The Train Has Left The Station
Daily COVID-19 cases according to data aggregated thanks to the coding and tech genius of the team at covid19japan.com
It’s only 48 hours since the olympics closing ceremony and one day since the athletes were sent home. While the paralympics doesn’t start for another week and a half, the olympics is basically over as far as most of Japan is concerned.
Today, Japan hit an all-time high record for COVID-19 cases of 18,888.
When the olympics started on July 23, new daily COVID-19 cases averaged about 4,000 per day across Japan, and the highest daily case count throughout the entire pandemic was 7,882 on January 8, a few days after the Japanese New Year holiday.
International Olympic Committee President Thomas Bach said the "risk for the other residents of Olympic village and risk for the Japanese people is zero," yet 518 individuals have tested positive within the olympic village, and daily COVID-19 cases across Japan are up over 400% compared to the highest numbers reported within the two months before the olympics. 95% of cases in Tokyo are the new Delta variant, which is twice as infectious as previous COVID-19 variants. This is largely in part to the fact that Delta has a much shorter incubation period of 4 days compared to the previous 6, and a viral load that is 1260X higher than its predecessors. Not only is it more contagious, it’s also more deadly because of its viral load density. Delta’s transmissibility makes it move through a population exponentially with speed that makes contact tracing much more difficult than before.
The big question now is whether or not this wave will be different from previous waves.
I think we are on the verge of a case explosion and the ensuing medical and emotional crisis not unlike what is being experienced in the United States where larger and larger groups of unvaccinated people are getting infected faster than ever and becoming sicker than ever all at once, taxing an already overburdened medical system that simply cannot keep up. I think this wave will be different, for a number of reasons.
Mounting public frustration
First, we have to look at why case loads are increasing at such a rapid clip country-wide. This certainly isn’t the result of inbound tourism. We know the olympic “bubble” was hardly effective, but even spread of the virus via rogue athletes and teams galavanting around Tokyo and some parts of Japan doesn’t seem sufficient to significantly increase case loads across all prefectures simultaneously. It seems instead that we should be looking for some behavior exhibited by a group of individuals that is present in all prefectures. This is where you see the first fracturing of Japanese society happening in a massive exhibition of tatemae, quietly but very directly ignoring all requests by Japan’s leadership to help slow down the pace of COVID-19 infections. Brad Glosserman, deputy director at the Center for Rule Making Strategies at Tama University, and Ulrike Schaede, professor at the University of California San Diego, reveal what is the greatest breakdown in Japanese society since World War II in their article for Nikkei Asia Japan's fractured polity exposed by COVID-19 crisis:
As Japan buckles under yet another wave of COVID-19 infections, there is confusion and mounting anger at the government's response.
Whatever the intention, the public sees hypocrisy, inconsistency and incompetence. The vaccination rollout has been a mess. The public was asked to practice "self-restraint" and stay at home for the fourth state of emergency as the country opened its doors to tens of thousands of athletes and officials for the 2020 Olympics.
This dismal state of affairs clashes with the image of competence and professionalism that Japan has enjoyed for decades, and for which it is admired around the world.
As the case load exploded this Obon holiday week, I was away in a much smaller town. There’s a large, local park I run in every time I visit, and in the center of the park is a pool complex with a “lazy river,” a long winding pool that winds around the complex that, before the pandemic, was always packed with hundreds of families and their various ukiwa swim rings and floats, propelled around and around by the moving water. Kids and their parents would line up for the huge, multi-story water slide, while other folks taking a break would head out to the food trucks lined up outside selling kakigori (shaved ice) or karaage (Japanese fried chicken).
In July and August of 2020 the water park was completely closed, with signs explaining that due to COVID-19, it was not possible to open safely. But this week, with infections skyrocketing, the new Delta virus running rampant and uncontrolled through Japan, and even the new Lambda variant revealed to have reached Japan, the water park was open. As I walked through the park, I saw rows upon rows of beach sun shades lined up shoulder to shoulder, each with families, most unmasked, enjoying food and drink. The Lazy River was completely full of parents and grandparents floating in circles while their kids laughed and screamed as they played in the water around them.
My jaw dropped. I couldn’t believe it. We are in a situation that is much worse than the same time last year. Unlike the Alpha variant last year, Delta actually makes kids sick, and can result in serious medical conditions and even death. And on top of that, this brings me to the second point. In Kobe, my home town, there’s a much, much bigger waterpark called Dekapatosu. Still staring at the water park in front of me in disbelief, I grabbed my iPhone and called Dekapatosu. A girl answered the phone. I asked if they were open, to which she replied with the affirmative.
Unbelievable.
Japan’s slow vaccination progress
As of August 3, only 30% of Japan is fully vaccinated. Many had their vaccination appointment cancelled in the beginning of July when several prefectures announced vaccine shortages. Depending on who you ask, you’ll hear different theories of who’s at fault and why, but the facts are the facts:
Many people had their vaccination appointments cancelled.
For weeks prior to this, many vaccinations were destroyed due to no-shows or cancellations with no standard waiting list mechanism people could take advantage of. Side note: One incredibly innovative individual LaShawn Toyoda took it upon herself to create such a mechanism, findadoc.jp.
Most people under 65 were told that they would have to wait several weeks to make a new appointment.
While this was happening, and throughout the olympics, anti-vaxxers of all sorts were given the lion’s share of televised attention, with TV talent and announcers on national television showcased and waxed on about complaints of various post-vaccination symptoms, complete with infographics that visually and vastly overstated the well documented and almost entirely innocuous side-effects, without ever giving attention to the clear and urgent benefits of the vaccine. In Japan, national TV still has power. When you consider research into consumer behavior responding to input like this (see Leventhal, Singer and Jones (1965) The effects of fear and specificity of recommendation. Journal of Abnormal and Social Psychology), it’s almost a certainty that national TV influenced a very significant number of people to not get vaccinated.
On top of all this, refrigerator terrorists were pulling the plugs, literally, on refrigerators across the country, resulting in the intentional destruction thousands of doses of vaccine. Anti-vaxxer and right-wing political candidate Masayuki Hiratsuka even campaigned in Tokyo on an anti-mask and COVID-denying platform, tweeting “Thanks! #pulltheplug,” to his followers. At the same time an anti-vaxxer American Pharmascist was sentenced to three years in jail for tampering with 500 doses, Masayuki and those he provoked and directed went without penalty.
So where does that bring us?
None of this matters to the virus
Tokyo isn’t a normal city.
When Los Angeles hosts the Olympics, Washington DC and New York, Austin, San Francisco, etc. etc. could care less. While the olympics consumes the city (in more ways than ever), it typically doesn’t consume the country. That’s not the case in Japan, where the country’s identity is practically inseparable from Tokyo, the largest city in the world with a population of over 37 million spanning the greater Tokyo area. The olympics consumed Japan’s attention, which means attention was diverted from the vaccination effort.
While the population of Tokyo found ways to get together to watch and celebrate the olympics, the virus continued spreading.
While the population of Japan passive-aggressively ignored requests to mitigate the spread, the virus kept infecting.
While all of this was happening, the Delta variant quickly and predictably became the dominate mutant strain, accelerating the spread and rapidly increasing the number of infected.
At best, even if the country succeeded in vaccinating 36 million of its elderly residents by July 31, it would still mean that 70% of the population is unvaccinated. The Mainichi Shinbun wrote that all of this “may be too little, too late.”
Delta isn’t a normal COVID-19 virus.
With the Alpha variant, it takes about 3 hours of exposure to someone else’s air to get a sufficient viral load to become infected. With Delta, it takes about 1 minute in the same space. It infects children and younger adults in their 20s, 30s and 40s readily, and fully vaccinated individuals can still contract and transmit Delta to others.
What happens when a highly contagious virus that operates with incredible speed meets a largely unvaccinated population? It’s not just the number of infections that should be the concern, but rather, the timing. At scale, medical resources can be instantly overwhelmed, which means those that need attention and medical resources can’t get it. In Tokyo there are over 17,000 COVID-19 patients sick in their own homes, the result of a policy that would only hospitalize those needing a ventilator. That policy was only put into place several days ago when the COVID-19 daily case load exceeded 10,000. According to NHK, sick patients are now being sent to other prefectures.
The case load explodes is already booming in several prefectures. The tipping point appears to be about 500/day before is accelerates to 1,000/day and beyond. What happens when all prefectures are overloaded and overwhelmed?
While Delta keeps marching forward, kids continue to go to their cram schools, tennis clubs and swim lessons. Public schools plan to open within a week, and across the country they are planning the traditional 4th and 5th grade overnight camping classes.
It’s incredibly difficult to see how Japan can get out of this situation.
What is easy to see, unfortunately, is what the case load will look like two to three weeks from now.
