Japan

Viral Tweet Praises Korea But Doesn’t Mention Japan

In a recent viral tweet, Vincent Rajkumar – a professor at the Mayo Clinic – said the following:

South Korea followed the textbook principles of epidemiology. Kept deaths 40 times lower all the way till 75% of population fully vaccinated. This is success.

His tweet was accompanied by a chart showing the cumulative Covid death rate in the U.S., U.K. and Korea, with the line for Korea being much lower than the other two. In a follow-up tweet, Rajkumar identified the measures that supposedly account for Korea’s success, basically masks and contact tracing.

The implication is that if only the U.S. and U.K. had “followed the textbook principles of epidemiology” like Korea, they too could have achieved very low Covid death rates. But I’m not convinced.

First, there’s one small technical detail, which is that the U.K. did try both masks and contact tracing, and neither had much impact on the epidemic’s trajectory.

A recent report by the Public Accounts Committee concluded that Test and Trace (the U.K.’s contact tracing scheme) had “not achieved its main objective”, despite an “eye watering” budget. £37 billion here, £37 billion there, and pretty soon you’re talking about real money…

So far so bad for idea that all we needed was masks and contact tracing. But there’s another reason to doubt the implication of Rajkumar’s tweet: Japan achieved exactly the same outcomes as Korea, and it did almost nothing until the start of this year.

In 2020, Japan had zero days of mandatory business closures and zero days of mandatory stay-at-home orders. The country relied on “limited contact tracing” (a designation given in the Oxford Blavatnik School’s COVID-19 Government Response Tracker). This is in contrast to Korea, which used “comprehensive contact tracing”.

The chart below plots the stringency index for Japan, Korea and the U.K. Apart from a brief period at the start of 2020: the U.K.’s index has consistently been highest, while Japan’s has consistently been lowest.

In spite of this, both Japan and Korea have had zero excess mortality to date, whereas the U.K. – the most stringent of the three countries – has had between 6 and 20% excess mortality, depending on how you compute it.

The experience of Japan, combined with the global pattern of excess mortality, suggests that some cultural or biological factor that’s unique to East Asia explains the low death rates – and indeed the low infection rates – in that region. This factor could be more diligent social distancing or perhaps greater prior immunity.  

Whatever the explanation, it’s unlikely Korea’s success could have been replicated in Britain – even if we’d ploughed the entire NHS budget into Test and Trace.

Early Closure of Bars and Restaurants Had No Impact on the Spread of Covid in Japan

When comparing the impact of Covid in different countries, Japan is a clear outlier. In 2020, the country had zero days of mandatory business closures and zero days of mandatory stay-at-home orders. Despite seeing less change in mobility than major European countries, Japan has not had any excess mortality since the pandemic began.

As you may recall, the country hosted the Summer Olympics between 23rd July and 8th August. But even that did not lead to a large number of deaths. It has been suggested that Japanese people, and perhaps East Asians in general, have some degree of prior immunity to the virus.

In January of this year, Japan introduced restrictions on businesses for the first time. Specifically, 11 prefectures (including the capital, Tokyo) prohibited bars and restaurants from selling alcohol after 7pm, and forced them to close at 8pm.

In a recent preprint, Reo Takaku and colleagues investigated the impact of these measures on the spread of Covid. They began by checking whether the measures had their intended effect – of reducing the number of people frequenting bars and restaurants. This cannot be taken for granted: the night curfew in Greece had virtually no impact on mobility.

The researchers analysed survey data collected in the autumn of 2020 (when there were no restrictions in place) and the winter of 2021 (when there were restrictions in place). As the chart below indicates, the measures do appear to have had their intended effects.

The x-axis represents how far respondents lived from the border of a prefecture that introduced restrictions. The blue and green lines (corresponding to the right-hand y-axis) show the fraction of people who went to a bar or restaurant at least once in the relevant month.

The blue line corresponds to the autumn of 2020, and the green line corresponds to the winter of 2021. Notice that the green line is substantially flatter than the blue line, but only on the right-hand side of the chart. This suggests that restrictions did reduce the number of people frequenting bars and restaurants.

Third Man Dies in Connection To Contaminated Moderna Vaccine Doses in Japan

The suspension of over two and a half million doses of the Moderna Covid vaccine in Japan following the discovery of contaminants in a number of batches did not come soon enough, with yet another death having been reported after vaccination of a potentially dodgy dose. This time, a man approaching his 50s died just one day after receiving his second dose. The Guardian has the story.

The 49 year-old man had his second shot on August 11th and died the following day. His only known health issue was an allergy to buckwheat, the Health Ministry said on Monday. As with the previous two deaths, the ministry said it had yet to establish if the latest fatality was linked to the vaccine.

The shot came from one of the three batches that were part of a recall of 1.63 million doses of the Moderna vaccine on August 26th, but not from one of the batches found to have fragments of stainless steel in them. The three batches were manufactured in Spain under contract by Moderna.

The company said: “This is a tragic event, and the loss of life is something that we take very seriously. We offer our sincerest condolences to their loved ones.”

Last week Moderna issued a joint statement with local distributor Takeda Pharmaceutical, saying: “The rare presence of stainless steel particles in the Moderna Covid vaccine does not pose an undue risk to patient safety and it does not adversely affect the benefit/risk profile of the product.”

Early last month, two men in their 30s with no underlying health conditions died within days of getting their second dose of the Moderna vaccine.

Contaminants believed to be pieces of rubber fragments from vial stoppers that entered the vaccine liquid due to incorrectly inserted needles were found in Okinawa, Gunma and Kanagawa in late August and early September. No problems were reported among those injected with the contaminated vaccines, which came from different batches to the previously recalled ones.

Worth reading in full.

Another Million Doses of the Moderna Covid Vaccine Suspended in Japan Over Contamination Fears

The recent deaths of two Japanese men in their 30s after being given potentially dodgy doses of the Moderna Covid vaccine was not the end of Moderna’s troubles in the country, with another million doses having now been temporarily suspended following the discovery of contaminants in more batches. Reuters has the story.

The suspension of Moderna supplies, affecting more than 2.6 million does in total, comes as Japan battles its worst wave of Covid yet, driven by the contagious Delta variant, with new daily infections exceeding 25,000 this month for the first time amid a slow vaccine roll-out.

The latest reports of vaccine contamination came from Gunma prefecture near Tokyo and the southern prefecture of Okinawa, prompting the suspension on Sunday of two more lots in addition to the 1.63 million doses already pulled last week.

A tiny black substance was found in a Moderna vaccine vial in Gunma, an official from the prefecture said, while in Okinawa, black substances were spotted in syringes and a vial, and pink material was found in a different syringe.

Japan’s Health Ministry said some of the incidents may have been due needles being incorrectly inserted into vials, breaking off bits of the rubber stopper. Other vials from the lots can continue to be used, the ministry said on Monday.

The contamination cases followed a Government report on Saturday that two people died after receiving Moderna shots that were among lots later suspended.

The Government had said that no safety or efficacy issues had been identified and that the suspension was a precaution. The causes of death are being investigated.

“It is unlikely, in my opinion, that contamination of foreign substances led directly to sudden deaths,” said Takahiro Kinoshita, a Physician and Vice Chair of Cov-Navi, a vaccine information group.

“If the contaminated substances were dangerous enough to cause death for some people, probably many more people would have suffered from some symptoms after the vaccination.

“However, further investigations are definitely needed to evaluate the harm of the particular doses in question.”

Worth reading in full.

Two Die After Taking Moderna Vaccine From Now-Suspended Batches

Two men in their 30s have died in Japan after being given a dose of the Moderna Covid vaccine from batches that have since been suspended following the discovery of contaminants. Reuters has the story.

The men in their 30s died this month within days of receiving their second Moderna doses, the [Japanese Health] Ministry said in a release. Each had a shot from one of three manufacturing lots suspended on Thursday. The causes of death are being investigated.

Japan halted the use of 1.63 million Moderna doses shipped to 863 vaccination centres nationwide, more than a week after the domestic distributor, Takeda Pharmaceutical Co, received reports of contaminants in some vials.

“At this time, we do not have any evidence that these deaths are caused by the Moderna Covid vaccine,” Moderna and Takeda said in a statement on Saturday. “It is important to conduct a formal investigation to determine whether there is any connection.”

The Government has also said no safety or efficacy issues had been identified and the suspension of the three Moderna batches was a precaution. …

The contaminants found in some vials in Japan are believed to be metallic particles, public broadcaster NHK reported, citing Health Ministry sources.

Worth reading in full.

Japan Names and Shames Quarantine Rule Breakers

Japanese officials have publicly named three nationals who broke travel quarantine rules and have threatened to do the same to others who do not self-isolate for two weeks after returning from abroad. The Guardian has the story.

The Health Ministry said the three Japanese nationals named had clearly acted to avoid contact with authorities after recently returning from abroad.

The announcement late on Monday, the first of its kind, sparked a flurry of speculation among Twitter users about the details of those identified, such as their jobs and locations.

Japan is asking all travellers from overseas, including its own citizens, to self-quarantine for two weeks, during which they are asked to use a location-tracking smartphone app and report on their health condition.

Japan last week expanded its Covid state of emergency to four more areas beyond Tokyo after record increases in infections while the capital hosts the Olympic Games. …

Emergency measures already in place in Tokyo and the southern island of Okinawa will also be extended until the end of August, after the Olympics and well into the Paralympics, which start on August 24th. …

Tokyo’s Governor, Yuriko Koike, has noted that people in their 30s or younger accounted for many recent cases and urged them to “share the sense of crisis” and follow basic measures such as mask wearing and avoiding having parties.

Worth reading in full.

Postcard from Itoshima

We’re publishing a new postcard today in our ongoing series – “Around the World in 80 Lockdowns”. This one is from Itoshima in Japan. As the author points out, restrictions were voluntary during the first state of emergency in Japan, it only lasted six weeks, and then there were practically none until January 15th of this year when a second state of emergency was declared – and now that’s been ended everywhere apart from Tokyo. In spite of this, Japan’s total death toll is only 8359. Here’s an extract:

I’m not sure about the lockdowns in other countries, but during our state of emergency the Japanese government didn’t have the legal authority to restrict people’s actions. They essentially asked people to stay home, work from home and limit their movements, and generally the public has been extremely co-operative. This is because Japan has been traumatised by the Government having too much power in the past so now the Government tries to first rely on citizens complying voluntarily before resorting to force. We didn’t have any fines for not wearing face masks or opening businesses until much later.

The first state of emergency was only for about a month and half and Japan successfully flattened the curve, but it was simply because of the citizens’ discipline, obedience and social pressure. Regardless of no forced restrictions, businesses and individuals voluntarily followed the request, which led to less compensation from the Government because they didn’t force us to stop working.

Worth reading in full.

Postcard From Itoshima

by Joji

Itoshima, situated to the West of Fukuoka City, has a population of around 100,000 people and offers an excellent quality of life due to its stunning nature and urban life. People drive out from Fukuoka city for a dip in the warm ocean, the magnificent views, mountain walks and the high-class restaurants and fashionable cafes.

Fukuoka underwent its first state of emergency from April 7th to May 25th in 2020. From the start of the restrictions, as people couldn’t hang out in the city centre as before, some started coming to Itoshima more often to spend time in nature, although they are now not stopping at the cafes or restaurants as much. During the first state of emergency, as I was not living in Itoshima, I also used to come here often to visit the beaches but not the cafes, which looked so awfully quiet that I eventually started going to them. Many of the cafe and restaurant owners have suffered from this change and some have even gone out of business.

I’m not sure about the lockdowns in other countries, but during our state of emergency the Japanese government didn’t have the legal authority to restrict people’s actions. They essentially asked people to stay home, work from home and limit their movements, and generally the public has been extremely co-operative. This is because Japan has been traumatised by the Government having too much power in the past so now the Government tries to first rely on citizens complying voluntarily before resorting to force. We didn’t have any fines for not wearing face masks or opening businesses until much later.

The first state of emergency was only for about a month and half and Japan successfully flattened the curve, but it was simply because of the citizens’ discipline, obedience and social pressure. Regardless of no forced restrictions, businesses and individuals voluntarily followed the request, which led to less compensation from the Government because they didn’t force us to stop working.

While the cases were going down, both the people and the economy were depressed. From July 22nd 2020, in order to promote domestic travel and to help boost local businesses, the Japanese government set up the ‘Go to Travel campaign’, which provided residents with subsidies of up to 50% on transportation, hotels, restaurants, tourist attractions and shopping within Japan. Moreover, when you booked through the campaign, you got a ‘Go to eat campaign’ coupon worth 2000 yen per person, which you could use to buy food when travelling. Many people took advantage of this campaign and some people were even travelling practically for free.

However, the campaign was only applicable when people booked through big travel agencies, so the big corporations benefited the most. In addition, every individual in the country was given a 100,000 yen personal subsidy.

Thanks to the ‘Go to travel Campaign’, people started going on domestic vacations and day trips more. Whilst travelling abroad wasn’t an option, Itoshima became even more popular as a destination. The Itoshima local government also subsidised travel and food service industries and managed to attract domestic tourists. Consequently though, they began to see the number of coronavirus cases rise so the economic incentives had to be suspended towards the end of 2020.

One of the interesting things about the precautions against Covid infection in Itoshima is that people, both locals and tourists, weren’t as strict about mask wearing and social distancing as in other parts of Japan. This was probably because people felt relaxed and let their guard down when surrounded by nature or just because of people’s relaxed nature in Itoshima. However, as soon as they started finding out that the cases were going up people began to act differently and are now more cautious.

Just like the rest of Japan in 2021, Itoshima got off to a quiet start with the second state of emergency declared on January 14th. However, having experienced the previous restrictions, cafes and restaurants are coping with the situation better this time.

The good news is that the state of emergency was lifted at the end of February in Fukuoka and most of Japan, except for Tokyo. On the other hand, the Fukuokan prefectural government has been asking the residents to still behave the same way as under the state of emergency for three more weeks just to be safe. Fukuoka has had 18,320 cases and 311 deaths so far whilst the whole of Japan has had 4410,000 cases and 8359 deaths.

As spring is right around the corner, plants and trees are blooming throughout Itoshima, the air is scented and intoxicating with a plethora of spring flowers, the ocean is getting warmer and the sky is becoming more and more colourful and beautiful at sunrise and sunset. The sun is setting over the horizon from Itoshiman peninsula, which is what most of the tourists come here for.

It seems that places like Itoshima have been valued more in this pandemic. It was listed as one of “Bright lights, small cities” by Monocle last year.

Despite all the challenges that we are facing at the moment, I’m still hopeful about Itoshima’s future. In a time of chaos, having lost what we had before, people have started thinking more about our quality of life and it is becoming more popular to be free from the city and surrounded by nature. As a resident of Itoshima, I’d like to entertain and heal people when they come to Itoshima.