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Testing Is Key to Beating Coronavirus, Right? Japan Has Other Ideas Testing Is Key to Beating Coronavirus, Right? Japan Has Other Ideas
(1 day later)
TOKYO — As the world tries to get a handle on the coronavirus and emerge from paralyzing lockdowns, public health officials have repeated a mantra: “test, test, test.”TOKYO — As the world tries to get a handle on the coronavirus and emerge from paralyzing lockdowns, public health officials have repeated a mantra: “test, test, test.”
But Japan went its own way, limiting tests to only the most severe cases as other countries raced to screen as many people as possible. Medical experts worried that the approach would blind the country to the spread of infection, allowing cases to explode and swamping hospitals.But Japan went its own way, limiting tests to only the most severe cases as other countries raced to screen as many people as possible. Medical experts worried that the approach would blind the country to the spread of infection, allowing cases to explode and swamping hospitals.
It hasn’t happened. Japan — the grayest country in the world and a popular tourist destination with large, crowded cities — has one of the lowest mortality rates from Covid-19 among major nations. The medical system has not been overwhelmed. And the government never forced businesses to close, although many chose to.It hasn’t happened. Japan — the grayest country in the world and a popular tourist destination with large, crowded cities — has one of the lowest mortality rates from Covid-19 among major nations. The medical system has not been overwhelmed. And the government never forced businesses to close, although many chose to.
This week, Prime Minister Shinzo Abe declared Japan’s battle against the outbreak a resounding success, taking the country off an emergency footing — a sort of “lockdown lite” that lasted only a month and a half.This week, Prime Minister Shinzo Abe declared Japan’s battle against the outbreak a resounding success, taking the country off an emergency footing — a sort of “lockdown lite” that lasted only a month and a half.
“By doing things in a uniquely Japanese way, we were able to almost completely end this wave of infection,” Mr. Abe said, adding that what he called the “Japan model” offered a path out of the global pandemic.“By doing things in a uniquely Japanese way, we were able to almost completely end this wave of infection,” Mr. Abe said, adding that what he called the “Japan model” offered a path out of the global pandemic.
It’s still unclear, though, exactly what accounts for Japan’s achievement and whether other countries can take lessons from its approach. Critics say Japan has undercounted coronavirus deaths. And some warn that further waves of infection could undermine the government’s self-congratulatory pronouncements.It’s still unclear, though, exactly what accounts for Japan’s achievement and whether other countries can take lessons from its approach. Critics say Japan has undercounted coronavirus deaths. And some warn that further waves of infection could undermine the government’s self-congratulatory pronouncements.
Instead of testing widely to understand and limit the virus’s spread through the general population, Japan has focused on quickly containing small outbreaks through contact tracing. Instead of dictating strict constraints on daily life, it has focused on educating people about measures like social distancing and gently prodding them to follow along.Instead of testing widely to understand and limit the virus’s spread through the general population, Japan has focused on quickly containing small outbreaks through contact tracing. Instead of dictating strict constraints on daily life, it has focused on educating people about measures like social distancing and gently prodding them to follow along.
Theories for the country’s relatively low mortality rate run the gamut from cultural attributes — widespread mask wearing, a practice of regular hand washing, a near absence of physical greetings like hugs and handshakes — to just plain luck.Theories for the country’s relatively low mortality rate run the gamut from cultural attributes — widespread mask wearing, a practice of regular hand washing, a near absence of physical greetings like hugs and handshakes — to just plain luck.
A combination of many other factors, including government measures and changes in behavior among a public that feels strong pressure to follow the rules, could also be at work.A combination of many other factors, including government measures and changes in behavior among a public that feels strong pressure to follow the rules, could also be at work.
Individual actions “may seem small or mundane,” said Keiji Fukuda, an epidemiologist who directs the School of Public Health at the University of Hong Kong. But, he added, “the cumulative impact of all of those efforts across the entire country to really implement some kind of distancing” may have been substantial.Individual actions “may seem small or mundane,” said Keiji Fukuda, an epidemiologist who directs the School of Public Health at the University of Hong Kong. But, he added, “the cumulative impact of all of those efforts across the entire country to really implement some kind of distancing” may have been substantial.
Whatever the formula, Japan has so far succeeded in keeping deaths low. The country has recorded fewer than 900 deaths even as the United States and European countries have reported tens of thousands.Whatever the formula, Japan has so far succeeded in keeping deaths low. The country has recorded fewer than 900 deaths even as the United States and European countries have reported tens of thousands.
Epidemiologists say widespread testing for the virus is important because it allows officials to isolate those who test positive, and to track trends in infection rates to help determine when it is safe to reopen schools, businesses and other places where people congregate.Epidemiologists say widespread testing for the virus is important because it allows officials to isolate those who test positive, and to track trends in infection rates to help determine when it is safe to reopen schools, businesses and other places where people congregate.
Researchers at Harvard have said the goal should be to test nearly everyone who has at least mild flulike symptoms, as well as an average of 10 contacts for each person who tests positive.Researchers at Harvard have said the goal should be to test nearly everyone who has at least mild flulike symptoms, as well as an average of 10 contacts for each person who tests positive.
Countries like South Korea and China that faced fast-growing outbreaks early in the pandemic quickly ramped up testing. China performed more than three times as many tests in Wuhan in a single day than those Japan has conducted nationwide since Feb. 18 — about 455,000 tests on around 278,000 people.Countries like South Korea and China that faced fast-growing outbreaks early in the pandemic quickly ramped up testing. China performed more than three times as many tests in Wuhan in a single day than those Japan has conducted nationwide since Feb. 18 — about 455,000 tests on around 278,000 people.
Japan initially told people who suspected they were infected with the virus not to seek help unless they had experienced a fever for four days, or two days if they were over 65. Even some people with seemingly severe symptoms were refused, provoking theories that the government was trying to hide the true extent of the problem.Japan initially told people who suspected they were infected with the virus not to seek help unless they had experienced a fever for four days, or two days if they were over 65. Even some people with seemingly severe symptoms were refused, provoking theories that the government was trying to hide the true extent of the problem.
Medical experts said the guideline was intended to conserve hospital resources. A national law on infectious diseases mandated that anyone who tested positive, even those who were asymptomatic, had to be placed in one of the country’s few isolation wards, creating a strong disincentive for doctors to test patients with milder symptoms.Medical experts said the guideline was intended to conserve hospital resources. A national law on infectious diseases mandated that anyone who tested positive, even those who were asymptomatic, had to be placed in one of the country’s few isolation wards, creating a strong disincentive for doctors to test patients with milder symptoms.
The Japanese government also said early on that test kits must be rationed because they were in short supply. That argument has since faded, however, as Japan has never used even half of its testing capacity on any given day, and it has increased its testing capacity to just over 24,000 a day.The Japanese government also said early on that test kits must be rationed because they were in short supply. That argument has since faded, however, as Japan has never used even half of its testing capacity on any given day, and it has increased its testing capacity to just over 24,000 a day.
Japan has since eased its rules to allow those who test positive but are asymptomatic to stay in hotels. It is preparing to begin limited testing for antibodies, hoping to get a better grasp of the number of people who have been infected. It also plans to introduce a smartphone app to help with contact tracing.Japan has since eased its rules to allow those who test positive but are asymptomatic to stay in hotels. It is preparing to begin limited testing for antibodies, hoping to get a better grasp of the number of people who have been infected. It also plans to introduce a smartphone app to help with contact tracing.
Despite the constrained testing for the virus, the rate of positive results has dropped below 1 percent, a fact that the government’s expert panel on the virus says demonstrates that current testing levels are sufficient.Despite the constrained testing for the virus, the rate of positive results has dropped below 1 percent, a fact that the government’s expert panel on the virus says demonstrates that current testing levels are sufficient.
But a group of prominent Japanese academics, businesspeople and other figures has called on the government to take a much bolder step: build a capacity of 10 million tests a day and offer testing to anyone who wants it. Consecutive negative results, the group argues, could allow people to fully resume social and economic activities.But a group of prominent Japanese academics, businesspeople and other figures has called on the government to take a much bolder step: build a capacity of 10 million tests a day and offer testing to anyone who wants it. Consecutive negative results, the group argues, could allow people to fully resume social and economic activities.
As the country has seemingly defied the odds, many public health experts, including some in the government, have warned against drawing any definite conclusions from Japan’s experience.As the country has seemingly defied the odds, many public health experts, including some in the government, have warned against drawing any definite conclusions from Japan’s experience.
They caution that Japan is not in the clear yet, and that a second or third wave of infections could strike at any time. As more data on deaths from this year becomes available — there are indications that Tokyo has undercounted dozens of coronavirus deaths — the picture may not look quite as good.They caution that Japan is not in the clear yet, and that a second or third wave of infections could strike at any time. As more data on deaths from this year becomes available — there are indications that Tokyo has undercounted dozens of coronavirus deaths — the picture may not look quite as good.
Some say Japan may have a large hidden population of asymptomatic cases. Shigeru Omi, the deputy head of the government’s expert panel on the coronavirus, told lawmakers that the real number of infections could be as much as 10 or 20 times as high as currently believed. Japan has reported fewer than 17,000 cases, versus more than 1.7 million in the United States.Some say Japan may have a large hidden population of asymptomatic cases. Shigeru Omi, the deputy head of the government’s expert panel on the coronavirus, told lawmakers that the real number of infections could be as much as 10 or 20 times as high as currently believed. Japan has reported fewer than 17,000 cases, versus more than 1.7 million in the United States.
Updated June 30, 2020
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Norio Sugaya, an infectious diseases expert at Keiyu Hospital in Yokohama, noted that Japan’s mortality rate, while vastly lower than those in hard-hit countries like Spain or Britain, is one of the worst in Asia.Norio Sugaya, an infectious diseases expert at Keiyu Hospital in Yokohama, noted that Japan’s mortality rate, while vastly lower than those in hard-hit countries like Spain or Britain, is one of the worst in Asia.
In February, an outbreak of the virus aboard the cruise ship Diamond Princess left officials scrambling. The response was widely seen as a disaster, but health experts turned it into a learning opportunity.In February, an outbreak of the virus aboard the cruise ship Diamond Princess left officials scrambling. The response was widely seen as a disaster, but health experts turned it into a learning opportunity.
Epidemiologists and public health experts used the data from the ship to help develop a framework for stopping the virus’s spread in Japan.Epidemiologists and public health experts used the data from the ship to help develop a framework for stopping the virus’s spread in Japan.
The approach emphasized reducing people’s exposure to the conditions that led the pathogen to spread on the ship. A public education campaign urged people to avoid the “Three C’s” — closed spaces with poor ventilation, crowded places and close contact.The approach emphasized reducing people’s exposure to the conditions that led the pathogen to spread on the ship. A public education campaign urged people to avoid the “Three C’s” — closed spaces with poor ventilation, crowded places and close contact.
On TV talk shows, hosts took a “no question is too stupid” approach to talking about the virus, assuaging viewers’ anxiety and stressing the basic science of prevention: wash your hands, wear a mask, keep your distance from others.On TV talk shows, hosts took a “no question is too stupid” approach to talking about the virus, assuaging viewers’ anxiety and stressing the basic science of prevention: wash your hands, wear a mask, keep your distance from others.
At the same time, community health centers raced to investigate clusters using a monitoring system that had been developed to trace cases of influenza and tuberculosis.At the same time, community health centers raced to investigate clusters using a monitoring system that had been developed to trace cases of influenza and tuberculosis.
Another key factor may have been Mr. Abe’s decision to close schools in late February, well before almost any other country. The decision was hugely unpopular, but it appears to have provoked an almost instantaneous change in behavior, according to polling conducted by researchers at Hiroshima University.Another key factor may have been Mr. Abe’s decision to close schools in late February, well before almost any other country. The decision was hugely unpopular, but it appears to have provoked an almost instantaneous change in behavior, according to polling conducted by researchers at Hiroshima University.
The day after the announcement, the percentage of people who were avoiding crowded places nearly doubled, rising to almost 60 percent. By mid-March, it was over 75, the study found.The day after the announcement, the percentage of people who were avoiding crowded places nearly doubled, rising to almost 60 percent. By mid-March, it was over 75, the study found.
In April, as cases began to spike, Mr. Abe declared a state of emergency. Businesses were requested to close or reduce their hours. People were asked to make only necessary trips. There were no penalties, but many complied anyway.In April, as cases began to spike, Mr. Abe declared a state of emergency. Businesses were requested to close or reduce their hours. People were asked to make only necessary trips. There were no penalties, but many complied anyway.
Makoto Sasho, 50, decided to close his grilled eel restaurant in the Meguro neighborhood of Tokyo and focus on delivery and carryout, despite assurances from the government that businesses like his could continue table service.Makoto Sasho, 50, decided to close his grilled eel restaurant in the Meguro neighborhood of Tokyo and focus on delivery and carryout, despite assurances from the government that businesses like his could continue table service.
“We conformed to society’s expectations of us,” he said, adding that “when I thought about the future, I knew we absolutely could not be responsible for a cluster.”“We conformed to society’s expectations of us,” he said, adding that “when I thought about the future, I knew we absolutely could not be responsible for a cluster.”
As Japan now begins to reopen, some experts fear that people will begin to let down their guard.As Japan now begins to reopen, some experts fear that people will begin to let down their guard.
In a speech on Monday night, Mr. Abe emphasized that the end of the state of emergency did not mean a return to normal life.In a speech on Monday night, Mr. Abe emphasized that the end of the state of emergency did not mean a return to normal life.
“What we need to aim for,” he said, “is establishing a new normal.”“What we need to aim for,” he said, “is establishing a new normal.”
Mr. Sasho said that his customers were clamoring for him to reopen, but that he was not sure he was ready.Mr. Sasho said that his customers were clamoring for him to reopen, but that he was not sure he was ready.
“It’s a new way of life,” he said. “Maybe I’ll just stick with delivery and takeout.”“It’s a new way of life,” he said. “Maybe I’ll just stick with delivery and takeout.”
Motoko Rich contributed reporting.Motoko Rich contributed reporting.