Coronavirus Japan. 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. However, I have no medical or scientific training or background. This is my two cents on why Japan has relatively few Covid-19 cases. Including seasonal and cultural influences, Government policies and actions, masks and B.C.G.
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 (January 14th also has been reported).
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
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. There is a possibility too that a long term national B.C.G vaccination policy is also contributing.
- Testing and outbreak clusters
- Hay fever and flu season
- Mannerisms and self-quarantine
- Curtailment measures
- A national BCG vaccination policy**
**The BCG theory was added on April 4th further to increasing support of the possibility the B.C.G vaccine is affording some protection.
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)
Japan coronavirus testing
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.
Prior to Covid, I personally had never worn a mask to prevent illnesses, but it is a common preventative measure here. I do wear masks when the pollen levels are high. And I do wear a mask now to prevent covid. 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.
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.
Added on April 4th – B.C.G Vaccine
I was reluctant to add the information about the B.C.G when I initially wrote this article on Coronavirus Japan on March 21st. Although several reputable scientific magazines and media outlets had picked up on it, there still wasn’t enough “evidence” to support the theory. Which suggests that countries, such as Japan, that have had a long term nation wide B.C.G vaccination program have fewer per capita COVID cases.
There is mounting support across the global scientific world as we get a better picture of the figures of Covid-19 in dozens of countries, that there may indeed be some protection afforded by the B.C.G vaccine. To the point that both Australia and the Netherlands are currently conducting B.C.G trials with health workers. (Source: University of Melbourne and Sciencemag.org).
|Country||National BCG Program||Date of |
1st COVID case
|Cases Per Million||Deaths |
|Deaths Per Million May 4th|
|Japan||Long term||January 16th||23||0.5||4|
|China||Long term||December *Disputed||57||2||3|
|Taiwan||Long term||January 21st||15||0.2||0.3|
|Spain||Stopped in 1981||January 31st||2,668||251||540|
|UK||Stopped in 2005||January 29th||562||53||419|
|Australia||Stopped in 1991||January 25th||218||1||4|
Compiled from: Worldometer and BCG World Atlas and media sources (1st case dates)
Further reading on the link between B.C.G and coronavirus provided at the bottom of the article.
Why Japan is about to have an increase in Covid-19 cases
Even if there is protection from the B.C.G vaccine, there is no way that Japan is completely 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.
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.
The approach Japan has taken seems similar to the controlling measures of herd immunity. Regardless of 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.
April 4th update: the numbers started to rise in Japan from March 24th. They continue to rise daily, however, the increase is nothing like what we have seen in other countries which some scientists attribute to the long term national B.C.G vaccination program in Japan.
Further Reading – B.C.G
Science Mag, March 23rd 2020 – Can a century-old TB vaccine steel the immune system against the new coronavirus?
University of Melbourne, March 27th 2020 – Preventative vaccine trial for COVID-19 health workers.
Murdoch Children’s Research Institute, March 27th 2020 – Murdoch Children’s Research Institute to trial preventative vaccine for COVID-19 healthcare workers.
New York Times, April 3rd 2020 – A tuberculosis vaccine invented a century ago is cheap and safe, and seems to bolster the body’s immune system.
Euractiv, April 1st 2020 – The Brief – Is Eastern Europe more resilient to COVID-19?