I live in Japan. Among the various things I do is trend analysis, mostly political but recently medical. Partly, it’s a just something that interests me, an extension of my regular work in PR, branding and marketing. Every now and then a foreign company hires me to analyze something happening in Japan, relative to media narratives, and try to figure out what is really going on. So far I have a pretty good track record. And it buys me the occasional sushi dinner.
In the case of COVID19, I correctly predicted Japan’s second wave, it’s timing and infection numbers. It was clear to me that that Japan would try to emerge from its voluntary semi-lock down and “open up” prematurely — desperate to keep Japan Inc. running.
The “Japan Model” ?
Crash and burn.
There is no “Japan Model” — not if that means a coherent governmental strategy and set of policies, as you see in China, Vietnam, South Korea or New Zealand.
My analysis predicted that Japan’s “second wave” would be probably worse than the first, which is what appears to be happening now with daily infection numbers soaring. COVID is not going away anytime soon. And, even if treatments are improving and fewer people are dying, damage to the economy and people’s lives is cumulative.
By and large, Japan has avoided mass testing, despite having the capacity to do so. Public outcry has caused Tokyo to increase the pitifully small number of tests given at the time of writing of my initial analysis to around 4000 a day currently. As tests go up, infection rates rise in proportion. As a result, infections are at an all time high, trending towards 300.
Keep in mind that Tokyo is the world’s largest city, with a core population of over 9 to 14 million (depending on how you count) and 37 million in the Greater Tokyo area. The Tokyo government wants to give 10,000 tests a day — eventually. Given that infection numbers are meaningful only in terms of the small samples on which they are based, if 4000 tests yield 300 positives, what would ten million tests yield. 100,000? 150,000?.Who really knows? Let us keep in mind that while China has give 91 million tests, and tested all of Beijing in just ten days. Japan lags at just over 600,000. The Chinese were also able to contain the virus in Beijing without shutting down the entire city. At the time of writing, there had been NO new infections for two weeks.
I posted some thoughts on these matters on Facebook on a site for foreigners in Japan, suggesting that the “authorities” manner of reporting COVID19 in Japan at best un-authoritative, at worst misleading — and instantly got a lot of replies.
Some people agreed with me. But there were Denialists, whom I call “Head in the Sand People”. From their various “replies”, I was able to identify common false assumptions, which I suppose afflict a significant number of people.
a ) mass testing is “impractical”.
b.) current published stats by “authorities” are accurate.
c.) the hospital system is not “overwhelmed
d.) things are improving
e.) there are fewer serious cases.
Let’s address the caveats, one by one.
First, is mass testing impractical?
I am not an epidemiologist. But Dr.Kenji Shibuya is. He is Senior Advisor to the Director-General of the World Health Organization (WHO) and Professor and Director of the Institute of Population Health at King’s College London . He says that Japan has the equipment, technicians and capacity for full mass testing as was the case in South Korea and China. Also that there is no other way to contain a virus such as this. That said, there is considerable dispute among epidemiologists and virologists about COVID19. SARS/COV2 is, after all, a NOVEL coronavirus — it doesn’t have to obey the rules. Your guess is as good as anybody’s.
In any case, mass testing in Japan IS possible, as Dr. Shibuya says. Why then is it not done?
In my work, I look for contradictions. It is here that truth resides.
In neoliberal capitalist systems, such as Japan, pandemics are not so much medical issues but major political issues with huge impact on business and public compliance — the “consent” which corporate elites must manufacture and monitor. Most Western “democracies” are undeniably not true democracies but rather inverted totalitarian plutocracies or oligarchies. This is obvious with the USA; but also true of Japan. Business and the interests of elites come first: the public good comes second.And Japan has a long history of sacrificing the lives of its people for the interests of the “nation”.
Socialist systems such as China’s must at least appear to prioritize the public good. Let us keep in mind that 65 to 90% of Chinese (depending on whose statistics you believe) trust their government. — the highest rate of support in the world. If trust breaks down? Insurrection. The Cultural Revolution was not so long ago.
The Chinese responded to the pandemic pragmatically with public policies decided by technocrats rather than corporate CEOs and politicians as in the West and Japan Inc. By and large, statistics from socialist countries are pretty accurate to keep the public cooperative with government policies. As a result, China was able to contain the virus with only temporary damage to the economy. While the Western world is on track for contractions in all economies between 10 and 30%; China will post between 2 and 5 percent positive growth this year.
The statistics that ANY government in countries with capitalist ideology give for infections, treatments, etc, always have political consequences — so there is always doubt as to whether the numbers are being manipulated for someone’s profit. We see therefore constant accusations of over counting and undercounting, not that counting is ever easy, as we can see from China’s revision of numbers after Wuhan. But the Chinese were transparent: in the West governments just lie.
In the case of Japanese statistics,we simply don’t know. Excess mortality rates were down relative to previous years at the beginning of 2020, with fewer flu’ cases; then up in “hotspot” areas such as Tokyo. In the case of Wuhan and some other localities, overall mortality remained stable thanks to fewer traffic deaths, less influenza and fewer deaths due to environmental problems. So “spikes” in the mortality rate in Tokyo are suspicious. Still, there is no way of really knowing.As in the US, some hospitals have lots of empty beds. Others, such as Tokyo Women’s Medical Hospital in Shinjuku are overburdened and have hundreds of nurses threatening to quit. In other words, many hospitals are just fine; some are not. A clue to the trend here is that the Tokyo government is currently trying to prepare for a surge in hospitalizations. Again, the problem is statistics. Can we trust Japanese government numbers? “R”for example, is the real-time transmission rate. But:
The health ministry announced Japan’s R for March on April 1. But it did not release any of the data used to make the calculation or provide more recent estimates for Tokyo or anywhere else in the country.
While the sheer amount of information might be overwhelming for some, the numbers we don’t know — or can’t possibly know — are just as important, said Kenji Shibuya, director of the Institute of Public Health at King’s College London and a senior advisor to the director-general of the World Health Organization.
To understand the damage caused by the pandemic, Shibuya pointed to “excess mortality” or “mortality displacement,” which denotes a temporary increase in the death rate in a given population and is typically attributed to environmental phenomena, famine, war or infectious diseases.
But he said the biggest concern is the number of asymptomatic and pre-symptomatic transmissions, both of which are effectively impossible to measure without further testing and open data.
“Without public availability of data, we can’t say anything,” Shibuya said. “It’s important for the government and experts to share that kind of data set so we can understand what’s happening.”
In other words, Japanese government data is not transparent. And therefore cannot be relied on.
Next: the hospital system…..
Is the hospital system “overwhelmed” in Japan?
We cannot be sure about the state of hospitals. But the medical system clearly has issues:
As in the US, some hospitals have lots of empty beds. Others are in trouble. In Japan, some hospitals are fine but some overburdened — such as Tokyo Women’s Medical Hospital in Shinjuku where hundreds of nurses threatening to quit. In other words, many hospitals are just fine; some are not. A clue to the trend here is that the Tokyo government is currently trying to prepare for a surge in hospitalizations.
So, are things improving?
Most cases of COVID19 are mild or asymptomatic. Currently we are told there are very few “serious” cases in the hospitals. Wuhan studies showed 1.4% of people diagnosed with COVID die, higher than the 0.1% number for the flu’. COVID mortality studies in other countries yield higher or lower death rates — depending on…nobody really knows.
Excess mortality is hard to figure out. Especially in this case when we have had two mild flu’ seasons in a row, which should have reduced annual excess mortality. In addition, social distancing, working from home, etc may further reduce flu’ deaths, as well as deaths. If we believe the Japanese government’s numbers we would expect mortality rates to have dropped overall. But they did not, spiking to 1107 in April in Tokyo. Just over a hundred of those were labeled as due to COVID19.
We DO know that older people or people with weakened immune systems or pre-existing conditions such as diabetes or heart disease are at considerable risk. And just letting the virus have its way with the population is irresponsible.
How serious IS COVID19?
Given the recent rise in infections, the current dip in coronavirus mortality will not necessarily last. As more people socialize, those with milder infections might end up ferrying the pathogen to vulnerable individuals. As states reopen, local leaders are urging residents to continue physical distancing and to wear masks. But even tempered by warnings, moves back toward normalcy could inadvertently signal to people that the worst is already over, Dr. Popescu said.
Experts are also reluctant to place too much emphasis on falling death rates. “We’re training a lot of attention on the idea of mortality,” said Dr. Jennifer Tsai, an emergency medicine physician at Yale University. Behind that picture, she added, there is a great deal of suffering. Reports from around the world have painted a sobering portrait of chronic Covid-19 syndromes, some of which last for months. Patients may be saddled with physical and emotional distress that persists long after the virus has left their bodies.
Some virologists insist that the seriousness of this disease is exaggerated; others disagree. There is no consensus. But one thing is certain: it kills people, especially, as I have said, the most vulnerable — the old, the infirm, the unwell — and also the poor. In the US and UK , death rates are higher for black and brown people, who are poorer and therefore less healthy, with poor water and water.
So this is not just an ageist disease — it is racist too. And “classist”.
It does seem that COVID is not killing as many Japanese as it does other nationalities. Why aren’t the Japanese dying at a higher rate, you ask? Again, we don’t really know how many people are dying of COVID in Japan.
Let’s say that I am right about mortality rates being higher in Japan. Even if the mortality rates were 10x higher, you would have maybe 9000 deaths in a country with 126.5 million people. My home country of Canada has 37.9 million people — and roughly a little over 8800 deaths. What is it that Japanese people have that others don’t. If they are not dying as much, it is certainly not because of their feckless government policy.
One advantage is the lower BMI of Japanese people.The higher the BMI the greater the risk.
The average Canadian male is overweight with a BMI of 27.4 The average BMI (for both sexes) in Japan is 22.6.
Finally, when we think about the seriousness of COVID19, it is useful to look carefully again at the graphs for deaths in Canada and Japan. You will notice that deaths spike suddenly. Now, take a look at the infection rates for Japan, which, whether or not accurate , are statistically only “samples” indicative of the epidemiological trend.
Deaths spiked highest around April 17, with another peak a month later. Prior to April 17, infection numbers were rising from a relatively modest level. Then those numbers began to fall off. The voluntary “lock down” coincided with both low infection numbers and low death rates. Now, with “business as usual”, the numbers are again rising.
Remember that COVID19 symptoms take about one to two weeks to manifest. If the condition worsens to ARDS that will take another week. So, from initial infection to a critical state takes two to three weeks. If death occurs, that could be one to five weeks afterward hospitalization. There is a lag. A spike in the number of infections will NOT result in immediate strain on medical institutions and higher death rates — but eventually the effects will be felt.
Even one unnecessary death is a tragedy. Father, mother, grandma, grandpa, husband, wife…. When one person dies, a part of everyone they know and love dies too.
If Japan does not face up to its problem, it will have to wait for a viable vaccine — next year — maybe. In the meantime, its economy will bomb along with those of all the other neoliberal economies while China, Vietnam, and other socialist countries grow.
The “Japan Model”?
Gets an “F”. It’s just PR.
But Japan Inc. has done a good job of convincing the world that the “Japan Model” works and that testing is really not necessary.
Japanese politicians have told the public that infection numbers would rise with more testing — but — not to worry for most people it’s little more than a cold ! When Donald Trump said that kind of thing he was attacked as a murderous moron who should be impeached. Now he is being attacked for trying to limit funds for testing and contact tracing — with over 30 million tests already given. The Donald needs to hire some Japanese PR flacks.
There is also outrage in Japan, which has given a paltry 785,000 tests (as of July 31)#55 in the world, right after Ghana. The Japanese social media is full of impotent rage. Naturally…the Japanese have seen their government cover up disasters before. Fukushima, for example.
But the Japanese political system allows them no options, with all parties hardly distinguishable in policy , just as the US political system offers Americans no viable alternatives, with both Democrats and Republicans serving the same corporate masters. Yes, I know Biden is promising all sorts of things. But when was the last time a Democrat carried through on his promises?