Covid-19 pandemic: Japan’s controversial strategy to ‘live’ with the coronavirus

The country does not perform the best among Asian countries: Thailand, South Korea or Vietnam, which adopted more drastic measures, registered fewer cases.

But Japan’s new strategy has proven unique in that it combines scientific approach, flexibility, and common sense.

“In Japan, we are using a different approach than what has been used in most of the world,” says Hitoshi Oshitani, professor of virology at the Tohoku University School of Medicine, in an interview with BBC News Mundo. Spanish from the BBC).

“In most of the world, the strategy has been to try to contain the coronavirus. From the beginning, we did not have that goal. We opted for something different: we decided to learn to live with this virus,” he completes.

According to Oshitani, to do this, “we seek to reduce transmission as much as possible, maintaining social and economic activities.”

“We accept that this virus is something that cannot be eliminated. In fact, the vast majority of infectious diseases cannot be eliminated, so we understand that the best way to combat it was to live with it, ”he says.

Now that a second wave threatens Europe and predictions of new cases are increasingly worrying for the winter, Japan hopes that its experience can help other countries think of new ways to deal with the pandemic and, at the same time, try save the economy.

According to Oshitani, one of the elements that led Japan and other Asian countries to be better prepared to face the coronavirus is that, throughout history, they have suffered other epidemics and are located very close to China.

“As we are relatively close to Wuhan, which was where the pandemic originated, we prepared very quickly because we knew we could have many cases,” recalls the expert, who was one of the government’s main advisers on the strategy against the coronavirus.

A few weeks after the virus became public in China, Japan also registered its first case.

It was just January 16 and it did not take long for the situation in the country to be aggravated by a cruise ship, the Diamond Princess, which became a source of contagion in the port of Yokohama.

“Then, in mid-March, we had another outbreak, which was caused by travelers arriving from Europe, the Middle East, North America and many other countries,” recalls Oshitani, who has also served as a former adviser to the Organization. World Health Organization (WHO) for communicable diseases.

“This outbreak was under control in mid-May. The government decreed a state of emergency and suspended it that month, but by then another wave of infections had started in Tokyo, which is now beginning to subside,” he added.

It was in this context, Oshitani recalls, when the authorities in Japan understood that they needed a different way of dealing with covid-19

“We knew from what happened in Wuhan that it is possible to contain the virus, but it is extremely difficult to do so. In Japan, however, we had no way of implementing a quarantine or forcing people to stay home,” he says.

The country, despite being one of the most developed in Asia, also lacked the capacity to mass produce and test, as did neighboring South Korea.

“It was clear that we needed a different approach,” says Oshitani.

In May, then-Prime Minister Shinzo Abe lifted the state of emergency and, at the same time, announced that Japan’s strategy to deal with the virus would be “a new lifestyle” in which the coronavirus would begin to be seen as part of everyday life.

“Now, we are going to venture into new territory. So we need to create a new lifestyle. We need to change the way we think.”

The demands, however, were part of common sense: wear a mask, maintain social distance, wash hands, do not yell, do not speak loudly, do not kiss or hold hands.

According to Oshitani, the reasoning behind the Japanese strategy of living with the virus was not motivated solely by political or infrastructure reasons.

“It was based on our knowledge of the virus and what we were discovering about it,” he says.

Although the role of asymptomatic patients in the transmission of Covid-19 is now known around the world, it was the basis of Japan’s strategy before it was accepted elsewhere.

Since mid-February, Oshitani’s team has recommended taking into account that the virus could be transmitted by apparently healthy people.

“We knew there were a lot of asymptomatic cases or very mild symptoms. That makes it very difficult to find all the positive cases. So our purpose was not to contain them from the beginning, but to try to suppress the transmissions as much as we could.”

Oshitani recalls that Japan’s experience with the Princess Princess ship led them to better understand how the virus worked.

“We knew that the majority of those infected with the virus, almost 80%, do not transmit it to anyone. Instead, a small proportion infect many others,” he says.

The effect, currently known as “super contagion events” and which were later documented in other countries, led the Oshitani team to understand that “the transmission of this virus cannot be contained if the bunches infections are not controlled (group of similar health events that occurred in the same area at the same time) “.

“Controlling these groups has also been the foundation of our strategy for living with the virus,” he says.

Experts from Japan soon came to another conclusion that some countries still do not accept and that the WHO, although it has not ruled out, also did not categorically recognize: that the coronavirus can be transmitted by air.

Thus arose the strategy known as “san mitsu”, a public health recommendation that became the golden rule for living with the virus:

As part of this principle, sporting events are allowed, for example, but people cannot shout. In many bars and restaurants, customers are asked to speak quietly or listen to music instead of speaking.

For Oshitani, various cultural and idiosyncratic aspects of Japan have also contributed to the local response to learning how to live a “normal” life during the pandemic.

“It is well known that the Japanese are more likely to maintain more physical distance than in the West, and another element that has had a lot of impact is social pressure, and no one in Japan would like to be held responsible for the transmission of the virus.”

According to a study by the Doshisha University Faculty of Psychology, the widespread use of masks in the country is not linked to the desire to prevent the spread of the virus, but to social pressure: most Japanese prefer not to be questioned by don’t use it. there.

“Social pressure has certainly helped contain the virus in Japan, but it has also created situations of discrimination against sick people or health workers,” says Oshitani.

The Japanese strategy, however, has been quite unpopular: opinion polls show the general discontent of the population with the central government, accusing it of a slow and confused response.

The low level of tests to detect the virus early and the obstacles that still exist to its access have also led many media and local experts to affirm that they have been an obstacle to effective screening for the disease.

And with the Olympics postponed until, ideally, 2021, the eyes of the world will follow for months as the country continues to fight the pandemic.

However, Oshitani doubts that, despite the results and the strategy of living with the virus, Japan can hold a sporting event of this magnitude next year.

“We are not fighting this virus for the Olympic Games, because we know that for something like this, we must also consider what other countries are doing. That is, we know that without the control of this virus in most of the world, it is not possible to have the Olympics, “he said. points.

“If we are going to host the Olympics, we have to do it safely and find the best way to do it. And at the moment, I’m not sure we have the capacity to do it,” he adds.

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