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Journalist ponders meaning of Japan's (currently) low coronavirus infection numbers

31 Comments

First a disclaimer: Telejournalist and author Jiro Shinbo fully admits his educational background is in the humanities, not science. He also tells readers of his weekly column in Flash (May 5) that what he writes is presumptive and requires substantiation by the scientific method. With those two points on record, let us now proceed to the article's headline, which is phrased in the form of a question: "Why hasn't the number of infected people in Japan undergone an explosive increase?" 

Considering the predictions of widespread infections issued by a number of public health experts, many others may be asking the same question. Look at New York City, he writes. The number of new cases had increased to 50 per day; but then within a span of six days, the number had risen to four digits. In Tokyo by contrast, the "known" number of cases was at 50. And three weeks later, the figure had increased four fold to 200. The rate of increase in Osaka was similar. 

Compared with what has been occurring in the U.S. and Europe, so far, Japan appears to be fortunate. 

Looking at the average worldwide, it has been estimated that an average of 80% of people infected with the coronavirus show only light, or no, symptoms. Another 20% require hospitalization, of which around 5% depend on intensive care in attempts to keep them alive. 

With that, Shinbo raises four hypotheses that relate to his question. The first is, despite the differences in the volume of testing being performed in Japan as compared to other countries, Japan's figures do appear lower -- even among the most the elderly, who are the most vulnerable to the contagion. In this country, it's not customary for younger people to exchange hugs and kisses with elderly members of the same household. In Japan, a higher proportion of elderly also live alone (or with a spouse) compared to households in, say, Italy, where it's common for three generations to live under the same roof. 

For generations to live separately may be undesirable in good times, but during a pandemic, it may be working to Japan's favor. Moreover, from the low percentages of positive results when testing for the virus in Japan's rural areas, where several generations do live together, it does not appear that incautious young people are spreading the virus to their grandparents in large numbers.

The second factor, writes Shinbo, may relate some sort of racial component. Some public health officials have raised the issue of greater vulnerability to infection, along with more severe symptoms, among people of certain racial groups and sub-groups. While socio-economic factors are also likely to be involved, it's possible a greater understanding of this phenomenon can offer some insight into controlling the spread.  

A third hypothesis relates to personal sanitary practices. In Japanese, the polite word for toilet, otearai, literally means "hand-washing place." Even before the pandemic many Japanese could be seen wearing masks in public due to seasonal hay fever -- although foreign tourists may have had the mistaken impression their purpose was avoidance of contagious diseases. Be as it may, it's possible habitual hand-washing and wearing of masks may have had a somewhat beneficial impact on limiting the spread of the virus. 

Shinbo's fourth hypothesis involves the so-called "herd immunity" that is anticipated to follow mass infection that's occurred in the hardest-hit countries. Since Japan cannot be said to be on the downward slope from a peak, then it is possible there is no benefit for it to continue halting social interaction. After all, he writes, the policy of "self restraint" cannot be maintained indefinitely.  

"If, for the reasons stated above, Japan's risk of exponential increase in infections is not as high as in Europe or North America," he writes, "then while boosting protection for the most vulnerable elderly and promoting 'Japanese-style' sanitary practices, I believe it will be safe to revert to normal social activities." 

Still, Shinbo cautions, he would only advocate a return to normal activities if confirmed through scientific evidence.

© Japan Today

©2020 GPlusMedia Inc.

31 Comments
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This article reeks of nihonjin ron crap. disgusting

16 ( +18 / -2 )

Yes, I was looking forward to reading this article, but it is quite disappointing in most respects.

15 ( +15 / -0 )

The writer, perhaps due to lack of coherent subject matter, is rambling, thinking out loud. He's usually pretty good when he stick to topics he knows, like politics or social issues.

8 ( +8 / -0 )

'In Japanese, the polite word for toilet, otearai, literally means "hand-washing place."'

Yes, and in American it is bathroom, which means more-or-less the same thing.

12 ( +14 / -2 )

Totally lost me at the disclaimer in the beginning. Basically means its all speculation and he's talking out of his ass

15 ( +16 / -1 )

First a disclaimer: Telejournalist and author Jiro Shinbo fully admits his educational background is in the humanities, not science.

My background is in science but I know very little about viruses. Best have people with a background in studying viruses and coronaviruses in particular.

Not a very useful article.

14 ( +14 / -0 )

Good article. Japanese are very special.

-7 ( +2 / -9 )

habitual hand-washing

...and at 95% of train stations there is no soap nor hot water...so what is with the habitual hand washing idea?

I have to disagree with the cleanliness thing.

11 ( +14 / -3 )

Who came up with this idea that Japanese people are habitual hand-washers?

Most bathrooms don't have hot water, and probably only half have soap.

Do Japanese people think they're the only ones who wash their hands? I find it hard to believe that the average Japanese person thinks that the rest of the developed world just rarely washes their hands.

Nonsense.

11 ( +14 / -3 )

I can just think of the bathroom at our local JR train station, complete with a sign written in Japanese that says "please do not steal our soap" and there's a place for a bar of soap (which has already been stolen) and everyone is supposed to share as they wash their hands with cold water.

By the way, what's the 4th hypothesis? Keep on keepin' on cause it's hard to control ourselves?

I'm embarrassed this published.

5 ( +6 / -1 )

Come on savethegaijin, it’s definitely true that Japanese are way more hygienic than westerners. Just do a survey and compare the results : -how often do you shower?

-Japanese : every day of course

-Average Westerner : ehhh, twice a week maybe ?

In Europe people who wear masks are/were often ridiculed. They’re not laughing anymore...

And Tom, at least in Japan there’s public lavatories everywhere...and they’re super clean. Try finding a public restroom in Europe that is not disgusting and vandalised and full of graffiti. Go to France, I rest my case.

I’ve lived in Europe most of my life and Japan for a number of years now.

Just my opinion, you’re not gonna like it but I think Europe sucks. Japan is so much better, it’s not even comparable, it’s like a different planet. But Japanese are modest, they never shout about it like Americans do “we’re best country in the world”. Usually by those who’ve never travelled outside of the USA.

-8 ( +7 / -15 )

Rubbish. This idiot has not got a clue. The rest of the world sees through it, and that’s enough to put him in his place.

4 ( +7 / -3 )

Those who criticize, try arguing against the numbers.

Compare the amount of people who are hospitalized treated in critical care using ventilators and the ones who dies of pneumonia in Japan against other parts of the world. The CRVID-19 pneumonia cases are quite different from usual pneumonia cases so doctors have already differentiated CRVID-19 type pneumonia with other types of pneumonia.

-6 ( +1 / -7 )

Come on savethegaijin, it’s definitely true that Japanese are way more hygienic than westerners. Just do a survey and compare the results : -how often do you shower? 

-Japanese : every day of course

-Average Westerner : ehhh, twice a week maybe ?

Which ‘westerners’ are you talking about? I saw a poll saying most British and French people shower every day. Same for the US. Australians more. Also, try taking a morning train in summer in Japan - taking a shower in the morning after you’ve been sweating in bed should be encouraged.

8 ( +8 / -0 )

Clearly, the athor is no scientist, or logician. Calling this screed illogical would be a compliment

6 ( +6 / -0 )

If Shinbo is a journalist he needs to look for a new line of work, but wait, in Japan people like him are EVERYWHERE in the media & that is why journalism in Japan is 98%+ crap!

5 ( +6 / -1 )

Tele journalist and author Jiro Shinbo’s opinion no more, no less, a veritable concoction, jumble of ethnocentrism, contrivance, or just plain old invention.

Certainly, Japanese culture refrains from close personal contact, in the office (business), or within the home environment.

The second factor, writes Shinbo, may relate some sort of racial component.

One doesn’t require a background in virology to sense more than a whiff of balderdash.

1 ( +1 / -0 )

If I believe scientifically that some races (understand general gene pools) can be less prone to covid in some little %, the cleaning thing is non sense. Talking a shower is useless if you have not cleaned every items of yours which have been possibly touched/received coughs from the outside.

Now imagine being in a packed train with one infected person in Japan right now...

1 ( +1 / -0 )

@Kurt Galle, Do you honestly think westerners wash twice a week?

Perhaps you do but I don’t know anyone else that does.

I regularly see people walk straight past the hand basin after using the toilet in stations and large office buildings.

3 ( +4 / -1 )

Jonathan Prin, correctly stated, there is no escape from the packed in like sardine’s tube journey home. Or the crazy corona-tose zombie family at the supermarket checkout.

2 ( +2 / -0 )

Not sure what people were expecting from an article such as this, scientific proof as to why the numbers are lower respectively or a biological one? Given how much we know about this virus, unlikely.

I think overall Japanese are a bit more hygienic but I believe the positives from it would be outweighed by the negatives such as packed trains, high density, high variance(in hygiene).

0 ( +0 / -0 )

It is an interesting article in the sense that it is what a layman can imagine is the reason for the current situation. Not blindly assuming this has to be the case but thinking what could be the explanation.

The problem is that the hypothesis are based on faulty or incomplete information. Very limited testing means that we don't really know how expanded is the infection in the country, so there is not much point in thinking why is has not been an explosive growth if we cannot be sure there is not one (or will be in the near future).

Nevertheless we can see there has not (yet?) been an overwhelming of the health services as in other countries, it may be some obvious reason like a culture of not touching much and using mask routinely, but it can also be something not so evident, like being an island country (since most have been doing quite well in comparison). The best case scenario is that the outbreak is somewhat controlled and economy cautiously re-opened even when nobody really understand why.

0 ( +0 / -0 )

Lower numbers of diseases in Japan can be attributed to 3 good habits as: 1.Taking off shoes before entering home, 2.Wearing masks and 3. No physical contact for greetings and above all, the concern for the collective

-1 ( +1 / -2 )

Look at New York City, he writes.

Well, if he'd read the NYT, it said recently that 94% of Covid-19 patients at one NYC health facility had existing chronic health problems. Hypertension, obesity, and diabetes were mentioned.

It is also a known medical mystery that Japanese smokers get lung cancer at about 1/6 of the rate of smokers in Western countries.

This actually leaves lots of room for speculation about general health in Japan, especially lung-related health. You don't have to rely on the ol' Nihonjinron tropes.

2 ( +2 / -0 )

I just think that the everyday use of masks in this country helps a lot, that with there being had sanitizers around a lot and public space surfaces wiped down.

I keep telling my elderly parents back in the UK to wear some sort of face covering when they go shopping, it seems no one does there.

0 ( +0 / -0 )

5th hypothesis: Make testing close to impossible, to control the real numbers! coronavirus hotline actually CHARGES 30yen per min (if you’re lucky to get through). More chance of another earthquake than getting tested over the weekends due to limited hours/closed local health centers. Although PCR might be covered by healthcare, test needed before PCR will cost at least 30,000yen or much higher....If all else fails, blame the giajins. The infected/death figures were/are substantially higher.

Final Hypothesis: Japan is a magical land, whereby unicorns roam free, and are immune to coronavirus.

2 ( +2 / -0 )

Jonathan PrinApr. 27 01:24 pm JST

If I believe scientifically that some races (understand general gene pools) can be less prone to covid in some little %, the cleaning thing is non sense.

Nope not really, there is a slight possibility that Japan had encountered this virus in the past and had developed resistance to it.

Nobody would have thought it was a new disease a hundred years ago in the end of the 19th century and and travelers to Japan from abroad would have been near zero and isolated from the general population so it would have been nearly impossible to contract it. It would also been nearly impossible to take back to the home country since a person will be staying for months in Japan and would not have traveled back when they were feeling under.

-1 ( +0 / -1 )

This article reminds me of the South Park episode where Gerald moves his family to San Francisco and in one of the scenes he is shown to enjoy smelling his own fart as a caricature of uppitiness and smugness. Why is this nihonjinron crap necessary? Do the foreign readers enjoy this?

1 ( +1 / -0 )

Sorry, but I can’t take anyone around my local hospital’s 6th floor as it is closed to all but corona cases and medical staff.

Cases are not so low in Japan anymore...

0 ( +0 / -0 )

Just do a survey and compare the results : -how often do you shower? -Japanese : every day of course

-Average Westerner : ehhh, twice a week maybe ?

Which ‘westerners’ are you talking about? I saw a poll saying most British and French people shower every day. Same for the US. Australians more.

Westerners typically shower in the morning - and they typically wouldn't leave the house until they had showered because they use showering to wake themselves up

0 ( +0 / -0 )

Ah. Anecdotal commentary disparaging the author's musings - nice of everyone to add to the conversation or spin out some dead witticism or rude nonsense. Some of the figures he cites are correct. 80% of those infected will be asymptomatic or suffer a mild case of coronavirus. 20% will suffer medium to severe cases. 5% will require intensive care. To which can be added: over 80% of cases are comorbidity the most common comorbidities were hypertension, obesity, and diabetes. Among patients who were discharged or died, 14.2% were treated in the intensive care unit, 12.2% received invasive mechanical ventilation, 3.2% were treated with kidney replacement therapy, and 21% died. You want S C I E N C E. Here it is from a JAMA study in NYC. But, if you don't want to read, here is a summary: If you have a comorbidity: hypertension, diabetes or obesity and are elderly, you have a high probability of being hospitalized and you are in the cohort with the highest number of fatalities. If you are male, that increases your risk. If you end-up on a ventilator: almost 90% of patients on a ventilator die. Which is a standard measure, no matter the reason, before coronavid-19 existed, the numbers were over 80%. If you are healthy and not elderly, you probably will acquire a mild case. The biggest factor is comorbidity. And age. Though if you are a 40 year-old fat, chain-smoking diabetic with heart problems, best you isolate at home, give-up smoking, lose weight, get on a nutritious diet and do some exercise. Otherwise, SARSCoV-2 or not you are headed to the land of pine boxes. So whether you are a stinky American or smelly French person or a typical Japanese (whatever that means) wash those hands after you take a dump. Put a mask on. Practice social distancing. And if sick or showing symptoms: stay home. If it continues, call your doctor. But. Most people will make it thru. Just don't kill off your older relatives with bad habits.

 A total of 5700 patients were included (median age, 63 years [interquartile range {IQR}, 52-75; range, 0-107 years]; 39.7% female). The most common comorbidities were hypertension (3026; 56.6%), obesity (1737; 41.7%), and diabetes (1808; 33.8%). At triage, 30.7% of patients were febrile, 17.3% had a respiratory rate greater than 24 breaths/min, and 27.8% received supplemental oxygen. The rate of respiratory virus co-infection was 2.1%. Outcomes were assessed for 2634 patients who were discharged or had died at the study end point. During hospitalization, 373 patients (14.2%) (median age, 68 years [IQR, 56-78]; 33.5% female) were treated in the intensive care unit care, 320 (12.2%) received invasive mechanical ventilation, 81 (3.2%) were treated with kidney replacement therapy, and 553 (21%) died. As of April 4, 2020, for patients requiring mechanical ventilation (n = 1151, 20.2%), 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital. The median postdischarge follow-up time was 4.4 days (IQR, 2.2-9.3). A total of 45 patients (2.2%) were readmitted during the study period. The median time to readmission was 3 days (IQR, 1.0-4.5) for readmitted patients. Among the 3066 patients who remained hospitalized at the final study follow-up date (median age, 65 years [IQR, 54-75]), the median follow-up at time of censoring was 4.5 days (IQR, 2.4-8.1).

The Charlson Comorbidity Index predicts 10-year survival in patients with multiple comorbidities and was used as a measure of total comorbidity burden.8 The lowest score of 0 corresponds to a 98% estimated 10-year survival rate. Increasing age in decades older than age 50 years and comorbidities, including congestive heart disease and cancer, increase the total score and decrease the estimated 10-year survival. A total of 16 comorbidities are included. A score of 7 points and above corresponds to a 0% estimated 10-year survival rate. Acute kidney injury was identified as an increase in serum creatinine by 0.3 mg/dL or more (≥26.5 μmol/L) within 48 hours or an increase in serum creatinine to 1.5 times or more baseline within the prior 7 days compared with the preceding 1 year of data in acute care medical records. This was based on the Kidney Disease: Improving Global Outcomes (KDIGO) definition.9 Acute hepatic injury was defined as an elevation in aspartate aminotransferase or alanine aminotransferase of more than 15 times the upper limit of normal.

A total of 5700 patients were included (median age, 63 years [interquartile range {IQR}, 52-75; range, 0-107 years]; 39.7% female) (Table 1). The median time to obtain polymerase chain reaction testing results was 15.4 hours (IQR, 7.8-24.3). The most common comorbidities were hypertension (3026, 56.6%), obesity (1737, 41.7%), and diabetes (1808, 33.8%). The median score on the Charlson Comorbidity Index was 4 points (IQR, 2-6), which corresponds to a 53% estimated 10-year survival and reflects a significant comorbidity burden for these patients. At triage, 1734 patients (30.7%) were febrile, 986 (17.3%) had a respiratory rate greater than 24 breaths/min, and 1584 (27.8%) received supplemental oxygen (Table 2 and Table 3). The first test for COVID-19 was positive in 5517 patients (96.8%), while 183 patients (3.2%) had a negative first test and positive repeat test. The rate of co-infection with another respiratory virus for those tested was 2.1% (42/1996). Discharge disposition by 10-year age intervals of all 5700 study patients is included in Table 4. Length of stay for those who died, were discharged alive, and remained in hospital are presented as well. Among the 3066 patients who remained hospitalized at the final study follow-up date (median age, 65 years [IQR 54-75]), the median follow-up at time of censoring was 4.5 days (IQR, 2.4-8.1). Mortality was 0% (0/20) for male and female patients younger than 20 years. Mortality rates were higher for male compared with female patients at every 10-year age interval older than 20 years.

Among the 2634 patients who were discharged or had died at the study end point, during hospitalization, 373 (14.2%) were treated in the ICU, 320 (12.2%) received invasive mechanical ventilation, 81 (3.2%) were treated with kidney replacement therapy, and 553 (21%) died (Table 5). As of April 4, 2020, for patients requiring mechanical ventilation (n = 1151, 20.2%), 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital. Mortality rates for those who received mechanical ventilation in the 18-to-65 and older-than-65 age groups were 76.4% and 97.2%, respectively. Mortality rates for those in the 18-to-65 and older-than-65 age groups who did not receive mechanical ventilation were 19.8% and 26.6%, respectively. There were no deaths in the younger-than-18 age group. The overall length of stay was 4.1 days (IQR, 2.3-6.8). The median postdischarge follow-up time was 4.4 days (IQR, 2.2-9.3). A total of 45 patients (2.2%) were readmitted during the study period. The median time to readmission was 3 days (IQR, 1.0-4.5). Of the patients who were discharged or had died at the study end point, 436 (16.6%) were younger than age 50 with a score of 0 on the Charlson Comorbidity Index, of whom 9 died.

For both patients discharged alive and those who died, the percentage of patients who were treated in the ICU or received invasive mechanical ventilation was increased for the 18-to-65 age group compared with the older-than-65 years age group (Table 5). For patients discharged alive, the lowest absolute lymphocyte count during hospital course was lower for progressively older age groups. For patients discharged alive, the readmission rates and the percentage of patients discharged to a facility (such as a nursing home or rehabilitation), as opposed to home, increased for progressively older age groups.

Of the patients who died, those with diabetes were more likely to have received invasive mechanical ventilation or care in the ICU compared with those who did not have diabetes (eTable 1 in the Supplement). Of the patients who died, those with hypertension were less likely to have received invasive mechanical ventilation or care in the ICU compared with those without hypertension. The percentage of patients who developed acute kidney injury was increased in the subgroups with diabetes compared with subgroups without those conditions.

0 ( +0 / -0 )

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