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The number of elderly people in Japan is higher than in any other country in the world. Why have so few Japanese died from the coronavirus? The question sounds a bit grim, of course, but this statistic has spawned many explanations – from peculiar Japanese habits to speculation about some kind of supernatural immunity among the country’s inhabitants.
Incidentally, Japan still does not have the lowest Covid-19 mortality rate in the region: South Korea, Taiwan, Hong Kong, and Vietnam all have even lower death rates. But in the first half of 2020, Japan recorded even fewer deaths than the average for this time of year. This is despite the fact that Japanese authorities announced in April that there had been a thousand more deaths than usual – possibly due to Covid-19.
All of this is particularly surprising given the large number of people in Japan who are considered particularly vulnerable to the coronavirus, and the fact that the authorities did not impose strict quarantine measures as other countries, including neighboring countries, have done. Since the outbreak in Wuhan, China, in February, when hospitals were overcrowded and many countries closed their borders to Chinese tourists, Japan has kept its borders open.
Compared to countries such as South Korea, Japan has a relatively small number of people tested for coronavirus. As the virus spread, it quickly became clear that it was primarily lethal to the elderly and spread rapidly in crowded places or through prolonged contact. Japan has the highest percentage of elderly people of any country in the world. In addition, Japan’s major cities are very densely populated. 37 million people live in and around Tokyo, and for many of them, the only means of transportation is the crowded Tokyo subway.
Japan has refused to heed the WHO’s call to “test, test, test”: to date, only 348,000 people, or 0.27% of the country’s population, have been tested for coronavirus using PCR (polymerase chain reaction) tests. In addition, the authorities did not impose a strict quarantine. In early April, a state of emergency was declared in Japan, but residents were not required to stay at home, only advised to do so. Shops selling non-essential goods were advised to close, but no penalty was imposed for non-compliance.
Even when a state of emergency was declared in Japan, people were not explicitly forbidden to leave their homes, but were only advised not to do so. Despite the lack of strict measures, five months after the first case of Covid-19 was recorded in Japan, the country has registered less than 20 thousand cases and less than 1 thousand deaths. The state of emergency has already been lifted and life is quickly returning to normal. Scientific data also confirms that Japan has largely succeeded in containing the spread of the virus. At least for now. Telecommunications giant Softbank tested 40,000 of its employees for antibodies – and found that only 0.24% of them had them. Selective testing of 8,000 residents of Tokyo and two of its prefectures showed an even lower impact of the virus: only 0.1% of the tests were positive. When Prime Minister Shinzo Abe announced the lifting of the state of emergency in June, he spoke proudly of the “Japanese model,” implying that other countries could learn something from Japan.
There are a lot of people on the streets again in Japan. We explain quickly, simply, and clearly what happened, why it matters, and what happens next. The number of offers should remain: episodes. The End of the Podcast Advertising Story What is so special about the country’s inhabitants? According to Deputy Prime Minister Taro Aso, it all comes down to the “exceptional qualities” of the Japanese. In a statement that sparked sharp discontent among many, Aso said that leaders of other countries have asked him the reason for Japan’s success. “I told them: In your country and ours, people have different ‘mindo. Here they opened their mouths and fell silent,” the deputy prime minister said. Literal…
Translated, ‘mindo’ means ‘human quality,’ although this term is often translated as ‘cultural level. This concept is related to the era of Japan’s imperial ambitions and is associated with ideas of Japanese racial superiority and cultural chauvinism. Therefore, Taro Aso was widely criticized for mentioning it. However, many Japanese people, as well as some scientists, believe that the Japanese are indeed different from other nations – they have a certain special “quirk” that has served as a protection against Covid-19. Perhaps the fact that the Japanese naturally keep their distance from each other, hugging and kissing less, also plays a role, but this is not the main explanation.
Professor Tatsuyuki Kodama of the University of Tokyo, who is studying how Japanese patients respond to the new coronavirus, believes that Japan has already encountered covid before. Not Covid-19, but a very similar coronavirus that left a mark on the population’s immunity.
The Japanese began wearing masks en masse long before the coronavirus pandemic. When a virus enters the human body, the immune system produces antibodies that attack the invading pathogen. There are two types of antibodies – immunoglobulin class M (IgM) and immunoglobulin class G (IgG). The way they react shows whether the person has been exposed to a specific virus or a very similar one. “In the initial infection, IgM usually reacts first. And then the IgG response appears. But if a person has the same infection a second time, the lymphocytes have already remembered it, so only IgG starts to react, and very quickly,” Professor Kodama explains. So what kind of picture does he see in his patients? “When we looked at the test results, we were surprised because all the patients had a rapid immunoglobulin G response, and only later, and to a much lesser extent, did the immunoglobulin M response appear. It seems that they had previously been exposed to a very similar virus,” explains the scientist.
Karaoke was very popular in Japan, and experts consider it dangerous in terms of spreading the coronavirus. Professor Kodama believes that the SARS-CoV virus, which causes atypical pneumonia, has been circulating in the region before, which is why the mortality rate is so low not only in Japan but also in China, South Korea, Taiwan, Hong Kong and Southeast Asian countries. This version was met with some skepticism. “I don’t understand how a virus can be confined exclusively to the Asian region,” says Professor Kenji Shibuya, Director of the Department of Public Health at King’s College London and a former senior advisor to the British government. He does not deny the possibility of differences in immunity or genetic predisposition to Covid-19. However, the expert is skeptical about the idea of a special “highlight” among the Japanese that would explain the low mortality from the new coronavirus. In his opinion, the countries that have successfully fought the epidemic have done so in the same way – by greatly reducing the likelihood of transmission.
The Japanese began wearing masks over 100 years ago during the “Spanish flu” epidemic that began in 1919, and they have essentially never taken them off. This is because it is customary in Japan for a person with a cough or runny nose to wear a mask to protect those around them. “I think it serves as a physical barrier. And also as a reminder that we need to be vigilant. That we still need to communicate with caution,” says Keiji Fukuda, a flu specialist and director of the Department of Public Health at the University of Hong Kong.
The contact tracing system in Japan was established and perfected in the 1950s during the country’s severe tuberculosis outbreak. In Japan, two important characteristics of coronavirus spread were quickly identified early in the pandemic.
The statistics show that one-third of all infected people usually contract the virus in very similar places and circumstances,” says Kazuaki Jindai, a researcher at Kyoto University and a member of the working group to prevent cluster outbreaks. “Our data show that many of those who became infected visited concert halls or nightclubs, where people shout, sing… We realized that these are exactly the places to avoid,” says the scientist. First, his working group identified the following activities as risky for the spread of COVID-19: anything that promotes heavy breathing, especially singing in karaoke bars, at parties and clubs; loud conversations in bars and pubs; exercising in fitness clubs. Second, Japanese scientists from Dr. Dzinday’s research team have determined that the infection is spread by a small percentage of individuals who are carriers of the virus. One of the early studies found that about 80% of those infected with the SARS CoV-2 virus (which causes Covid-19) do not infect others, while the remaining 20% are super-spreaders. These discoveries prompted Japanese authorities to launch a nationwide prevention campaign, “Avoid the three Z’s.” “I think it worked better than just telling people to stay home,” says Professor Dzindai. And even though the offices were not on this “dangerous” list, officials hoped that the “three Z” campaign would slow the spread of the virus enough to avoid a lockdown. That was true for a while, but then in mid-March, the infection rate in Tokyo skyrocketed, and it seemed that the city was facing an explosion similar to what happened in Milan, London, and New York. But it didn’t happen: whether Tokyo was just lucky or whether the people behaved wisely remained unclear. Professor Kenji Shibuya believes that the Tokyo experience can offer the same lessons as in the case of other countries: “For me, the key here was timeliness.” Prime Minister Shinzo Abe declared a non-mandatory state of emergency on April 7, urging people to stay at home if possible. “If this measure had been postponed, we would have been in the same situation as New York and London. But as it is, the mortality rate in Japan is low,” Shibuya notes.
“A recent study by Columbia University (in New York State) showed that if the quarantine measures had been implemented in New York two weeks earlier, thousands of deaths could have been prevented. A recent report from the Centers for Disease Control and Prevention in the United States found that people with chronic conditions such as cardiovascular disease, diabetes, and obesity are six times more likely to be hospitalized if infected with the coronavirus – and 12 times more likely to be killed. As for cardiovascular disease and obesity, the number of Japanese diagnosed with these conditions is the lowest among developed countries in the world. However, scientists insist that even such important statistics do not explain everything. “These physical differences may indeed have some effect, but in my opinion there is something more important. We have learned from Covid-19 that there is no simple explanation for the phenomena we observe in relation to it. Many different factors influence the final result,” says Professor Fukuda.
So what is the result – should the country not be placed in full quarantine? The answer is both yes and no. As for the Japanese being particularly susceptible to the coronavirus, they have no special “quirk”. It was simply important to break the chain of infection transmission. And in Japan, the authorities can be confident that people will follow the advice. They were not forbidden to go out, but they were told to stay home – and they stayed home. Professor Fukuda says, “How can we reduce contact between an infected person and a non-infected person? This requires the cooperation of the entire population and is not easy to replicate in many other countries. The Japanese government asked its citizens to exercise caution, avoid crowded places, wear masks and wash their hands, and for the most part they did just that. Nothing special.