787,411 confirmed cases worldwide; 37,846 deaths reported (as of March 30, 2020). And the numbers continue to rise on an hourly basis. Since its appearance last year in China, the novel coronavirus, COVID-19, has spread dangerously fast around the world and has been declared a pandemic by the World Health Organisation. Some of the worst-hit countries outside China are Italy, the United States of America, Spain, the United Kingdom; the list goes on. On the other hand, there are countries that are still shielded from this global pandemic. Countries appearing on this list are mostly those that are cut-off from the mainland, for instance, Fiji, Solomon Islands, Tonga, Barbados, Taiwan, etc. However, one name that stands out and has puzzled health experts is coronavirus in Japan.

It is not that the Japanese have not contracted it, in fact, it was one of the first countries to be hit by the coronavirus. But from being among the firsts to now being one of the least affected developed countries, it has left people wondering whether Japan has dodged a bullet or is about to be hit.

First, some background and facts. Japan is home to 127 million people with a ‘negative’ population growth rate of approx. 0.27 percent. 28 percent of its total population is aged 65 years and above, which is the highest in the world, i.e. Japan has the world’s oldest population. This was one of the reasons why coronavirus in Japan was expected to multiply rapidly, as it did in Italy (with the second oldest population) when the news hit on February 1 that a passenger aboard the Diamond Princess Cruise ship had tested positive. Japan’s decision to keep passengers and crew on board the ship and poor hygiene practices resulted in the spreading of the virus. Cases shot up from 10 to 630 while it was quarantined in Yokohama for two weeks. Initial slow response to the virus became a cause of worry with some saying that Japan could become home to a ‘second Wuhan’. However, what’s shocking is that despite all this and its proximity to China, as of March 30, Japan has a little over 1800 confirmed cases and 50 deaths. So, how did Japan manage to control it?

Kenji Shibuya, former chief of health policy at the WHO, sees two possibilities: one that Japan has contained the spread by focusing on outbreak clusters, or two, that there are outbreaks yet to be found.

Whether or not Japan will witness the second wave of outbreaks needs to be seen. But one thing is for sure that Japan has managed to somehow limit its spread till now. One of the reasons was an early diagnosis. Japan, being close to China, became aware of the disease when it was in a more controllable phase. It alerted the public and took proactive measures with regards to border control, availability of sanitizers, face masks and basic steps to protect public health. Since it was still early, even moderate social distancing had an impact on cutting the infection rate. Along with this, a good percentage of Japan’s population practices good hygiene practices including, but not limited to, frequent hand-washing, gargling, disinfecting and maintaining physical distance from strangers in public. Japanese culture rarely promotes shaking hands or hugging when greeting. In addition to this, learning from previous pandemics, Japan adopted the culture of wearing face masks when ill or even traveling in routine. Thus, early identification and built-in cultural habits helped flatten the curve of coronavirus in Japan.

Japan has also been successful in identifying infection clusters early on. The government ensured that anyone who has been in contact with an infected person is located and tested. A specialized team of medical experts has been created to identify and isolate such infection clusters. A lack of large case explosions, akin to ‘Patient 31’ of South Korea who single-handedly managed to spread the disease to thousands, suggests that these measures have been effective so far. Japan also has an accessible and widespread national health system in place that specializes in treating pneumonia, the main way that coronavirus kills.

Another explanation for low positive turnout is low testing. Despite having the means to conduct about 7,500 tests a day, Japan’s daily average is close to 1,200 only. Thus, while South Korea (with a population half the size of Japan’s) has tested close to 365,000 people, Japan’s count is only 25,000. Dr. Tomoya Saito, director of the department of health crisis management, said that the limited testing was intentional. Japan’s current policy is to test patients with a fever greater than 37.5°C (99.5°F) for more than four days, in order to avoid draining healthcare resources with less severe cases. However, the government’s strict testing criteria have been criticized and have led many to conclude that the numbers do not indicate the true spread of coronavirus in Japan. In fact, the recent outbreak of coronavirus in Tokyo has brought Japan’s status quo into question.

Japan, unlike much of Europe and the USA, has not imposed any draconian isolation measures or mass quarantine lockdowns. Although schools had been closed for a month and the government had requested the cancellation of large gatherings, the public had not taken such warnings seriously so far. Life was relatively normal in cities like Tokyo, with people riding crowded subways, gathering for ‘hanami’ (cherry blossoms viewing) season, living under the false pretense of Japan’s relatively low number of confirmed cases. However, cases developed in Tokyo may prove that under-testing was masking the extent of the spread of coronavirus in Japan. While Japan’s culture might have helped it slow down the beginning, it may not help contain the spread further. Thus, before people let down their guard, it is necessary to take appropriate measures.

The Japanese government is hoping to improve citizen’s response to coronavirus through ‘thorough behavioral changes’ and ensure that people avoid places meeting three conditions of ‘poor ventilation, dense crowds, and dense conversation’. The government’s insistence that Japan doesn’t require a lockdown may prove fatal. Nonetheless, Prime Minister Shinzo Abe has appointed a task force to determine whether he should declare a state of emergency. Japan has the tools to handle a surge in cases. According to World Bank data, it has the highest number of hospital beds per 1,000 people – 13 – among the G7 nations. Hopefully, the verdict will be out before it’s too late.

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