Why Japan has so “few” Covid-19 cases

An opinion piece on why Japan has so few Covid cases from a long term resident of Japan. I have been living in Japan for 20 years, permanently since 2006. I was here after the triple disaster of March 11th 2011, which gave insight into how Japan handles crises. I have no medical or scientific training or background. This is my two cents on why Japan has relatively few Covid-19 cases.

On Friday March 20th 2020 Japan’s confirmed number of Coronavirus cases exceeded 1000 people for the first time. A number exceptionally low considering that Japan was one of the first places to record a case outside of China as early as January 16th.

You would think given that parts of Japan are so densely populated and our proximity to China, plus the numbers of Chinese tourists that visited Japan during Chinese New Year, that Japan would have seen an explosion of Covid-19 cases by now. We haven’t, but we will very shortly, and here is the why to both…

Why Japan has so few Covid-19 cases

Why does Japan have so few Covid-19 cases?

There are multiple layers to why Japan currently seems to have such relatively few Coronavirus cases. They include testing policies, outbreak cluster control, self-quarantine, seasonal influences, mannerisms and Government measures.

  • Testing and outbreak clusters
  • Hay fever and flu season
  • Mannerisms and self-quarantine
  • Curtailment measures

Testing and outbreak clusters

If you haven’t heard by now: Japan is not testing the way other countries are. Despite having the capacity to test around 6000 people a day, they had only tested 37,726 people in total between February 18th and March 19th 2020. (Source: Kyodo News, March 22nd)

At first I was extremely frustrated and annoyed that Japan was not testing. And I would like to see them testing more. However, I can see some of the benefits of Japan’s approach to date, but unfortunately this can no longer be sustained as, I believe, Japan’s figures are about to multiply in the coming days. (See Why Japan is about to have an increase in Covid-19 Cases below).

In order to get tested in Japan you need to have a had a fever for five days or more. You can’t just rock up to any hospital and request a test. First you have to ring the designated coronavirus management center in your area. They will take your history and details. If you have had a fever and other symptoms for five days, and / or have been in close contact with someone who has had the novel coronavirus or who has traveled to regions where there is a high prevalence of Covid-19, they will come for you in a hazmat suit. Otherwise, they will tell you to self isolate and record the progress of your symptoms.

The benefit this has had to date is that regular hospitals and clinics have been protected, for the most part, from infected patients. They also have not been inundated and can go about regular practice. It also succeeds in keeping sick people home long enough to determine without a test if they have something other than Covid-19. Furthermore, it has kept panic at bay.

Other countries are placing a great emphasis on testing. As I said above, I wish that Japan would test more. However, testing alone will not magically curb the spread. Japan has been focusing on identifying outbreak clusters. But of course the fear is that there are other clusters they haven’t identified. Mass testing avoids that, but it also creates fear especially as the figures are often given out of context. On the flip side, under testing has created a risky level of complacency.

Hay fever and flu season

Japan had a warmer than normal winter. I have only suffered from hay fever for four years, but I get it quite bad now. However, this was the first time I was effected by hay fever as early as January. And I wasn’t the only one. Due to the warmer than normal winter many of us started taking antihistamine and/or hay fever medication from late January. (And I have wondered if by any chance antihistamine might unknowingly been giving us some protection from Covid19?)

Also, as it was flu season hand sanitizer was posted at the entrance way to most shops and restaurants as is customary here every winter. Those who weren’t wearing masks for hay fever were wearing them as a precautionary step against catching the flu.


Coronavirus Japan why does Japan have so few Covid-19 cases

I personally never wear a mask to prevent illnesses, but it is a common preventative measure here. I do wear masks when the pollen levels are high as I find them effective when I am out and about in nature. Due to the early onset of hay fever this year, and as it was flu season, a large percentage of the Japanese population were wearing masks in January and February.

Masks in my humble opinion are useful in helping to curb the spread. As the World Health Organization (WHO) themselves said; many people are asymptomatic. So they are carrying and spread the virus without ever showing signs of having the virus themselves. Similarly, they have told us that most likely people are contagious before they show the symptoms of the virus. So by wearing masks you are less likely to spread the virus if you have it unknowingly.


As you know in Japan we bow rather than shake hands, hug or kiss. While this in itself is not enough to curtail the spread of the novel coronavirus there is a chance it has helped in slowing and/or reducing the spread.

The cases from the Princess Diamond and people repatriating from China in the early days were asked to self-quarantine. For the most part people were co-operative and adhered to self isolation without policing. There were of course exceptions.

Curtailment measures

Prime Minister Abe came under a lot of criticism for how he initially managed the outbreak. Then on Thursday February 27th he did a 180 and surprised the nation by introducing additional curtailment measures. On the 20th they had started the ball rolling by requesting events that attract more than 500 participants a day be either postponed or cancelled.

A very good analogy regarding herd immunity and controlling an outbreak came out of England. Think of a sink with several taps. If all taps are turned on full blast at once it doesn’t take long for the sink to fill up, overflow even. But if the flow of the taps is controlled, particularly with some turned off, it takes longer for the sink to fill or overflow.

On February 27th Abe gave the word to turn off several taps! By requesting schools finish up for the school year (which ends at the end of March in Japan) by March 2nd, he essentially turned off several taps. By closing down museums, amusement parks, zoos and other tourist attractions he turned off several more. (See places effected by the Covid-19 closures in Saitama Prefecture.) I personally believe that Abe and the Government were trying to buy time to get things in place for the surge in numbers that is yet to come…

Why Japan is about to have an increase in Covid-19 cases

There is no way that Japan is immune from this viral outbreak. Abe and the powers that be know that. In my humble opinion, by slowing down the spread in early March, they bought sometime to get things in order for an upsurge in numbers, which I personally believe will be seen in the next week or two. Because on Friday 20th of March several taps were turned back on simultaneously.

Pick up: Self-quarantine

Japan are now asking tourists from dozens of countries to self quarantine for two weeks after arriving in Japan. They are also asking them not to use public transport. Source: Japan Times.

Back to school

In a press conference late on Thursday March 19th a representative of a panel of experts announced that schools could choose to start back at their own discretion. They asked that events remain cancelled for the meantime, and that people refrain from picnicking under the cherry blossom trees, but other than that they insinuated that life can go back to normal.

Back to normal

On Friday March 20th, the start of a three day weekend in Japan, life sure enough did go back to normal. People who had been cooped up at home for the past two to three weeks, welcomed the opportunity to get out and about again. Images of full shopping streets and lines at restaurants dominate social media. In my own area, on a drive to a remote nature spot, we passed a mall that had queues of cars to get in and out of the parking lots. We witnessed sleepy rural towns bustling with tourists and people sharing food in close proximity to each other.

In effect, since March 20th people are no longer isolating themselves at home, people are not practicing social distancing, and for all intents and purposes life seems to have gone back to normal. So unless there is something preventative in the antihistamine and hay fever medication around 20% of Japan’s population is currently on, it only makes sense that this sudden return to proximity of people will lead to a surge in the Covid-19 cases in Japan within the next week or two.

In summation

I personally believe that the measures Japan took bought us sometime. I think Abe chose to cancel events and close schools in order to do that, but he knows we can’t evade this virus forever. And so now that they’ve done what they can to prepare, they are actually encouraging the spread by letting people go back to normal.

I think this is a move to induce the peak as long away from the Olympics as possible. Even if its not about the Olympics, the approach Japan has taken seems similar to the controlling measures of herd immunity. Regardless the real motivation and reasons behind the approach Japan has taken, the lifting of restrictions on March 19th is no doubt going to have a knock on effect. And I have absolutely no doubt we are going to see a surge in covid-19 numbers in Japan in the next week or two.

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6 comments on “Why Japan has so “few” Covid-19 cases

  1. AndysWorldJourneys

    interesting. the thing about testing is, you cant count as a someone with the virus if it hasnt been confirmed and to confirm it, you need to be tested. So generally worldwide we are not seeing the true numbers of people with the virus. With only 37000 tested in Japan, the number of actual cases is likely to be CONSIDERABLY more. Masks apparently do not stop you from getting it. although they may help if you have it from spreading to others to a certain extent. Japan is a pretty sterile country and i remember hand santiser in so many places when I was there where it isnt normally found in other countries – at many places where social events are held for examples, EVERYWHERE in schools, and students (and teachers) use it because there is such an emphasis. so that probably helps, clean habits are ingrained in the psyche. I wish the same could be said here and elsewhere.
    \take care through this crisis Australia is slowly moving to lockdown – Victoria (State where I live) is going to a much stricter lockdown as of Tuesday because people have not been following the guidelines. its all going to get a lot worse before it gets better

    1. L M N

      I totally agree. I think we can never possibly know the true numbers. Even in China I suspect the numbers are higher for the reason you stated: the whole population was not tested. And the same thing is happening in Japan. South Korea are trying their best to test as many as possible. What I would like to know but don’t is what percentage of people who were tested were negative. I can deduce it for Japan, but actually its not accurate because some people have been tested multiple times. There have even been in two cases in Japan were people had it, were released from hospital after 3 weeks after testing negative twice in 24 hours and ten days later tested positive again. One of them has subsequently died. 🙁

      We will just never truly know. But of course testing gives us a better indication and I do truly wish japan would test more.

      As for masks – they tell us they are not effective, but then why do medical staff wear them? That is a can of worms I really don’t want to open, but I agree that they are not completely effective for preventing you from getting it, but I do think they can help limit the spread.

      Thanks a million Andy.

  2. Anika

    I agree. I also believe we will see an increase of case in one to two weeks.
    However, specialists advise to let the infections come in waves by restricting life, loosening it, and then restricting it again.
    I think that this is what we will see in Japan.
    Meanwhile I hope that it will be easier in the future to get the antibody-test to see if our common cold already was Covid-19. It would be so nice to know..
    At the moment we don’t know if the cough and sore throat is coming from hay fever or not😅

    1. L M N

      Thank you for commenting Anika. That would be great if we could see in the future if we already had Covid-19, it would certainly bring some peace of mind especially if it turns out we had it without being sick from it. I didn’t know about the waves, I really like that idea and somehow find it comforting actually, that maybe Japan is on top of it and executing a plan that will be for the greater good. I really appreciate your thoughts <3

  3. Helen

    I hope you and your family will all be fine. Seems that Japan has been taking a somewhat similar approach to Britain. I have no idea if this is a positive thing but it makes a change to read about other perspectives.

    1. L M N

      Hi Helen, thank you. Likewise I hope you are all well. I check in on your blog – and garden 😊- from time to time, delighted to see your still blogging too.
      I have noticed the similarities between the UK and Japan too. Our PMs had a good chat about it supposedly. The big difference is transparency in Britain. I think its good that Japan and the Uk are taking a different approach, and Korea a separate one too… we won’t know for sometime yet which is most effective but I think its risque for all countries to do the exact same thing – sorry I’m not very articulate first thing in the morning!!


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