
Why is Japan still a coronavirus outlier? - notlukesky
https://www.japantimes.co.jp/opinion/2020/03/21/commentary/japan-commentary/japan-still-coronavirus-outlier/#.XnZH06FRUlQ
======
bruxis
> 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.

~~~
tomerico
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.

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

~~~
standardUser
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.

~~~
lovemenot
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.

------
l_davis
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.

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

~~~
dragonwriter
> 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.

~~~
barry-cotter
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/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440799/)

------
nabla9
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.

~~~
Reason077
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.

~~~
Hamuko
> _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.

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

~~~
why-oh-why
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...](https://www.who.int/substance_abuse/publications/global_alcohol_report/msb_gsr_2014_3.pdf)

~~~
barry-cotter
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.

------
sendos
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

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

~~~
SideburnsOfDoom
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_...](https://en.wikipedia.org/wiki/List_of_countries_by_hospital_beds)

~~~
chmod775
> 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.

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

------
delhanty
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/](http://hntokyo.io/)

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

[2]
[https://www.japantimes.co.jp/news/2020/03/20/national/school...](https://www.japantimes.co.jp/news/2020/03/20/national/school-
can-reopen-april-after-coronavirus-shurtdown/)

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

~~~
delhanty
HN Kansai meetp & slack are here:

[http://hnkansai.org/](http://hnkansai.org/)

[https://hnkansai-slack.now.sh/](https://hnkansai-slack.now.sh/)

HN Fukuoka is here:

[https://www.meetup.com/Hacker-News-Fukuoka/](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](https://github.com/antontarasenko/hacker-news-groups)

------
randcraw
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://ageconsearch.umn.edu/record/14321?ln=en)

[https://en.wikipedia.org/wiki/Obesity_in_Italy](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.

~~~
mscrivo
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.

------
phkahler
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.

~~~
lioeters
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.”

~~~
phkahler
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.

------
DoreenMichele
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...](https://www.verywellhealth.com/the-japanese-lung-cancer-smoking-
paradox-2248990)

~~~
m3kw9
Maybe check how many smokes they usually do. I know some people in western
countries will smoke a pack a day.

~~~
DoreenMichele
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.

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

------
K0SM0S
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.

~~~
lazyier
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.

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

~~~
claytongulick
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).

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

~~~
K0SM0S
[https://science.sciencemag.org/content/early/2020/03/13/scie...](https://science.sciencemag.org/content/early/2020/03/13/science.abb3221)

> 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.

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

------
philliphaydon
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.

~~~
flocial
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.).

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

[https://news.ycombinator.com/item?id=22605657](https://news.ycombinator.com/item?id=22605657)

~~~
Zarel
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.

~~~
pdr2020
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.

~~~
Zarel
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.

------
syntaki
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.

~~~
syntaki
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.

~~~
lopis
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.

~~~
robocat
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).

~~~
brianwawok
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.

~~~
robocat
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.

------
lemoncookiechip
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/](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.

~~~
pldr2244
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.

------
ivalm
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.

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

~~~
klipt
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.

~~~
deelowe
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.

~~~
ttsda
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.

~~~
maxerickson
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.

~~~
bluGill
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)

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

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

------
scythe
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-...](https://www.japantimes.co.jp/news/2020/02/25/national/japan-
mask-shortages-covid19/)

> _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?

~~~
hyperman1
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.

------
kirubakaran
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](https://twitter.com/patio11/status/1241103181511180288)

~~~
forgotmyhnacc
I don't think patio11 is a Japan expert.

~~~
spion
Yeah, he simply lives there.

------
Quarrelsome
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.

~~~
greedo
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.

~~~
taeric
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.

~~~
greedo
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.

~~~
taeric
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.)

------
adev_
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.

~~~
maps7
\- 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

~~~
barry-cotter
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](http://bit.ly/37Ay6Cm)

[https://twitter.com/Surgeon_General/status/12337257852839321...](https://twitter.com/Surgeon_General/status/1233725785283932160?s=20)

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

~~~
barry-cotter
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.

~~~
boomboomsubban
>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.

~~~
barry-cotter
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.

~~~
boomboomsubban
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.

~~~
tagrun
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.

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

~~~
tagrun
> 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.

------
exegete
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...](https://covid19dashboards.com/compare-country-death-
trajectories/) 2\. [https://covid19dashboards.com/compare-country-
trajectories/](https://covid19dashboards.com/compare-country-trajectories/)

------
tosser0001
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?

~~~
mschuster91
> 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.

~~~
tosser0001
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.

~~~
mschuster91
> 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.

~~~
MikeAmelung
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.

~~~
mschuster91
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.

------
chvid
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.

~~~
pldr2244
They really didn’t implement a China travel ban? I find that hard to believe

------
jccalhoun
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.

------
timtim2020
points not discussed well in western media: 1) they do crashing clusters very
well based on this paper.
well[https://www.medrxiv.org/content/10.1101/2020.02.28.20029272v...](https://www.medrxiv.org/content/10.1101/2020.02.28.20029272v1)

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...](https://data.oecd.org/healtheqt/computed-tomography-ct-scanners.htm)
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.

------
pldr2244
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.

------
timtim2020
points not discussed well in western media:

1) they do crashing clusters very well based on this paper.
well[https://www.medrxiv.org/content/10.1101/2020.02.28.20029272v...](https://www.medrxiv.org/content/10.1101/2020.02.28.20029272v1)

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...](https://data.oecd.org/healtheqt/computed-tomography-ct-scanners.htm)
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.

------
timtim2020
points not discussed well in western media:

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

------
justicezyx
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.

~~~
adev_
> 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.

~~~
justicezyx
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.

------
vr46
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.)

~~~
cmod
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.

------
nobody0
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...](https://inc42.com/buzz/masayoshi-son-gets-criticised-for-his-free-
coronavirus-testing-initiative/)

------
ljw1001
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.

------
narogab
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?

------
gridlockd
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.

------
billfor
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.

------
jameslevy
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.

------
m3kw9
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.

------
daxfohl
I wonder if "no shoes in the house" plays a role.

~~~
saluki
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.

------
zachguo
It's worthwhile to track whether there's suspicious spike in number of
Kodokushi.

------
tarkin2
Re social distancing:

Italians and Spanish kiss when they greet each other. They’re the worst hit in
Europe.

------
mirimir
I wonder if there could be a genetic factor. Maybe something ~unique to
Japanese?

~~~
tcbawo
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](https://www.bbc.com/news/world-us-canada-51978164)]. Being
relatives, though, they may have all had similar comorbidities.

~~~
mirimir
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.

------
corey_moncure
Isn't India the real elephant in the room here?

------
proffeature8
More iodine in their diet?

------
pritovido
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.

------
tompccs
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.

