measures to contain the spread of the virus in the country. However, several factors led to a delay in taking decisive action, including conducting aggressive and systematic testing for the virus.

First, some Japanese leaders in February and March feared that if Japan showed a large number of infected cases, this could lead to the 2020 Summer Olympics, scheduled for July and August, to be postponed or canceled. They saw the Olympics as important not only as a vehicle to assert Japan’s presence on the world stage — as was done in 1964 — but as a catalyst to stimulate demand, investment, tourism and innovation in a sluggish economy.

In addition, taking credit for a successful Olympics was seen by many as key for Prime Minister Shinzo Abe to enhance his historical legacy, shape the political agenda (including a possible election) for the final year of his third three-year term as president of the ruling Liberal Democratic Party, and influence the choice of his successor as prime minister.

Second, public health authorities worried that if testing for the coronavirus uncovered a large number of infections, patients could overwhelm the medical system and lead to scarce resources being devoted to those with mild symptoms to the detriment of those with severe symptoms who required intensive care. This fear of a “collapse” of the medical system’s ability to cope with a large infected patient population led to the conscious and explicit policy to limit the number of tests conducted for the coronavirus.

Third, during the early stages in January and February, the number of infected cases in Japan was small enough so that by identifying “clusters,” contact tracing could be fairly effective in tracking down those who had been infected. By April, however, it became clear that there were too many cases to permit accurate tracing of more than a small fraction of the infected cases.

Fourth, Japan has lacked a sense of urgency in part because the its number of confirmed infected cases per million (119) — compared to Spain (5,359), the U.S. (3,675), Italy (3,505), France (2,596) and Germany (1,985) — and the number of deaths per million (four) have been far fewer than in most other countries.

However, the number of infected cases in Japan is not really comparable to that of other countries because the number of tests conducted per million in Japan (1,459) is minuscule compared to other countries — Spain (41,332), Italy (36,244), New Zealand (32,335), Germany (30,400), Australia (26,069), the U.S. (22,729), Hong Kong (20,674), South Korea (12,488). According to the OECD, Japan’s use of the PCR test ranks 35th out of 36 OECD member countries.  That is, the policy to pursue minimal testing has fostered a sense of complacency in Japan and a serious underestimation of the spread of the virus.

Prospects

On March 24, the government and the International Olympic Committee agreed to postpone the Summer Games. This paved the way for the government on April 7 to finally announce a one-month state of emergency from April 8 to May 6 for Tokyo and six other prefectures. And on April 14, this was expanded to the entire country, although the “lockdowns” are partial in nature and largely exhortatory, lacking the power of legal enforcement and penalties for infractions. Now the state of emergency is to be extended.

The sense of urgency in Japan has been heightened in recent weeks by several events. First, the desperate plight of New York City, Tokyo’s sister city in the U.S., has prompted Tokyo Gov. Yuriko Koike to emulate New York Gov. Andrew Cuomo by conducting a daily news conference to update the public and to instill a sense of urgency about the need to “stay home” and to engage in “social distancing.”

Second, the April 23 death by coronavirus at the age of 63 of Kumiko Okae, a well-known actress and popular television personality, heightened a sense of immediacy and fear of the lethality of the virus among the public. Finally, a growing number of doctors and public health experts domestically and abroad have been warning the Japanese political leadership and public about the dangers of overconfidence and complacency.

In Japan, as in most other countries, there is a delicate balance between the scientists and public health professionals who advocate a conservative approach to minimizing social and business activities until the virus is fully contained or eliminated, and the political and business community that desires an aggressive schedule to restore business as usual and to resume normal economic activity.

The annual Golden Week holiday in early May and its immediate aftermath should provide an indication of whether Japan will end up in the group of countries that is on the way successfully to containing and eliminating the virus or in the group that experiences an exponential growth in the number of infected cases and deaths. One can only hope that the former scenario will prevail.

Glen S. Fukushima is a senior fellow at a Washington think tank. He served as deputy assistant U.S.Trade Representative for Japan and China and as president of the American Chamber of Commerce in Japan.

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