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Why, Japan, Why? JUNE 2020

How did Japan escape a severe COVID pandemic without lockdowns or mass testing?

Only In Japan subscribers who already saw the list of 43 reasons: scroll down to the gray boxes for background info and commentary!

Hachiko statue at Shibuya Station wearing a face mask
(Photo courtesy of Taiwan News)

Did Japan beat the virus without lockdowns or mass testing? It’s beginning to look that way. In a country with over 126 million people, there have been only 825 deaths from the virus, even though they had no “shelter in place” edicts and testing was laughably limited.

But why?

As the State of Emergency lifted, a piece began circulating in the Japanese media (in Japanese) that lists 43 reasons the Japanese themselves give to explain how they beat the odds. (Remember, these are answers given by the average salaryman on the street, so naturally, some of them are legit and unique to Japan, and others are…well, anywhere from wishful thinking to fake news.) 

Here’s the list, in English, along with some background and insights into the ones that are either untrue or put them decisively in the “Why, Japan, Why?” category:

Japanese people explain why there were so few COVID deaths in Japan

Being Asian saved us

1. Asians (especially East Asians) were originally resistant to coronaviruses

2. Asians have already been immunized by another coronavirus

Being Japanese saved us

3. We wear masks

4. Each household already had a mask stockpile, because hay fever season was starting

Okay, this is one point that is undeniably true and uniquely Japanese—Japan is not the only mask-wearing culture in Asia, but worrying about personal hygiene is practically a national sport in the country that invented the bidet toilet (all hail the mighty ToTo!) You only have to visit the “travel” department at Tokyu Hands and ogle the many inventive products designed to help Japanese travelers feel comfortable in the primitive cultures that exist outside their homeland to understand why the average Japanese person fears running out of masks almost as much as running out of toilet paper. The stink-eye is aimed at anyone sneezing on the morning commute train without wearing a mask—even in times when it’s obviously just cedar pollen season—so most Japanese carry spares, and buy in bulk. When the inevitable panic-buy happened as the virus ramped up, most people already had a stockpile of masks they could wear while the supply chain recovered.

5. I use my hands to gargle (meaning, my hands are clean and my throat is regularly flushed of pollen and pathogens)

6. There is plenty of clean water and soap in the city

7. We take off our shoes indoors

8. We take baths every day

9. People of all ages don’t regularly gather for religious services in Japan

10. People of all ages don’t regularly gather for large-scale demonstrations in Japan

11. We don’t usually hug or kiss anyone

12. Japanese speakers are less likely to disperse droplets that could be the source of infection during conversation, compared to other languages

AHAHAHAHAHA okay, sorry, do people actually spew fewer germs around while speaking Japanese than when speaking other languages? I couldn’t find anything the least bit scientific to support this claim in either English or Japanese. This popular theory seems to be based solely on a wildly viral Tweet (like so many questionable “facts” these days) that featured a video demonstration originating at the Tokyo Broadcasting Service:

13. The BCG vaccine that was used as a group vaccination (i.e. routinely given to infants) had the effect of increasing immunity.

14. Many elderly people and young people do not live together

Eating Japanese food saved us

15. Except for breakfast, we use chopsticks when eating with people outside our families (i.e. don’t usually eat with the hands or share utensils)

16. Food is not served on a platter (and passed from person to person) but is divided up in advance and served in individual dishes (i.e. no “family style” serving)

17. The hot pot season was already over

This one deserves the Most Japanese Answer Award. If it were true that eating from a communal dish was a COVID vector (it’s not), the Japanese really would have been saved by their love of enjoying things only in the season they were invented for. Since even soft drinks made purely of chemicals come in and out of season along with the natural flavorings that inspired them, believers in this piece of questionable wisdom felt they were lucky that the pleasure of eating nabé (the Japanese hotpot cooked communally on a burner in the middle of the table) was already So Last Winter by March.

Good leadership saved us

18. Schools were closed relatively early

19. Large-scale event cancellation was requested relatively early

20. The heads of local governments issued warnings to citizens relatively early

21. Government policymakers consulted experts and did not do anything extra (i.e. they followed the experts’ advice, but didn’t impose unnecessary restrictions)

22. The heads of large local governments in Tokyo, Osaka, Aichi, etc. took appropriate pre- and post-measures.

23. The timing of self-restraint (i.e. requests that businesses voluntarily close, people work from home and avoid crowded places unless necessary) was appropriate

Experts saved us

24. From the beginning, each medical institution had a high response capacity

Japan was actually extremely lucky to avoid a truly catastrophic outbreak, because this is not quite true. It turned out that the “plenty of hospital beds” touted at the onset included beds in many small private hospitals, which were in no way equipped to treat dangerously infectious COVID patients. Instances of ambulances being turned away at dozens of emergency rooms before finding a hospital that agreed to treat an acutely ill COVID patient were reported multiple times daily during the period of peak infection. Many hospitals didn’t technically lack beds, but they were hamstrung by policies that prescribed only one infectious patient to rooms that were set up to accommodate more. In addition, patients are not discharged from Japanese hospitals until they are pronounced completely cured (for example, even the usual maternity stay in Japan is a week). so patients who could have been safely sent home to make room for the acutely ill continued to occupy beds until they tested negative.

25. We had a lot of contact tracing

26. The expert team [pandemic advisors] was excellent

27. The cluster [tracing] team was excellent

28. The experts called on citizens to thoroughly wash their hands and avoid the three Cs (Closed spaces, Crowded places, Close-contact settings)

29. The experts created guidelines for refraining from going out and requested citizens to comply

I’m not going to argue that the “Three Cs” aren’t good advice, because they are. But it was either cruel or laughable to exhort employees not to pack onto crowded trains and go to work when a huge number of shops/restaurants/bars/offices stayed open and very few businesses (only 18%) allowed them to work from home. Most of the population heeded the “Three Cs” warnings over the weekends, but on Monday morning, it was back to the “Seven Cs”: crowded, closed, close-contact, cattle car commute trains.

30. Hospitals were prevented from becoming a source of infection by limiting PCR tests

They did, but at a cost of knowing how much the virus was spreading, and where. Japan severely limited access to COVID tests by very strict phone screening––you couldn’t get tested unless you were given a hospital testing appointment through the screening hotlines, and many people who had all the symptoms but were judged to be able to recover without hospital intervention were denied both tests and treatment. I recall checking the testing report on one day, when the published number of “positive” test results was 78, and the total number of tests given was…79. This did circumvent the counterproductive Japanese regulation that anyone who tested positive had to be immediately quarantined in a hospital and kept there until they tested negative (whether their illness was severe enough to require hospitalization or not), but wouldn’t it have been easier to adjust the “must hospitalize” protocols to allow various responses to severity of infection and institute widespread testing? Nope, not in Japan, the land where inflexibility is a way of life. Change happens slowly, and then only by mass consensus. And change especially does not happen when it served the political agenda of trying to save the Olympics from being cancelled and keeping the number of confirmed cases low enough so people wouldn’t demand more of a shutdown (and government compensation for lost wages/business). 

31. The health center’s ability to track patients was high, and “cluster crushing” was successful.

Learning from experience saved us

32. Japan successfully survived the (early and unexpected) outbreak on the Diamond Princess cruise ship

33. Thanks to the Diamond Princess cruise ship experience, knowledge on the new coronavirus deepened relatively early.

If by “learning what NOT to do by multiple bad decisions” is what this means, Japan excelled in spades. They quarantined the cruise ship at the dock, trapping hundreds of uninfected passengers in the same cage as infected ones, with haphazard contagion control measures on board. By the time the14-day quarantine period was up, ten cases had mushroomed to 619, and health officials who had come on board to assess the situation and the crew were also infected. Then, most inexplicable of all, passengers who tested negative were allowed to leave the ship and get on public transportation to find their way to the airport.

34. Hokkaido successfully survived the first wave of infection

35. According to the knowledge obtained from the first wave in Hokkaido, it was widely known to the public that the cluster crushing and the request to refrain from going out were effective as countermeasures before the second wave (i.e. outbreaks in the rest of Japan) occurred.

Being Japanese saved us, again

36.Citizens followed the advice of the experts

37. Citizens obeyed non-compulsory self-restraint requests from the government

38. Mutual monitoring among citizens transformed mere self-restraint requests into forceful ones

39. Everyone wore a mask

40. Everyone washed their hands

41. Everyone refrained from going out

Scary news saved us

42. The world news fueled constant fear

42. Ken Shimura (a popular comedian) died and everyone was scared

So, which of these are most likely to be the REAL explanations? 

Many of the successful strategies on this list are shared by all the countries that eventually contained the virus, so let’s pull out the ones that are unique to Japan and might have given them an advantage:

#4: Not only are they a mask-wearing culture at all times, people had stockpiles of masks, so when the shortages arrived, most still had masks they could wear until the supply chain caught up

#11: Japanese people greet each other by bowing (already naturally maintaining social distancing) instead of shaking hands, hugging or kissing, and seldom touch people outside their immediate family

#13: The BCG vaccine given to Japanese infants to prevent tuberculosis is a common link between the countries with the least catastrophic outbreaks, and may provide some immunity. Multiple studies are ongoing.

#38, #39, #40, #41: EVERYONE wore masks, washed their hands, and refrained from going out when asked to do so, and scofflaws were shamed into compliance by their neighbors and co-workers.

I’d like to add a couple of things that also may have contributed significantly to Japan’s low outbreak, but weren’t mentioned on this list:

1: Japan is an island that exercises strict border controls and has few passport holders living elsewhere. Once the border was shut, there were very few people from harder-hit areas who had a legal right to cross into Japan and bring the virus with them.

2: Japan is 98% ethnically Japanese. Ongoing research is being conducted to determine if there’s a genetic predisposition (or resistance) to COVID infection, and if a genetic resistance turns out to be common among Japanese, nearly all the population will share it.


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Jonelle Patrick writes mystery novels set in Tokyo, and blogs at Only In Japan and The Tokyo Guide I Wish I’d Had

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