Tobias J Gibson comments

I'd like to see the breakdown of where those infections were/are within Tokyo over time in order to assess overall risk when visiting / passing through those areas.

stopcovid19.metro.tokyo.lg.jp/en/ has this information under 'Test positives (by area)' in the 'Other Indexes' tab, however the formatting could be more user friendly.

what's the hospital capacity with special isolation rooms and infection protocols?

stopcovid19.metro.tokyo.lg.jp/en/ states there are currently 2640 beds secured for covid-19 patients in the Metropolitan Tokyo Area, with 150 of those beds being available for ECMO/Ventilator patients (severe symptoms).

https://www.stopcovid19.jp/ specifically monitors hospital capacity nationwide in Japan by prefecture. For Tokyo, it lists occupancy at 37.7%. It uses opendata drawn from individual prefectures and provided by the Ministry for Health, Labor and Welfare, which is not always up to date, so I would treat it more as a good estimate than exact.

https://www.mhlw.go.jp/content/10900000/000676194.pdf

Comparing these two sites does highlight the issue of varying definitions between prefectural governments and the central government. For example, while the Tokyo Metropolitan government states there are 2640 beds for covid-19 patients, according to the MHLW there are 5860 (4000 regular beds and 1860 ICU beds as of 9/23). Similarly, while the Metro government only considered the 28 patients receiving ECMO/ventilator support as serious, the Ministry states there are 119 serious patients (ICU patients) as of 9/23.

In any event, the data seems to support the assertion that as of today, the hospital system is not under immediate threat, in my opinion.

They only test people with symptoms, as has been said here many times over.

According to the stopcovid19 statistics page, 116 of those confirmed cases have a known route of infection, while 79 have a unknown route of infection. While it is reasonable to assume that those with an unknown route of infection presented with symptoms, those tested via contact tracing may or may not be symptomatic. Unfortunately, there isn't data regarding the proportion of total individuals tested which are identified via contact tracing as opposed to presenting with symptoms.

Furthermore, while there were a reported 1952 tests conducted for September 21st in the Tokyo Metropolitan area, the number of individuals tested was 1,759, according to the stopcovid19 statistics page. This would indicate that approximately 200 tests were retests of individuals (presumably pending discharge).

https://stopcovid19.metro.tokyo.lg.jp/en/

Disclaimer: I am not expressing an opinion as to the quality of the covid-19 response in the Tokyo Metropolitan Area, only clarifying data according to my reading.

dougthehead13Today  01:34 am JST

Thanks for the link. Now I have a more detailed situation of the coronavirus. In the prefecture of Tokyo.

Your welcome. I also recommend the following site for statistics relating to wider Japan:

https://toyokeizai.net/sp/visual/tko/covid19/en.html

"Receiving treatment at lodging facilities"  216 people.

Lodging facilities are hotels which have been acquired by the government to house asymptomatic or mild cases where hospitalization is unnecessary, but home recuperation is inappropriate (i.e. dormitory residents).

https://www.mhlw.go.jp/content/10900000/000634753.pdf (at p.8)

Hospitalization / Medical treatment, etc. 304 people. 

I admit, I found this figure very confusing as well. As far as I can tell, this refers to individuals who have tested positive, but have not yet been advised as to the status re. treatment /hospitalization. Generally, this is because of bureaucratic delays with the public health offices, however it may also be that the patient is unable to be contacted. This article from NHK touches on the issue, however it is in Japanese:

https://www3.nhk.or.jp/news/html/20200715/k10012516671000.html

Went to my local conbini today,

The plastic sheets around the counter had suddenly disappeared.

Wonder if its just a one off or has the government sent out a directive?

I went to three conbinis today (I know, I have a problem) and all still had the plastic barriers up. I am not aware of any government directives, past or present, either way (i.e. to use them or not). I suspect it maybe down to the conbini, especially for franchisee branches.

28 people had severe symptoms (which must equate to hospitalization.)

This is a common misinterpretation of the data. There are currently 1,258 hospitalised covid-19 patients in the Tokyo Metropolitan area. This figure does not include those housed in designated lodgings or recuperating at home. 28 are classed as ‘severe symptoms’, which refers to those patients who need ventilators or ECMO.

I would encourage Japan Today to alter their reporting to include this definition, as it seems to be a reoccurring error in the comments.

https://stopcovid19.metro.tokyo.lg.jp/en/

Finally, as a disclaimer, I am not drawing any conclusions based on this data in this post, only clarifying the data for those who wish to do so.

dougthehead13Sep. 22  11:49 pm JST

All ECMO and ventilator patients They are ICU patients. 

Do you have a source for this statement, because the Tokyo Metropolitan Government, in its statement explaining the decision to use the current definition, specifically states that:

人工呼吸管理下の重症患者が必ずしも、ＩＣＵに入室していない

[Severely ill patients under mechanical ventilation are not necessarily in the ICU]

https://www.bousai.metro.tokyo.lg.jp/_res/projects/default_project/page/001/011/435/7kai/202008207.pdf

It is clear that there are more patients in the ICU. Patients from other diseases, post-surgery, work accidents or traffic accidents.

It is also highly likely there are covid-19 in ICU who do not require ECMO or ventilators. Again, as the Tokyo Metropolitan Government itself has stated:

ＩＣＵ在室者の全てが、必ずしも重症でない

[Not all ICU residents are seriously ill]

But the number of people seriously affected by coronavirus in Tokyo Prefecture is 30. A fortunately low figure, for an area where 14 million people live. The important thing is that hospitals are not overcrowded. And that the health system does not collapse. 

That's why I say the data is not worrying. For now.

I am merely trying to correct the common misinterpretation of the data presented here. Whether it is 'good' or 'bad' in your opinion is not at issue, and I have specifically not mentioned my opinion on this. If you want to continue to attempt to defend your clear misstatement when it does not necessarily undermine your opinion, that is your prerogative, however, resistance to fact checking and correction usually will undermine your position.

This is the most important fact of all. People admitted to the ICUs.

It is a little tiring to repeat this every few days, but severe symptoms does not mean admitted to ICU in Metropolitan Tokyo reporting; this is the number of patients on ECMO or ventilators.

Mr Kipling,

Leaving aside that the 3400 figure is taken from excess mortality (as stated in the citation), that pneumonia mortality data is not available for the period in question (so there is no way of saying it is twice that figure), and the fact that you offer no citation for you claims, it stands to reason that the same is true of covid-19 reporting; where covid-19 is not listed as a cause of death, then those cases won't be counted.

In any event, this article is about suicide, so if the moderators do not remove our comments, then at least lets end the off topic discussion here as i get the feeling we wont convince each other anyway.

This single month figure easily outnumbers the whole corona-related deaths (1,495 since February of this year).

The suicides for August is higher than the total covid-19 death toll. However, if there wasn’t a “lockdown” and other measures taken this may not have been the case. Impossible to know for sure. But shows that the economic and social problems brought on by covid-19 management should also be taken into accounts,

Sounds like the medicine is worse than coronavirus. 

Attributing the total number of suicides to the SARS-CoV-2 response is intellectually dishonest. The total increase in suicide deaths in August compared to last year is 283. That is less than covid-19 death's in the same period (296): https://toyokeizai.net/sp/visual/tko/covid19/en.html. As Mr. Kipling points out, to determine whether the SARS-CoV-2 response was warranted (using the grim, and largely inappropriate, calculus of deaths alone) is impossible, as we can neither determine how many deaths have been prevented, nor how many of those excess suicides are directly attributable to the response. It is conceivable that suicides would be the same, or even higher, in circumstances where there was a significantly higher death rate from the virus, even without media coverage (i.e. grief as a contributing factor to suicide).

As a side note.... the covid death toll is still only about 15-20% of last years influenza toll in Japan. The two are different and direct comparisons are not always useful but sometimes good to keep things in perspective.

Influenza statistics are usually calculated by season, rather than by calendar year. The most recent data is for the 2018-2019 Influenza Season (basically from August 31 2018 - September 1st 2019), which saw approximately 3400 influenza deaths: https://www.niid.go.jp/niid/en/2019-10-04-07-17-22/865-iasr/9288-477te.html. Additionally, where the 2019-2020 influenza season was originally predicted to be one of the worse in recent history, it is now predicted it will see significantly less deaths, due to the coronavirus response also being effective at suppressing influenza: https://jamanetwork.com/journals/jama/fullarticle/2764657.

In any event, 1495 is 43% of 3400, and, if we prorate the flu death total to 8 months as we have for covid-19, it is 67%. Finally, as pointed out above, when actual data for flu deaths in the same circumstances as covid-19 deaths is available, I expect it will continue to demonstrate, as the vast majority of the scientific community has continually said, covid-19 is significantly more dangerous that influenza.

Finally, suicide is a complex issue, and has long been a serious problem in Japan. In recent years, Japan has in fact made good progress addressing this, but has a long way to go. Being distracted into blaming the covid-19 response and economic impact of what is largely an unavoidable natural disaster (yes, pandemics happen) is ignoring the primary issue that even last year without those issues, around 1500 people decided they could no longer continuing living. Please don't use that as a way to further your political agendas re coronavirus.

Well, to be fair, the economic impact on NZ of their particular approach has been greater than on other nations for Q2. 12.2% vs around 8% for Japan, Sweden and around 9% for the US.

Of course, comparing public health results, NZ has had greater success, albeit not total as originally touted.

But most importantly, for all those above on either side of the issue, this is only half time, if that. Lets see Q3 and Q4 data for both economics and public health before we declare winners and losers (as so many, rather morbidly, seem to want to do).

The total number of people with corona is .0026% of the population. But yeah, let's keep making everyone wear masks, and keep making a lot of people wear gloves, force shops to use plastic shields and close early.

Are suggesting that the mitigation and prevention measures have worked, therefore we should abandoned them?

People have been saying that for months now and things continue to remain under control.

Interesting take on it. My recollection was an uncontrolled spike in March, followed by an SOE which brought things under control and down to less than 50 cases a day, and almost zero deaths per day. This was followed by a push to resume economic activity and claims of success and victory, which in term led to an uncontrolled spike again, which was again followed by the reintroduction of numerous measures such as early closures, as well as the public returning to preventative behaviours (for example the massive drop in travel during Obon). This has scaled back cases to what appears to be around 500 cases and 8 deaths a day nationally. I think its fair to say there hasnt been a consistent sense of control as much as ebb and flow, and as people now adjust to think 500 a day is fine and we can go back to normal, we will see another spike, followed by more mitigation, followed by a new baseline of maybe 1000 cases and 20 deaths a day slowly becoming the new normal... But yeah, it is what it is. To be honest, life with corona now is not so bad, so I hope people are smart enough to at least continue as we are now until there is an effective, available vaccine, rather than being fooled into letting their guard down.

 I also wanted to clarify that. 23 severe cases which I understand to mean 23 people currently in ICU in Tokyo, which has a population of 14 million. Am I getting that right?

No. Severe cases are 'those patients who need ventilators or ECMO' in the Tokyo Metropolitan area. The reasoning for this definition over the standard ICU admission plus ventilator/ECMO used by the Ministry of Health, Labor and Welfare, is that 'not all ICU patients are critically ill'. It can be inferred from this that amongst the 1,262 hospitalised patients in the Tokyo Metropolitan area, there are some who have been admitted to the ICU, but are not consider serious/severe cases.

Source: https://stopcovid19.metro.tokyo.lg.jp/en

So far there have been 1,439 deaths from Coronavirus in Japan. I'd be interested in knowing how that figure compares with other diseases and deaths, such as flu, smoking-related diseases, road deaths, suicides, etc.

Unfortunately, it is very difficult to locate official mortality data for 2020 at this stage. Of the causes you listed, the only actual data I have located is for traffic fatalities. In the period since between Mar 1 and September 1, there were 1,236 traffic fatalities. However, this is around 15% down on the same period last year, with drops or almost 30% during the lockdown in April and August Obon periods.

Source: https://www.e-stat.go.jp/en/stat-search?page=1&toukei=00130002

In terms of other communicable diseases generally, and respiratory diseases specifically, there is strong reason to believe they have been suppressed this year by the increased efforts regarding covid-19. For example, recent reporting has observed a significant reduction in cases during the traditional southern hemisphere flu season: https://www.motherjones.com/kevin-drum/2020/09/flu-season-disappeared-in-the-southern-hemisphere-this-year/ In light of this, there will likely be a significantly reduced fatality rate compared to previous years, making comparison unhelpful.

Similarly, while I cannot find data on suicides during the pandemic period, reporting has suggested a 20% drop during the lockdown in April, and expects expect a sharp increase following the pandemic, for reasons relating to psychology during crisis and economic difficulties brought on by covid-19: https://www.reuters.com/article/us-health-coronavirus-japan-suicides/calm-before-the-storm-for-japan-suicides-as-coronavirus-ravages-economy-idUSKBN2350BE?feedType=RSS&feedName=topNews

The overall point is that the covid-19 mortality rate must be viewed in the distinct circumstances with which cases are occurring; widespread anti-pandemic measures and hyper-vigilant personal behaviors. Those making the 'X kills more people than corona, and we don't do anything about that' are ignoring the fact that if we did do something about that, it would kill far less people than covid-19, or, put the other way, if we don't do anything about covid-19, it will kill far more people than many other causes. Look at countries like Sweden and the U.S.A which have attempted a minimal approach (albeit still with some precautions and recommendations, and in the U.S.A case, lockdowns). Covid-19 is predicted to be the third leading cause of death in the U.S.A, behind cancer and heart-disease, both of which have multiple causes: https://www.webmd.com/lung/news/20200818/covid-the-third-leading-cause-of-death-in-the-us

In Sweden, around 57.41 people per 100000 population have died due to covid-19 since the pandemic began. The leading single cause of death for Sweden in 2019 was Ischemic heart disease, which caused 56.24 deaths per hundred thousand inhabitants. https://coronavirus.jhu.edu/data/mortality and https://www.statista.com/statistics/528942/sweden-number-of-deaths-by-cause-of-death/#:~:text=The%20most%20common%20cause%20of,28%20thousand%20deaths%20in%202019.&text=Chronic%20ischemic%20heart%20disease%20is,that%20causes%20the%20most%20deaths.&text=In%202018%2C%2056.24%20deaths%20occurred,Sweden%20due%20to%20the%20disease. The death rate in Sweden is now slowing, however whether this is due the intrinsic qualities of the virus, or due to changes in personal behaviors amongst Swedes is unclear. Again, until we won't really know until later how the vast social, economical and cultural changes brought on by the pandemic have impacted other causes of death. I am comfortable concluding, however, that without action the death rate for covid-19 would be significantly higher.

23 people admitted to ICU for coronavirus. Throughout the Tokyo metropolitan region. 

To clarify, the definition of 'serious cases' for the Metropolitan Tokyo area is:

patients requiring ventilators or ECMO

This is a significantly higher bar than admission to the ICU.

With that said, the level of ICU admissions for Japan is still lower than many countries, as you note.

Or, the 'panic' is the reason for Japans relatively low numbers. Arguing that because cases are low, people should abandon mitigation is misguided. In countries with a greater resistance to mitigation the situation is demonstrably worse. Likewise, arguing that a baseline of 1000 cases wont spiral upward if individuals change behaviours to less preventative ones is demonstrably false. Of course, we all just speculate.

Too late! The present dominant socioeconomic model has been busily digging its own grave since the days of "the Gipper". Covid is providing the coffin.

Exactly. Any argument that people have a personal responsibility to 'save the economy' is bizarre. Roughly 46% of government revenue comes from individuals (income tax, consumption tax, various taxes on gas etc), while 12.7% comes from corporate tax. For decades the free market model has built these brittle economic structures, while companies focus on maximising profit and avoiding contributing to a safety net wherever possible. Individuals pay taxes, pensions, insurance to protect our health and welfare. Arguing that in addition we should get risk the death of our families, or illness, even mild, to save business which are unwilling to contribute to our welfare is backwards.

Could the moderators clarify if the reported deaths are for Tokyo or nationwide?

Moderator: Nationwide.

Seems more or less consistent with the 'strategy' so far. Push economic goals, and rely on individual action when cases tick up as a result. Im am curious to see economic data for Q2 and Q3; I suspect its still down as most people I know are actively avoiding 'risk' situations.

Maybe a wry observation, but it appears less people get tested on weekends, with a higher positivity rate. I realise its partly due to testing centres such as hospitals being closed, but perhaps during the week people are also more sensitive to 'symptoms' when faced with the long train ride to work?

Funny, number of tests is actually in red.

Its a link to the official release of the data (pdf).

The number is the result from 5,486 tests conducted on Aug 26.

Could the moderators clarify this is the total tests conducted, or discreet individuals tested? I believe it is the former, with discreet individuals tested being closer to 4,775 for August 26, according to the metropolitan stop covid website.

As a disclaimer, I am not making any argument either way as to the state of the pandemic, I am merely trying to clarify the reporting.

Thanks.

The number of infected people with severe symptoms requiring hospitalization is currently 31...

As clarification, 'severe symptoms' is defined as 'those patients who need ventilators or ECMO.' The number of hospitalisations for mild to moderate (meaning anything less than requiring a ventilator) is currently 1,443 in the metro Tokyo area.

https://stopcovid19.metro.tokyo.lg.jp/en/

Severe symptoms usually develop in patients over a 10 day period, and are represented in data roughly 14 days after infections:

https://www.japantimes.co.jp/news/2020/08/21/national/science-health/severe-coronavirus-19-cases-tokyo/

Also, covid-19 is currently designated as a class 2 infectious disease under the Infectious Disease Control Act, which means that hospitalisation is not required for confirmed cases, though the prefectural government may order it. This accounts for the 713 patients recuperating at home or at lodging facilities.

https://www.loc.gov/law/help/health-emergencies/japan.php#:~:text=Japan's%20Infectious%20Diseases%20Prevention%20Act,and%20the%20severity%20of%20symptoms.

Finally, I offer this only as clarification. I believe that there was a spike that has not declined to a base level.

I can only speak to my experience in Aichi prefecture. I take my temperature daily as part of my place of work's prevention measures. In mid-June I had a temperature of 37.8 for two days (I didnt go to work). I had no other symptoms. On the third day I went the municipal hospital, received a test, along with xrays, blood work and a flu test. The PCR test came back around 36 hours later negative. My "fever" also subsided on the 4th day.

First week of August I again had a low grade fever, with headaches and a cough. Same procedure on 3rd, again negative result.

Both times I did pay around 5000 yen, but this was including all the other tests and was covered by NHI.

This may be off topic, but it is inappropriate to compare this reporting to Covid-19 reporting. This articles states:

12,799 patients were taken to hospitals for heatstroke...

That does not mean they were hospitalised. A proportion may have been discharged on the same day.

Likewise:

387 were seriously ill, requiring more than three weeks of medical care...

This definition is different to the definition of serious ill for covid-19 patients, which is (generally) in the icu or requiring ECMO or a ventilator.

Of course, the heat wave and heatstroke are serious issues. However, it is largely independent of the pandemic (beyond minimal impact following behavioural changes).

Also, I note that there has been a marked reduction in people pointing to the death rate as some sort of metric of success. Is this because in August there have already been more deaths than all of the last week of May, all of June and and all of July combined?

As some are want to say; a few deaths amongst the elderly is acceptable to save the economy. Well economic data isn't available yet for that period, but I hope there is a significant improvement to justify the statement.

Based on what? Japan has so far done a pretty decent job on a world scale, markedly better than the disasters of the US and UK. But "ahead of the rest of the world"? Regional neighbours like Taiwan, S Korea, Hong Kong, Singapore, Malaysia and Vietnam all have lower death rates and have largely done it with no mass lockdowns. Yes, they've used masks too.

I agree. Globally, according to world-o-meters, Japan is 131 of 215 for deaths per capita. Pretty average.

With regard to the regions listed, Japan has the second highest rate of deaths per million population after Hong Kong.

In terms of economic impact for the regions listed, by year-on-year GDP growth for Q2 2020, it is second worse after Singapore.

With the current rate of infections appearing to hover around r1 nationally, I expect that the current rate of infections, hospitalisations, and deaths represents the baseline. It may spike again as individuals relax personal precautions, or the government attempts to stimulate the economy, and seasonal factors influence the virus. It will likewise trough again as individuals react to those spikes. I do not expect any change of strategy by the central government short of a massive spike. All in all, Japan is pretty middle of the pack with regard to the world, and towards the worse impacted in East Asia and the western Pacific region.

Finally, I like living in Japan. I enjoy the culture, the people, the climate and much more. But I do think it is wrong to claim that the Japanese model one of the more successful on either a public health or economic metric.

Unfortunately, I do not know of any recent reporting as to the availability of or access to testing. I can say, anecdotally, I have been tested twice on my own request based on presenting with only a low grade fever (37·5 - 37.9) between June and August. Both times were negative results thankfully. While it wasn't exactly easy, I didn't run up against any overt resistance from the health center or hospitals. Again, I do think testing should be widely available and that infections are under-reported; however I do not believe there is a conspiracy to mask infections and that a downward trend in the reporting we do have is indicative of a wider trend. Again, anecdotally, I have observed most people in my community are taking increased measures to avoid community spread. Not everyone, as you note, but an increased proportion, which would impact numbers. As I said, I think as numbers drop, especially as that drop that will change. But I believe, for now, there has been a decline.

I understand the view that Japan's testing regime is inadequate, however the decline in test numbers is due to less people presenting with symptoms or being identified via contact tracing. I agree that the raw number itself is misleading as to the rate of decline, however the proportion of positive results to tests conducted is also declining, so I think it is fair to note a downward trend (not necessarily as large a downward trend as some may claim though). The issue is that the way these reports are presented leads to a kind of panic/celebratory cycle and in lieu of a comprehensive strategy there is nothing to stop the numbers going up again when people let their guard down as they did last time the numbers dropped (i.e. after the SoE).

One way or another, the government needs to pick a lane. The half measures and indecision has meant that both public health measures and economic revitalisation have failed to be anything but palliative at best. The virus, while not skyrocketing out of control, is still chipping away at domestic economics and maintaining a pretty solid baseline for future surges, while the economic stimulus fails to stimulate domestic consumers. Of course, as I have stated before, I think the public health option is the better one, but Id even support full economic focus over this current strategy.

More people die from tb than corona.

Leaving aside the vast differences between TB and covid-19 (for example, one is bacteria borne, the other is viral), and the fact that SARS-CoV-2 is a new virus which has only been circulating for roughly 8 months, it is also worth pointing out that more people die from TB than any other infectious disease, as it is the leading cause of death from a single infectious agent:

https://www.who.int/news-room/fact-sheets/detail/tuberculosis

In fact, given that in the time since the first person was infected in China roughly 9 months ago, SARS-CoV-2 has already killed roughly half of the annual total for TB for the entire 2019, and given the escalating global death rate, it is entirely possible Covid-19 will take that crown this year.

Not testing enough means infected cases go unnoticed and don't feature in any statistic or the r0 that your talking about.

Actually, I agree that Japan's testing policy and overall strategy (or lack thereof) is inadequate and that there are likely far more cases in fact. This is evidenced by the fact that the majority of cases still originate from unknown contacts. I also believe that the current definition of close contact is insufficient for adequate contact tracing.

However, while I believe that there have been a small number of misclassified deaths and symptomatic individuals who have been unable to procure testing, I do not think there is a widespread conspiracy to prevent testing generally. Symptomatic individuals generally can be tested by contacting their local health center and reporting to a hospital. I have done so twice since June, both times with a negative result. As such, while there are likely many unidentified asymptomatic cases, I believe the apparent decline is indicative a true decline presuming the rate of symptomatic cases is relatively stable.

Your statement makes it look like the virus is very easy to mitigate this virus.

Again, my preference would be for the Diet to reconvene and pass into law lockdown measures for roughly 2 months to bring the level down to a manageable level. I believe that would be the most efficient and effective course both economically and in public health terms.

However, I have long since accepted the unwillingness to do so by the Japanese government, specifically the LDP. What I have observed, both anecdotally in conversations with people, primarily native japanese, and through reporting indicating widespread, majority support for greater measures such as an SoE, is that in lieu of government action, most people are in fact electing not to participate in risky behaviors. Of the 100 or so people I have spoken to in the last week, none travelled or visited family during the Obon period. Plans were cancelled. None of them have participated in enkai or other social gatherings since mid July when cases began to rise. Overall, i think generally the public is reacting to the reporting on numbers and this response is suppressing the virus.

As I note in my previous comment, I have concerns that this response will be insufficient. Honestly, I don't think the unstructured, individual actions of the populace will bring the number down to less than 100 cases, as it was in June. I also believe that people will fatigue faster, and resume 'normal activity' more readily in the face of reporting of decline. When this happens, cases will surge again, and to higher numbers, which will lead to more deaths, and more economic decline when people get scared again. I was saying I hope it doesn't happen; I sincerely hope somehow this strategy works. Because I have given up on the powers that be taking appropriate action.