Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
Forget Sweden, Follow Japan
I have begun to believe that when it comes to dealing with the Wuhan Flu, all of the so-called experts are just making it up. In the immortal words of Hollywood wizard William Goldman ( Butch Cassidy and the Sundance Kid, The Princess Bride): “Nobody knows anything.” In evidence, I offer Japan:
Did Japan Just Beat the Virus Without Lockdowns or Mass Testing?
By Lisa Du and Grace Huang | Bloomberg.com | May 24, 2020
Published in HealthcareJapan’s state of emergency is set to end with new cases of the coronavirus dwindling to mere dozens. It got there despite largely ignoring the default playbook.
No restrictions were placed on residents’ movements, and businesses from restaurants to hairdressers stayed open. No high-tech apps that tracked people’s movements were deployed. The country doesn’t have a center for disease control. And even as nations were exhorted to “test, test, test,” Japan has tested just 0.2% of its population — one of the lowest rates among developed countries.
* * *
Experts consulted by Bloomberg News also suggested a myriad of factors that contributed to the outcome, and none could point to a singular policy package that could be replicated in other countries. …
While the central government has been criticized for its slow policy steps, experts praise the role of Japan’s contact tracers, which swung into action after the first infections were found in January. The fast response was enabled by one of Japan’s inbuilt advantages — its public health centers, which in 2018 employed more than half of 50,000 public health nurses who are experienced in infection tracing. In normal times, these nurses would be tracking down more common infections such as influenza and tuberculosis.
* * *
Experts are also credited with creating an easy-to-understand message of avoiding what are called the “Three C’s” — closed spaces, crowded spaces and close-contact settings — rather than keeping away from others entirely.
“Social distancing may work, but it doesn’t really help to continue normal social life,” said Hokkaido University’s Suzuki. “The ‘Three C’s’ are a much more pragmatic approach and very effective, while having a similar effect.”
* * *
While the overall population is much smaller, Asian neighbors such as Taiwan had just seven confirmed deaths from the virus, while Vietnam had none.
“You can’t say the Japan response was amazing,” said Norio Sugaya, a visiting professor at Keio University’s School of Medicine in Tokyo and a member of a World Health Organization panel advising on pandemic influenza. “If you look at the other Asian countries, they all had a death rate that was about 1/100th of Western countries.”
* * *
Yeah, it’s getting harder and harder to come to any other conclusion. However, since they are “experts”, rather than admit they don’t know things, they just stumble from one edict to another, many of which contradict one another with no acknowledgement of same.
Americans regard the right to worship as one of those that the present Government, which was not imposed on them but created by them, is not only not permitted by its creators to violate, but positively required to protect.
Now in the first half of 2020, many of our State Governors have issued edicts making an essential practice of our traditional Jewish and Christian religions–congregational worship–a crime. NY’s Governor has even boldly claimed that according to his new political dogma, religion is officially “non-essential”. They have made swaggering threats, such as the use of violence against even peaceful worshippers who have promised to worship from their cars in their own parking lots in an effort to appease their rulers.
These edicts are marketed as just one element of a general set of restrictions on mass assembly justified by public health goals. But in fact, they are not that at all, as everyone knows. They are, specifically, restrictions on freedom of religion, not on assemblies of people in general, which are in many non-religious cases permitted (bars, marijuana stores, big box retail outlets, abortion clinics, etc.)
This raises a political question of fundamental importance to Americans, given the above foundational beliefs, and the character of these actions against their freedoms by government.
We are continually presented arguments in favor of the edicts by a faction which might be called the Defenders of the Data. They think of themselves, and promote themselves, as advocates of science, but in fact they present conclusions that they derive directly from data, without any scientific reasoning intermediating, and without even offering any premises, let alone logic, connecting their speculations about aggregate statistics to moral or policy conclusions.
Has any epidemiologist, statistician, or other public health expert presented a logical case consistent with their expert knowledge of the Wuhan virus (infection rates, case death rates, population death rates, rates of increase in all of the above, etc., etc., etc.) that any State governor should outlaw worship services?
I’ve been wondering about Japan and several other countries as well. Sweden is doing about the same as its European neighbors in terms of deaths and infections. Japan, South Korea, Indonesia, Malaysia, Vietnam (if you believe a communist regime), Taiwan, Mongolia, Thailand, Laos, India, Nepal, Kazakhstan, Pakistan, Kyrgyzstan, Tajikistan, and Uzbekistan, ALL have death rates about one-hundred times less than western European Countries. All of them are neighbors of China, too. Almost the entire Asian Continent has escaped the virus’s rampage, except China. Noteably, Japan, South Korea, Taiwan, and Indonesia did not do lockdowns like everybody else.
This defies any of the logic that we have been hearing about how to combat the Wu Flu by the experts. Perhaps the virus has its own agenda of the countries it wants to attack, or there are other factors that the experts are overlooking.
Weather is a big factor.
I’m fanatical about the weather factor because of my experiences as a home gardener. In the years when I pat myself on the back because the lilacs or roses are doing really well, I find out later that everyone’s lilacs and roses were amazing. When I try keeping my plants watered during a dry spell, I always think I’m managing pretty well and then we get a good rainstorm. I look outside the next day and every plant and tree is suddenly gorgeous. The water I was applying was not even close to what they needed. Every year when the kids were little and getting colds all winter and late spring, the warm air would flood Cape Cod in early May and presto! Everyone was suddenly healthy. When the summer ends and cold dry air finally moves in, I always laugh. The Good Lord makes such a joke of our pitiful efforts. One blast of cold air from a Canadian cold front and all of the air-conditioners look pathetic. :-)
I think we’ll simply have to learn to live with this new type of virus in the winter months and then air out our houses and get outside and soak up the vitamin D from the sunshine as soon as we can each spring.
You might have something there. Brazil was almost totally unaffected by the virus until their fall weather (Southern Hemisphere) started to creep in. Somebody early on published a paper showing that all the major Covid outbreaks occurred in a narrow temperature band surrounding the earth. Those black circles indicate the very first significant outbreaks of Covid as of early March. The Yellow band is a unique temperature range that had occurred averaged over the previous several weeks.
I saw a very plausible argument: exposure to similar viruses increases immunity. There are countless coronaviruses in the world, and Japanese people are exposed to their own set.
Maybe being previously exposed to a virus that is similar to the WuFlu makes one much less likely to become infected, symptomatic, or contagious?
Sort of like CowPox and SmallPox?
I know. I even saw somewhere this was initially called a “disease of latitude.” The one study the Chinese did early was on the temperature band the virus thrives–40 to 52. That turned out to be an excellent predictor of outbreaks. :-)
I am sure this is the case.
I keep going back to the Diamond Princess. The infected people were walking around that ship for perhaps as long as a week before they had symptoms. There’s no way that the other passengers escaped contact.
I am convinced some people have innate immunity to this bug. As you’ve said, exposure to a cousin of this virus somehow might also create immunity to it.
I keep wondering too if anyone has thought to find out if people who developed antibodies to the initial SARS outbreak in 2003 turned out to be able to resist this virus.
We need to find out about “durable immunity” with this. And I think we need to expect mutations, the way we work with the flu each year.
Someone here on Ricochet wrote a post about this a while back. Sorry I don’t remember who. European diseases, particularly smallpox, were said to have decimated native Americans, so there may be some precedent.
Totally unrelated: Did you see the news that Japan is looking at covering half of tourists’ expenses if they visit in the next year? I’m totally there. https://loyaltylobby.com/2020/05/21/japan-foreign-arrivals-down-99-9-in-april-to-cover-50-of-travel-expenses/
Refugee from Tokyo here (relocated in late February to my hometown in the Boston area).
The number of infectious disease specialist MDs in hospitals in Japan generally is alarmingly insufficient; ditto the number of ICUs worthy of the name. I also have seen writeups about the contact-tracing capabilities of the nursing workforce throughout Japan that totally contradict what’s suggested in the OP’s source — in other words, sufficiently trained nurses in sufficient numbers are just not there.
On the whole, while the Japanese medical system is superbly equipped to handle chronic health concerns and “lifecycle” medical matters such as obstetrics, it’s simply not ready for prime time regarding emergency medicine and a variety of acute situations. I knew this from considerably earlier, and this recognition was part of the impetus behind my mid-February decision to exit Japan. And when you think about it, even without the Wuhan Virus, Japan would have been running a very foolish risk with the 2020 Olympiad.
As a general matter, absent a vaccine, I don’t see myself getting back on a Logan-to-Narita JAL flight (however superb — and they are) anytime soon. Maaayyybe if the virus pulls the same kind of peculiar “just plum burned itself out” stunt that the circa-2003 SARS outbreak apparently did.
Even the editorial board at the Nikkei newspaper (Japan’s equivalent of The Wall Street Journal) is saying that there’s a weird feeling of unease among many Japanese as the Abe Cabinet now moves to lift the stay-at-home advisory for families and businesses across the Tokyo metropolitan area, after lifting the advisory elsewhere throughout the country.
https://r.nikkei.com/article/DGXMZO59532670V20C20A5I00000?s=4
The feeling of unease, per this viewpoint, stems from a nagging sense that the cabinet and public health officials were forever winging it in policy formulation and issuing guidance — nothing at all seemed data-driven, medically informed, or carefully tracked. As such, the Nikkei editors contend that there’s no coherent body of public health practice and crisis management strategy emerging from Japan’s political and medical experience with Wave 1 of the pandemic — nothing that can seriously be termed a “Japan Model” offering globally useful attributes and insights, anyway.
Indeed, in the view of the Nikkei editors, if there’s a Wave 2 outbreak this Autumn, they can’t say with confidence that there are any Wave 1 lessons-learned that can be gleaned and applied within Japan itself, from Japan’s own experiences (!). I myself note in this essay that the Nikkei editor writing it very pointedly leaves out any mention of the vaunted “cluster” containment strategy that Japan’s public health officials were said to be using to great effect (and pointing to as justification for severely constraining actual testing).
I’ll try to do a copy/paste of this Nikkei editorial board essay in a subsequent comment, for those interested in the details and tolerant of Google translate or similar machine translation output.
Per my #11 comment above, here’s the Japanese text from behind the Nikkei paywall.
[Headline]
日本はうまくいったのか 解除後もモヤモヤ続くわけ
[Text]
新型コロナウイルスに関する緊急事態宣言がほぼひと月半ぶりに解除された。当初恐れられていた感染爆発を免れ、日本の流行はいったん収まりつつある。にもかかわらず、どこかしっくりとこない。モヤモヤしている人も多いだろう。果たして日本の新型コロナ対策はうまくいったのか。
ウイルス学者や感染症の医師といった新型コロナ対策のプロが集う「コロナ専門家有志の会」のメンバーの1人が5月中旬、緊急事態宣言の一部解除を前に発した言葉が印象的だった。「感染者は確実に減ってきた。ウイルスを封じ込めているようだ。しかし、いったい何がこんなに効いたのか。よくわからない」 パンデミック（世界的大流行）の第1ラウンドでは各国の医療体制や対策への巧拙が感染者数や死亡者数を左右した。情報テクノロジーをうまく使いこなした台湾や、徹底した検査と追跡、隔離で感染を抑え込んだ韓国、官学一体で合理性ある戦略にこだわったドイツなど、いずれも「台湾モデル」「韓国モデル」「ドイツモデル」として他国は手本にしようとする。
日本は感染者数や死亡者数といった結果だけみるとこうした国々となんら遜色がない。しかし、「日本モデル」という称賛の言葉は聞こえてこない。対策はデータを重んじる合理性や一貫性を欠き、「自粛要請」という矛盾した言葉を国民の行動に強いてきたからだ。まねしようにもまねできるものでない。
外出制限の前提になった「8割」自粛。本来は人と人との接触を減らす数値目標だった。しかし、緊急事態宣言下でいつの間にか主要ターミナル駅や繁華街といった都市部への人出（人の流れ）の削減に焦点が移った。人出が減るのと、人と人との接触が減るのとはイコールではない。そもそも接触機会の削減をどう定量的に示すかも定まった手法はない。
記者会見する新型コロナウイルス感染症対策専門家会議の（右から）脇田隆字座長、尾身茂副座長（4日、厚労省）
緊急事態宣言が発令された4月7日以降、各都道府県では一体、何割の接触削減が達成できたのか。それが感染者や死亡者の動向にどう影響したか。今後、きちんとした検証が待たれるが、科学的根拠の希薄な「8割目標」はモヤモヤの温床といえる。
PCR検査不足に対する説明が不十分な点も社会に不安や不信をかき立てた。厚生労働省の一部の医系技官が中心になって、検査の絞り込みを決めたとされる。疫学調査を優先し医療崩壊を防ぐのが目的なら、過少検査でも問題がないとする根拠を丁寧に説明すべきだった。そうした機会はなかった。
検査数が十分でなく、国内の感染状況を正しく反映していない可能性もあり、各国が出口戦略に活用した「実効再生産数」と呼ぶ流行を映す数値を採用することができなかった。宣言解除に向けた基準作りは難航し「感染状況」「医療体制」「監視体制」の3つから判断せざるをえなくなった。「総合的に判断する」というのは聞こえはよいが、政策に情緒や思惑が入り込む余地をつくった。データを軽んじる結論にやはりどこか疑念の目が向く。
発足当初から政府内での位置づけが不明確だった専門家会議の迷走も、対策への信頼を損なう要因になった。同会議はあくまで医学的な見地から政府に助言を行う組織で、政策の決定者ではない。にもかかわらず時に大いなる存在感を示した。
極め付きは専門家会議が5月4日に公表した「新しい生活様式」だ。買い物では通販を積極的に利用し、食事の際は対面ではなく横並びに座る。生活の場面ごとにきめ細かく示した実践例は、医学的助言とはほど遠いものだった。責任をとりたくない政治や行政が、専門家という権威を巧みに利用したともいえる。
日本大学の福田充教授（危機管理学）は「（新型コロナのような）感染症対策では情報を収集、分析、調査し適切にわかりやすく伝える能力が国に問われる。何かが隠されていると思わせるのは、リスクコミュニケーションとしては大失敗」と指摘する。
日本では同調圧力が強く、人目を気にして行動を控えた人も多いだろう。外出してもなんら罰則があるわけではないが、連休中の移動抑制は、緊急事態宣言が海外の都市封鎖よりも威力を発揮したあらわれといえる。こうした強いられた我慢もコロナ疲れを増幅させていく。
秋以降、北半球では流行の大きな第2波がくると予想される。政府は第1波で感染者と死亡者数が比較的少なくすんだ「勝因」をきちんと分析し明らかにする必要がある。再び、むやみに「8割減」を求められても国民はついていかない。
Seriously?
Tags: Self-deprecating Humor by an American Who Only Knows English; Comments That You Shouldn’t Try to Figure Out Because They are Just Camp Trying Once Again to Be Funny.
I did a Google Translation of your Japanese text:
Did Japan go well? Why does it continue to flicker even after cancellation?
[Text]
The emergency declaration for the new coronavirus has been lifted for the first time in almost a month and a half. The Japanese epidemic is once subsided, avoiding the initially feared outbreak. Nevertheless, it doesn’t come out right. Many people may feel confused. Did Japan’s new corona countermeasures work?
One of the members of the “ Corona Expert Volunteer Association ” gathering professionals for new corona countermeasures such as virologists and doctors of infectious diseases issued a word in mid-May in front of the partial cancellation of the emergency declaration It was “The number of infected people has definitely decreased. It seems that they contain the virus. But I don’t know what worked so well. I’m not sure.” In the first round of the pandemic, the medical system and measures of each country were taken. The number of people affected the number of people infected and dead. “Taiwan model” “Korean model” “German model”, such as Taiwan that made good use of information technology, South Korea that suppressed infection by thorough inspection and tracking, isolation, and Germany that stuck to rational strategy with government and academia As other countries try to set an example.
Looking at the results of the number of people infected and the number of people dead, Japan is no different from these countries. However, we cannot hear the praise of “Japanese model”. This is because the measures lacked rationality and consistency in respecting data, and forced the people’s actions to use the contradictory word of “request for self-restraint.” It is not something that can be imitated.
“80%” self-restraint was the premise of going out restrictions. Originally, it was a numerical goal to reduce contact between people. However, under the emergency declaration, the focus suddenly shifted to reducing the number of people (flow of people) to urban areas such as main terminal stations and downtown areas. It is not equal to reduce the number of people and to reduce the contact between people. In the first place, there is no method that can quantitatively show how to reduce contact opportunities.
Press conference (from the right) Takaji Wakita, Vice Chairperson Shigeru Omi (4th, Ministry of Health, Labor and Welfare)
After April 7, when the declaration of emergency was issued, what percentage of contact reductions were achieved in each prefecture? How did it affect trends in infected and dead people? In the future, proper verification is awaited, but it can be said that the “80% target”, which has a weak scientific basis, is a hotbed of Moyamoya.
Translation Continued:
The lack of explanation for the lack of PCR test also caused anxiety and distrust in society. It is said that some medical technicians of the Ministry of Health, Labor and Welfare played a central role in narrowing down the examination. If the aim was to prioritize epidemiological investigations and prevent the collapse of medical care, the reason why there was no problem with under-testing should be explained carefully. There was no such opportunity.
Because the number of tests was not sufficient and it may not reflect the infection situation in the country correctly, it was not possible to adopt the number that reflects the fashion called “effective reproduction number” used by each country in its exit strategy. It was difficult to make standards for declaring the declaration, and there was no choice but to judge from three factors: infection status, medical system, and surveillance system. “Comprehensive judgment” sounds good, but it creates a room for emotion and speculation in the policy. After all, some doubts turn to the conclusions that neglect the data.
The straying of the expert meetings, whose positioning within the government was unclear from the beginning, also impaired confidence in the measures. The conference is an organization that advises the government from a medical point of view and is not a policy maker. Nevertheless, he sometimes showed a great presence.
Ultimately, it is the “new lifestyle” announced by the expert meeting on May 4. Actively use mail order for shopping, and sit side by side instead of facing each other when eating. The detailed example of each life situation was far from medical advice. It can be said that politics and administration that do not want to take responsibility skillfully used the authority of experts.
Professor Mitsuru Fukuda (Crisis Management) at Nihon University said, “Countermeasures for infectious disease (like the new corona) require the country to collect, analyze, investigate, and appropriately convey information in an easy-to-understand manner. It is a big mistake for risk communication to make people think that they are there. ”
In Japan, there are strong entrainment pressures, and many people may be cautious about their eyes and refrain from taking action. Although there are no penalties for going out, it can be said that the restraint of movement during consecutive holidays was more effective than the overseas city blockade. Such patience also amplifies corona fatigue.
It is expected that a large second wave of the fashion will come in the Northern Hemisphere after autumn. The government needs to properly analyze and clarify the “winning factor” that caused the relatively small number of infected and dead people in the first wave. Again, the people are not able to keep up even if they are unnecessarily asked to reduce by 80%.
This is a fascinating insight you have provided on Japan. Us armchair epidemiological pundits in the States are always assuming that other country’s infection rates or death rates must be the direct result of governmental actions, but I’m finding out that that is not necessarily true. Another Ricochet member who is currently living in South Korea, @dotorimuk, has also given some fascinating insights into that country. He basically said that our perception of South Korea’s much vaunted testing and isolation measures are somewhat of a myth, among other surprising confounding factors. (Don’t quote me directly on that, I am paraphrasing.)
I am curious as to why you are afraid to leave Boston and travel back to Japan when Japan’s overall death rate from the Wu Flu is 134 times less than Massachusetts.
I just came across this article of interest about Japan’s tepid, yet successful response to the virus:
https://www.bloomberg.com/news/articles/2020-05-22/did-japan-just-beat-the-virus-without-lockdowns-or-mass-testing
Of course, they’re making it up. That’s the thing about a novel coronavirus. It’s novel. No one can be an expert. I don’t mind that so much, but I wish they’d exhibit more humility.
I don’t think that the Japanese example can be transferred to many other countries in the world. Japan is exceptional in some ways. They have millions of people packed into a tiny country, tiny apartments full of people. It takes a lot of civic mindedness to make that work.
If you have visited Japan you might have noticed row upon row of bicycles parked by the curb not one of which has a bike lock on it. You might have noticed Japanese wearing face masks which they wear to protect others when they themselves have a cold, not to protect themselves.
All you’d have to do in Japan to get them to socially distance is tell them what to do and they’d do it without fail. Tell them to avoid contact with others and they will. Tell them to wear face masks and wash their hands and they will without fail, every one of them. Send a contact tracer around and Japanese will tell the contract tracer the truth. Tell them to go into quarantine and they will stay in quarantine perfectly.
In America, by contrast, we had a number of people who were not with the program. Close the ball game and they go to the bars. Close the bars and they go to big private parties. Close the barbers and the barber cut people’s hair at their homes or the barbers home. So, all sorts of violations. And it shows.
It’s not that Japan’s programs were different or better. It’s that Japanese are more likely to follow the rules
I’m not so sure about that. All I’ve seen for the past three months are people who are so scared out of their wits that they walk 50 feet away to avoid others on the street, never mind six feet. No one will dare come near me. I don’t think I’m that ugly. I’ve had only a single man offer to shake my hand during this period. I am still not convinced that all the government and private actions are 100% responsible for the great disparity in outcomes of different countries. We have eight states that never locked down their citizens, and they all have some of the lowest death rates from Wu Flu among the 50 States.