
Did Japan Just Beat the Virus Without Lockdowns or Mass Testing? - rendaw
https://www.bloomberg.com/news/articles/2020-05-22/did-japan-just-beat-the-virus-without-lockdowns-or-mass-testing
======
standardUser
"Experts are also credited with creating an easy-to-understand message of
avoiding what are called the “Three C’s” -- closed spaces, crowded spaces and
close-contact settings"

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.

~~~
beamatronic
Schools will have to be outdoors-only when they reopen in the fall. This will
work great, for a while.

~~~
standardUser
More time outdoors instead of indoors is always better. In Denmark, things
like teacher meetings are supposed to be outdoors now, and there's rules
around picking up and dropping off kids outside. But for kids n class, a
primary strategy places have used when reopening is to have kids stick with
the same group of ~10 everyday. In Denmark, they used museums and other public
places as overflow classrooms to keep class sizes extra small.

------
veidr
I live in Tokyo, and I just want to point out that the voluntary compliance
with the "request" to limit how much you go out appears to be better than the
compliance with legally mandatory lockdown in California, which itself is far
better than most other states in the US.

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.

~~~
svat
We have some data: looking at Google Covid-19 Community Mobility Reports, here
are the numbers for (Japan, California, US) compared to baseline:

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).

------
pjc50
We could do with HN's own patio11 to weigh in on the subject. He's been
tweeting intermittently about it:
[https://twitter.com/patio11/status/1260181776086925312](https://twitter.com/patio11/status/1260181776086925312)
[https://twitter.com/patio11/status/1255879667271086081](https://twitter.com/patio11/status/1255879667271086081)
[https://twitter.com/patio11/status/1255618267885924352](https://twitter.com/patio11/status/1255618267885924352)

"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](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](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)

~~~
tensor
Even a cursory google search is showing that many things in Japan are/were
closed: [https://jw-webmagazine.com/places-in-tokyo-closed-due-to-
the...](https://jw-webmagazine.com/places-in-tokyo-closed-due-to-the-novel-
coronavirus-covid-19/)

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.

~~~
xyzzy_plugh
Yes, the headline was rather shocking to me! What a misleading article, it's
very disappointing.

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.

~~~
anonymoushn
We don't have a lockdown because it's unconstitutional. The situation where
there's no lockdown and non-essential businesses that defect against society
by remaining open are financially rewarded is motivating talk of fixing the
constitution to allow lockdowns.

------
Seb-C
I live in Tokyo and I think the biggest factor is the individual sense of
responsibility.

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.

------
thonos
Living in Japan, the handling of the virus has been nothing but disappointing.
We entered "state of emergency" but besides schools and a few stores closing
nothing has changed. It is less people than before but the trains and buses
are still packed, there are lines at the supermarket, even fast food chains
(for takeout) and convenient stores, and families now chill outside and meet
other families because children are at home. Parks are filled with people and
the governments response has consistently only been "please stay at home"
which, based on my experience of doing grocery runs, got ignored mostly
outside of the major areas like Shibuya/Roppongi. Some business like pachinko
parlors flat out ignored the governments requests and the reply to that was
"close down or we will publicly announce your name".

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.

~~~
brenden2
Japan has pretty low rates of obesity and heart disease, that might be related
to the low death rate from the virus.

~~~
lbeltrame
Or perhaps the virus did not make way into hospitals or nursing care homes.
That's what happened in Italy, with hospitals turned into infection centers.
And hospitals have a significant number of people at risk in them. Same for
nursing care homes.

~~~
esyir
This is the country with the most dramatically aged population though. I'm
rather surprised.

------
anonymoushn
"businesses from restaurants to hairdressers stayed open" is a weird way to
describe a situation in which most restaurants are closed and many open ones
have transitioned to takeaway only.

Source: I live in Tokyo

------
jeffbee
There’s so much analysis about why this happened or that happened, but I feel
like these things are just incredibly sensitive to initial conditions. Some
place has a million cases because five infected people flew in and went to a
popular club. That place has few because one sick person arrived and just went
to bed at home. There’s not a lot of evidence that policy and response is
causal.

------
hprotagonist
_Japan has tested just 0.2% of its population -- one of the lowest rates among
developed countries.

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?!

~~~
standardUser
If the virus had spread in Japan at the same rate that we've seen in Italy and
New York, we would know it. We would see it in hospital admissions and the
number of deaths.

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.

------
xeromal
Read through the article and it seems like Japan didn't do anything out of the
ordinary besides using skilled contact tracing. I'm just guessing, but that
makes it seem to me like something cultural or genetic helped them avoid the
worst.

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.

~~~
dboreham
Mask wearing perhaps?

~~~
tzs
That's likely a very big part. There was a recent study which found that if
80% of a population wore masks, that would cut the COVID cases to about 1/12th
of what it would be in a population that took no protective measures.

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...](https://www.vanityfair.com/news/2020/05/masks-
covid-19-infections-would-plummet-new-study-says)

[2] [https://www.newegg.com/p/pl?d=masks](https://www.newegg.com/p/pl?d=masks)

[3] [https://www.newegg.com/picotee-face-
mask/p/0CE-02AC-00001](https://www.newegg.com/picotee-face-
mask/p/0CE-02AC-00001)

[4] [https://www.tomsguide.com/news/where-to-buy-face-masks-
and-c...](https://www.tomsguide.com/news/where-to-buy-face-masks-and-
coverings-online)

~~~
fraculus
I think first link really oversells the study it references, though.Key
quotes, from the paper:

"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](https://arxiv.org/pdf/2004.13553.pdf)

------
spion
The rate of infection largely depends on the initial rate of growth within the
country, which in turn depends mainly on cultural and environmental factors.

This spreadsheet

[https://docs.google.com/spreadsheets/d/1AeG07Bt1fOA-
msWYb9jW...](https://docs.google.com/spreadsheets/d/1AeG07Bt1fOA-
msWYb9jWAl_bdo2ThBea7t2NzjFp2to/edit#gid=0)

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/](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](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.

------
cczizou
Does anyone know if they wear masks more in Japan? That might make a
difference.

~~~
PKop
Way more. More culturally accepted and practiced widely.

This[0] is early April, government representatives all wearing masks, a normal
practice for Japan.

[0]
[https://www.arabnews.jp/en/japan/article_14235/](https://www.arabnews.jp/en/japan/article_14235/)

~~~
StavrosK
Is it really? Do you live in Japan, or have visited? When I was there, only
sick people (even from a cold/flu) wore masks, to prevent the spread of
disease.

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.

~~~
veidr
I live in Tokyo. In normal times, people wear masks when they are sick, as you
say. It's good manners, consideration toward others.

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.

~~~
StavrosK
That makes sense, thanks for the update. Where I live, it would have been
extremely weird to wear a mask outside, but now all the employees wear masks
everywhere. Some of them slack off sometimes and lower them to their neck, but
that's about it. Amazing how cultural norms can change in a few days.

------
8bitsrule
"... with deaths well below 1,000, by far the fewest among the Group of Seven
developed nations.... experts praise the role of Japan’s contact tracers,
which swung into action after the first infections were found in January. The
fast response was enabled by one of Japan’s inbuilt advantages -- its public
health centers, which in 2018 employed more than half of 50,000 public health
nurses who are experienced in infection tracing.... 'It’s very analog -- it’s
not an app-based system like Singapore...' "

Experienced people - not tech - working for a public health program. Prepared
for a blitz of 'news' about how this was a failure?

------
burlesona
So in short no one knows why it didn’t hit Japan harder, but they suspect
Cultural factors (mask wearing, speaking distance, etc.), along with
potentially genetic factors (fewer comorbities, possibly a different strain of
the virus).

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).

~~~
gizmo
Japan is certainly exposed to all strains because of air travel in the first
couple of months. So if there is a less virulent strain it would lose to the
more virulent strains out there.

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.

~~~
mikem170
Virulence describes a pathogens severity or infectiousness.

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).

~~~
gizmo
It's not inconceivable, but it would be a very convenient coincidence. I take
it this less harmful strain also got to Greece, Belarus, Morocco, Bolivia, and
Florida?

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).

------
ck2
How can you do near zero testing then declare the curve has been flatted? You
can claim anything if proof isn't required.

~~~
gizmo
Either the bodies pile up or they don't. No bodies no crisis.

------
zebrafish
What happened to that guy who posted a few weeks ago with warnings about Japan
that had tweeted hashes of his text files?

~~~
StavrosK
patio11?

------
neonate
[https://archive.md/uyP7B](https://archive.md/uyP7B)

------
sinker
Anyone know why this is flagged?

~~~
detaro
The number of top comments suggesting that it's not accurately reporting the
situation on the ground seem like the likely reason.

------
LatteLazy
Unless Japan is willing to close its borders for a long time, this is a
pitstop and likely mismanagement

------
gridlockd
Japan barely did any testing at all, the virus is bound to have spread much
further than numbers would lead to believe.

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.

------
ed25519FUUU
> _No restrictions were placed on residents’ movements, and businesses from
> restaurants to hairdressers stayed open._

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!

~~~
JadeNB
> 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!”

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.

~~~
gizmo
How would you know closing park benches or beaches works? Studies clearly show
that covid19 is primarily transmitted in enclosed spaces with poor air
circulation. This is also common sense, because if the virus was so contagious
that it would spread on park benches or beaches then the virus would spread
like wildfire in grocery stores. 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.

~~~
JadeNB
> How would you know closing park benches or beaches works?

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.

~~~
huonpine
The USA strategy unfortunately is the re-election of the current
administration, a strategy that will never have widespread support so any
tactics you implement will not have widespread adoption without heavy-handed
enforcement.

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.

