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It’s a strategy that has helped Japan avoid quarantine and thousands of deaths, but now faces a new challenge as infections spread rapidly as cold weather begins. Oshitani fears that his people are not prepared.
“People’s attention is waning,” virologist and infectious disease specialist H. Oshitani told Bloomberg News. “We may see a sudden increase in serious cases and deaths.”
His predictions seem to come true as Japan records a record number of infections on a daily basis.
Oshitani became a global ambassador for the “Japanese model” due to his early understanding of how the virus is transmitted. While many public health experts focused on washing hands and handing out surfaces, and some countries discussed wearing masks, Oshitani began caring for infected groups in March and made sure people avoided the “Three Cs” .
As a result, the number of cases in Japan was far from the same in the United States and many European countries, even when life had largely returned to normal. Japan registered a total of around 188,000 cases. In a country with the oldest population in the world, more than 2,700 people have died from COVID-19.
But now the country faces a growing and resurgent outbreak: the number of cases is reaching new records (more than 3,000) and the capital, Tokyo, announces all-time highs. Local officials across the country have begun to consider stricter measures to limit working hours, although authorities can only take limited measures because the constitution does not give them the legal power to force residents to comply with quarantine.
However, Oshitani worries that it is becoming increasingly difficult to influence the behavior of the population compared to spring, when the uncertain threat of a pandemic has forced people to change their habits. Although many countries face quarantine fatigue, Japan’s position is particularly difficult: without the possibility of a forced quarantine, the country must rely on the cooperation of the people through voluntary measures.
“I do not think the virus will disappear in the next few months or even years, so we must find the best way to live with it,” he emphasized. “We are tired of it, we are trying to find the best way.”
Hitoshi Oshitani
© Zuma Press / Scanpix
Initial knowledge
From the beginning, Oshitani believed that the new coronavirus could not be eliminated, only controlled. The SARS outbreak was completely different, during which he coordinated the Asian response while working in the Western Pacific division of the World Health Organization.
“From the beginning, he said there was no way to squash the virus; humanity needed a fundamental rethinking of its current way of life,” said Kaori Muto, a professor at the University of Tokyo who worked for the Oshitani government advisory group.
By analyzing preliminary data from Japanese health centers and the Diamond Princess cruise ship, as well as discussing his contacts with the WHO, H. Oshitani quickly narrowed down all possible trends in the transmission of the new coronavirus in collaboration with Hiroshi Nishiura, a modeling expert. Infectious Disease Mathematicians at Kyoto University. .
Oshitani also drew on the intuition developed in earlier work: He recalled a WHO study that found that flu, usually transmitted by droplets and contact, travels short distances in the air. This led him to hypothesize that the same could be said for the new coronavirus that had just emerged in Wuhan.
Months before their colleagues, Oshitani and Nishiura, they realized that the virus spreads more easily in poorly ventilated rooms and developed a “three Cs” strategy to address this source of transmission. The WHO did not recognize the transfer by air until July.
Japanese researchers have found that most infected people do not transmit the coronavirus to other people, although, unlike influenza, a small group of superdistributors can be responsible for a large number of infections. Rather than rush to assess and identify each infected person, as authorities in other countries have done, Japanese officials have focused on breaking down groups of infections. Not only that, they have noticed that the virus can also spread between asymptomatic carriers who probably don’t even know they are infected.
Although many of these ideas are now widespread among public health professionals, they were not yet widely accepted at the time.
“Most people believed that the coronavirus spreads like the flu, and Oshitani’s theories are just the fruit of his imagination, or delusions,” said Tomoya Saito, director of the Department of Health Crisis Management at the National Institute of Health. Public health.
Hitoshi Oshitani
© Zuma Press / Scanpix
Experience with SARS
While that response meant that Japan’s initial success was met with doubt, skepticism, or deemed a mystery, H. Oshitani has become a renowned public health expert since the spring. Last week, he spoke at a Harvard University webinar with more than 200 US officials to share facts about Japanese contact tracing methods and offers interviews to the world’s media almost daily.
“It is only because of your efforts and how you present your data that we know so much today about what can be done in the Covid situation,” said David Heymann, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine. has worked with PSO.
Mr. Oshitani, a modest, seer, 61-year-old man, is little different from an ordinary servant. Educated as a field epidemiologist, H. Oshitani shook hands with him while working for the Japanese Development Agency in Zambia and spent most of his career as an academic, currently working at Tohoku University. In his native country, he is much less well known than other top infectious disease officials, such as Anthony Fauci in the United States. Unlike the Swedish epidemiologist Anders Tegnell, nobody tattoos his image of himself on the body.
But those who have had to work with Oshitani say his initial sense of urgency and constant call on government officials to do more were vital to Japan’s response.
In his thinking, H. Oshitani remains an iconoclast. It is not concerned with detecting each and every case of the virus and has criticized Western nations for the massive testing, saying it makes it impossible to trace contacts. It is quite likely, according to him, that the official number of cases in Japan represents only a third or half of the actual number of infected people, which could be closer to 1 million.
Oshitani’s real fear is overlooking a cluster of infections that could lead to an uncontrolled spread of the virus in Japan, affecting nearly a third of the country’s population over 65 and destroying the healthcare system. Such a scenario is becoming increasingly plausible as new clusters emerge in various parts of Japan, threatening to stretch their model to breaking point.
And if that happened, given that the influence of the country’s authorities is very limited, Japan would have to wait for its population to wake up from pandemic fatigue, and voluntary compliance would help control the infection.
“In a week or two, the number of cases can increase at any time,” Oshitani said. “If we wait for the number of cases to reach a certain point, it may be too late.”
The new wave is heavier
Differences between the latest coronavirus spike in Japan and the waves suppressed in the summer are forcing lawmakers to pause and experts to rethink their strategies as the country’s most vulnerable population enters winter.
Japan has recently recorded alarming figures of more than 3,000 COVID-19 cases per day. These are record numbers for a country that was praised for controlling the first wave of coronavirus.
At first glance, the wave of cases that has risen since early November does not appear to be any different from the jump in the summer, which was slowed only by a slight adjustment in policy. But this time, the country’s government is calling for “worst case” preparations, as the number of severe cases is well above the summer peak.
“The fact that the number of serious cases has skyrocketed forces us to take immediate action,” said Health Minister Norihisa Tamura. In Japan, there are almost no trade restrictions due to the pandemic. The use of protective masks is recommended.
With infections rising sharply, the government is working to ensure there are no shortages of beds and doctors.
The current outbreak in Japan mainly affected four areas of the country with the largest populations in metropolitan areas: the city of Sapporo, on the northern island of Hokkaido, the first area where an increase in cases was recorded during the current outbreak and primary in February; industrial Aichi, the main port of Toyota Motor Corp .; commercial homeland called Osaka; and the capital Tokyo.
In many of these regions, bed capacity for critically ill patients is already declining.
The definition of “severe cases” varies from region to region. Tokyo applies it to those who need a lung ventilator or ECMO device, while by national definition, this category includes those patients who are treated in intensive care units.
The reason for the jump in severe cases is very simple: there is an increase in the number of older people at higher risk, who are more likely to contract COVID-19 at this time of year than during the summer wave.
This trend is particularly pronounced in Tokyo, where young people accounted for a higher proportion of cases in the summer, resulting in a lighter burden on the healthcare system.
When the total number of daily infections in Japan reached 2,000, authorities in all districts of the country called for an intensified three-week anti-virus period. In each of the four metropolitan areas, bars and restaurants are asked to close early.
Despite concerns that the public may already be feeling “pandemic fatigue,” mobility data suggests that calls for bars to close earlier are having the desired effect of restricted movement in nightlife areas.
Still, Japan must prepare for higher mortality. More than half of the more than 2,600 coronavirus victims in Japan are in the age group 80 and over, an age group with a 14 percent death rate, according to the Health Ministry. Japan, with the oldest population in the world, has more than 11.6 million. people belonging to this category.
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