Did Japan Just Beat the Virus Without Lockdowns or Mass Testing?
bloomberg.com
bloomberg.com
This makes sense. In the US and other countries, people have become obsessed with things like runners not wearing masks or people gathering at beaches or washing their groceries, but all of those things are extremely low risk. Evidence keeps piling up that outdoor transmission is very difficult and surface transmission is remarkably unlikely. The primary way to spread a virus via droplet transmissions is to spend a sustained amount of time around lots of other people in an indoor space. That accounts for virtually all of the super-spreader events and avoiding these activities is likely responsible for the vast majority of the reduction in the transmission rate during these lockdowns.
I think we're gradually moving towards a system of restrictions based on universal mask wearing when indoors and avoiding crowded indoor spaces altogether. Most other restrictions are likely not necessary to keep the transmission rate low enough to avert catastrophe.
In some ways, very similar to TB, although a much shorter exposure time is sufficient for transmission.
Measles, for example.
The point is sustained contact, not the route of transmission.
1. Weather and building permitting, open all of the windows.
2. Install a high efficiency filter (Probably MERV 14 or better is needed). This probably requires upgrading blower fans in the HVAC system.
3. Install the highest MERV filter that the system can support, and supplement this with a UV-C disinfection system inside the air handler. In general you need pretty powerful UV-C lights in the air handler to destroy viruses as they're passing through the system, but these are commercially available (https://www.johnsoncontrols.com/-/media/jci/be/united-states...)
4. Bring in more fresh air, possibly by changing HVAC settings, possibly install a contraflow heat exchanger to recover heat/cooling as air is exchanged.
5. Install portable HEPA type filters. You will need a lot.
"Evidence keeps piling up that outdoor transmission is very difficult and surface transmission is remarkably unlikely"
Where's the evidence and what does "unlikely" mean in percentages? AFAIK there's in fact zero evidence about anything regarding outdoor or surface transmission, because for some reason no one's testing relevant scenarios like "how long does the virus survive on fruit?" and instead they're making guesses worth exactly jack shit.
I'm more worried now that I read that I'm not the only one who suspects that people spending prolonged periods of time together are the main cause of the spread of Covid-19. To me it seems ridiculous to think that 1.5m distance will magically make thing work. Even in supermarket every single visit I all but bump into others. But there's very little spittle from talking or coughing, so I imagine the risk is much lower.
At this point what I hope for is that summertime will make a big difference, and that perhaps my government knows this and is crafting a 'public' message that just doesn't paint the full picture.
But honestly, much as I think we in NL have done pretty okay (middling, really), at this point I expect we'll have at the very least a 'second wave' and probably end up in the middle of death statistics for that too.
I kind of wish we'd try to do a bit better and follow the example of, I think, some countries in Asia, and just assume that things will be different now, and adjust how our society interacts in some basic ways. Core to that would be: - wear face masks. anything where a cough doesn't douse a lighter is 'good enough'. - make testing a regular, common thing. take temperatures every time you show up at work. - rigorously limit the distance between people in bars, cafe's, public transport, shops, etc. I think we're doing okay on this front in most shops I've gone too: a fixed number of trolleys or carts, and people wait if they run out. Just last week I waited for ~20 mins at a second hand store. - be as lenient as possible for those outside. it does a lot to take the pressure off, and the risk seems relatively low. - for the love of God, don't let up to 30 people in an enclosed, badly ventilated space, and don't make an exception for people who claim that "they're flatmates/partners".
One can dream.
This makes perfect sense. Imagine asking parents to sit at separate tables from their children. If kids in a home are infected - trust me - everyone in that house is infected. Have you ever tried to social distance from a 3 year old?
No difference than being in the same household.
Not saying I agree just pointing out it isn't really worth arguing what rules will/can be bent.
I suspect it's mostly, but not entirely true. In my circles the 'meet at a bar or other public place' circle is significantly wider than the 'meeting at someone's place' circle.
But perhaps even that looser circle is still good enough compared to the pre-lockdown situation (clubs being open, for one).
> At this point what I hope for is that summertime will make a big difference
If the greatest risk of transmission is close contact in enclosed spaces, and most of these spaces (homes, stores, restaurants, offices, mass transit, etc.) are air conditioned (making them cool and dry), why would summer weather have a significant effect on the propagation of the virus?
The differences in numbers are quite large. (For example NYC is twice the size of LA, but manages 7x the amount of subway riders.)
Using this model, the differences showed that the data isn't just reflecting general population size / city density.
Yes, "businesses from restaurants to hairdressers stayed open", but most of them that I've ever used living here closed. Almost none of our restaurants (meaning the ones we used pre-COVID19) are open, or only do takeout. None of the places my kids have ever gotten their hair cut are open.
So I think this article might be placing too much emphasis on what the government mandated, and not enough on what people and businesses actually are doing.
I was watching TV news and they were naming and shaming pachinko slot-machine parlours that refused to close — and it was like 4 of them.
Not to say that it has been perfect. But likely much better than you seem to imply here.
Retail & recreation: (-40%, -47%, -30%)
Grocery & pharmacy: (-12%, -7%, -3%)
Parks: (-52%, -14%, +32%) (yes that's a positive sign!)
Transit stations: (-55%, -41%, -34%)
Workplaces: (-23%, -27%, -24%)
Residential: (+14%, +12%, +9%)
So this data more or less seems to confirm what you said, though with obvious caveats (e.g. looking at say county-level may overturn some of this: compliance in Tokyo may be less than in San Francisco county and about as good as Santa Clara county, along some dimensions).
"Some observations from a socially distanced walk around central Tokyo yesterday:
* less foot traffic than you’d expect on beautiful day in spring that was holiday, but still high
* 98% mask usage
* 95% of neighborhood boutiques shut down"
https://twitter.com/patio11/status/1255091793130950657
“How serious is the state of emergency? I heard it is not a lockdown?”
As of tomorrow, there is no McDonalds in the nation which will let you eat there."
https://twitter.com/patio11/status/1254836838344175616 "This is the WSJ, and I’m just one guy who happens to be able to read Japanese, so weight appropriately, but the consensus of experts is we’re at the brink of losing the capability to do emergency medicine over approximately half of the country." (in response to over-optimistic WSJ coverage)
This article is feeling like American propaganda trying to justify giving up on response measures in the US. The most charitable interpretation is that it's factually incorrect in a broad way.
I know folks in Japan and life is anything but normal there. They didn't need a "lockdown" because of Japan's strong culture of conformity, and people take recommended precautions seriously.
Restaurants closed, schools closed, parks empty, everyone wearing masks, lots of social distancing.
The scale of the public's participation vastly exceeds that of the west -- there are little to no "nay-sayers" or people ignoring the rules. It makes a pretty big difference, evidently.
Anyone speculating that "Japan did less than the West and had an easier time how bizarre" is missing the forest for the trees.
From the beginning (and it gradually started far before the emergency declaration), most people and organizations recognized their role and responsibility and did whatever they could do to help.
My company gave material and instructions about washing hands, gargling and improved the frequency of cleaning in february, and then switched to remove-working for everybody as early as march. The company managing my share house did almost the same and even increased the frequency of cleaning.
Shops set up barriers in front of the cashiers. Restaurants either decided co close or switch to sake out only. Almost everybody started to wear masks since the beginning. When masks were impossible to find in shops, my company somehow achieved to deliver dozens of masks to all employees. When I got sick they also helped me by delivering furnitures and foods to my room.
So many people from western countries that are always talking about freedom seems unable to do anything else than ask their government to forcefully lockdown everybody. A government is not omnipotent and cannot fix everything magically. Recognizing your role and willingly do whatever you can is the only solution. Here, the government only asks people to do things whenever it is necessary, and they do.
People that got sick weren't allowed to take the test unless they fulfilled some checklist someone came up with. People with pneumonia symptoms got turned away at hospital after hospital and instead asked to rest at home which also had an effect on the low number of confirmed cases.
Some articles of people that got confirmed coronavirus but instead of getting quarantined, asked to please not work and self isolate (<- there are also reports of people that were sick for weeks but just continued working with a mask until they were no longer able to). Same for charter flights and people from the cruise. Some people just denied getting tested, so they went home directly.
I have no idea how Japan got away with this but it's true that we are much better off than other countries. The official numbers don't reflect reality a single bit, but I can't argue about the low number of fatalities.
- Japanese people have no hangups about masks and social distancing
- There aren’t quite as many large, touchy feely inter-generational family gatherings as in Italy
- Even if people aren’t strictly following stay-at-home orders, they might have confidence that with the common wearing of masks and social distancing, they’ll probably be fine, especially in outdoor environments. You know this more than me, but Japanese people tend to have higher attention to detail. They can more effortlessly be aware of situations where they may get infected, and they won’t just say “oh well I’ll take the risk,” they’ll put in the little amount of effort to mitigate getting infected.
We will only know the true numbers with the excess mortality numbers. But given the circumstances it will still be a 0.2% IFR country according to my estimations. Not worrying at all.
Source: I live in Tokyo
Yet the curve has been flattened, with deaths well below 1,000, by far the fewest among the Group of Seven developed nations. In Tokyo, its dense center, cases have dropped to single digits on most days.
excuse me, but given that testing rate, how the crap do you know that 1. the curve is flat, 2. deaths are at any particular number at all or 3. case rates are in any digit range at all?!
If early antibody testing is correct, then we don't know the actual transmission rate or number of cases in any nation. Though Japan may be even more opaque because of their astoundingly low testing rate.
excess deaths over a given time period are a pretty good indicator, which haven't increased at all compared to recent years.
One of the comments in the article guessed it was their low obesity rate. Interesting stuff! I'm excited to see some write ups for every country once this plays out.
Could be though. It's just interesting that they pulled it off without any lockdowns. It could be their isolation as an island as well.
It seems only China is being overly cautious, implementing lockdown-type measures on a Russian border city with 130 confirmed cases
To be honest, i suspect the movement restrictions are less about the virus now and more about controlling the "low end population" and other working class people. (Middle class people tend to live in gated communities anyway so the government didn't need to put up fences to control their movements.)
In short, China is definitely still being overly cautious, and it's not just up in the north.
Countries in Asia not hammered by the virus: Indonesia, Philippines, Thailand, Japan, Singapore, South Korea, Taiwan, Vietnam, Malaysia, Mongolia, Myanmar, Laos.
I'd add China to that list, however absolutely nothing about their reported figures can be trusted. All authoritarian nations are very aggressively lying across the board about their numbers (North Korea as another example). Russia is in a similar situation, they're undercounting cases and deaths to an absurd extreme (half the deaths of Canada, with 4x the cases; Britain with 10x the deaths of Russia, with fewer cases; yeah right).
It makes little sense to pretend it's masks making all the difference for all of them. Indonesia, the Philippines, Malaysia, Vietnam, Laos, Myanmar, Mongolia are extremely poor and there's no evidence it's some kind of cultural hygiene action protecting them all (an often floated contributing theory for Japan or Singapore).
Cities in Vietnam and Indonesia didn't avoid an outbreak like Wuhan / Milan / Madrid / NYC thanks to instantly 100% masking up back in November - January.
Based on what we now know about SARS-CoV-2 there are only a few reasonable explanations (some of which blend, multiple factors).
Being on an island blatantly helps, just ask Hawaii and New Zealand. As with Taiwan, Japan, Singapore, Indonesia and in practical terms South Korea. Australia also largely fits that qualification (their major cities are population islands).
A lower susceptibility due to an unknown genetic factor. We do know that Vitamin D levels are very important, such that darker skin in cooler climates like NYC (cooler during flu season) can be a deadly combination as it pertains to getting a bad case of Covid. Someone on HN stated that 40% of deaths in Sweden are Somali Swedes despite their very small share of the population (5% of Covid cases are Somalis, and they're about 0.8% of the population). Severe Vitamin D deficiency has been repeatedly linked to bad outcomes. This is also an important factor with some other respiratory viruses.
There may be a lot of cases in some of these nations, however they're not producing large death rates due to health factors, specifically far lower rates of obesity, cardiovascular disease, diabetes, etc. If you're an average person and catch a mild case of Covid in Indonesia, you're not going to the hospital for it unless it progresses and you get very sick.
We do know there has been some lying about cases, however it doesn't appear that nations like Indonesia are covering up any mass number of deaths (I've yet to see any evidence supporting the notion that they're hiding eg tens of thousands of deaths).
Many of these nations have not tested at a high level, which may explain some of the lower case rates, however it doesn't explain the lack of large death numbers. Deaths have tended to prompt nations to get aggressive on higher rates of testing, so unless you're seeing a lot of deaths, a poorer nation may choose to avoid the cost of high rates of testing.
There's no question that masking up helps to a huge degree. So to the extent that nations have done that, it has helped them imo (I think the evidence is overwhelming at this point). Japan and South Korea to name two, have clearly seen the benefit from that.
And last but not least, climate. It's likely that the hotter, poorer nations in Asia have had some protection from the virus for the same reason cities in Texas, California and Florida have done so much better than eg Chicago, Boston, Detroit, NYC, Philly, Wuhan, Milan, Madrid, etc. We know the virus, as with influenza and SARS, does not do as well against high temperatures and high humidity. It doesn't stop the virus, it slows it down versus what would otherwise occur. Also, being in a very cold climate (Canada, Finland) would have been a benefit until warmer weather hit (we saw that in Moscow), as it reduces various social activity naturally.
If you were to bundle together: fewer comorbidities, climate, island and masks, you'd have just about an ideal mix of protections (a culture that will consistently respect social distancing would obviously help also).
You've missed Singapore there, which has been hit extremely badly on a per-capita basis. For number of confirmed cases, they're 8th in the world. They're not getting mentioned as often because their very good healthcare means they have few deaths - less than 1%, unlike Sweden [1] where currently 45% of people who catch the virus die from it.
[1] https://www.worldometers.info/coronavirus/country/sweden/
To put this in perspective, this is 10x higher than the initial estimate of 1-3% death rate, and 0.4 to 0.8% fatality rate after random testing became more prevalent.
But you're right that even if you take the 3,992 deaths out of 33,188 confirmed COVID-19 cases in Sweden, their 10% death rate is still almost 10x higher when compared to Australia (1.5%) and much more compared to Singapore (0.08%).
This is a disease that is spread by breathing in air contaminated by a infected person coughing or talking.
Nobody uses the phone (it's bad manners here), so like the only time anybody talks is like when a group of people gets on together (not usually the case when I commute).
I mainly bike so my subway experience might not be very typical, but it's one anecdata point.
Almost all my subway-riding experiences this year have been such that 95% of the other passengers are wearing masks, and nobody talks.
Can't be the main factor, but it might be one factor.
If only 40% were to wear masks, they found almost no benefit.
By "masks" they don't just mean N95 masks. They include surgical masks, scarfs and bandanas used as masks, and other homemade or improvised masks.
Here's an article about that study [1].
For those who don't want to make their own or improvise, masks are becoming reasonably available. Newegg, for example, has several sellers which a search there on "masks" will find [2]. This includes some with stock in the US ready to ship, with delivery in a week or less. I just bought 50 disposable surgical-style masks for $30 from this listing [3], and they arrived in just over a week. At the time I bought they shipped from the seller but since then Newegg is handling shipping.
I picked that seller because they shipped from the US. A lot of sellers ship from China. Many of those do have reasonable shipping time, but I have no idea if the US Customs and Border Patrol is still seizing and redirecting PPE supplies that cross their paths. I figured a shipment that was entirely domestic was less likely to fall prey to government fuckwittery.
Tom's Guide has been maintaining a list of places with masks avaiable, which they update frequently [4]. That was were I learned that Newegg had masks in stock.
[1] https://www.vanityfair.com/news/2020/05/masks-covid-19-infec...
[2] https://www.newegg.com/p/pl?d=masks
[3] https://www.newegg.com/picotee-face-mask/p/0CE-02AC-00001
[4] https://www.tomsguide.com/news/where-to-buy-face-masks-and-c...
"The factor by which β was reduced was conservatively set to 2."
"Varying degrees of mask effectiveness are modelled by the mask transmission rate T and mask absorption rate A, which denote the proportion of viruses that are stopped by the mask during exhaling (transmission) versus inhaling (absorption), respectively. Weset T = 0.7 and A = 0.7 to model the use of inexpensive, widely available, and even nonmedical or homemade masks [...]"
So basically, they assume certain values for how effective masks are, and then simulates the dynamics of the epidemic. Nowhere do they try to justify the specific values chosen.
I expect that the conclusions cited (if only 40% wear masks, there is little benefit; if 80% wear masks, total cases go down by a factor 1/12) to be heavily dependent on those assumptions, and so I would be cautious to read too much into it.
Link to paper: https://arxiv.org/pdf/2004.13553.pdf
There is a trial in New Zealand, I think, to test whether it gives protection or not. Not sure if they'll be able to finish, given the virus was aggressively stomped there.
The NY Times did run this article on it in early April. From that article:
“This vaccine has saved as many lives as the polio vaccine — it’s an amazing story,” said Dr. Curtis, who designed and launched the B.C.G. trial in Melbourne in less than a month, hoping to stay one step ahead of the coronavirus’s spread in Australia.
While he described the B.C.G. vaccine as underappreciated, he emphasized that it was “not a specific Covid-19 vaccine.” B.C.G. also cannot be administered to anyone who has a compromised immune system, because it is a live-attenuated vaccine — meaning it contains live but weakened TB.
Dr. Faustman said it should not be used in hospitalized patients with active disease, because it may not work fast enough and could interact poorly with other treatments.
Not everyone is convinced B.C.G. holds much promise. Dr. Domenico Accili, an endocrinologist at Columbia University, said he thought efforts to use the vaccine against the coronavirus sound “a bit like magical thinking.”
While acknowledging that B.C.G. is “a non-specific booster of the immune system,” he said, “we should be able to deploy a more tailored approach.”
https://www.nytimes.com/2020/04/03/health/coronavirus-bcg-va...
I admit I reflexively dismissed it as wishful thinking that would disappear under closer scientific scrutiny. I don't know that that has happened. But it does appear, based on responses here, that there are other bigger social factors at play in Japan's success, if that word is even appropriate at this point.
Outside the odd reference here or there like yours, I still haven't organically come across any big articles on BCG in my usual Western sources (which includes wide-ranging outlets like HN, Twitter, and /r/Coronavirus). I am a NY Times subscriber, but that one slipped by me when it was published.
https://www.pri.org/stories/2009-11-10/fat-japan-youre-break...
This spreadsheet
https://docs.google.com/spreadsheets/d/1AeG07Bt1fOA-msWYb9jW...
compares two countries, each starting at an initial observed death rate of 1.0 / million. (The rate of growth here is (1 + Rt / serialInterval) or about the average daily spread to others)
The first country has a higher daily growth rate and locks down immediately, starting a process that will have its final effect on the deaths per million in 18 days.
The second country delays lockdown by 30 days and needs to do far fewer changes to reduce the growth rate to 1.01, and yet it doesn't surpass the deaths per million of the first.
You can get an approximation of (1 + Rt / serialInterval) but delayed by about 18 days if you look at the ratio of total deaths between two days (will need to be smoothed due to reporting variations). If you want a more realistic model you can get the same thing by tweaking R0 and intervention strengths/delays at https://covid19-scenarios.org/
This is a simplification (since it assumes that the entire population is a spreader rather than those infected 3-6 days before) but the conclusion doesn't change when you make the model more complex, and it explains why different countries seem to be doing so differently. The initial rate of growth completely dominates any other factors.
This image generated with covid-scenarios: https://imgur.com/a/BRpkb0I describes the variation in infected depending on R0 given everything else is the same with 2.5 being the average, 2.0 the lower bound and 3.0 being the upper bound.
This[0] is early April, government representatives all wearing masks, a normal practice for Japan.
That's still "more culturally accepted and practiced widely", but it was far from some claims I see that "everyone is wearing masks". Everyone is wearing masks when they're sick, not every day.
EDIT: Reading the comments again, it seems that they're talking about post-COVID, so I misunderstood.
But now, and since COVID-19 became a thing (February here), "everyone is wearing masks" even when they themselves are not feeling sick.
I sometimes count them when I go out and it is about 95% of people in the streets and 100% of all the shop employees I interact with.
Of course this is mostly for the sick, but also generally in times of seasonal illness, but also yes.. this pandemic. But across this spectrum, Japanese cultural acceptance of wearing masks is much higher than even right now in the middle of covid for Americans and particularly their political leaders, to say nothing of non-pandemic mask usage. So the contrast is stark.
Here's a random article[0] I just googled (but I've seen many more speaking to this dynamic) of prevalent mask usage in Japan, written in 2017. There's some pictures there too, of Japanese people wearing masks.
[0] https://theculturetrip.com/asia/japan/articles/why-do-japane...
Experienced people - not tech - working for a public health program. Prepared for a blitz of 'news' about how this was a failure?
The possibility of a distinctly less virulent or less severe strain of the virus seems very interesting to me. It would contribute to the story of how so many Asian countries contained the disease so successfully while Europe struggled. It would also fit the much less severe spread in the US west coast (introduced via Asia) versus the northeast (introduced via Europe).
Europe as a whole didn't struggle. Just look at eastern Europe or Greece or Portugal. Only parts of Europe struggled, and specifically those parts that reacted in the worst possible way, by e.g. putting sick people in nursing homes. In the US it's the same story. Most states are doing fine, and a few states royally f'd up.
It is possible that a more infectious and less severe strain of the coronavirus could explain different outcomes in the east and west. There are a number of different strains out there.
Studies involving gene sequencing to identify strains and outcomes across different populations would be necessary to prove this one way or the other.
It could be that a solution to this would be to vaccinate people with the mild strain (as advocated by some learned people).
Outperformance in Asia is much better explained by partial immunity created by prior exposure to SARS/MERS. But even that doesn't explain why regions all over the world are hardly affected by covid19, including those that didn't have prior SARS/MERS exposure.
Data strongly suggests that this coronavirus is seasonal just like other coronaviruses and not especially deadly so Controlled Voluntary Infection shouldn't even be necessary (but it would work).
The difference is probably due to cases being mild or asymptomatic. Even older people are generally healthy, there are very few obese people in Japan and Vitamin D deficiency is relatively rare.
I think most of us know at this point these measures (along with laughable things like wrapping up park benches and closing access to beaches) was never going to have any material effect on the spread of the virus, but was done anyway as a way for politicians to say “look we’re doing something!”
How they kept their notoriously close quarter trains from being vectors is a good question!
Wait, are you say restricting movement and closing private spaces do not affect the spread of the virus (not just as a matter of study, but obviously)? This seems to contradict the experience in much of the US (indeed of the world—but I follow US numbers more closely, since that's where I am), where the implementation of exactly these measures reduced its spread, and where numbers seem to be starting to rise again as restrictions are eased.
If anything, being in outside spaces where we can get fresh air and synthesize vitamin D in the sun probably has broader positive impact to our immune system — even if it comes with abstract risks.
But then again, I’m just spitballing here! Just like our elected officials did when they put their heads together and said “let’s wrap up park benches so people can’t enjoy the sun here to protect them from the virus”
I was responding to what I took to be your full claim, which seemed to cover restricting movement as well as these two measures. (That's why my first question was whether I was understanding the full claim correctly.) I agree that closing or marking off park benches probably doesn't have much effect, but I don't know; but I think restricting movement and closing public spaces where people stay relatively still for an extended time (as opposed to, for example, trails on which people walk or run) do have an effect.
> But we know it doesn't because people still go to grocery stores without wearing masks or taking any other precautions and cases are dropping rapidly.
Not in the non-New York US! I admitted up front, and hasten to say again, that I am speaking from a US-centric perspective.
The countries that are dealing with the virus the best, were able to present a strategy to their population which allowed groups to create their own tactics to complement the overarching strategy.
But restaurants and hairdressers are known to be places where COVID-19 can be actively spread to large groups of people. And gyms are even worse.
We should be encouraging people to go outdoors, and to not congregate in large groups.
Finally, bear in mind that public officials, like scientists and laypeople, are just figuring all this out, too. It's a novel infectious agent, after all. But it's important to self-correct quickly.
Ironically, it looks like masks may turn out to be one of the most effective interventions, yet there's a huge political backlash against them that many pols are stirring up, so 20-30% of the country will never wear them.