How Far Has Japan Come in Controlling Pandemic? Health Ministry Should Update Its Info

It is hoped that Dr. Omi’s slides from 2020 are updated for two reasons. First, to demonstrate to the rest of the world that Japan is constantly assessing the latest science concerning the novel coronavirus. The second reason, probably more important, is to reassure the Japanese and English-speaking public that the government of Japan, based on its accumulated knowledge, is doing all it can to protect and promote the well-being of its citizens.

A slide presentation from June 1, 2020, on Japan’s Ministry of Health, Labour and Welfare (MHLW) website concerns Japan’s initial response to the novel coronavirus pandemic. The main author of the slides, Dr. Shigeru Omi, was, and still is, chairman of the “Government Advisory Panel on COVID-19,” a non-governmental panel of specialists.

As far as I can tell, these English-language slides have yet to be updated after being posted. These slides are therefore like a time capsule. The old slides provide a great starting point to see how far knowledge of the novel coronavirus has advanced this past year.

What Were the Experts Saying a Year Ago?

In the MHLW slides, Dr. Omi listed three reasons why the number of COVID-19 cases and deaths had been “relatively small” up to June 2020:

“Easy access to medical care under the national health insurance system”;
“Generally high quality of medical care”; and
“Japanese public’s high standard of hygiene, willingness to comply with government requests, and other cultural traits and lifestyle habits.”

These will pass muster with most Japanese. After all, Dr. Omi, a high-ranking World Health Organization (WHO) official and president of the Japan Community Health Care Organization, said so. It’s a case of following the science as explained by experts in the field.

“Follow the science” has been the mantra chanted by United States public health officials since the beginning of the novel coronavirus pandemic. To Americans, “following the science” means stay-at-home orders (under penalty of law), mask mandates, up to 12 months of business and school closures, and, soon, vaccination mandates.

“Follow the science” in the U.S., in the form of social distancing and quarantine, has increased cases of serious affective disorders and alcohol usage, especially in young people. (Exploring the full psychic and economic costs of “following the science” is worthy of another essay.)

Digging Deeper into the Details

With respect to “easy access to medical care,” it is not entirely clear how this would suppress COVID-19 cases and deaths. I, a non-citizen, have had to consult with physicians for non-COVID-19 reasons — without an appointment — so “easy access to medical care” is generally true.

However, earlier in 2021, CNN reported that Japanese citizens had difficulty contacting public health centers for assistance when they had COVID-19 symptoms. Japan has the most hospital beds per capita in the developed world. But to prevent overwhelming the hospital system, Japanese citizens were told by the Ministry of Health to stay at home or in a designated hotel if they showed “mild” signs of COVID-19 or tested positive for the novel coronavirus but had no symptoms.

Japan does have an easy-to-access medical system, but this alone does not explain Japan’s relatively small COVID-19 cases and deaths.

When one says “relatively,” one is inviting comparison and it would be good here to make some comparisons.

Japan has had extremely low COVID-19-related deaths per capita since the start of the pandemic. At Japan’s peak last year, on May 3, 2020, the U.S. had about 30 times as many deaths (5.69 per one million people) and Canada had 26 times as many deaths (4.9 per one million people) as Japan, which had 0.19 per one million people. At the most recent peak, May 23, 2021, Japan had 0.9 deaths per one million people, while the U.S. had 1.7 deaths per one million people on that date.

Remember, however, the fact that almost half of the U.S. had at least one dose of a COVID-19 vaccine. Other countries in which half its people had at least one dose of a vaccine on May 23 were Israel (63%) and Canada (51%), and deaths in these countries were much lower than that of Japan’s.

The Vaccine Factor

The vaccine campaigns in the U.S. and Canada have further reduced deaths, but beginning in July of 2021, COVID-19-related deaths climbed in Israel, one of the first countries to achieve large-scale vaccination. On July 14, the number of deaths per one million people in Israel (0.2) was almost double that of Japan’s (0.11).

Interestingly, even with the number of vaccinated in the U.S. and Canada on July 14, 2021, the number of deaths in the U.S. (0.8) and Canada (0.27) were at least double that of Japan. By July 14, about one-third of Japanese had at least one dose of a COVID-19 vaccine.

Vaccinations therefore appear to be helpful in some countries and perhaps not so much in other countries. The reason for this needs serious investigation. By any measure, the low vaccinations concurrent with low COVID-19-related deaths in Japan suggests something other than government health care may be operating.

Ethnicity and Underlying Conditions

An abundant COVID-19 literature clearly shows that nearly all patients that died after COVID-19 infection had an underlying condition. In 2020, the U.S. Centers for Disease Control and Prevention (CDC) stated that 94% of COVID-19 patients had an underlying condition. Some of these included influenza and pneumonia, respiratory failure, hypertensive disease, diabetes, and high body-mass index (BMI). Similar comorbidities were reported in the United Kingdom.

With respect to Japan, the Organization of Economic Cooperation and Development found that Japan has the lowest rates of heart disease of any OECD country. Also, Japan has the lowest percentage of overweight and obese people. Perhaps this is an effect of a “generally high quality of medical care.” We must in any event take into account the general good health of the average Japanese person as a reason for the low incidence of COVID-19-related deaths.

One obvious factor that Dr. Omi left out — or ignored — is race. In the U.S., there appears to be a marked disparity between Whites and Blacks in terms of positive PCR test result, hospitalization for COVID-19 severity, and deaths — even at the same level of income. It appears that Asians in the U.S. have a higher incidence of positive PCR test results and more severe symptoms compared to Whites. (Across all racial groups, men are at greater risk than women for severe illness and death.)

If there are clear differences in COVID-19 hospitalization, illness severity, and deaths between racial groups, then this needs to be elucidated. It is crucial to identify which groups are at-risk and thus will require more medical resources.

What Works, What Doesn’t

One final note on Dr. Omi’s “time capsule” slide presentation. We know that the novel coronavirus is spread mainly through respiratory aerosols from an infected person, and not through surface contact. Thus, strategies for reducing novel coronavirus transmission could include increasing air flow for indoor spaces when people tend to be indoors during the summer to escape the heat and during the winter to escape the cold, rather than cleaning surfaces and hand sanitizing.

Other strategies implemented by the government to mitigate the spread of the novel coronavirus, so-called non-pharmaceutical interventions, need re-evaluation. Prior to the novel coronavirus pandemic, the WHO reviewed these NPI for evidence of effectiveness in mitigating influenza pandemics. For example, the WHO’s review “identified a lack of compelling evidence for the effectiveness of hand hygiene, respiratory etiquette and face masks against influenza transmission in the community.” Likewise, the “evidence for the effect of surface and object cleaning on influenza prevention is limited,” the WHO found.

While the WHO suggested that workplace and school closures, travel-related measures, and border closures could be effective in slowing the spread of influenza, and feasible during an influenza pandemic, the evidence is of low quality and not compelling. The WHO did note that for school and workplace closures, travel restrictions, and border closings, there was the potential for social disruption and economic consequences.

The WHO also stated its preference that passenger health screening “should be conducted voluntarily” and that the “human rights of mobility” should be considered. There are indeed a number of ethical considerations in the selection of NPI that should have been taken into account, but it appears that few countries, including Japan, gave these wider considerations much thought.