Why is Japan still a coronavirus outlier? | Hacker News Reader

Why is Japan still a coronavirus outlier?

japantimes.co.jp

258 pointsnotlukesky415 comments

> New tests that produce produce results in 10-15 minutes are becoming available, but even with the improved tech, under the current policy a test will only be administered in the most extreme circumstances, when people have had a fever for four days or more.

This is an important factor that may indicate this "outlier" is more of a delay, rather than a reality of some exception.

As a resident, I'm quite concerned about the lack of testing.

Extreme testing policies wouldn’t hide exponential growth - if it is growing exponentially, you’d expect the number of people meeting the criteria to also grow exponentially.

It wouldn't hide it FOR LONG. In a month, we'll know which hypothesis was correct.

It’s unlikely to take that long, in the US our number of dead ~= number of infected 2 weeks ago. Part of that is from in insufficient testing, but 30+% daily increases mean 2,600+% growth per month.

Ops, 2,600x+ growth or 260,00+% growth per month.

It wouldn't hide it at all. Shifting an exponential curve gives you another exponential curve.

This is only true over the reals, not over integers. People are integers.

People are complex, and often irrational.

A month ago Italy was fine and now 5,000 people are dead. A month ago the virus had been in Japan for a month already... and still today fewer than 50 deaths.

Obviously time will tell with all of this. But so far, time has told us that either a) the transmission rate is extremely low in Japan for some reason or b) no one is dying from the virus in the world's oldest country, for some even harder to explain reason.

The world needs to be looking hard at Japan to see what the hell is going on there.

I strongly agree. Yet Japan is rarely mentioned along with Taiwan, HK, S. Korea as exemplars of good management.

I think it's because they've bucked the Test, Test, Test advice yet still had a relatively good outcome so far.

It feels wrong to so ignore Japan. If they are doing something right here, the world should try to find out.

If the number of tests administered is the limiting factor, and if you only increase the number of tests linearly in time, then case numbers would grow linear as well.

I suppose that in that case you would see an increase of deaths and also the count of respiratory illnesses(covid-19 missclassified).

yes and this would give you an opportunity to estimate how far off the mark you might be.

Only if all tests are positive already. Otherwise you should see an exponentially increasing number of positives if the number of infected is increasing faster than the number of tests.

the number of cases presenting themselves for testing follows the exponential curve. people are displaying symptoms in numbers following an exponential curve.

when the number of symtomatics become very large and saturate the testing process, the reporting will no longer follow the real curve of cases over time, only the number of test that can be performed over time.

[i meant to reply here | moved from previous reply below]

> if it is growing exponentially, you’d expect the number of people meeting the criteria to also grow exponentially.

I don't know for Japan, but here in Canada, on top of showing symptoms, we need to have taken an international flight, or be in contact with a known carrier. The number of people having taken a flight won't grow... that's for sure, and contact, well it's recursive at that point and depends on whether you were in contact with someone that has taken a flight, has shown symptoms, has taken the test instead of following the quarantine asked, and has been positive. So essentially in our case, the number of people meeting the criteria can only go down actually.

We would expect the number of people requiring hospitalization with symptoms to grow though. I don't know if that's enough to skip the criteria though, here in Quebec our number of death got lowered yesterday because the test came back negative...

It does makes sense though to keep theses criterias, because most case doesn't require hospitalization, and there's a very limited amount of test available. In Quebec it seems like we are now able to carry enough test for people with theses criterias, so with some luck, we will remove the contact criteria soon, and get a better picture of the propagation.

In South Korea 30% of the infected are in the 20-30 range, it's most probably the same everywhere but we just don't know it because they would most probably be asymptomatics.

I think that as long as the availablity of tests is finite, this is a complicated process. Probably the goal should be to optimise for true positives: of the people that have the virus, we want to find as many as possible. In that case, if there is a limitation on the number of tests that can be performed each day, it does make sense to give those tests to the people who are most likely to be positive. Unless some people fit the symptom profile so neatly that they can be treated as though they were positive without a test. Can anyone with expertise weigh in along this line of thinking?

I think it's more complicated than that and the people decrying "wasted" negative tests are [redacted] idiots.

If you're at home with what appears to be a relatively mild case of COVID, testing you doesn't tell us much right now[0]. Isolate yourself, even from your cohabitants, and scrub everything like the dickens when you feel better. You should be doing this anyway, even if it's "just" the flu.

Testing people that were around you, however, is critical for preventing the virus from spreading. This is especially true for people are asymptomatic or presymptomatic but nevertheless shed the virus.

[0] This might change in the future as we learn more about if and how long the immunity lasts; perhaps you could go back to work. Hopefully sereological testing will fill that gap soon.

I spent some time in Japan for work and was always amazed how many people had face masks on (even when there is no pandemic) and the prevalent of wearing gloves (driving etc). With my limited time there it seemed to be one of the most proactively sanitary cultures I’ve seen. Also it seemed to me that at business meetings generally people bow instead of shaking hands. And I wonder if this reflects the general approach to person to person contact. Contrast that to Italy for example where kissing and embracing is not uncommon even when meeting someone for the first time.

I think this is the case. Japanese (and other East Asians) already have a pre-existing mask culture. Wearing a mask is normal over there and is encouraged. They also do not hug, shake hands and have body contact with does that are not family or close friends. Another big factor is that they tend to follow the rules unlike in Italy or America where social distancing suggestions were not taken seriously by a large chunk of the population.

Even with these explanation, I'm still perplexed as trains in Japan are always packed and it's impossible to stay 6-feet away from others when you're travelling in dense cities in Tokyo. You're also constantly touching poles/handles in the train or pushing elevator buttons.

Also generally speaking the culture doesn't have too much "family style" eating habits which helps at the margins.

There’s way more family style eating in Japan than the US at least.

The social distancing suggestions (laws) in Italy have been taken extremely seriously. It is effectively voluntary, so there are some people who flaunt the rules. But people went from kissing everyone to never getting <2m from a non-household member in a matter of days. I went from passing many thousands of other people on my daily movements to 4-5.

I think people in Italy feel that the quarantine isn't working because it's not strong enough. And people around the world kind of expect Italians not to take it seriously. Actually, it doesn't work except to decrease the exponent on the growth of the epidemic. In China, with a much stronger lockdown, they had the same R0 as we have in Italy now ~1.25 until they started moving people who were symptomatic or had contact with positive COVID cases to hotels and, if serious, field hospitals and ICUs. We have to do the same or it will sweep through the entire population.

> I think people in Italy feel that the quarantine isn't working because it's not strong enough.

That's also because, in my view, those in power have no idea how to read the curves and the scale, and the fact that you have at least 10-14 days in lag before seeing any effect. Also, this is about growth, so the number of cases (and, unfortunately, deaths) will keep on increasing even with a perfect containment until it "burns out". Again, the powers that be, at least in their public statements, seem to have little to no understanding of this fact.

But they also prefer cherry picking those who don't follow the rules (or go with statements that can't be traced to the data itself).

What is needed most now is field hospitals, staff and protection equipment, because the system, again even assuming a perfect containment, will take at least a month to get relief from the pressure. But those, as opposed to quarantine measures, still go through bureaucracy (note for the non-Italian HN crowd: it's really hard to explain because it is something very peculiar of highly burocratized governments, and in some aspects, unique to my country).

Also this won't be able to go perfectly for more than a couple months at best, IMO. Let's not mention economy, for now, but isolation (despite the "reassuring" messages from the media) will start taking its toll sooner or later. We're at week 3 and for me (in Lombardia) I'm already starting to feel that. Not that I'm going to break quarantine, but if the period extends for too long, some may tempted to do so, with potentially bad effects.

You can’t find masks anywhere since more than a month. Few people wear them (I would say about 30%). Granted, people have less physical contact.

The real reason for the low number of cases is the lack of tests. I’ve spoken today with multiple Japanese friends and other residents, all think the government is lying and hiding it to save the Olympics. We will see the truth in a month...

30% usage is approximately 500x what I've seen in suburbia US.

agree, we will know in a month, but even if govt is lying about cases, we should be seeing a deluge of patients in the ICUs and rise in deaths and we aren't seeing that

How would you know they haven’t? If you don’t test a death for the virus, the death doesn’t show up in virus death counts. And if you aren’t in a hospitals, the deaths wouldn’t show yet.

At some point it would become too big to ignore. But is Japan there yet? This is definitely a space to watch over the next 2-3 weeks.

You look at death counts overall and for other reasons. The spikes will show up somewhere, if they exist.

The CDC lumps deaths by pneumonia into its influenza estimates. Presumably epidemiologists would do the same here and just miss the distinction from actual influenza deaths.

Given where they could have been if they’d followed the same trajectory as Italy, I’d say the strain should be visible if it was there.

I see more like 70% wearing in Tokyo.

Japan has the oldest population of any country with a median age of almost 50 years old.

I can see the virus spreading silently among the young and healthy. But Seattle and Italy have showed us that it’s very clear when the very old start catching it.

Doesn’t this suggest that Japan truly isn’t experiencing a wave of silent infections?

And yet, there have only been 36 reported deaths in the entire country.

As long as you test symptomatic cases, the death count should at least be reliable, right?

That a third the deaths of South Korea (who has very aggressively contained).

Kind of extrapolating from other countries, I think this points to the number of cases as being about 3-4x higher than reported -- if you are trying to do an apples to apples comparison (which is virtually impossible, but...). Also, I think it's instructive to look at the ratio of people tested to the number of positive results. Wikipedia has about 18k people being tested as of 2 days ago (compared to the nearly 70k people tested in the UK). So the ratio of people infected to the ratio of people tested is fairly close to other places. This indicates to me that the lower numbers of people infected are primarily due to lack of testing.

I don't think your conclusion necessarily follows from your premises.

For instance, if there's a significant difference in testing regime and/or calibration of results.

I'm not talking about cases, I'm talking about deaths.

There could plausibly be 10x more cases than reported.

But it's much harder to under-report deaths. And those are low.

Finnish health officials have said that they do not plan on implementing lower barrier testing. They made a few points about testing.

* Those who can weather corona at home do not benefit from testing.

* Performing the test requires the same protective equipment as treating corona patients and there's already shortages on those worldwide.

* Performing the tests requires some of the same people, who could be actually treating corona patients.

It could simply be that the test will not work until several days have passed. To get a test with such a fast result, trade-offs elsewhere probably need to be made.

Even South Kora required symptoms for free testing. Else it cost about $140 as I recall. That would certainly motivate me to wait a bit to watch symptoms. A fever should mean staying at home, no matter what the cause turns out to be.

I don’t think having a fever for 4 days or more is unreasonable? If you have other symptoms of COVID maybe it makes sense to get tested, but a normal flu also causes a fever and is much more likely.

In Japan, people wear masks so they don't spread their germs. In the US, people want to wear masks to avoid other's germs. Totally different mindset. And in the US we are being discouraged from wearing masks because they don't block the virus from going in even though they could be keeping asymptomatic people from spreading.

Well I feel duly embarrassed for not thinking that way earlier. Just ordered some cotton masks.

I'm sure there are other reasons the spread is different in Japan but this is something we can do. Not the disposable ones though.

I do wish US politicians would tell people to go back to work, but wear operation masks.

Do you think people would actually wear them, and wear them correctly enough that it would be effective?

I don't think the US can be culturally expected to handle the situation the same way east Asia does.

Where would we find operation masks? s far as I can tell they’re still sold out literally everywhere.

I ordered cotton masks from Etsy. They are supposed to arrive by the end of the month. Select vendors in the US for speed. Amazon has lots of cotton masks, but they all seem to be shipped from China, which means they will take awhile to arrive. (Am assuming US buyers. Looks like Etsy vendors are all over though so you can probably find a vendor locally in many countries.)

There are plenty of patterns for cotton masks online and I think ways to use a 3D printer to make one. I would much rather just buy one, myself.

3D printing cotton masks? Are there 3D printers that can work with plant fibers?

I wasn't clear; I meant some kind of reusable 3D mask, not cotton.

I know nothing about 3D printing, so if you do you might want to search and see if what you find looks workable. I got many results that indicate it is possible.

> I ordered cotton masks from Etsy.

“Cotton masks” from Etsy are almost certainly not the same thing as the medical/operation/surgical masks being suggested, which typically have a melt-blown polymer filter layer between non-woven fabric exterior layers.

It's true that even medical providers are turning to these type of masks as emergency supplies (and calling on hobbyists to make them for medical use!) because actual proper surgical masks are in short supply, but that doesn't mean that they are as effective and, moreover, it means that mass public use would lead to supply shortage into what has become the necessary fallback for actual medical use.

They aren't the same thing as medical masks. I'm well aware of that. But if people start making their own or get them from providers that aren't supplying medical needs anyway, it could very well reduce spread without taking masks from medical providers.

Why is Japan an outlier? One thing they do differently from most of the rest of the world is wear masks. Not perfectly but certainly more than in the US. And many Japanese are making their own now as they can't find professionally made ones either.

Yes it's a desparate measure but this is becoming more serious by the day.

I did have the opportunity to ask a Japanese person his opinion on why the rate of increase is lower than in the US. One reason he gave is wearing masks. Another one is the practice of taking shoes off when entering one's home (you bring in fewer pathogens that way). He did preface his answer with the statement that he is not a medical professional and that he was stating that it was his opinion only. But maybe something to consider.

Editing to see that the question I answered might suggest that I was saying those types of cotton masks are medical grade. I didn't mean to suggest that and agree that it's not responsible for someone to use a medical grade mask now without a medical need. My apologies for any misunderstanding I created.

I ordered something from Japan last week. I was worried about delays due to travel restrictions and they had a warning about them on the website.

But it arrived in the US two days. It wasn't overnight shipping or anything fancy or expensive either. I was expecting 5+ days.

I order lots of stuff from Japan, from Amazon US from Japan-based sellers. It's taken anywhere from a few days to two months (my last purchase). So I didn't want to risk it. Didn't find Japanese sellers of masks anyway.

There are a lot of misconceptions about masks. They are not effective for protection if not paired with eye protection. Plus viruses and bacteria actually cling to it, and lay people not used to wearing one will end up touching it way too often (try it, you’ll immediately realize how hard it is to not touch it).

As the GP mentioned, the main reason for wearing masks is to avoid spreading your disease to others. Glasses are not necessary for this.

Based on a hunch from the example of 1 country with an unusually low spread? Why would anyone assume that risk?

> I do wish US politicians would tell people to go back to work, but wear operation masks.

Surgical masks, as well as N95 respirators, are already in short supply for medical use. Encourage further non-medical use would exacerbate the supply shortage and hasten the rapidly-approaching catastrophic collapse of the healthcare system.

The current recommendation (and, increasingly frequently, mandatory order) that non-essential work that cannot be done remotely should be suspended is correct.

A vacuum cleaner bag is over 80% effective at catching virus size particles, a tea towel/dish cloth 70%, a surgical mask 90%. There’s no tea towel shortage. Western governments should be encouraging use of makeshift masks.

> Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440799/

> In Japan, people wear masks so they don't spread their germs. In the US, people want to wear masks to avoid other's germs. Totally different mindset.

Absolute orientalist BS.

I work in a Japanese workplace. Lots of people here don't normally wear masks. When they do wear masks, they pull them down to cough or sneeze so that they don't walk around with a wet and dirty mask. The idea that I could be dirty and infecting people doesn't cross the minds of most people, just like how in many places around the world people are taking international trips and dodging quarantine.

Recently, almost everybody is wearing a mask. People have jokingly asked if the new mask wearers are infected, to which they quickly reply along the lines of, "No way. I just don't want to get infected by you guys."

Japan isn't some society of honor and sacrificing oneself for the good of the country or whatever like movies based on ancient stereotypes make it seem. Most people are looking out for themselves just like anyone else. The way it's done is just sometimes different.

>> Absolute orientalist BS.

I politely disagree with your observations, though I acknowledge that I may not be right, I have observed and discussed this behaviour dozens of times with Japanese people in Japan for over twenty years and most find your parent's observation to be correct.

Please don't call people a racist for espousing reasonable views that you don't happen to believe.

I think I understand the point behind that post. Many Japanese believe that they are special and superior and love to sell that to non Japanese. It can be really annoying, and it isn't true that as a nationality they are somehow inherently superior.

If you can, get over your feelings.

I do not believe Japanese are superior. Nor do I believe that most Japanese people think that way. On the contrary. YMMV though.

This thread isn't about that anyway. We are just trying to understand what, if anything, has worked so far in one country and what is not working elsewhere.

I said many, not most.

I watch NHK World regularly. One of their programs, Japangle, ends every episode with the catchphrase "It means that Japanese people are so special." A datapoint to show why I made my statement.

And, speaking of what works in one country as opposed to others, I started watching Japanese news instead of American news years ago because of the calm delivery. I do read news from many other sources, but I don't listen to other TV news programs. My two cents on that is that American news goes for getting people emotional, and hearing it affects the ability to think rationally. Taking this pandemic seriously but not getting worked up enough that one loses the ability to be rational is something that would benefit us all.

Certainly Japanese people look out for their own self interest. And there are non altruistic reasons for wearing masks - including, if you are female, skipping makeup. I don't buy into the stereotypes that you mention, but I do believe that Japanese manners, in general, make it easier for people to coexist in crowded places. That includes wearing masks. And maybe I'm completely wrong about that. I still think that if more asymptomatic people in the US wore masks in public (and I don't think complete distancing is sustainable long term), the spread of this could be slowed. So I do intend to wear the masks I purchased when they arrive. I do hope I keep up with that resolve. On my last trip to Japan I had a cold and wore masks to try to be polite and avoid spreading my germs. They really aren't that comfortable.

In South Korea epidemic was started with one sick cult member spreading it to wast number of people. In Italy the person who started Lombardy cluster was first asymptomatic for weeks, was later misdiagnosed and spreading the disease in hospital. It seems that the epidemic is starting without similar super-spreaders in Japan.

Case fatality deaths to recovered rate in Japan is 18%. In South Korea it's 6.6%. This might indicate that Japan has 3X larger undocumented/documented rate.

This early in the exponential curve 2x difference is just 1-2 week delay.

There were 30 or so cases before the Shincheonji contagion, in which, yes, one cult member single-handedly tripled the number of cases in one day. But at the usual 33% per day intra-country contagion rate, even single-handedly tripling the number of cases only moves the calendar forward by about 4 days.

I do agree that Japan probably has diagnosed a much smaller proportion of cases.

IIRC, there were no new case or low single digit cases for almost a full week before the ShinCheonJi outbreak, after which the number of cases increased to three digits new cases per day.

You're right about that, and that would amount to effective containment, so I guess I was wrong.

The outlier is that Japanese statistics don't seem to show an exponential curve at all. Their highest daily counts of new cases remain in mid-February, and they've been oscillating closely around 50 a day for over 2 weeks now. There's almost surely undertesting happening based on their testing criteria, but even with fixed testing criteria, exponential growth at any rate above like 10% per day should have been obvious in severe cases by now.

Notably, there's a big difference between South Korea - which seems to largely have largely gotten the epidemic under control, and Italy where it seems to be totally out of control despite a severe lockdown.

Whats a key difference between South Korea and Italy? Widespread use of face masks.

>Whats a key difference between South Korea and Italy? Widespread use of face masks.

Gonna wager a guess that there are vast amount of differences between South Korea and Italy that could affect the spread of a virus.

Indeed. Italy has among the highest rates of working adults living with their parents in the world for one.

And South Korea has the highest rate of soju drinkers.

If you’re gonna pull a statistic out of a shadowy place, at least explain its link to the question.

(For the record South Koreans drink twice as much alcohol as Italians)

https://www.who.int/substance_abuse/publications/global_alco...

People were going to work in Italy in non-essential industries until recently. Those workers went home to their aged parents. Countries with lower rates of working aged adults living with the elderly are likely to have higher infection rates of a particularly vulnerable age group than those where such living situations are less common.

That’s a very good point.

There must be multiple social and environmental factors that have contributed to Italy being hit so hard (age of population, high rates of smoking and high levels of air pollution have also been suggested), but that could well be one of them.

No. It's early testing and quarantine at scale

Could be that social norms of Japan make the exponent approximately 1. It's a stretch, but not impossible.

Patient zero in Lombardy has never been found.

The guy that that fellow in Codogno met could have brought back contaminated item from Wuhan

Have you got any source on this? If you do you should contact italian authorities.

Lots of Chinese staffed sweat shops are manufacturing "Made in Italy" products.

People are mentioning this is due to lack of testing, but if that were the case wouldn’t hospitals be overwhelmed like they have been in Italy and elsewhere?

Testing or no testing if hospitals run out of ventilators for people in need, or out of masks, that would still happen if the disease was spreading like it does elsewhere

The counterclaim is that Japan has an unusually high per capita number of ICU beds.

https://www.forbes.com/sites/niallmccarthy/2020/03/12/the-co...

So is this nonsense?

This appears to be true, it is #1 in hospital beds (not the same as ICU beds, but should be correlated)

https://en.wikipedia.org/wiki/List_of_countries_by_hospital_...

Note: that article also lists number of ICU beds per 100000 population, and it seems that it's not that highly correlated. Turkey has the most ICU beds.

> but should be correlated

It's not, as shown by the very link you posted. ICU beds are a separate column in that table. Japan only has ~7.3/100k.

That seems to be correct. Oh well, I hope that the link helped.

I have no real data to back this up, but it could also be that there's a lower number of comorbidity across the average population. Or it could be that Japanese have perfected 'social distancing'.

Age is the best correlating factor right now. They are prime for an outbreak demographic wise.

>http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9...

I think due to the nature of (generally) exponential growth, no country can be expected to be able to "cover" a true outbreak. However, it's also true that the spike in cases will only happen in a very short period of time so it's not very informative to look at hospital beds if the peak is not there yet.

That said, I would expect Japan to be further on the growth curve compared to other Western countries, so not sure what's going on especially given the limited information.

The article discusses that.

We've been discussing these questions recently on the #covid19 channel of the HN Tokyo Slack [0] - all the same sort of points raised as below - but nobody knows for sure.

There was an outbreak in Hokkaido a few weeks ago and that was the Japan hotspot for a while. The governor there quickly declared a state of emergency and that was brought under control - if you believe the official figures that is.

The best Japan tracker that I've seen is here [1]. From that you can see that there have been 16 deaths in 愛知 (Aiichi - prefecture capital is Nagoya) but only 141 cases as of now. Assuming deaths have an approximately average lag of 3 weeks from infection and an about 1% death rate, 16 deaths would translate to very approximately 1,600 deaths 3 weeks ago. As the general Japan is upwards, even according to official figures, there are probably several thousand cases in Aiichi today.

For new cases, in the last few days Tokyo is ahead.

Also, the government has given schools to reopen in April [2] . If that happens, cases may start rising sharply.

[0] http://hntokyo.io/

[1] https://covid-2019.live/

[2] https://www.japantimes.co.jp/news/2020/03/20/national/school...

Do you know if there are slack workspaces for other regions?

HN Kansai meetp & slack are here:

http://hnkansai.org/

https://hnkansai-slack.now.sh/

HN Fukuoka is here:

https://www.meetup.com/Hacker-News-Fukuoka/

I found them via the unofficial HN meetup page maintained by Anton Tarasenko here:

https://github.com/antontarasenko/hacker-news-groups

Japan's obesity rate is only 3.6% while the US's is 32%, and Italy's 42%.

https://ageconsearch.umn.edu/record/14321?ln=en

https://en.wikipedia.org/wiki/Obesity_in_Italy

This suggests many consequent differences, like far fewer seniors taking all of the drugs that accompany obesity, like ACE and ARB inhibitors for hypertension, and the myriad drugs that combat diabetes.

But ignoring the contribution of specific drugs, it's much more likely that fitness and the absence of comorbidity diseases are the principal factors that favor countries with significantly better basic fitness like Japan (and Taiwan and South Korea) and their reporting fewer cases.

What's more, since most positive cases will never be counted unless they need hospitalization, we may simply be seeing healthier immune systems reduce case severity, so more cases in these countries are flying below the radar.

Italy's obesity rate is not 42%. That's the rate for 2 year olds, which is bad in and if itself. The obesity rate overall is about 10% though, which is amongst the lowest in oecd counties.

That wikipedia article makes no sense at all.

Here's a good resource

https://www.oecd.org/els/health-systems/obesityandtheeconomi...

One out of 10 italians is obese. The 42% you're referring to is the data for children.

I'll offer one hypothesis and a quick explanation.

Iodine. The Japaese have a high iodine content in their diet. I'm taking 10x the US RDA. Some have suggested this is the reason for lower breast cancer rates there (no time to cover all that here and now).

I read about Iodine years ago, and followed some doctors suggestions that it can help asthma. My asthma is effectively gone and my last PFT showed my lungs function better than average for my age. I haven't touched an inhaler in years.

Since we are dealing with a respiratory virus, I figure anything that helps the lungs is probably a good thing.

For some fun reading you might want to read about the relationship of iodine and: cancer, lungs, mitochondria, apoptosis, breast cancer, asthma, type 2 diabetes, heart disease and any number of thyroid problems.

If you think Iodine is only good for the thyroid gland, I suggest reading about the sodium-iodine-symporter and which tissues have it.

Anyway, I had already thought about this when it seemed Japan's death rate from covid-19 was lower.

That's an interesting theory I hadn't heard before. I've read about iodine in seaweed and seafood, part of common diet in Japan; and how iodine influences thyroid hormones.

Just started searching on the role and effect of iodine in the body - indeed, it seems to be fundamental in fetal development and cell regeneration (its suppression, apoptosis); the endocrine system, metabolism, repiratory, immunity.. I never knew how important iodine is, thank you for pointing this out, I'll study more.

A possibly relevant snippet:

> Based on the reported values in seaweed, some have claimed levels of 12 mg (12,000 mcg) in Japanese diets, leading Abraham and Brownstein to propose that

> “only mainland Japanese consume adequate amounts of iodine and that 99 percent of the world population are deficient in inorganic, non-radioactive iodine; that is, they have not reached whole body sufficiency for that essential element.”

There is also a widespread claim that too much Iodine will negatively affect your thyroid. All of those claims seem to be rooted in a single experiment that others have reviewed and say it does not support the claim. My own experience and that of the Japanese suggest otherwise too.

There was one cool study that showed the connection between kelp and reduced incidence of breast cancer. It was based on Japanese women whose cancer rates shoot up when the move to the US. The funny part for me was at the end, where they suggest that people don't start eating a lot of kelp because of the high iodine content which has these negative effects. They then proposed further study to see what was in the kelp that prevented cancer. I was just... I dunno. SMH.

>> indeed, it seems to be fundamental in fetal development and cell regeneration (its suppression, apoptosis); the endocrine system, metabolism, repiratory, immunity.. I never knew how important iodine is, thank you for pointing this out, I'll study more.

Indeed, once you see how much it affects there is danger of sounding like some moron beating the same drum. Every time someone has any of those issues: "did you look into iodine?"

Another pet theory of mine is that the thyroid hormones are not signaling molecules, but rather the bodies storage place for iodine atoms. They are indeed named T1, T2, T3, and T4 based on the number of iodine atoms in the molecule.

The Japanese smoke more, but see less lung cancer. If we can figure out why, it might cast light on the covid19 pandemic.

https://www.verywellhealth.com/the-japanese-lung-cancer-smok...

Maybe check how many smokes they usually do. I know some people in western countries will smoke a pack a day.

I imagine they've already eliminated the really obvious explanations of that sort.

IIRC, genetics and a high consumption of seafood, especially shell fish and other things high in iodine, seem to be likely factors.

If you tolerate seafood well, that's potentially of interest. People could look into studies relevant to that angle.

If iodine is the reason, probably from seaweed rather than shellfish.

In western countries, a pack a day used to be considered moderate. Some people still smoke a ton more than that, chainsmoking every hour they're awake, but it's not as common as it used to be.

I'm also thinking of the "biological resistance" angle.

Japan is known to have extremely low rates of common comorbidity factors: cardiovascular conditions, obesity, etc. By very significant margins, consider dividing the prevalence of these conditions by 2 to 10 compared to the West.

Add to that a generally balanced nutrition, due to a culinary culture quite aligned with those goals (whether by chance or by design, that's another question...)

Hypothesis: added to the factors you mentioned, you end up with a population 'much less likely' to develop complications with COVID-19 (also possibly immune quicker on average after infection, thus lower R₀). So they get it but instead of 20% requiring hospitalization, maybe only 1-5% do, and that's somehow manageable and results in much lower numbers since they only test critical cases.

We'll only see in the postmortems of all these patients, but I'm willing to bet right now that most cases requiring ICU treatment had some sort of underlying condition that favored the virus progress; age being one such condition (as defined by De Grey, essentially tear and wear of the machine conceptually).

I don't know, but there's definitely something with Japan and COVID-19, and the slow progression of infections (despite the lack of strict confinement measures or systematic testing) is already fact compared to any other country I'm aware of. It's not just luck.

Probably more likely they are just ignoring it.

In 2018 influenza killed around 61,000 people (46000-95000 95%UI) in the USA. Estimated 45,000,000 people got sick. 21,000,000 people made hospital visits with around 810,000 people hospitalized.

So it didn't fling the USA into a recession. Business continued as normal.

For Italy you had 7,027 deaths for the '13-'14 flu season, 20,259 '14-'15, 15,801 '15-'16, and 24,981 '16-'17.

So why does ~25,000 deaths one year goes practically unnoticed, yet less then 5,000 deaths send the economy into a death spiral and the government to essentially strip all rights from the population?

It's not like if people just continued with business as usual the death toll would be unusually high. I fully understand why you want to slow the spread of the disease... but if ultimately if 70-90 thousand people die in the USA and 30-40 thousand people die in Italy.. it wouldn't even be that unusual or extreme. It would just be a slightly higher then average people die from just run of the mill every year seasonal disease.

It's the same reason why although terrorism killed 25 people in the USA in 2019 and was all over the news and people freaked out, and caused panic attacks, and calls for legislation and.. so on and so forth. Yet bee/hornet attacks killed around 60-90 people in the same time period and nobody, except close family members and friends of the victims, gave two shits.

It's the novelty, strangeness, and uncertainty that causes a massive reaction. And it is the response that is causing damage to the economies, society, and destroying people's lives. Not the disease. Not yet. Maybe it will, but that is far from certain.

In other words...

The reason it's not a big deal in Japan has nothing to do with how many people get sick or die or inherent vulnerability to the sickness. The median age of a person in the USA is 38. The Median age of a person in Japan is 46. This is a massively older population and there is a limit to how much a healthy lifestyle really makes in fighting disease.

The real reason it's not a big deal in Japan is because they choose to not make it a big deal.

> So why does ~25,000 deaths one year goes practically unnoticed, yet less then 5,000 deaths send the economy into a death spiral and the government to essentially strip all rights from the population?

Because Covid is not comparable to the 2018 influenza in terms of how many ICU cases it produces and how quickly. The common flu is also far less infectious. That combination is the problem.

The 2013-2014 flu season in Italy didn't collapse their healthcare system with intensive care patients. 10-15% of the people testing positive for Covid are ending up requiring intensive care. If four million people with flu in the US in 2018 were put into intensive care (much less just during the span of the flu season), it would have collapsed the US healthcare system rapidly. It would take less than a month of that onslaught to collapse the US healthcare system entirely. The majority of US ICU beds are routinely being used (meaning there would have been very little spare capacity at all for the four million flu ICU patients).

In that scenario, with four million ICU patients from the 2018 influenza, you're going to see several million deaths.

Because one is an annual total, and one is a subannual total of a number that is increasing exponentially, so they aren't comparable.

I could not agree more with this. Do keep in mind that Italy has had 5000 deaths in a rather short timespan, while the 25,000 deaths in 16-17 was over a much longer timespan. I fear the economic repercussions will be grossly underestimated, when we could have done like Japan. At least the environment will benefit from all the lockdowns around the world.

At a 4.3% death rate if the same number were infected you would be looking at 2 million in the US.

4.3% is just simply wrong, even by absolute worst case measures. Please don't spread this number.

Even in Wuhan, they revised the official number down to 1.4%, and every serious epidemiologist is saying it's likely much lower, because of undocumented cases. (Current models have it at 86% unreported).

Which model has it at 86% unreported? I just haven’t seen this particular study.

https://science.sciencemag.org/content/early/2020/03/13/scie...

> We estimate 86% of all infections were undocumented (95% CI: [82%–90%]) prior to 23 January 2020 travel restrictions.

I think that's what GP was talking about.

Thank you, I hadn’t seen a study quote it that high previously.

It's by far not the worst case number. To get the worst case number, we need to know these variables:

% of your population that eventually gets infected * % of all cases requiring hospitalization * % who get no medical attention * Death Rate for people who get no medical attention OR ~0.5 - 1%, whichever is higher.

We can start putting error bars around these figures: Best estimates from China/SK & Diamond Princess all indicate that ~20 - 30% of cases at most are asymptomatic and if ~20% of all symptomatic cases require hospitalization, that means the lower limit is ~15% of all cases require hospitalization. If you go with the "herd immunity" approach of 70% of people eventually getting it, then ~10% of all people require hospitalization which is 10 - 1000x overwhelming of the hospital system, no matter how much you "flatten the curve" so 90+% of people will just flat out receive no medical intervention.

The only other key number left in the equation is what % of hospitalized cases, if given no attention, will eventually die and the data from Italy seems pretty grim. Italy in a few days, will already have more deaths than ICU beds which means the untreated death rate might be as high as 50% vs 5% for treated.

Multiply all of these numbers together and it's not hard to see how 4.3% might end up being a conservative estimate of the death rate.

It also becomes obvious that the ONLY variable that matters in this equation is the % of people eventually infected. If you can keep it below 1% forever, you're in a reality far different from if it goes above 30%.

The people who claim wearing a mask doesn’t work are missing one of the biggest benefits to wearing a mask. If you are sick and don’t have symptoms yet. It help reduce your chances of infecting others.

Yeah they arent 100% fool proof. But it’s better than nothing. If it reduces my chance of getting sick by 1% and that 1% turns out to be the bit that makes my daughter not get sick then it’s worth it.

I think that once this crisis passes we will have an updated view on the true effectiveness of masks. All the Asian countries that flattened the curve heavily endorsed the wearing of masks. But there may be other factors at work rather than the direct efficacy of masks (not touching your face, sending a social signal to keep distance, elevating humidity around your mouth and nose, etc.).

Some days ago, I found this comment from someone living in Japan.

https://news.ycombinator.com/item?id=22605657

This is what I've heard from my friends living in Japan – people are sick, but the government is refusing to test them because they want to keep the numbers down so the Olympics don't get cancelled.

But other threads further up pointed out that even with massive under-testing, it should be hard to cover up a COVID-19 outbreak if it spread exponentially as expected – there would be reports of hospitals being overloaded and having to turn away people with severe symptoms, so maybe something else is going on.

I'm sure PM Abe is sweating bullets. Japan has been in an economic slump for decades. The Olympics and associated tourism was supposed to fix that (and Japan has seen a big increase in tourists in recent years as they gear up). And now this?

If the government has such strict criteria for testing, might it also not have implemented strict 'stages' that you must proceed through after a diagnosis? And a further, stricter criteria before even allowing hospitalisation?

My other suspicion is severe cases will try their best to hold off on self-reporting given the strict government testing criteria and lack of awareness/panic.

This is one key way that Japanese and US society diverge - Americans are much less afraid to 'make a fool of themselves' if they believe they are correct/in danger. Japanese unfortunately, much more so and especially when given direct government directions.

That doesn't explain the difference in death rates. If Japan were turning away severe life-threatening cases (especially despite plenty of hospital capacity), you'd expect an increase in deaths and rioting in the streets – at the very least, _some_ indication that something was wrong.

And if they _weren't_ turning away life-threatening cases, you'd expect reports of hospitals stretched far beyond capacity.

There really aren't any other plausible explanations than "Japan actually has significantly fewer or less severe COVID-19 cases than expected". It would have to be an implausibly massive cover-up.

>> Japanese unfortunately, much more so ..

Look, I can and frequently do make a case for weak Japanese, strong Americans in various domains. But not about this.

If culture is a part of the reason for divergence of rates of infection, it's certainly in Japan's favour.

Remember, we are talking about society overall. Not what might benefit any given individual.

I live in Lombardy, and I can assure you that the conditions to meet in order to get tested are the same. Me and my three flatmates had 37-39 °C for some days, including a very bad cough. We called the emergency number, and they said that they could test us only in case of prolonged temperature and/or respiratory problems. This happened like 2-3 weeks ago, and considering the current state of the national health service, I don't think requirements became lesse strict

Thanks for sharing your experience. Hope you and your flatmates are doing better.

The one (Japanese PM, IOC or others) who mentions about postponing or cancelling will have to be responsible for the financial damages in Olympics and thus are just pretending everything is alright until someone takes the lead.

Don't look at politicians at face value.

I’m here in japan and have been trying to find an answer to this for the past week. It has to be the masks.

To elaborate, yes Japanese are pretty clean by nature and do have social distancing naturally, but everyone is still taking the subway, the government has not cracked down much. Ubiquitous wearing of masks is the only really unique thing i can think of. (Actually even now not everyone is wearing them, but its still a good percentage and as soon as Japanese feel sick they wear masks) So I’ve come to the conclusion that if Japan isn’t just “lucky” (Lucky after 8 or 9 weeks is probably impossible) it has to be the masks.

So assuming it’s the masks, why have masks stopped the explosion we see elsewhere? We can theorize it must have kept the R rate down (Reproduction rate).

But, I do think a lot of people ARE still getting sick here. I think the government is only testing those with very severe symptoms so we aren’t seeing the true extent of the infection rate. I even think I might have had it a week ago as I had (very minor) similar symptoms. The weird thing is we don’t see a lot of severe cases here in japan. The main thing that I believe the masks are doing is stopping droplets getting spread from infected people (Meaning infected people who wear masks don’t spread the droplets as much). I think this reduces the rate of spread, but also I think reduces the amount of viral load that is getting transferred from infected people and can reduce severity of symptoms.

You reduce Infection Rate and you also reduce Infection Severity (reduce viral load) by wearing masks which combined with japan only testing severe cases leads to the results we see now in Japan.

Riding the subway doesn't make you sick. Not washing your hands and then touching your face with hands that have the virus from touching parts of the train makes you sick. You can't touch your face much if you have a mask on it. The virus doesn't just float around in the air. It only exists in water particles that fall quickly onto surfaces.

Most people will actually touch their face a lot when wearing a mask, to adjust it, scratch an itch or temporarily remove it to speak...

Yep, originally i believed everyone when they said masks aren’t useful except to keep yourself from touching your face, but after wearing masks I realized it’s also really hard to stop adjusting it.

My point is that it keeps infected from spreading droplets through the air and on those surfaces.

If an infected person without a mask coughs in a crowded subway, the virus is aerosolized for a good amount of time. If most are wearing masks, then even if infected, they're not spreading the virus.

This is commonly believed, but how do we know how true it is?

If breathing particles into your throat and lungs is the primary vector (seems likely to me, although I don’t know exactly what is), then what you are saying is wrong.

It seems that masks are being de-emphasised, based on the obvious fake reason of saving the retail stock for the front-line workers (how does avoiding buying retail stock magically get masks into hands of nurses?).

It also seems to me there is an over emphasis on washing hands, and avoiding touching your face (well mouth, nose or eyes). That could be one vector (although unlikely to be the main vector) yet why is everyone so hyper focused on it like it’s the critical vector? It’s the emphasis on washing and touching I find disturbing (even though obviously we should wash hands and avoid touching holes).

Washing and touching is what people can do without shooting each other over masks. I am sure it helps like 10%. Doubt it will have a massive impact either way. I’d like to think most people wash their hands reasonable often.

Yep.

What weirds me that it seems likely a bandana over the mouth could change R0 from 2.2 to 2.0, yet we talk about washing hands.

A 10% reduction of transmission is super good when you are dealing with exponential growth.

We need both together, yet we are focusing on only one.

Citation? Everything I've read contradicts that: https://www.cdc.gov/coronavirus/2019-ncov/prepare/transmissi...

In Czech Republic everyone now has to cover their nose and mouth while being outside, on a public transport or in an office. Obviously there is not enough respirators/surgical masks, so people are just sewing ordinary face masks.

It will be interesting to watch what kind of effect it will have on new infections

I am so angry at the experts saying masks were not helpful at the beginning of all this.

Sewing Ordinary face masks should help! The lie was that only n95 rated masks help because the virus is so small it goes through ordinary masks, but its not about that. It’s about stopping infected from spreading large amounts of it through droplets.

It’s in Japanese but I found this website on recommendations on how to create a mask: (I had to use Google translate) https://www.cottontimemagazine.com/page/10

And technically, SARS-CoV-2 is smaller than the filter on the n95. It's just that the virus clumps with moisture, and that is too large to pass through.

If you would think for 2 seconds, you know masks can help reduce spitting in front of you and also stop some of the ones others spread near you to get in your mouth.

Easy to think it's better than nothing.

They also give a hand cleaning product at like every food place before you eat.

I think that goes under the “Japanese are generally clean” explanation. Along the lines of them not wearing shoes in the house, social distancing, washing their hands/bodies regularly etc. The hand cleaning product is actually called “Oshibori” and its usually just a wet towel. I am sure it helps but its not disinfectant or soap.

There seems to be evidence (a lot) of asymptomatic people infecting others. If you only wear a mask when you feel ill, that doesn't seem like it could be the driver.

Japanese people have the oldest population in part because they live longer. Maybe it's genetic?

> There seems to be evidence (a lot) of asymptomatic people infecting others.

I've usually seen the opposite in public policy articles (CDC, NIH). Do you have an article I could read?

What if the vaccine program for school children that ended in 1994 has introduced a slower spread of virus ?

Interestingly, that program had a real impact on the flu, but was still discontinued, link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210121/#!po=1....

Personally, and this is my opinion without any evidence to back it up. I believe that this is just a combination of several factors:

- Japan acted sooner than most by closing schools, tightening their borders, informing their citizens and asking for their cooperation.

- Japan's culture is a big factor, people respect and obey their government in general, the use of masks is common place, practicing social distancing is already part of their culture, with no kissing, hugging or handshakes for the most part, the exception being their public transportation, which are well known for how packed they are near the Tokyo area.

- Japan has a good health care system https://www.who.int/whr/2010/en/

Lastly, let us assume that Japan isn't testing everyone they can as suggested by some, as a way to somehow keep the Olympics going.

- Japan has an older population, which is high risk group as we know.

- IF they are in-fact manipulating numbers as some suggested by not testing, than we would be seeing a spike in the death rate for the 60-80+ age groups. Now I can't provide a metric to prove or disprove this and the only thing we can do is wait and see, but I have doubts about the government ignoring their people in-favor of an event that likely won't happen this year or at least not the early half of the year.

EDIT: Lastly and this is a factor that none of us even suggested, is luck. Luck is important and impossible to control.

>EDIT: Lastly and this is a factor that none of us even suggested, is luck. Luck is important and impossible to control.

Luck doesn't work with this kind of scenario. You'd have to be lucky hundreds of millions of times (every time there was a potential spread)

Consider this:

To date, have you observed any other countries and governments undertesting? And if so, was it for reasons other than the Olympics?

That gives you a baseline of disincentives to report.

Now extend: - what would the cost (financial, reputational, etc) be to Japan the government if the Olympics do not go ahead? - might there be other disincentives for Japan to undertest relative to its neighbours?

Also recall, in some cases a little bit of disincentive mixed with poor planning/incompetence leads to a lot of unplanned underreporting :)

The trick in all cases is to look for a metric that governments have not thought to obscure/or cannot control that strongly signal the thing you’re trying to verify.

This interesting and really shows the power of social distancing. I believe this is also why China/Korea/Taiwan/Singapore were able to overcome the disease. The virus doesn’t spread well without close contact.

I think it will turn that wearing masks has a much bigger effect than anticipated. (I suppose that's a form of social distancing.)

Agree with this. I live in Hong Kong and there was no forced lockdown here either because 95% of the people wear them voluntarily.

It almost certainly has more to do with your society's overall approach to sickness than it does with just masks specifically. Here in NYC, loads of sick people have no qualms with squeezing in between two people on the subway, coughing into the same hand they're about to use to turn a doorknob with, and so on. Wearing masks might help a tiny bit against inconsiderate people like that, but not a lot. I'm sure such inconsiderate people exist in Hong Kong too, but I'd be willing to bet that there are fewer, and that wearing masks is an indicator that more people are actually considerate about their sicknesses in HK than in the US.

Imagine if the whole pandemic could have been prevented if we just manufactured masks at a higher rate and everyone wore them.

Now even hospitals are running out.

I cannot for the life of me understand why we aren't turning every available textile mill into mask manufacturers right now. It should be trivial to do and clothes aren't a critical item. I'm sure most countries have planned something like this as it's a common need during major wars. We're basically saying that since it's not 100% effective, so it's not worth it. Meanwhile, neither is social distancing, but that's super dooper important.

Most of the textile industry has moved to Asia in the last 30 years.

This is such an important point and so widely misunderstood.

I feel like most Americans, when talking about the loss of US manufacturing, think of Ohio, Indiana, and other "rust belt" states, when the reality is, a huge amount of textile production centering on the east coast, from furniture manufacturing in North Carolina, to paper mills and cotton processing down to Atlanta, is gone.

My working theory is that it's because those places are national election battleground states. Just kind of shocking when you realize there are 30-40K coal miners in the entire US, not even a Google worth of people, let alone a midsize city, and this small group is deciding our elections?

https://en.wikipedia.org/wiki/Coal_mining_in_the_United_Stat...

> My working theory is that it's because those places are national election battleground states. Just kind of shocking when you realize there are 30-40K coal miners in the entire US, not even a Google worth of people, let alone a midsize city, and this small group is deciding our elections?

Unfortunately, you just discovered the unjust math of "popular" elections. This is the reason for a paradox why people like TD have such success winning elections in countries with plurality voting.

Small, but extremely zealous coherent voting blocks consistently outmatch, a wide, but piecemeal support across many diverse groups.

The states are important because they're swing states, and coal is important only because of what it represents about identity and messaging.

A lot of the rust belt was blue when Democrats focused their messaging heavily on workers protections.

People in the rust belt only have a few strong political priorities:

1. Their communities have watched their quality of living decline gradually over 40+ years now as industry and manufacturing in the US have become less competitive. They want jobs in their community, specifically ones they envision their community as capable of doing. Many of them take advantage of government benefits, and whether or not they are personally able to work or have a job, they know their community was better off when they had jobs.

2. Their population skews older and has more traditional ideas about social issues, but the rust belt is not the bible belt. Church attendance across the rust belt is very average compared to other states. Most aren't looking to push their beliefs on anyone else, but they don't see progressive social policies as something they personally want or need.

3. After long periods of decline, they don't trust promises. Many of them have grown poorer after every national election in their lifetime, as they've watched the rest of the country become more prosperous. For those growing up, success is measured by whether or not you 'made it out'. When someone promises them prosperity, they learned it's not for them, it's for everyone else.

4. While they don't trust politicians, they also don't trust businesses. They've had a front row seat view of what it means for businesses to chew people up and spit them out. They were heavily pro-union.... when they or their parents had jobs. Now many are questioning themselves, did unions help us or cause our jobs to disappear?

These people aren't policy experts or economists. They're working-class people with working-class educations and working-class expectations for themselves.

Whether or not Democratic platform policies would actually help them, the rest of the image of the Democratic platform rubs them the wrong way so much that it doesn't matter. Many of them voted blue for years, only to now feel like the party has passed them by and now only cares about the social and economic needs of people living on the coasts.

I live in Portugal and some producers are being told to make disinfectant out of drinking alcohol.

I assume the same is being done with mask production, or will be done. The same is happening with alcohol in other European countries, I don't know about the US.

Yes, some breweries and distilleries are making sanitizer.

There's places doing it, but not by mandate.

With the amount of ethanol produced for fuel in the US, it's the other ingredients and packaging that would be the capacity limit.

With the Russia - Saudi Arriba oil war going on ethanol producers are caught in the crossfire and have no problem supplying all the ethanol sanitizer users could want. (I don't think they are happy about it considering, but they are eager to corner this new market even if it only lasts for a few weeks)

Can confirm - here in Czech Republic the government even released illegaly produced alcohol they have confiscated in the past few months for companies to make sanitizers.

And not only alcohol related companies are making sanitizer now, even chemical oriented high schools and university faculties. Even a fuel distribution company reportedly reprurposed one of their huge tanks for large scale sanitizer production.

Because different environments yield different behavior. Just like in finance or business.

I feel like we've grown accustomed to a world where money is readily available (low interest rates), there's relative peace/safety, little trade friction, and we can ship things around the world cheaply.

Maybe we need to let the pendulum swing back a bit and do a little more manufacturing in the US? The problem is that it probably isn't economically viable except in times of crisis. So unless the federal or state government comes out and subsidizes it outright (something they do do in China, btw) it probably won't happen.

I do, on the other hand, think the last few years might be peak globalization. Wages are rising in China, there's more trade tension, and more environmental consciousness (shipping)...I'm no Trump supporter, but you kind of can see the outline of how some manufacturing might be coming back to the US.

> I do, on the other hand, think the last few years might be peak globalization.

Peak globalisation, and likely peak capitalism too. Protectionism is the one Trump policy I agree with.

There’s enough manufacturing capacity in the US to produce plenty of ventilators, masks, and and test kits.

But nobody took the warnings serious in January and connected enough dots to think of ramping up production. Even now, nobody seems to be in charge. There are manufacturers on Twitter claiming they’re ready to produce masks but are being asked to apply for certification by mail.

> Meanwhile, neither is social distancing

It's effective if you do it right.

It's only effective if nearly everyone does it right and that's the issue. A large number of people can't.

I wonder - there seem to be all kinds of studies going on about SARS-CoV-2 and results seem to spread fast in the current news climate. Are there studies for the effectiveness of masks planned or going on as well?

This article says one study estimates 5 fold reduction: https://www.google.com/amp/s/amp.theguardian.com/world/2020/...

If that reduces the R infection ratio 5-fold, it would drop below 1 and change exponential growth into exponential decay.

FWIW, this was announced this afternoon. Not sure if any of their plants are still in the US though: https://news.bloomberglaw.com/pharma-and-life-sciences/trump...

And the surgical masks are so fucking cheap to. The amount of money this country will lose because we failed to up mask production when we say this coming a million miles away.

There really was a planning failure by somebody here. We had lots of warning this was coming.

WHO:

* wearing mask does nothing

and...

* workers desperately need mask

this is the problem when you lie to your audience to achieve some end. Your message not only gets disregarded but you don't actually achieve what you were trying to achieve with your lie in the first place.

We are all lucky to have Tedros as our one-world doctor.

Those two things can both be true in a way: if an untrained person uses masks in non-high risk situations they may gain no significant benefit and even cause more harm by causing supply pressure.

I don´t disagree. But one face mask has a mayor benefit on a doctor or nurse and minimal effect on a regular person. But millions of masks on millions of people may have a major effect in the pandemic.

It's not a lie. Those two statements are taken wildly out of context. Wearing a mask while walking down the street does effectively nothing for you. But if your job is to be surrounded by infected for the whole day, a mask helps your chances of avoiding getting sick, since you're in close contact all day long. I'm not really sure why people don't understand this.

I think the masks make the most difference when the sick people wear them, which is probably happening in Japan I guess.

Masks on sick people probably have the most impact when sick people wear them before they realize they're sick.

This is also a good point!

People in Japan pack pretty close together on public transit and that probably offsets whatever other social distancing is going on there.

Healthier population and strong pre-existing social norms/habits conducive to limiting spread?

Those are definitely some “pros” but a big “con” is they have the oldest general population of any country.

Is it really so outlandish to blame the masks? Relative to Westerners, East Asians seem to wear a lot more masks, and are willing to improvise.

https://www.japantimes.co.jp/news/2020/02/25/national/japan-...

>A tweet from the Tokyo Metropolitan Police Department’s Disaster Response Division (@MPD_bousai) offers advice on how to wear masks and dispose of them properly, while a free DIY mask instruction manual is available in English, Chinese and Korean on the Oita Prefectural Government’s website

Can you imagine that happening here?

Belgium here. My wife is creating a mask right now, based on free internet instructions. She is not alone in our neighbourhood, and I see masked people at our bakery. I'd say we're not there yet, but learning very fast.

This is what patio11 had to say about it:

"I will say this: when Japan had major natural disasters in 2011 I praised the response and wrote a long blog post about how things were much better than commonly believed.

I have written no such post this year. That is not because of insufficient personal interest in the topic."

https://twitter.com/patio11/status/1241103181511180288

I don't think patio11 is a Japan expert.

Yeah, he simply lives there.

Why do we place such low stock in mere fortune? If original cases that penetrated borders were asymptomatic then that merely creates a rare event (i.e. all Japanese risk vectors being clearly symptomatic) and its always plausible for a rare event to happen.

Instead we're bending over backwards wondering if its about Japanese bowing/shoe/mask culture.

Factually the virus has not accidentally missed Japan. Japan has a substantial number of cases, on par with countries that are entering danger zones, just seems like there is no exponential spreading.

Luck can play a role, but consider the confounding factors against luck:

1. Travel with China. There was a huge amount of inter-country traffic up until the New Year. 2. Population density. Japan is quite high, and this should increase the country's R0. 3. Population demographics. Over 20% of Japan's population is over 60. This should increase the CFR for the country.

So there are two basic scenarios. One is that Japan is somehow mis-counting patients and deaths (similar to kodokushi). This could also be intentional, in a misguided attempt to protect the economy and the Olympics, or it could simply be a bureaucratic flaw in their methodology.

The second is that something unique to how the Japanese culture, healthcare system, etc is giving them an advantage.

Once we're on the other side of this pandemic, there's going to be a world of fascinating research/study into how different countries reacted to COVID-19, and how successful they were.

This is the correct mode of thinking.

Rationally consider what conditions could be creating the current scenario, and keep all of them in mind when considering any news/claims that Japan is an outlier.

Also agree that COVID-19 will be fertile ground for dissertations in the future.

I have been looking at it the other way. That it is not something about Japan making it better. There is something about Italy, Milan specifically, that makes it worse. Point I was able to isolate is air quality.

My hypothesis that had borne out rather well, if a place reports high severe cases, they have historically bad air. At the least bad air for the past three months.

China had terrible air quality until they shut everything down, yet their CFR is half of Italy's, and that's probably due to the fact that it started there and the learning curve was steep.

I'll note my hypothesis is exposure. Thought being that the elder in Milan have had years more exposure to the pollution than what I understand to be the more transient working class of China. (Specifically, the area hit.)

Not so surprising. You have also the same outliers with Hong Kong and Taiwan.

- In Japan, people naturally respect social distancing. Touching someone is considered rude, everyone bows instead of shaking hands and nobody kiss.

- Almost everybody wear mask when they are sick to avoid contaminating others. They do that since way before Cornavirus and on voluntary based.

- Washing hands is common, being clean (bath culture) is part of common minimal respect.

- People listen and obey to their government.

- Last but probably very relevant: they have a completely different place of the elders in society. In Japan, the elders often live alone, sustain their life by themselves: it's a matter of proud. Even contact with their own kids is often sparse. Meaning, probably also lower risk of infection.

Counter point: My Japanese friends have been and still are going out to bars every night like nothing happened.

Maybe this shows the relative importance of different measures?

Not saying that we elsewhere should go out to bars, since we're thoroughly lacking in the other parts.

Edit: downthread people suggest a lack of testing, probably a better explanation.

Why shouldn't they? There are probably no cases in the community.

I have heard the same from a Japanese friend, not in a major city either. Seems even families are going about normally with their children, to McDonald's and such.

What they're not doing is sending their children to school. Maybe that intervention alone is enough to suppress it.

I heard that because school is out the young people just went out instead.

The real difference lies in the responsible community surrounding you which doesn't behave like nothing happened.

> Almost everybody wear mask when they are sick to avoid contaminating others.

The U.S. response is absurd.

I went grocery shopping the other day, and despite clear evidence of panic (empty shelves, hurried shoppers, long lines), but not a single person wore a mask.

Somehow, everyone is too scared to go to work, but not scared enough to wear a mask.

We're on course for the worst depression in history because we don't like masks?

No, we're not wearing masks because we don't HAVE any.

I live in Brooklyn and I'd love to wear a mask. I'd love to have been wearing a mask every day for the past two weeks.

But where exactly do you suggest I find one since they're sold out literally everywhere, and we're also getting advice not to wear them so they can be saved for healthcare professionals!

You ought to reexamine your assumptions. We love masks but don't have any.

Sheesh.

Wrap a t-shirt around your face and use a clothespin to secure it. It's not perfect but from the best of my reading it's far better than nothing.

I was referring to either storebought masks or homemade ones.

Literally some paper towel, wire, and rubber bands [1].

If you're willing to break out a needle and thread you can make a durable cloth one. [2] [3]

> we're also getting advice not to wear them so they can be saved for healthcare professionals!

AFAIK, surgical-quality sterilizing masks are separate from what you'd probably find in the store; you're not pulling from the same stock.

(Though I seem to recall some charity effort of people sewing masks for doctors, so IDK what the actual U.S. healthcare regulations are.)

[1] https://www.youtube.com/watch?v=aNjpH5lBZ8w (University of Hong Kong-Shenzhen Hospital)

[2] https://nypost.com/2020/03/20/doctors-are-now-running-out-of...

[3] https://www.deaconess.com/How-to-make-a-Face-Mask

EDIT: "Sheesh"

> I'd love to have been wearing a mask every day for the past two weeks

Well, that’s the reason they are sold out, and heath professionals are desperately asking for donations.

You don’t need a mask unless you are sick. For protection you need a mask and glasses, but keeping your hands clean and away from your face does 95% of the job.

> You don’t need a mask unless you are sick. For protection you need a mask and glasses, but keeping your hands clean and away from your face does 95% of the job.

Except you do, because carriers without symptoms are contagious and the main drivers of this pandemic.

And no, coronavirus doesn't have wings, they are carried by water droplets, and any sort of barrier that can stop water droplets is better than no barrier at all.

If you’re truly asymptomatic then you wouldn’t be coughing.

There are lots of other things that can cause coughs, especially now that spring allergies are starting to kick in.

1. coronavirus isn't the only thing that cause coughing 2. coughing isn't the only way people spread out water droplets 3. you also don't want water droplets from other people landing directly on your face 4. nor you want to accidentally touch your face after touching potentially contaminated surfaces 5. people like you are being a hazard to their communities with this kind of behavior

Wear a scarf. The OP didn't say criticize people for not wearing mask-alternatives in a time of a shortage, they critized people for not wearing anything. DIY masks may not be as effective, but they still help (some top HN post claimed 70%-80%). This isn't a situation where if you can't do something perfectly you might as well not try. This is a situation that calls for doing anything within reasonable measures (don't raid hospitals for masks etc).

Paper masks are in shortage in Vietnam but that doesn't stop people from wearing big respirator kits or cloth masks that they rotate out.

Scarves are about the least effective makeshift masks, catching less than 50% of virus sized particles. A tea towel/dish cloth catches over 70% and a vacuum cleaner bag is over 80%, almost as good as a surgical mask.

> Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440799/

> ... catching less than 50% of virus sized particles.

This is true but irrelevant.

You want to catch larger globs that carry virus-sized particles, and almost any material will help to some extent with this.

Not discouraging it, just pointing out that there are much better alternative materials.

But breathing through a vacuum cleaner bag is too hard.

Still, it might work if you did a radical pleat. I'll try it.

As I recall, two layers of cotton t-shirt is the best option.

That would be awesome but I think you meant a "radial" pleat.

Huh. I meant radical in the sense of large surface area. And I was thinking ~cylindrical.

But radial is a great idea. And as soon as I started playing with paper, the ancient muscle memory of folding filter paper came back to me.

Edit: OK, I used filter paper from a shop vac, 20 cm wide by 30 cm high, with six faces triangular faces on the top and bottom, and eight faces on the sides. The ends of the faces on each side are sewed together, with an elastic strap connecting them. So the base is a diamond, ~18 cm wide and ~12 high. There's cloth edging on the top and bottom, and a cloth-wrapped 1 cm x 5 cm strip of aluminum edging to seal the top of the nose.

Well technically we didn’t like masks before... if we like them we like them now that the situation is bad.

Try making your own mask: https://smartairfilters.com/en/blog/best-materials-make-diy-...

Some folks have only recently been made aware of the actual usefulness of masks. Before a couple of days ago, I saw and believed the stuff being put out by the CDC. Next time I am shopping I will have a make-shift mask on.

Unfortunately there simply aren't enough masks produced in western countries. If governments directed factories to produce face masks, like they are currently doing for ventilators, then we could have enough. And I believe most people would actually wear them if they were widely available and governments directed it.

It seems like that would cost less, and might also be more effective than shutting down half the economy?

If it were more effective, don't you think at least one country on earth would have thought of that?

Masks may be able to help a little, but odds are good that if you're in a bus with an infected person coughing or sneezing, you'll be infected with or without a (regular surgical-style) mask. Those masks are almost entirely designed to keep stuff in, not to keep them out of your nose/mouth/eyes.

The slightly reduced incidence of infection from direct contact would not at all affect the greatly increased incidence from much more frequent direct contact. Which is why no country is relying on it.

Many countries did think of that. In most of East Asia, including Japan, many factories have been diverted to mask production and delivering masks to the general public has been a key government priority.

The masks is more for the coughing/infected person to wear, although they help reduce transmission on either side.

Think of widespread use of masks as a kind of surrogate herd immunity. Not as a surrogate vaccine. It's only effective in a statistical sense. But it is effective.

I feel the crux of Japanese resilience (vis a vis Western) has been their tendency to consider and act in the group's interest, rather than in own interest.

However, it's far from over and time will tell. Yesterday I saw many people doing hanami, cautiously.

> “Those masks are almost entirely designed to keep stuff in”

“Keeping stuff in” is exactly the point. Covid-19 causes mild symptoms for most, so many people walk around infecting others without even realising it. Where there is widespread use of masks, transmission is greatly slowed/reduced.

The point of wearing the mask is not only to protect yourself, but even more so to protect others in case you are infected.

I don't think anybody has masks to wear even if they'd like to. I certainly don't. The US surgeon general was also adamantly advising people not to buy masks over the past month. At this point, any and all masks are being redirected to hospitals, as there is a critical shortage. Paint shops in my local area have donated their entire supply to the local hospital -- the health department is encouraging people to hand sew masks to donate. If we had a surplus for every family, I'm sure things would look different.

I actually have two old FFP1 R rated masks in my closet from the past two pollen seasons. Since I only used them during the pollen season, they're probably still okay. But I haven't been wearing them recently, since the effectiveness of them hasn't really been clear. There's really also the stigma of being a leper, although that didn't really stop me during the pollen season.

> went grocery shopping the other day, and despite clear evidence of panic (empty shelves, hurried shoppers, long lines), but not a single person wore a mask.

That means nobody knew they were sick and went shopping anyway. Which is good.

Many people in the US think masks are like gas masks, used to prevent dangerous things from getting in your body. Masks are used to prevent people from spreading a disease, and you should assume anyone wearing one is sick.

It also means nobody who was sick but didn't know was wearing a mask that would have helped limit others' exposure. Which is kind of relevant here, where you are infectious to others for days before you feel sick.

For the elders point only if they have some disease that can impact the family. So it also makes sense their death rate is lower

Do you know these are the real reasons or are you just rehashing what you have read? This feels more like confirmation bias. Can't imagine the rest of first world countries are completely shut down and here Japan is just doing fine with 1000s of ppl picnicking etc. There has to be something else going on..

That's.. actually a very salient point.

>Do you know these are the real reasons?

I don't pretend to know, that's my personal thoughts, I think they are. I am rather often in Japan for family reasons.

> Can't imagine the rest of first world countries are completely shut down and here Japan is just doing fine with 1000s of ppl picnicking etc.

I personally think one of the main reason is currently the exposition (or non-exposition) of the elders.

They account for over 95% of the victims. If for a reason the elders are more isolated / protected / healthy. It ends up impacting a lot how deadly the pandemia is.

> They [elders] account for over 95% of the victims.

Half the most severe cases in France are under 60 years of age. It begs the question of why Japan is also not seeing anything like that.

Deaths are certainly one thing to consider in terms of age, however if Japan had a mass spread of the virus I would expect to see a lot of ICU cases regardless. Even when countries aren't testing properly, the intensive care cases (or lack thereof) reveal what's going on eventually. I think it goes beyond the isolation of old people for Japan.

It's similarly puzzling as the German case to death ratio, versus eg Spain (comparable case counts, 15 times the deaths). I've seen that one explained that older people in Germany are far less likely to live with their families vs Spain or Italy (so fewer of the most vulnerable are catching it in Germany). And yet, Germany also has three times the cases of Switzerland, with the same number of deaths. Something is very strange there. The low recovery figures out of Germany might imply they're not deep enough into the outbreak, time wise, to have the death rate spiking yet.

(www.begthequestion.info)

> And yet, Germany also has three times the cases of Switzerland, with the same number of deaths

Switzerland is a much smaller country than Germany or France. Proportionally to their inhabitants they are highly infected.

But Switzerland is special, both largest cities in Switzerland are highly multicultural and with many people who were traveling in infected area every week, including in Italy.

What happened currently in Switzerland was easy to anticipate.

In Germany's case the main explanation from lead virologists is that they are testing much more and were lucky to catch it early. Germany had from the beginning a capacity of about 100k tests per week. Now they are increasing that.

So in conclusion, for Germany the number of infections is a bit closer to reality, where in Italy and Spain that number is/was much more far off.

Well, we won’t know whether the picnicking was fine until about 2 weeks hence. I hope it was indeed fine, but I’m doubtful.

a few random points to consider:

- Hong Kong, Taiwan, Singapore, Vietnam all in much warmer climate.

- hot spots in Italy and Japan are likewise in the northern region: Lombardy in Italy and Hokkaido in Japan.

- wearing masks during a global pandemic isn't apparently as fashionable in Japan.

- many Japanese elderly, or over 30K per year, die unnoticed in solitude. so it might take a while to catch up.

But on the other hand:

- In South Korea, most infections trace to a middle-aged lady "Super Ajumma" who is also a member secretive cult. Without the cult, the total infected with the virus in SK would be comparable to that of other Asian neighbors. So outside China, the spread of the virus doesn't seem so bad in Asia overall.

And even _in_ China, cases per capita are not that high (lower than most of Western Europe). In _Wuhan_ is another matter, of course.

Assuming China is not lying which is definitely up for debate.

Could you link some sources to your claims?

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3550308 For some informed ideas about temperatures/climate and coronaviruses

Specifically, https://i.imgur.com/ekiFd9S.png You will see that the largest outbreaks occur at the same temperature gradients

So do most of the major cities in the world. That's a hell of a confounding variable.

did you read the paper, or just comment of the cuff?

- Almost everybody wear mask when they are sick to avoid contaminating others. They do that since way before Cornavirus and on voluntary based.

We're told that masks do not work

Nobody should be saying that masks do not work. When worn by a sick person, they very effectively prevent droplets from leaving the mouth. They also help not breathing in contamination, as airborne viruses are usually contained in droplets. But there are other ways to get infected, so they don't help as much as people think they do.

There was definitely a lot of press early on basically saying masks (and latex gloves) don't work.

Generally they were clickbaity articles with headlines stating exactly that, but content stating the more reasonable idea that masks/gloves don't work (and may in fact cause more problems than they solve) if you don't use them correctly.

eg. someone buys a mask, keeps using the same mask day after day while handling the mask in way that may make the inside of it a contaminated surface, etc.

This should not be downvoted. There have been plenty of articles downplaying the importance of masks.

There are plenty of articles but that doesn't mean they are correct. Here is a peer reviewed study demonstrating that masks are helpful.

https://www.sciencedirect.com/science/article/pii/S221133551...

Masks provide two benefits. They protect other people from you when your are ill but currently asymptomatic and they protect you from "splashes" caused by people coughing and sneezing without covering their mouth.

maps7 didn't say masks don't work; they said that we've been told they don't work. maps7 is right, a lot of headlines at the least have been saying things like that.

Yeah, I am in the pro-masks camp but I feel like I can't wear one without being judged because the public have been told not to. I'm in Europe by the way.

Indeed. Here’s the US Surgeon General spreading disinformation on Twitter.

> Seriously people- STOP BUYING MASKS!

>?They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk! http://bit.ly/37Ay6Cm

https://twitter.com/Surgeon_General/status/12337257852839321...

The Surgeon General is correct. Masks are for the sick.

They said masks aren’t effective at stopping people getting sick. That’s misinformation. If they weren’t effective at reducing infection healthcare workers wouldn’t wear them.

Saying there aren’t enough for healthcare workers isn’t. Save respirators and surgical masks for healthcare workers. Wear a mask if you’re going outside even if it’s just a tshirt covering your face.

>If they weren’t effective at reducing infection healthcare workers wouldn’t wear them

Yes, they would. The healthcare worker may already be sick, and are regularly closely interacting with people that have compromised immune systems. An illness that wouldn't slow down a nurse may kill a patient.

Are you saying masks dont help in preventing ingestion of airborne viruses? That sounds like horse shit. Yes you can still get sick by touching contaminated surfaces and then touching your face...

Anytime a mask would prevent you from ingesting an airborne viruses, it becomes a contaminated surface.

So as your clothes and skin except that when you are wearing a mask you dont get sick.

Removing a contaminated mask involves both touching a contaminated surface and touching your face, which you say can still get you sick.

Have you read this article? https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-...

> Third, of course masks work — maybe not perfectly and not all to the same degree, but they provide some protection. Their use has always been advised as part of the standard response to being around infected people, especially for people who may be vulnerable.

That quote does not fully describe what is advised, but wearing one when you are knowingly interacting with an infected person is different than general use.

If we agree that masks slow the spread of disease from and to wearers then we are in clear disagreement with the Surgeon General. Masks work and the general populace should be encouraged to wear makeshift masks until such time as there are enough surgical masks for everybody or the crisis is over.

We don't agree. Masks would only help in the event that someone coughed/sneezed directly on your face but missed the eyes. Even then, removing the mask and washing your face without contamination would be difficult.

Makeshift masks don't necessarily even help in that situation, become a liability when contaminated, and putting it on then removing it causes additional risk.

This is why that someone also needs to wear a mask.

Don't worry, people aren't morons and have been using masks in Japan and other countries for decades just fine.

Yes, masks can hold contaminated droplets --that's their purpose. When people don't use masks on the other hand, those droplets that would have remained on the mask now end up everywhere else, and now you have a far more spread vectors with basically everything being potentially contaminated.

Using a mask ensures that a lesser percentage of your contaminated droplets end up in other places.

If you are sick, masks are great. Even homemade ones. This is about healthy people wearing masks.

> If you are sick, masks are great. Even homemade ones. This is about healthy people wearing masks.

First, masks work better when both sides use them. In Japan, healthy people wear masks as well during flu seasons because it makes it offers better protection than wearing nothing.

Second, in the specific context of COVID-19, how do you know they're healthy? That's the key, because asymptomatic cases are estimated to be the main driver of this pandemic by far. And it's only worsened by the fact that only few tests are available.

> If they weren’t effective at reducing infection healthcare workers wouldn’t wear them.

Have you seen the pictures of healthcare workers using "effective" mask protocol? Have you also noticed that said protocol almost always includes goggles?

If I can't trace the seal lines on your face for an hour after you remove your mask, it isn't doing shit for you as a healthy person.

If you are sick, however, that's a different story. The mask prevents droplets from being spewed out of your mouth at 120km/hr (70mph for the heathens) when you sneeze.

"If I can't trace the seal lines on your face for an hour after you remove your mask, it isn't doing shit for you as a healthy person."

Just because it isn't 100% effective doesn't mean it's not doing anything. Exposure isn't binary--the quantity matters.

Healthcare workers have very little room for error because they're constantly exposed to large quantities of the virus. For them, blocking 80% of droplets from a cough is useless, of course, because they're surrounded by infected coughing people all day long. Even 99% isn't good enough for them. But for someone going to the supermarket once a week, blocking 80% might mean the difference between a deadly level of exposure and a level that their immune system can fight off.

Also, this whole "only sick people should wear masks" refrain rather exasperatingly ignores that we don't know who's sick and who isn't. That's exactly why this virus is so difficult to contain. Supply issues aside, the only way to make sure all the sick people are wearing masks is to get everyone wearing masks.

> Also, this whole "only sick people should wear masks" refrain rather exasperatingly ignores that we don't know who's sick and who isn't.

And your argument exasperatingly continues to assume infinite availability of masks.

The masks most help when people are coughing or sneezing significantly. That's really obvious last I checked.

Someone not coughing or sneezing is spreading the virus roughly the same amount whether they wear a mask or not. Covid-19 doesn't actually seem to produce nasal secretions like the flu does so surface contact spread isn't quite the same.

If you want to spread good advice, tell healthy people to start wearing their glasses instead of contact lenses. It's probably more effective than a mask on a healthy person--especially since it prevents people from poking at their eyes with dirty fingers.

"And your argument exasperatingly continues to assume infinite availability of masks."

Except the part where I wrote "supply issues aside". Of course there's a limited supply. That doesn't mean masks wouldn't be effective if we had enough of them. I think we should prioritize making more, not just for healthcare workers, but for everyone.

"Someone not coughing or sneezing is spreading the virus roughly the same amount whether they wear a mask or not."

Scientific consensus so far is that coughing, sneezing, and talking is responsible for the majority of spread. Surface spread is secondary.

"probably more effective than a mask on a healthy person"

Again, we don't know who's healthy and who isn't.

Expect he is wrong and spread dangerously false information and pushed people toward danger. And you are also doing it here as well. His "correctness" is reflected in the number of infected people in the US, which is over 27000 now. Japan, despite having a head start and having a far higher population density, is at 1050. Let these numbers sink for a minute, and ask yourself what you could be doing better.

In Japan, people use masks to protect the community, which includes themselves as well as people around them.

When I read that I was suddenly wondering if maybe they were appointed by Trump due to similar communication style.

We were and some were being mocked who wore them and called racist (this is when the virus was only in wuhan).

This downplay is one of the major reasons for the slow public adoption of safety measures.

Look at who is telling you masks do not work. None of the authoritative sources I've seen over here have said that. They say things that can be misinterpreted that way, like "don't stop transmission" or "don't need masks" or "don't help as much". I haven't seen an authoritative statement that they don't help, either catching or spreading. Yet over here, despite many households already having good masks due to recent fires, few people are wearing them.

The CDC was being intentionally misleading to manipulate the public instead of speaking the plain uncomfortable truth that masks are useful but in a shortage (caused by catastrophic government failure at a simple task of stockpiling cheap nonperishable, valuable equipment) they want you to leave masks for people who need them *more. This has been called out by at least one epidemiologist.

If you are sick, masks are an effective way of preventing others from catching it.

If you are healthy, masks do not prevent you from getting sick.

It's a fairly easy misunderstanding to make.

Then why do doctors wear them in hospitals?

Surgical masks? To prevent the spread of bodily fluids.

Originally to protect the patient in surgery, not the surgeon.

No. You clearly have no idea how this works, and are basically an armchair health expert spreading patently false and dangerous information.

Health care workers are required to use masks to protect immunocompromised patients.

In Japan, people use masks to protect the community and goes both ways ---which is why it works.

>Health care workers are required to use masks to protect immunocompromised patients

Protect them from what? Their potentially disease carrying bodily fluids.

I don't have the slightest clue what misinformation you think I'm spreading. You have responded to four of my posts, and none of the replies give any reason to think healthy people should wear masks.

I gave two reasons, I'll give them here again:

1. Masks do work. Wearing a mask obviously provides a better protection than nothing for a healthy person.

You can also read a few studies https://journals.sagepub.com/doi/10.1177/003335491012500206 https://annals.org/aim/fullarticle/744899/facemasks-hand-hyg...

Mask isn't a substitute for hygiene and social-distancing, it's a complementary countermeasure.

2. You don't know for sure a person is healthy right now, and asymptomatic cases are the main drivers of the contagion.

The misinformation you're persistently perpetuating is that US surgeon general is right in saying

> Seriously people- STOP BUYING MASKS!

>They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!

which is not only wrong but also outright dangerous. How dangerous is this? Look at the spread rate and the number of cases in US vs Japan.

Yes, there is panic buying. The Japanese government is handling the situation by managing the responsible distribution of the masks itself. Like most countries, US may not be able to meet the full demand immediately for the masks that are necessary to slow down the spread, and yes, health care workers do need them, but that can't justify giving dangerous advice and lies to public.

>You can also read a few studies

The first study only advocated wearing a mask when sick,or within three feet of someone who was sick, and concluded

>there was no detectable additional benefit of hand sanitizer or face masks over targeted education on overall rates of URIs, but mask wearing was associated with reduced secondary transmission

And from the second

>facemasks seemed to prevent household transmission of influenza virus when implemented within 36 hours of index patient symptom onset.

So both say "wear a facemask when sick or interacting with the sick."

>You don't know for sure a person is healthy right now, and asymptomatic cases are the main drivers of the contagion.

Asymptomatic doesn't mean healthy though. If you feel unwell in anyway a mask is a good idea. Erring on the side of caution is different than everyone always wearing one.

>How dangerous is this? Look at the spread rate and the number of cases in US vs Japan.

Aren't masks common in both South Korea and China?

I made a mistake. I was reading about a study yesterday trying to show that stomach problems were a common symptom for people with coronavirus. This had me thinking "asymptomatic" meant showing irregular symptoms, when it is showing no symptoms.

That said, if you are asymptotic you aren't coughing or sneezing, so I'm unsure of how helpful a mask would be.

Yes, you are making a lot of mistakes. No, on the contrary, both studies encourage the use of masks. And it's totally beyond me why you're so bent on distorting the fact and trying to get that dangerous message of discouraging the use of masks.

Go back the first study and read the full sentence that you conveniently cut in the middle:

> In this population, there was no detectable additional benefit of hand sanitizer or face masks over targeted education on overall rates of URIs, but mask wearing was associated with reduced secondary transmission and should be encouraged during outbreak situations.

See the part about secondary transmission which you deleted? Also remember that unlike in that study (which was conducted in households with a known sick patient), in reality, there are sick people (both symptomatic and asymptomatic) whom you don't know in advance that they're sick and do not wear masks --which is something you can't fix by education and instead have to implement mass quarantine because now everything could be infectious and people have to avoid everything.

Second study:

> In conclusion, our results suggest that hand hygiene and facemasks can reduce influenza virus transmission if implemented early after symptom onset in an index patient.

And make sure you also read the word influenza, and remember that with COVID-19, the main driver is asymptomatic cases by far. Which means everyone should wear a mask.

> Aren't masks common in both South Korea and China?

Yes, masks are common in China and South Korea now, which is reflected in their low transmission rates: China 0.06%, South Korea: 2.0%. Compare that to 35% in US. Initial outbreaks in China and South Korea were driven by people not using masks. The spread rates plummeted after the implementation of countermeasures which include, surprise, use of masks by everyone!

> That said, if you are asymptotic you aren't coughing or sneezing, so I'm unsure of how helpful a mask would be.

Coughing isn't the only way people spread water droplets ---people do that just by talking. Virus is also carried in aerosol that remain in the air for longer periods. Coronavirus isn't the only thing that cause sneezing or coughing (especially in this season, so there could be people who think they just have pollen allergies while in reality they are symptomatic carriers of SARS-CoV-2). And regardless, it obviously is better than nothing. Yes, it's not going to be 100% effective, but even a 1% difference will be the difference between life and death for some people in your community.

Really, what are you trying to achieve by pushing this nonsense? If all people in the US don't start using masks already, they won't be able to achieve the success in suppressing the spread rates seen in Japan, China, South Korea, Taiwan, Hong Kong (all are countries where mask usage by everyone is high) within the same time frame. The growth will be stronger, there will be far more sick people and more and more fatalities. Is this what you want? If not, just stop, please, and start acting responsible as a member of your community. Please.

>Go back the first study and read the full sentence that you conveniently cut in the middle

I cut there for brevity, as it clearly means "the hand sanitizer and facemask usage outlined and tested in the study should be encouraged." You can't ignore everything else in the paper and say they are advocating everyone wears a mask.

With the second study, even what you quote supports my position. "After symptom onset" means "when sick."

>especially in this season, so there could be people who think they just have pollen allergies while in reality they are symptomatic carriers of SARS-CoV-2

If you are coughing or sneezing, you should be wearing a mask.

>If not, just stop, please.

So far, you have posted two articles that support my claim, and made references to various statistics implying face mask usage is responsible for the good stats. I am not spouting nonsense that will kill people, this is the WHO's position.

Are you being thick on purpose?

You are lying, you know you are lying, and you keep lying.

1. And you can't ignore the context and the conclusion of the study and cherry pick half sentences. What a convenient "brevity" that is. They do encourage use of masks in their limited context. Yes they don't say everyone, they say contagious people, and as I explained to 10 times already, in the context of a disease with asymptomatic spread, the requirement translates to everyone.

And for the nth time, mask isn't a substitute for hygiene and social distancing (which apparently is your faulty understanding because you keep bringing it up), it is complementary and effective countermeasure.

What part of this is so hard to understand?

2. "After symptom onset" is the contagious period for flu. For SARS-CoV-2, it starts before symptom onset. Meaning potentially everyone, again.

So no, both studies do encourage the use of masks for everyone.

And then there are indisputable, order of magnitude differences in infection rate numbers between countries that use and don't use masks --which you're also conveniently but consistently silent about. Try going to Japan and telling people that masks don't work ---but also tell them that US discouraged its people from using masks and has an infection spread rate of 35% with over 38000 infected people and nearly 400 deaths in a shorter timespan. See the reaction you get. Actually, no, I take it back, please don't ever come to Japan. Please stay wherever you are, we don't want people like you.

You are bent on harming yourself and people around you, and I'm done talking to you. The last thing I am going to say to you is: you are a disgrace and a harmful element to your society, to this world, and I am happy that at least my country is giving the right directions, doing the right things and that mine is a society where people like you get the reaction that they deserve.

>You are lying, you know you are lying, and you keep lying

I am not. You are being overly passionate and stating things are obvious facts without sufficient data. Even the prevalence of asymptomatic spreading is unclear right now.

>And you can't ignore the context and the conclusion of the study and cherry pick half sentences

I didn't ignore it, a studies recommendation is meaningless without the experimental results. I commented on the results. Similarly, you don't need the part I omitted to say...

>in the context of a disease with asymptomatic spread, the requirement translates to everyone.

This is not how studies work. You can't use this to assume long term use of masks by those without symptoms is beneficial. That kind of use may have unaccounted risks.

>And for the nth time, mask isn't a substitute for hygiene and social distancing (which apparently is your faulty understanding because you keep bringing it up),

I have no idea what part of my last post you think brought this up, the quotes from the studies? At no point have I tried to claim masks were a substitute for hygiene or social distancing, I don't know what led you to that idea.

>What part of this is so hard to understand?

The part where you attack something I didn't say is confusing.

>--but also tell them that US discourage their people from using masks and has an infection spread rate of 35% with over 30000 infected people and nearly 400 deaths in a shorter timespan.

It's a bit hard to talk with someone who accuses me of "cherry picking" data and then makes these random comparisons that ignore most of the world and any other potential factors.

>The last thing I am going to say to you is: you are a disgrace and a harmful element to your society, to this world,

All for following the recommendations of organizations like the WHO. Have a nice day, I hope you are fortunate enough to stay healthy, and remember to properly dispose of your masks after use.

A hazmat suit is better than a respirator. A respirator is better than a surgical mask. A surgical mask is better than a tea towel/dish cloth. A tea towel is better than a T-shirt. A T-shirt is better than a scarf. A scarf is far better than nothing.

Nothing short of a hazmat suit will prevent you from catching the virus but all of the above will reduce the chances of you catching it. There aren’t enough respirator, or indeed surgical masks for healthcare workers, never mind everyone else. But we should not let the perfect be the enemy of the good.

Removing a mask from your face will put your hands in contact with vulnerable areas that otherwise would be avoided.

Additionally, if a homemade mask were to become contaminated, repeated handling could put you and others at greater risk.

Wash your hands. Wash your mask. There aren’t enough surgical masks for healthcare workers and they’re reusing them after bleaching or exposure to UV. You can reuse a dish cloth after washing it.

This only works if you change your mask every time you remove it, and have no further contact with the mask until you clean it.

I'm baffled how one office spreading patently false information that defies logic and physics could be so effective.

Not using a mask as community will ensure that virtually everywhere is potentially contaminated and you are under a larger risk and at all times --not isolated to the moment when you remove the mask (which people typically do at a place where they can wash/cleanse their hands anyway).

So for crying out loud, please stop spreading this nonsense! Masks don't replace washing hands, general hygiene and social distancing, it supplements them. And of course they do work: https://doi.org/10.7326/0003-4819-151-7-200910060-00142 https://doi.org/10.1177/003335491012500206

>Not using a mask as community will ensure that virtually everywhere is potentially contaminated and you are under a larger risk and at all time

How does a healthy person wearing a mask prevent contamination?

> How does a healthy person wearing a mask prevent contamination?

How do you know they're healthy? That's the key, because asymptomatic cases are estimated to be the main driver of this pandemic by far. And it's only worsened by the fact that only few tests are available.

Which is amusing when they follow that with: save them for healthcare workers.

It's mind-bendingly confusing. Everyone seems to lap it up though.

- People do shake hands in Japan. In Western countries hand-shaking is limited almost exclusively to business (I’d imagine the same goes for Japan).

- Washing hands is common, but not necessarily any more of a practice than in Western countries. But in many places like in subway station bathrooms they do not have soap.

Some of the cultural things like mask wearing (which was born out of the density and close proximity in public transit) are shared between Hong Kong, Taiwan, and other Asian countries, but a lot of things are also different culturally so I don’t think you can easily attribute these reasons as “not surprising” with regards to coronavirus growth.

> In Western countries hand-shaking is limited almost exclusively to business

I can't speak for all Western countries, but in the US I shake hands with every new person I meet, whether in a professional or social settings. I'll also shake hands as a greeting for acquaintances I'm not close with. (As opposed to a hug for close acquaintances.)

Which city? This is not at all ordinary in my experience (at least in social settings - it’s normal in business settings).

Parent was probably referring to outgoing people who don't spend most of their time in the Internet.

It’s hugs or nothing, and hugs are only for family or good friends you haven’t seen in a while.

In my experience, the handshake-as-greeting between men in social situations is common in the Midwest US, at least.

Might be an age/generational thing. At least my generation (20s and 30s) it’s definitely not commonly done outside of formal business meetings.

Hot tip, if you’re in Japan and don’t want to shake hands right now. Bow first. I find people of Japan will shake hands to make you feel welcome if you don’t bow.

I just had a young doctor in a hospital shake my hand, I would say out if the important cultural need to be polite and pay respect to someone older. I don’t care or blame him even though I was surprised.

On a side note, I would say upwards of 75% of people in Tokyo are wearing masks

> On a side note, I would say upwards of 75% of people in Tokyo are wearing masks

I’d say more like 50%, but I think it used to be more, so now I wonder if everyone simply ran out...

Maybe it's not a big demographic on Hacker news (or non-US western countries either), but there's a lot of hand-shaking that goes in in churches. That was true in my church up until a few weeks ago.

I don't think this is the answer.

- There's no more social distancing in Japan than in the US. Nobody goes around hugging, shaking hands with, or kissing strangers in the US. Trains are still packed.

- Most public bathrooms don't have soap and I've rarely seen people wash their hands after using the bathroom anyways.

- People don't listen to the government - most people I know are arranging or participating in flower viewing parties despite the government's requests not to.

- Lots of the elderly in the US also live alone. I doubt the numbers are significantly different enough to affect transmission either.

TBH I had a hard time finding comparable statistics (re: single housing seniors and washing hands) though, do you have sources for any of those claims?

I agree with every point you're making, so I wonder if it isn't just one big factor: lots of people routinely put on masks at the first suspicion that they might be sick, even before they're sure. They just go ahead and do it just in case. And they do this all the time, so there's no delay due to self-consciousness or unfamiliarity or having to go buy a mask. It's just ordinary life.

Like taking shoes off in the house and making high school a college-admissions death march, maybe this widespread East Asian custom will spread in the West as well.

But we are being told that masks don't hep with prevention. Do you mean that sick ones do that not to spread?

Masks absolutely help. You are told otherwise for a whole other reason: to stop hoarding masks.

This has been asserted by so many different people, but there doesn't seem to be much scientific evidence backing it up. Why are you so sure?

There is evidence indicating it helps to prevent infection and to help prevent spreading infection.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153448/ “The overall effectiveness of vaccination and mask wearing was 9.9% and 8.6%, respectively.”

There aren’t nearly enough masks to go around for the general population so it would be reckless to recommend people in the USA wear (commercial quality) them right now due to the need for all available supplies to go to healthcare workers.

That paper also has:

> Hand washing (1.447, 1.274–1.644) and gargling (1.319, 1.183–1.471), however, were not associated with protection. In the natural setting, hand washing and gargling showed a negative association, which may have been due to inappropriate infection control measures or aggregating infected and non-infected children to conduct those measures.

So hand washing isn't effective and masks are? That's the opposite of what we're being told for a different disease. Are you going to say we shouldn't wash our hands?

I think there are plenty of other studies showing that hand washing can make a big difference.

But I don't think that negates the whole paper. It could be that the methodology used for the hand washing data is more flawed than the mask portion.

The recommendation is not to use masks unless you are sick.

Japanese people use masks all the time though, and it seems to help?

Even in Japan they traditionally only wear masks when sick.

not sure why you are being downvoted, as this was very much what we were told by outlets like cnn, etc. "dont where masks, they dont work and health care workers need them to not get the virus"

I was basically treated like a country bumpkin in a work channel (Amazon) for suggesting if you are going outside (Seattle) you should wear a mask.

> they dont work and health care workers need them to not get the virus

Isn't that an obvious oxymoron?

I don't think so, but its definitely a contradiction in logic...

That would depend on the assumptions, those being:

- context i.e. clinical setting vs on the street

- type of mask

- skill set of those using the equipment

For example, knives are very effective in surgery when they are:

- in a surgical theatre

- a scapel

- used by a surgeon

I don't suggest doing surgery in the street with a knife from your kitchen draw used by a teenager.

Surgical masks are designed to prevent you spreading viruses. That is the type most people wear in Japan. N95 masks are designed to protect you.

> Surgical masks are designed to prevent you spreading viruses

That maybe true but that doesn't change the fact they help you from catching it as well.

It simply doesn't make any sense going one way is 100% and the other is 0%

And what we want is to chip away at the R0 in as many ways as possible.

And that's skipping the fact people thinking they are protecting themselves are also protecting others.

If there were an unlimited supply of surgical masks that would make sense. If you wearing a mask deprives actually sick people of wearing one then you are still worse off then not wearing one.

Imagine if everyone didn't just accept this lie and we retooled factories 2 months ago

https://www.news-journalonline.com/business/20200320/coronav...

When you sell to the public to protect themselves they can fund a lot more than a hospital and maintain it for long periods of use.

Other than just letting people all die off and getting herd immunity any possible solution will involve everyone wearing masks.

We have a year more of this, there is still time to change direction.

Good advice 1 year too late.

> It simply doesn't make any sense going one way is 100% and the other is 0%

It's not 100% vs 0%. It's probably something like 70% vs 5% (Disclaimer: I'm pulling numbers out of my ass).

When someone who is sick wears a mask, they dramatically cut down on how much virus is PROPELLED OUT OF THEIR MOUTH. That's the big win. It still likely comes out their nose or is on their hands. But at least it isn't propelled with a cough or sneeze so if you wipe surfaces and avoid contact, you're probably okay. That mask protects dozens of people.

When a healthy person wears a mask, he protects only himself and the only thing he is "protecting" against is airborne droplets into his mouth. Most masks don't cover the nose and eyes which are the primary transmission routes for droplets. Most people don't breathe with their mouth open. You're probably safer simply wearing glasses, especially safety glasses. A lot of famous singers wear glasses/sunglasses all the time for exactly this reason.

A mask shortage will exacerbate these scenarios. One healthy person taking a mask away from one sick person is a TERRIBLE tradeoff.

Conceptually, I agree completely. Your conclusions are right.

Factually, perhaps you never have seen a mask such as we are discussing here. They do cover the nose. Perhaps not perfectly, but to a very large extent.

They don’t do very much unless you follow a protocol that you aren’t.

When they get wet and uncomfortable, you adjust the mask, and now you are transmitting the virus to the surfaces you touch.

Washing your hands and avoiding contact with crowds are the main ways to avoid getting sick. Everything else may help, like using your ring finger knuckle to press elevator buttons or wearing gloves that you change frequently or a mask. But they will only help marginally.

They don't do much to protect you from getting infected.

They do a lot to prevent you from infecting other people.

If masks don't prevent you from getting infected then why do medical professionals want masks? Everything I've read suggests that masks reduce your risk of infection, and that pairs with the common sense idea that filters in front of your respiratory tract entrance would reduce the risk of foreign particles entering and infecting you.

Simply putting on a mask does a great deal to limit the spread of a virus you already have - you’re not spewing particles all over your environment due to respiration.

Simply putting on a mask does very little to keep you from getting sick, because you’re very unlikely to be following proper PPE donning/doffing procedures. Unless you your house set up as a “clean zone” with two rooms between it and the outside world - one for removing PPE, and one for putting PPE on - then it’s really not helping much for reducing your exposure.

It makes sense to me.

I don't think that's how things work. Infection is a probabilistic thing. Maybe you'll get infected and maybe you won't. A high quality mask properly fit and worn according to an exacting protocol will reduce your risk of infection by X. Compromising on any of those factors may mean your risk is only reduced by Y and Y is less than X, but that doesn't mean it's a complete waste to wear a mask without a clean room or without fitting.

In one of the articles linked in this thread there is a study showing mask usage in children is nearly as effective as intervention against flu as vaccines are. I only read the summary of that paper but I don't think the children are working with clean zones or following doffing procedures carefully.

The article does mention that the effectiveness of masks was greater along older children. To me, that connects with what I wrote earlier. The better you are about using your mask, and here I expect mask diligence comes with age, the better a result you will have, but something is still better than nothing.

Oh, so that's why every hospital room has an air sealed clean zone that medical professionals have to enter to put on ppe?

For those that don't know, this is sarcasm. Most ICUs don't have any sort of sealed off clean zone.

> Most ICUs don't have any sort of sealed off clean zone.

Right - most ICUs aren’t set up to handle infectious diseases.

Here’s the CDC recommendation on doffing procedure. Note the repeated mention of the “doffing area”: https://www.cdc.gov/vhf/ebola/hcp/ppe-training/n95Respirator...

They simply need masks to protect their patients. They can never be sure that they themselves are not infected, and they treat a lot of severly ill (non COVID-19) patients in hospitals. If they spread the virus, those patients are at very high risk.

If that were true, all the medical professionals in America would already be infected.

Proper use of PPE very much decreases your chances of infection.

Pretty much all masks protect you to some extend, but the extend and the way in which they offer protection is different.

Surgical masks protect you from inhaling larger particles to some extend, but there’s large holes in it’s coverage, so you still basically get a bunch of contaminated air in, especially when spending time in a saturated room. What they do do however is prevent you from spraying droplets all over everyone near when you sneeze/cough/exhale, and that’s their main benefit. Protecting others from the bacteria and viruses in those droplets.

I think a study was done that indicated they make you about 30% less likely to get sick.

More highly rated masks (generally called respirators), will completely seal your mouth and nose (at least to a much greater extend than a surgical mask) and prevent bad stuff from coming in much better. Generally this is indicated in the form of a rating N95, N99, N100 (actually 99.97). And indicates what percentage of bad stuff the mask is likely to keep out. They’re less useful for protecting others, since there’s still some exhalation valve to get rid of excess air (still mostly same usefulness as surgical mask though).

Medical professionals generally want the N95 masks, but they’ll happily settle for just a surgical mask if that’s the only thing available.

It is too early to know whether what Japan has done is enough and whether it will be effective long term.

That said, It isn't just people wearing mask, or something innately Japanese. At the beginning of last year they had a serious flu outbeak[1]. This years flu cases saw a major reduction when measures to combat COVID-19 came into effect[2].

I have noticed a lot of little things that have come into effect as a response to covid-19.

* Medical clinics put signs up saying don't come in if you have flu like symptoms, phone and keep yourself isolated. That allows them to keep the vast majority of people with mild colds and flu separated from those with possible COVID-9.

* Stopping schools reduced the numbers of people on public transport.

* Putting pressure on companies to allow people to work from home.

* The supermarket bakery started wrapping all bread and pastries before putting them out, previously you would place what you wanted in a tray and they would wrap it.

1. https://www.nippon.com/en/japan-data/h00386/japan-gripped-by... 2. https://twitter.com/adtimmering/status/1240900101687480320?s...

Nobody goes around hugging, shaking hands with, or kissing strangers in the US.

Depends on the part of the US. Huggers actually exist.

> - Most public bathrooms don't have soap and I've rarely seen people wash their hands after using the bathroom anyways.

Where are you from? I see the opposite in Tokyo.

> most people I know are arranging or participating in flower viewing parties despite the government's requests not to.

Doesn't sound like the majority to me either.

and Bidets! TOTO knows whats up!

Taiwan had a much more comprehensive and thorough strategy, considering their threat was much higher due to close economic ties and travel with China.

https://jamanetwork.com/journals/jama/fullarticle/2762689

https://www.bbc.com/news/world-asia-49178314

I don't think the model in the paper accurately reflects the recent cross-strait relations. China already closed the border to Taiwan several months ago to retaliate Taiwan's arm purchases from the U.S, which brought nearly two months to handles the situation for Tsai. Though, Taiwan's response still has been much better than any other Western countries which already had three months to prepare against the situation while did absolutely nothing for the period.

Have you caught the JR Yamanote in peak hour?

I’ve never been touched by so many strangers so much in life.

Workers in japan also rarely take sick leave, even at this time.

Even in mildly packed trains people are basically breathing all over each other.

>In Japan, the elders often live alone, sustain their life by themselves: it's a matter of proud. Even contact with their own kids is often sparse

I doubt this is true. In most Asian cultures including Japan the children live very close to parents and take care of them all their life.

With Japan, things are not always as they appear. There appearances are everything. They will do everything to look clean, but it doesn't mean they really are. Even the masks are a bit of a show. There is, of course, truth behind it. They don't fake when they wash themselves and clean things up, and the masks really protect others, but don't assume they all behave the same way when no one is watching.

And while they tend to touch each other less then westerners they are also packed, and often go to public places in large groups.

For the elders, I don't know. The traditional way is to have everyone in the same house: children, parents, and grandparents. But the modern way leaves the elders by themselves. The traditional way would leave them very exposed, but I don't know how many are living like that. It is also more common for children to sleep with their parents.

And while the Japanese are generally more obedient and disciplined than we are, I am not entirely convinced about their faith in the government.

All and all, I think your points are mostly valid. But for me, it isn't as clear cut.

If they only behave the same way when someone is watching then it works. Same with obedient in and faith to government, the end result is they do what the government tell them to do. Pretentious or genuine does not matter.

Don’t know why you’re getting downvoted, anyone who lives here in Japan can confirm that these points are absolutely correct.

Interesting. One of the themes of the classic Japanese film Ponyo is how separating elders from the rest of society is bad for both.

And Japan has strong laws requiring filial care for elders.

Anyway, sequestering elders isn't uniquely Japanese. USA is famous for that.

I feel like we (the US) do a lot better just by advising the elderly to stay home, give them resources (free delivery, services brought to their home, etc) much more effectively then basically throwing our economy in a 40% GDP drop shitter.

Well, in France 50% of ICU patients are under 60.

I live in Japan. "Washing hands is common" this is incorrect. Most bathrooms do not have soap and many people do not wash their hands.

"People listen and obey to their government" This is also not true, many hanami events have been cancelled but there were actually more people out viewing yesterday than last year. I am relatively sure the turnout will be higher than last year to many of the parks.

>> there were actually more people out viewing yesterday than last year.

Incorrect from my close observation of three Tokyo hanami locations with which I have become familiar over a long period.

The density of picnickers has been lower than I have observed over previous years. Furthermore, the respect for mutual distance through eye contact has been new and noticeable.

Man sorry to say but all your comments are completely wrong.

- Social distancing does not exist in large cities like osaka and Tokyo. And that's a lot of people. Try to take a train at any time of the days and see if you can keep more than 10cm apart from anyone else. Good luck.

- Masks: there's no masks sold anywhere as we speak. And that's been a month already.

- Washing hands: more common than in other countries maybe, but I still see lots of guys who dont even rinse their hands after taking a piss. Both old and young.

- Listen to government: laughable claim. The government has been asking for social distancing and still in my neighborhood I can see parents and kids going together to play in parks with no care whatsoever.

- Elders in society? Ever heard of filled up nursing homes? yes, that is a thing in Japan.

> I can see parents and kids going together to play in parks with no care whatsoever.

I don’t know if they have no care. They’ve just weighed the horror of staying in their home with a kid for days on end against their chances of getting infected and chosen what makes sense for them.

So they decide to risk their own and their childrens lives as well as countless others just because they cannot stand their children for more than a couple of hours. Very responsible.

You risk you and your children’s lives any time you get in a car. That’s not irresponsible, that’s life.

So that leaves either green tea or nato as the magic antidote.

No. They simply don't test enough and they have good incentives not to do so. And please don't inconsiderately project your stereotypical image of Japanese, or Asian, on this matter unless you had spent a good amount of time (>20 yrs) in a relevant community.

The article gave several problems with that theory. If Japan's curve was where it is "supposed to be" weeks ago when people were making the same argument you are now, where are the piles of bodies and overwhelmed ICU's? They may eventually get there of course, since anything besides lockdown seems very risky these days. But the passage of time has proved your argument wrong time and again. More consideration is needed to understand what has happened there.

Though I certainly think they should just ramp up the testing and make it easier.

If you've ever been in a mens bathroom in Japan ... washing hands doesnt happen, let alone with soap

It’s just a little token splash of water.

"- Last but probably very relevant: they have a completely different place of the elders in society. In Japan, the elders often live alone, sustain their life by themselves: it's a matter of proud. Even contact with their own kids is often sparse. Meaning, probably also lower risk of infection. "

The elderly in Japan are extremely active and are very well socialized with other elderly thanks to public transportation and compact cities. They are very independent and mobile. Considering that Japan never took active quarantine measures on a nationwide scale, it's honestly a mystery why Japan is an outlier.

> They are very independent and mobile. Considering that Japan never took active quarantine .

And that makes the situation better, especially if you compare to country like Italy where a huge majority of kids still live with their parents and grand parents, potentially can infecting them.

https://cdn.statcdn.com/Infographic/images/normal/6413.jpeg

If social distance and mask works in public space, it does not at home.

The number of deaths seems to be tracking with South Korea’s trend [1] while the number of positive tests are much lower [2]. That does seem to indicate the testing is not matching up with South Korea’s at least. 1. https://covid19dashboards.com/compare-country-death-trajecto... 2. https://covid19dashboards.com/compare-country-trajectories/

I’ve been wondering the same thing about Massachusetts where I live.

We have 416 confirmed cases, 58 requiring hospitalization - it’s unclear how many of those require the ICU. I know of several people who are suspected of having it but have been told to just self quarantine but haven’t been tested, so obviously the infected numbers are much higher.

Still we only had our first death yesterday. He was an 87 year old already in poor health. By this point in Italy, things were already much worse.

Is this the beginning of the tsunami, or is it possible that it won’t get as virulent here?

> Is this the beginning of the tsunami

Yes. The problem with coronavirus is that young people apparently can be asymptomatic and spread the virus around massively, which means that without mass testing they will continue to spread... and then, detection of symptomatic CV patients takes time, both in that the patients go to testing and that the test gets executed. Unlike countries which have done mass testing for weeks/months, for the US, Germany and many others the current infection counts are a momentum in time of about ~1-2 weeks past. Time in which the virus can spread exponentially, something humans are not really good at visualizing.

Shit will look grim, especially the deaths, pretty soon. Italy shows the beginnings, and they hit hundreds of deaths a day now.

Actually Germany is another strange data point: according to Wikipedia’s sources they have 21,890 confirmed cases and “only” 77 deaths.

This seems dramatically different than Italy’s experience. Italy had over 1400 deaths by that point in their confirmed infection count. Is it how they’re counting? The age group infected?

Honestly, I’m just trying to find a ray of hope here.

> Italy had over 1400 deaths by that point in their confirmed infection count.

Italy has the problem that exploding rents after the financial crisis forced many young people to live with their parents and grandparents which not only means that they're heading for a demographic disaster as it's hard to get kids when grandma lives with you but also that the coronavirus has it easy to spread to elderly patients which are at horrible risk for serious corona cases.

Additionally, the financial crisis aftermath has wrecked the Italian healthcare system as it's easy to "save" money there on short term. Hospitals were closed and nurses and doctors fled to e.g. Germany or Switzerland due to higher pay, which means that now when the crisis hits the staff is overwhelmed, the beds are overwhelmed and people, especially old people, are sent home to die so that there is a chance to save those young who do develop severe coronavirus cases.

It sounds like you've hit on a reason that it might not be as bad for anyone else. Grandma and grandpa are sitting around having dinner with a bunch of asymptomatic but infected young adults. Everybody rubs their faces together when they show up and leave. It's a recipe for disaster.

The US has a different problem - people showing up sick (or symptomless but infected) at work because they cannot afford to stay home or lose their job.

Germany... let's just say we had to enact strict lockdowns due to utter idiots going to "corona parties" and God I wish I were joking here.

germany has a much more accurate infection count than italy. they haven't been overwhelmed yet.

I think this is a good question. Here are some random observations on Japan:

1. Japan, Tokyo area in particular, is crowded but clean and neat.

2. The Japanese, contradicting western prejudice, are not particular healthy. Lots of heavy drinking and smoking.

3. The Japanese never did a China travel ban. Lots of trade with and tourism from China.

I personally guess the answer to the question is that they did very good testing and contact tracing wrt. COVID19 and do not have the same testing bottlenecks as other countries.

They really didn’t implement a China travel ban? I find that hard to believe

It is really amazing how quickly we adapt to things. Earlier today I was watching a twitch streamer from someone at a bar in Japan and I was surprised to see that many strangers close together in one room and thought they were being reckless. A week ago I wouldn't have given it a second thought.

points not discussed well in western media: 1) they do crashing clusters very well based on this paper. wellhttps://www.medrxiv.org/content/10.1101/2020.02.28.20029272v...

2) Why packed train in Japan still hasn't caused outbreak They don't speak despite the high density in train (remember - it is utter silence on public transportation in Japan) and all wear masks.

3) Intensive use of chest CT scan to find out critical conditions. They have highest number of CT scan per 1000 people in the world. https://data.oecd.org/healtheqt/computed-tomography-ct-scann... Plus, remember, PCR has high false negative and testing everyone is waste of resources (look at Italy. they tested everyone regardless of severeness of symptom and totally fucked.) You can test a lot only if well-prepared like Korea with SARS experience.

4) Compliance Japan has always suffered from Tsunami, Earthquake, Fukushima, ...etc. They are used to calmly adjust their life without panicking. No toilet paper shortage. They don't get surprised at all with Earthquake with magnitude of 6 unlike Americans in California.

points not discussed well in western media:

1) they do crashing clusters very well based on this paper. wellhttps://www.medrxiv.org/content/10.1101/2020.02.28.20029272v...

2) Why packed train in Japan still hasn't caused outbreak They don't speak despite the high density in train (remember - it is utter silence on public transportation in Japan) and all wear masks.

points not discussed well in western media:

1) they do crashing clusters very well based on this paper. wellhttps://www.medrxiv.org/content/10.1101/2020.02.28.20029272v....

2) Why packed train in Japan still hasn't caused outbreak They don't speak despite the high density in train (remember - it is utter silence on public transportation in Japan) and all wear masks.

3) Intensive use of chest CT scan to find out critical conditions. They have highest number of CT scan per 1000 people in the world. https://data.oecd.org/healtheqt/computed-tomography-ct-scann.... Plus, remember, PCR has high false negative and testing everyone is waste of resources (look at Italy. they tested everyone regardless of severeness of symptom and totally fucked.) You can test a lot only if well-prepared like Korea with SARS experience.

Japnese are like Chinese, are quite obedient, therefore can follow quite throughly of the checks in the entry and exit of the country.

Plus, itself has much more modern and disciplined public health system, with more experiences dealing with similar issues.

Last but not least, the Japan lands are literally isolated from continents, making the transition of virus through other medium much more easier to track.

> Japnese are like Chinese

I would advise you to never say to a Chinese or a Japanese that they are alike.

Excepted if you want to enrich your vocabulary with new insults in a foreign language. Many of them are nationalists, and not really appreciating each other.

I wouldn't say the Chinese have a particularly penchant for being obedient any more any any one else.

The countries which are winning against COVID are those who don't give loudspeakers to stupid people.

Just saying.

Hahahah

Stereotyping is nature.

I am Chinese, I know very well what happened in WWII, and Japanese people willingly supported their fascism government, and the monstrosity committed by the Japanese invasion army on Chinese soil.

Then do I feel insulted that Japanese retained and even refined a lot of ancient Chinese traditions, and modern Chinese culture have been greatly influenced by Japanese, because they were more receptive to western influence early on?

In many people's eyes, I should.

But, no, I do not. I admit to facts, not sentiment.

Hmm, could they be lying to keep the Olympics? If so, how would they get away with it?

(Not accusing, just repeating something a Japanese friend said.)

At this point it will hardly matter what numbers Japan present to the world, it is the rest of the world that will decide.

Continued lockdown will make it very hard to train properly, leading to a belief that the olympics should be moved. The show must go on does not seem to apply.

Already now the European football championship has been postponed.

Why not wait until people will come and see it anyways? Rushing it seems foolish.

The olympics angle is somewhat irrelevant — if Japan is totally covid free, but the rest of the world is a mess, then the olympics still can't happen. Local coverup brings no obvious benefits.

To announce a shift in olympic schedule requires a total behind the scenes replanning. I suspect they're on that now, and will announce a new date once logistics have been finalized.

So far the places that have held up well (Singapore, China, Japan, South Korea) have a culture that favors masks.

In Hubei, you would be arrested if you were out without one (this may have lapsed now).

There may be other cultural/demographic/political aspects, but this seems key. Japan, in many ways, handled the crisis poorly. And yet they're still doing ok.

Because they don't test enough, Masayoshi Son was criticized by netizens because he wanted to test more people.

https://inc42.com/buzz/masayoshi-son-gets-criticised-for-his...

Because they're monocultural and don't have a lot of foreigners living or coming into the country, and the Japanese themselves tend not to travel as much internationally (these days). And yes they wear masks commonly.

I think cultural factor is huge in Japan’s case. They don’t really like hugging and touching each other socially. They are more restrained in their physical social behaviours.

Do Japanese people living outside of Japan have an unusually low rate of hospitalization? Perhaps there is a genetic component.

Or perhaps it involves some differences in diet, or treatment.

I wonder if "no shoes in the house" plays a role.

We don't wear outside shoes in our house. (Midwest US) Not sure it would play a role with viruses but definitely keeps out dirt and other contaminants, just makes for a cleaner environment.

It's worthwhile to track whether there's suspicious spike in number of Kodokushi.

Re social distancing:

Italians and Spanish kiss when they greet each other. They’re the worst hit in Europe.

I wonder if there could be a genetic factor. Maybe something ~unique to Japanese?

I was curious of a genetic link after hearing about a family in New Jersey where four members died after one dinner party [https://www.bbc.com/news/world-us-canada-51978164]. Being relatives, though, they may have all had similar comorbidities.

Huh. Italian family. So I suppose that they might carry susceptibility genes. It's my impression that Italians are extremely diverse genetically, but I guess that there could be ~isolated subpopulations.

I wonder whether anyone's looked for that in the data from Italy.

Isn't India the real elephant in the room here?

More iodine in their diet?

I can tell you what happened in Spain.

In Spain the Government did not take it seriously, it was a relaxed attitude. The person that was in charge of giving news , Mr Simon, said he expected two or three people getting infected in the future.

As a result of this attitude, there were no controls in borders. They let people(thousands) go to football(soccer) matches in Italy, where there were already known cases with no consequences.

Then serious cases started growing exponentially every two days, 50 to 100, 100 to 200, 200 to 500, and instead of doing something, they WAITED!!

How is that? Because the people in power are socialist and communist and considered a priority number one the 8th of March(8M) women manifestation. Doing something before meant cancelling the manifestation,(along 55 smaller ones in Madrid this day) which was super important for them.

So the only thing they did was hiding the exponential data two days earlier so people would go to the manifestation.

They believed they could wait and deal with it later after the 8M. In the manifestation more than 100.000 people gathered.

It was too late, after the 8M the two women of the prime minister(socialist) and the vicepresident (comunist) were infected. The communist one was already infected at 8M, so she alone herself infected hundreds or a thousand other people.

So it is just a matter of incompetent people in charge that prioritize their own party and private interest over serving the community.

Now it is the other way around, after doing nothing for so long they have become totalitarian despots(Well, they already were, specially the communist one, is only that they have an excuse now) and they won't let people go out of their houses and walk or run alone.

In the following weeks the weather in Spain will be much better and sun alone will be able to kill viruses and save us from our politicians.

It's because they acted early. All the epidemiological models show that if you lock down when there are only a handful of cases, the disease can be managed effectively. There is no mystery to this, it's because they "overreacted" by closing borders and schools when the West was still telling people not to, and now they can relax the restrictions.

Be rational and consider all options:

1. The data is accurate and captures all coronavirus cases.

2. The data is not accurate and does not capture all coronavirus cases.

I read the entirety of this thread as though HN assumes only 1 is possible. If 1 is correct, then HN’s inferences sound reasonable (habitual mask use, practiced social distancing).

But what if 2 is correct? Is there any disincentive for governments to accurately test and capture all cases? Is there any particularly outsized disincentive for Japan to do so?

I leave the above questions as an exercise for the reader.

Most people assume that the various governments' published statistics are accurate. They also often implicitly assume that the various statistical measures are consistent across nations. Are these reasonable assumptions given the politics of the various countries?

Italy is special not just because of its elderly population, but because of its socially active and well-connected elderly population. Multi-generation families are still normal.

By contrast, Japan's elderly population tends to live socially isolated in the country-site.

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