DID Japan JUST DEFEAT COVID-19?

May 25

Written By James

Today, with a population of 126 million people, Japan reported only 14 new reports of COVID-19 infections. It’s the ninth day of double-digit new cases reported. By comparison:

The United States (pop. 328.2 million) posted 22,784 new cases
Brazil (pop. 209.5 million) posted 16,508 new cases
Singapore (pop. 5.6 million) posted 548 new cases
France (pop. 67 million) posted 240 new cases
Canada (pop. 37.6 million) posted 1,141 new cases

On the surface, Japan appears to have beat COVID-19. What’s more interesting is that it appears to have been accomplished without lockdowns and mass testing. In fact, Japan plans to completely end the state of emergency related to the virus today.

How this has happened range from explanations about Japan-specific hygiene to ingrained cultural compliance, all the way to practices conspiracy theories of cover-ups and even fringe ultra-minority right-wing assertions of racial and cultural superiority. To figure out the real reason for Japan’s success to-date, we need to apply a little bit of scientific thinking to the situation. Only then do things start to get interesting.

The extremely low number of [reported] COVID-19 cases in Japan is curious.

Even most Japanese experts claim that there’s no single reason, and cynics who attribute Japan’s lower confirmed infection rate to insufficient testing agree that other factors may be playing a part. One of the explanations I keep hearing within Japanese circles is that the slower and lower rate of infection can be primarily attributed to a combination Japanese hygiene practices.

Initially, my inner skeptic had a difficult time with this hypothesis. After all, this is a virus that, once contracted, will shed and spread for several days before the infected individual ever showing symptoms, and it doesn’t take a Western-style handshake, hug or kiss to spread. Just breathing alone is enough to spread it throughout a classroom or small restaurant, and Japan is a densely packed, crowded, 126.5 million people jammed into a space smaller than California.

where are all the sick people?

Just how much of an impact could Japanese hygiene have? Since the number of person to person contacts is the metric we’re trying to reduce via social distancing, I’m less curious about a single practice (like bowing) and more interested in what the total list of hygiene practices looks like.

Because I have been in Japan long enough where I’m starting to take some of the practices for granted, I decided to grab a stack of books - and Google - to build a list of what Japanese do differently than most other humans on the planet. Sure, some of the practices may not be uniquely Japanese, but it doesn’t matter. I want to see the entire list of Japanese practices related to hygiene. Here’s what I found (so far).

The Japanese ANTI-VIRAL SOCIAL hygiene cocktail

Most Japanese tend to wear medical masks when one is sick or think one’s sick: Japanese don’t wear masks to protect themselves from other people. They wear masks to prevent spreading their own possible or real sickness to others.
Japanese bow. No handshaking. No kissing cheeks. No fist bumps. Not even elbow bumps.
Japanese typically avoid intimacy of any kind in public. No hugging, kissing and other physical contact. Except for those kids I just saw outside of Rokko Michi station. Seriously, get a room.
Oshibori, those typically piping hot steaming white towels served at the beginning of a meal, are used to wipe one’s hands and is standard pretty much everywhere.
In Japan, it’s rare to touch your food. Chopsticks are almost always used to handle food.
There are food etiquette rules almost everyone adheres to. For example, it’s commonly accepted that there is no double-dipping of food in sauces, and then there’s the practice of using the back of your chopsticks instead of the front when taking food off a shared plate, called kaeshi bashi.
It’s not obvious at first, but Japanese stand, sit and move differently. This is all rooted in Japanese concept and perception of space. There are even four separate words for space in Japanese: Wa, ba, tokoro, and ma. This is a whole other conversation.
When making payment, whether it’s at a convenience store or anywhere else, Japanese tend to use the little tray - referred to as karuton or coin torei, when giving cash or even a credit card.
Japanese always take off shoes at the home’s entrance, without exception. Shoes are then handled differently, with spaces identified for the storage of shoes in the home’s or business entrance.
Once shoes are off, we’re not done. Japanese typically provide all their guests slippers for inside the home.
There are even specialized slippers for certain applications, such as bathroom slippers. When you go to the restroom, you should leave your slippers outside and wear the special bathroom slippers in the bathroom only.
Shoe culture doesn’t stop at home. At school, kids wear special “indoor shoes” called uwagutsu.
For Japanese, wiping in concept and practice is more complicated than in other cultures. There are several words for “wipe” and even different words for the different kinds of towels you wipe with, depending on the application.
Even showering & bathing has specific practices. One never gets in the bath without a thorough soaping and showering off first. Why would you stew in your own dirt? Also, bathing is a ritual performed at the end of the day, everyday, to clean the body before going to sleep.
Japanese love bidets. There is widespread use of bidets across the country.
While controversial right now for a variety of reasons, it’s widely believed that Japanese tend to speak with their mouths open less. I agree with this a little, but not a lot. There are plenty of terrifically rude people in Japan that speak like an active volcanic blow hole, and even more people who have fairly obnoxious food etiquette, talking loudly with their mouths stuffed with food. And then there’s this silliness. Scroll through the Twitter thread for some entertainment.
Still, women do tend to cover their mouths more when talking. Reasons for this vary.
In general, most people do cover their mouths with their other hand when talking, eating, etc.

Just looking at this list and comparing it to the absence of the same practices in other cultures and countries (United States, Europe, etc.) and a slowdown in virus transmission seems fairly realistic. There’s just one problem: Collectively, none of this worked to prevent the virus explosion in April.

On February 29, the Prime Minister of Japan recommended that the country shut down all schools. On that day, there were only 9 reported new cases.

Source: Wikipedia. Each day shows new cases reported since the previous day.

We don’t know what impact closing the schools had on viral spread. We can assume based on volumes of data from the American Center for Disease Control that closing schools had a big impact, because children spread viruses quickly through a local population. In fact, when my son expressed his frustration with isolation from friends at school, I discovered and shared with him a video called Seeing Germs (link to Youtube video in English) that was so good in explaining social distancing to him that my friend Nathan Bryan and I decided to reach out to Youtuber Mark Rober for permission to localize it into Japanese (link to Youtube video in Japanese).

It almost goes without saying, closing the schools may have been one of the best (and maybe smartest) things the Japanese leadership has done so far during this pandemic.

Still, we know a few things about the virus:

It goes undetected for about two weeks on average. Check out the above graph between February 29 and March 15-ish.
It spreads like crazy during those two weeks. Just one infected person breathing alone can transmit it to everyone in a room, and ventilation can actually help it spread.
At the end of 1-2 weeks, a percentage of people will get sick. And a subset of those people will get really, really sick. A smaller subset of those people will end up on a ventilator and ultimately die. There’s the spike in the graph above on March 26.
All the other people infected over the course of two weeks will start spreading the disease to more people. And on and on. The peak of infection around April 13 on the above graph demonstrates this.

Japan’s COVID-19 Strategy and Plan

The government had put in place a Coronavirus strategy on March 1 and released details regarding its execution. On March 15, Japan closed its borders to most countries worldwide, resulting in a 99.9% drop in inbound tourism and a 99.8% decrease in Japanese travel abroad. The country was essentially shut down and isolated from the rest of the world, except for digital communication and the essentials of trade. With coronavirus cases still rising fast, Japan’s Prime Minister declared a State of Emergency on April 7. Clearly, at that point things appeared out of control. To slow down the spread of the disease, Japan needed the public’s assistance, and they asked for everyone to help by social distancing.

In the fight to contain COVID-19, Japan has some significant advantages compared to a lot of other countries:

It’s a small island country, and it has been able to quickly and easily prevent the inbound flow of people from over 111 countries (to-date) to prevent importing asymptomatic infected.
It’s a peaceful place, and Japanese society is linguistically, ethnically and culturally homogeneous. Of Japan’s 126.3 million population, 124.8 million are Japanese nationals, 98.1% of the population is ethnic Japanese, and 99.1% of the population speaks Japanese as their first language.
Japan is a peaceful country. Most Japanese share respect for authority, respect for each other, and hold social harmony up as a key priority. Social distancing didn’t turn into a political argument in Japan.

Add to this the decades and sometimes centuries of personal and social hygiene practices, and it seems that Japan has ideal conditions to fight COVID-19.

It seemed to work

In a matter of weeks since the peak of infection reports, Japan is now down to double-digit new infections for the ninth day in a row. And now, on May 25, the State of Emergency has just been completely lifted across the entire country. The borders remain closed, but businesses are beginning to open in new and admittedly different ways to meet the new normal.

What’s next?

As the country begins to reopen, the question remains, can Japan maintain and control the infection rate at its present low level? Schools are reopening across the country, and its unclear whether or not a strategy exists to prevent school age children from becoming dangerous vectors of infection.

Japan has tested less than 0.2% of it’s population, some 271,201 out of 126,500,000 people, and that’s only using PCR. Only next week, in June, will antibody tests start rolling out to see just how many people have been infected and are possibly carrying the virus. One study says there are a lot more people infected than previously identified and reported. In addition, over half of Japan pathologists' requests for postmortem coronavirus tests have been rejected, according to the Mainichi. That’s not to mention the number of pneumonia related deaths that have not been tested, or the number of deaths yet to be discovered.

Questions & Answers

Is Japan’s handling of the coronavirus and COVID-19 the gold standard that the world should look to and emulate? Only time will tell. If reopening schools, despite whatever precautions are being taken, results in a spike in cases, we may see the spike around the third week of June. Let’s hope this doesn’t happen.

Is it safe for the children to go back to school here? I’m not sure, and again, we’ll know in about a month if depending on the levels of COVID-19 infections. A lot has been learned about the coronavirus and COVID-19 in the past few months. More recently, a condition caused by COVID-19 affecting multiple children that was previously thought to be Kawasaki syndrome has been identified as multi-system inflammatory syndrome in children or MIS-C, a dangerous and sometimes fatal condition triggered by the virus.

Is it time to go back to normal? Absolutely not. COVID-19 is still with us, and there’s no vaccination against it yet.

UPDATE:

May 26: One day after publishing this post, the World Health Organization WHO called Japan's fight against virus a 'success'. WHO Director-General Tedros Adhanom Ghebreyesus spoke to reporters in Geneva, explaining Japan’s success as measured by a significant reduction in infections and keeping deaths to a minimum. He also emphasized that Japan cannot let it’s guard down, and while some measures may be lifted, the fundamentals of distancing, tracing and isolation must be a continuous priority.