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Comment by grosales | Hacker News Reader

This is just my 2 cents but according to https://www.worldometers.info/coronavirus/#countries Japan has only done 923 tests for 1M of their population. That's much lower than any developed nation. One thing the article claims is the spread of the virus by asymptomatic infected people. Given this low level of testing - it's hard to gauge the true level of infection in the country - although the continuous decrease on daily cases is good, it doesn't mean it cannot spike back up. We just have to wait and see what happens.

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What I find confusing though is Japan's low death numbers. I was assuming that spikes in mortality couldn't be hidden, but recent comments from inside sources in Japanese hospitals are starting to make me doubt this assumption. Still, there is not a crisis on Lombardia-level going on, which one would expect given the relative inaction of Japanese government. I'm guessing the truth is somewhere in the middle - Japan's reported numbers are underestimating the issue, but at the same time Japanese society is as a whole more resistant than at least Southern Europe.

One theory is that people are dying but it hasn't been discovered yet because of people staying inside. see https://en.wikipedia.org/wiki/Kodokushi

Having just ridden the Yamanote today though, it's unreal how empty it is.

I doubt there's much overlap in people who have so little human contact that no one knows they're dead and people who catch viruses that are still present in only a tiny fraction of the population.

Oh, and a third condition that these people be such recluses that they don't even call a doctor when deathly ill.

Dude, you're talking about the country that christened the hikikomori phenomenon...

There are undoubtedly recluses, but do they also have frequent contact with people to catch diseases from?

You can catch covid in many ways, it lives on hard surfaces for days.

Even people with little human social interaction need to get groceries from somewhere...

I mean, look at the comorbidity data - heart disease, hypertension, diabetes - aren't the Japanese one of the healthiest people in the world?

Yes, but the population is even older than in Italy, which is also a big factor.

Japan is a country where at the best of times, a lot of people die at home and are not discovered for some time. If you remove social contacts thanks to lockdown, this is going to become more common.

See https://en.wikipedia.org/wiki/Kodokushi for more.

Yes, that happens sometimes, but no, there are not thousands of unnoticed dead people in their apartments in Japan.

Occam’s razor in this case is that the pandemic in Japan isn’t as bad as the author projected. It’s not a conspiracy or coverup and there aren’t dead bodies hiding everywhere, the author was just wrong.

"Sometimes" is doing a lot of heavy lifting during a viral pandemic which hasn't been matched in severity for the last century.

Here are the facts as we have them.

From https://www.worldometers.info/coronavirus/country/japan/ Japan admits to about 10,000 cases now, with a doubling time of about 11 days so they will admit to 20,000 cases by the end of the month.

If you read https://www.who.int/bulletin/online_first/20-254565.pdf you will find credible reasoning for 90% of COVID-19 cases not being tracked in official numbers, with a wide uncertainty. That correction would make it 200,000 cases in Japan by the end of the month. If you update that argument with the lower IFRs suggested in https://www.cebm.net/covid-19/global-covid-19-case-fatality-... then you get to a projection of 500,000 cases in Japan. (The admittedly problematic Stanford study came up with a suggestion of similar underreporting factors in both Santa Clara and Los Angeles.)

Alternately we could arrive at a similar conclusion if you assume that Japan is doing less testing than average. And there is considerable evidence that this is true.

We therefore do not have reason from the officially reported figures that he is wrong.

Now let'd deal with the dead bodies argument.

Deaths trail infections with roughly a 3 week lag. (A week to get sick, 2 weeks to die.) Let's go back to the simple model of 90% of infections are not reported and the true fatality rate is 1%. On March 31 there were 1700 official cases. On that model there were 17,000 infected of which 170 should die. Guess what? Today there are officially 263 dead bodies.

We. Don't. Even. Have. A. Shortage. Of. Known. Bodies.

The stated conclusions only look absurd to anyone who HASN'T tried to understand the dynamics of exponential growth, and the problems with the official data. He might or might not have been correct. But directionally he was clearly a lot more right than the official government position at the time.

You are correct that official coronavirus deaths are low. But official influenza deaths (blue diamonds) were almost double their baseline value (green line) and above a threshold value (purple line, but I don't know enough Japanese to know what threshold) back in week 8 of this year (late Feb, early March, depending on how you count it.)

https://www.niid.go.jp/niid/ja/flu-m/2112-idsc/jinsoku/1852-...

I wonder if there are other, non-coronavirus causes of death that are significantly above their normal values?

To give an indication of how low that testing is, on that site Japan is ranked #119th country in the world in terms of testing.

We often conflate asymptomatic and presymptomatic people: my understanding is that asymptomatic people aren't very infectious, but presymptomatic people are. I can't find a solid citation for this, though.

The mechanistic basis for that is simply viral load: asymptomatic people have some virus, but not enough to ever make them really ill, whereas presymptomatic people have loads of virus, but it hasn't made them really ill yet.

With this disease it appears asymptomatic people are equally infectious.

That was very much not my understanding. Do you have a proper technical source for that? I don't, and i wish i did!

https://jamanetwork.com/journals/jama/fullarticle/2762028

TL;DR contact tracing shows numerous cases of asymptomatic people that have introduced the disease to people near them.

There is a world of difference between "asymptomatic people are infectious" and "asymptomatic people are AS infectious".

I saw early estimates based on detailed modeling from Chinese data that asymptomatic people were about half as infectious as symptomatic ones. I have not seen any such estimates for some time though, nor ones based on more recent data samples.

Given the widespread distrust of the Chinese reporting on what happened in January, and the fact that estimates of how infectious this is have approximately doubled from early estimates, I don't trust that early reporting. I would also love to see an estimate of how much more or less people are infectious when they are asymptomatic.

Given that I don't doubt that they can be infectious, research showing that they can be is not answering the question that I have.

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