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Looking at Japan’s mysteriously low COVID-19 death rate

Posted: Saturday, July 4, 2020. 5:07 pm CST.

By Aaron Humes: With just 972 deaths up to June 30, Japan enjoys one of the lowest death rates for COVID-19 worldwide and in its region.

But some want to know why. Is it that the Japanese have some sort of superior immunity? Did they do something different than other countries, or not do something other countries did?

A British Broadcasting Corporation (BBC) investigation has uncovered different ideas and theories. In the early part of 2020, Japan saw fewer deaths than average. This is despite the fact that in April, Tokyo saw about 1,000 “excess deaths’ – perhaps due to COVID. Yet, for the year as a whole, it is possible that overall deaths will be down in 2019.

This is particularly striking because Japan has many of the conditions that make it vulnerable to COVID-19, but it never adopted an energetic approach to tackling the virus that some of its neighbors did.

In short, Japan used none of the tough measures including closing borders, tight lockdowns, large-scale testing, and strict quarantines that other countries did, yet has limited its count to fewer than 20,000 confirmed cases and fewer than 1,000 deaths. The state of emergency has been lifted, and life is rapidly returning to normal.

Japanese politicians are only too happy to boast about their success: Prime Minister Shinzo Abe spoke proudly of the “Japan Model”, intimating that other countries should learn from Japan.

His deputy Taro Aso got into trouble for suggesting that Mindo (the level of people) is different between Japan and other countries; the expression dates back to the country’s imperial era and denotes a sense of racial superiority and cultural chauvinism. However, Japan does have a tradition of lack of close contact – a few hugs and kisses on greeting.

Still, others look to the science, with Tokyo University professor Tatsuhiko Kodama believing in a prior outbreak providing “historical immunity.”

When a virus enters the human body, the immune system produces antibodies that attack the invading pathogen. There are two types of antibodies – IGM and IGG. How they respond can show whether someone has been exposed to the virus before, or something similar.

“In a primary (novel) viral infection the IGM response usually comes first,” he said. “Then the IGG response appears later. But in secondary cases (previous exposure) the lymphocyte already has memory, and so only the IGG response increases rapidly.”

His study found that in patients exposed to COVID-19, the IGG response came quickly, and the IGM response was later and weak. It looked like they had been previously exposed to a very similar virus.

He thinks it is possible a SARS-like virus has circulated in the region before, which may account for the low death rate, not just in Japan, but in much of China, South Korea, Taiwan, Hong Kong and South-East Asia.

While this has been met with some skepticism, Japan does have experience with disease outbreaks – its people began to use face masks during the last major pandemic in 1919 and it is expected that if you get a cough or cold, you wear a mask to protect those around you.

Japan’s track and trace system also goes back to the 1950s when it battled a wave of tuberculosis. The government set up a nationwide network of public health centers to identify new infections and report them to the health ministry.

If community transmission is suspected, a specialist team is dispatched to track the infections, relying on meticulous human contact tracing and isolation.

Japan also discovered two significant patterns early in the pandemic. More than a third of infections emerged in particular circumstances: “heavy breathing in close proximity” including “singing at karaoke parlors, parties, cheering at clubs, conversations in bars and exercising in gyms” as the highest-risk activities.

The spread was limited to a small percentage (20 percent) of those carrying the virus.

So rather than simply tell people to stay at home, Japan’s government advised avoiding “the three C’s” – enclosed spaces with poor ventilation; crowded places with many people and close-contact settings such as face-to-face conversations.

After infections in Tokyo jumped in mid-March, Prime Minister Abe ordered a non-enforceable state of emergency on 7 April, asking people to stay at home “if possible”. By and large, most did.

Researchers say that if New York City had locked down two weeks earlier than it did, it would have prevented tens of thousands of deaths. A recent report by the United States Centers for Disease Control and Prevention (CDC) found people with underlying medical conditions such as heart disease, obesity, and diabetes are six times more likely to be hospitalized if they get Covid-19 and 12 times more likely to die.

But scientists remind that there is no simple explanation for any phenomena we see; that many factors contribute to the final outcome.


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