Japan's COVID-19 Control: A Great Success

Japan has done a quantitatively great job protecting Japanese citizens from COVID-19. What can we learn from them (about this, and so many other things)?

A Report From Japan

Via Eric Topol:

He alterted us to a quick article in Nature by Japanese virologist Hitoshi Oshitani of Tohoku University. ^[1]

We needn’t look very far to see why this is of import: consider as shown here the daily COVID-19 deaths in the US and Japan, per million people. It’s corrected for population size, so the 2 curves for the US and Japan show comparable risk rates in the 2 nations. This is not a theoretical issue here at Chez Weekend: in early 2020, the Weekend Editrix was considering a trip to Japan but cancelled due to the pandemic. In retrospect, we should have done the opposite and evacuated both of us to Japan to be safer than in the US. It turned out ok for us in the US, since we were capable of rigidly isolating for a period now going into a 3rd year.

This is especially curious: Japan has one of the most elderly poplulations, tends to very densely packed housing in cities, and has a legal structure that prohibits widespread lockdowns or quarantines. That should have ignited a firestorm of COVID-19, but did not, due to careful public health measures that saved lives.

But it itches: what should we have done differently?!

Oshitani explains what Japan did. Here’s Topol’s personally highlighted version of the article (just 1 page), so you can see what an expert like Topol thought was important. The lessons:

• Study the situation carefully, so you know what’s going on. Then communicate truthful and useful information to citizens (e.g., transmission by aerosols, not surfaces).
• Communicate simply and memorably. In Japan it was the sanmitsu: the 3 C’s (closed rooms, crowded conditions, and close contact; san means 3, and those 3 phrases all begin with “mi” in Japanese, so it was nicely alliterative). Sanmitsu (3密) is also a well-known phrase in Buddhism, referring to body/speech/mind of intelligent beings. So it was all packaged properly by using a well-known phrase whose alliteration called to memory the things to avoid. Well done!
• Vaccinate quickly and thoroughly, getting everybody, starting with the most vulnerable. Then get boosters. Check ventilation in public buildings.
• Have a well-funded, functional public health system. Japan had many public health nurses across hundreds of centers, doing retrospective contact tracing for diseases like tuberculosis. This was quickly vectored in the direction of COVID-19.

• Most of all, in response to public health guidelines, Oshitani says:

  People largely complied.

  They were not, as in the US, stupidly rebelling against their own interests based on superstition, disinformation, and inchoate rage like the American right wing.

So basically they did all the sensible things, and communicated simply and truthfully. The Japanese people understood & mostly executed good public health policy.

We should go and do likewise in the future.

The Weekend Conclusion

Oshitani’s conclusion (emphasis added):

Often, phrases such as ‘exit strategy’ or ‘back to normal’ are used by people longing for the days when we lived without the threat of this virus. But we are nowhere near back to normal. Nations must continue to seek the best balance between suppressing transmission and maintaining social and economic activities. How? By using all the tools at hand as they apply to cultures, traditions, legal frameworks and existing practices, to minimize suffering across the globe.

Yep. That’s my conclusion as well: we’re not back to normal yet, and we have a lot of work to do to lower suffering world-wide.

Whether we will actually do that work is the moral test before us.

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Notes & References

1: H Oshitani, “COVID lessons from Japan: the right messaging empowers citizens”, Nature 605, 589, 2022-May-23. DOI: 10.1038/d41586-022-01385-9. ↩