Japan seeks to continue social and economic life amid the pandemic. In Japan, eight months after registering the first coronavirus cases, no mandatory confinements, fines or quarantine have yet been imposed, yet life is slowly returning to normal.
Schools, restaurants, and bars are open, its specific trains are once again full, and the government implements national campaigns to encourage the population to travel within the country or eat out, as strategies to recover the economy.
It is, according to their authorities, the result of a “unique approach” to the pandemic that has helped them keep the virus at bay and reduce the economic impact.
According to official data, as of this Wednesday, the Asian nation had registered some 1,500 deaths and just over 82,000 cases, while the death rate per 100,000 inhabitants was around 1% (in the United States, for example, it is 59%).
It is not the best result among Asian nations: Thailand, South Korea or Vietnam, at the mercy of more drastic measures, have had fewer cases.
But Japan's new strategy has proven unique in its blend of scientific approach, flexibility, and common sense.
“In Japan we are using a different approach than that which has been used in most of the world,” Dr. Hitoshi Oshitani, professor of virology at the Tohoku University School of Medicine, tells BBC Mundo.
“In most of the world, the strategy has been to try to contain the chorovirus. From the beginning, we did not have that goal. We opted for something different: we decided to learn to live with this virus,” he adds.
According to Oshitani, for this, “we tried to reduce the transmission as much as possible, while maintaining social and economic activities.”
Learning to live with the virus has been the basis of Japan's strategy.
“We accept that this virus is something that cannot be eliminated. In fact, the vast majority of infectious diseases cannot be eliminated, so we understood that the best way to combat it was to coexist with it,” he says.
Now that a second wave threatens Europe and the forecasts of new cases are increasingly worrying for the winter, Japan hopes that its experience can help other countries to think of new ways to deal with the pandemic while also trying to save the economy.
The Japanese approach
According to Oshitani, one of the elements that led Japan and other Asian countries to be better prepared to deal with the coronavirus is that, through history, they have suffered other epidemics and, contradictorily, that they are very close to China .
“As we are relatively close to Wuhan, which was where the pandemic originated, we prepared very quickly because we knew we could have many cases,” recalls the expert, who has been one of the government's main advisers in the strategy against the covid -19.
A few weeks after the virus became known in China, Japan also registered its first contagion.
It was just January 16 and it was not long before the situation in the country was aggravated by a cruise ship, the Diamond Princess, which became a source of infections in the port of Yokohama.
“Then in mid-March we had another outbreak, which was triggered by travelers arriving from Europe, the Middle East, North America and many other countries,” recalls the former World Health Organization adviser on communicable diseases. .
“This outbreak was under control by mid-May. The government had decreed a state of emergency and lifted it that month, but by then another wave of infections had begun from Tokyo, which is now beginning to decrease,” he adds.
It was in this context, Oshitani recalls, when the authorities in Japan understood that they needed a different way of approaching COVID-19.
“We knew from what happened in Wuhan that the virus is possible to contain, but that it is extremely difficult to do so. In Japan, however, we had no legal way to implement a quarantine or to force people to stay at home. “, He says.
Japan did not impose mandatory quarantine.
The country, despite being one of the most developed in Asia, also did not have the capacity to produce and carry out mass tests, as neighboring South Korea was doing.
“It was clear that we needed a different approach,” says Oshitani.
Last May, when then-Prime Minister Shinzo Abe lifted the state of emergency, he also announced that Japan's strategy to confront the virus would be “a new lifestyle” in which the coronavirus would begin to be seen as part of daily life.
“Now, we are going to venture into new territory. Therefore, we need to create a new way of life. We need to change our way of thinking,” he said.
The demands, however, were part of common sense: wear a mask, maintain social distance, wash your hands, do not yell, do not talk loudly, do not kiss or shake hands …
The foundations of science
According to Oshitani, the reasoning behind the Japanese strategy of living with the virus was not only encouraged by political or infrastructure reasons.
“It was based on our knowledge of the virus and what we were discovering about it,” he says.
Although currently the role of asymptomatic patients in the transmission of Covid-19 is a known fact throughout the world, it was the basis of Japan's strategy before it was accepted elsewhere.
Since mid-February, the Oshitani team had recommended taking into account that the virus could be transmitted by apparently healthy people.
“We knew that there are many asymptomatic cases or with very mild symptoms. This makes it very difficult to locate all the positive cases. And for that reason, our purpose was not to contain it from the beginning, but to try to suppress the transmissions as much as we could,” he says .
Japan's trains have started to fill up as usual.
Oshitani recalls that Japan's experience with the Cruise Princess led them to better understand how the virus worked.
“We knew that most of those infected with the virus, almost 80%, do not transmit it to anyone. Instead, a small proportion infect many others,” he says.
The effect, currently known as “supercontagion events” and which have subsequently been documented in other countries, led the Oshitani team to understand that “the transmission of this virus cannot be contained if the clusters” of infections are not controlled (group similar health events that have occurred in the same area at the same time).
“The control of these clusters has also been the basis of our strategy to live with the virus,” he says.
As part of the strategy, people can participate in sporting events, but cannot yell.
Experts from Japan soon also came to another conclusion that some countries still do not accept and that the WHO, although it has not ruled out, has not categorically recognized either: that the coronavirus can be transmitted by air.
“The evidence very early made us understand that the coronavirus is not only transmitted through coughing, sneezing and contact, but also in microparticles that float and circulate in the air,” he says.
This is how the strategy known as ” san mitsu ” emerged , a public health recommendation that has become the golden rule for living with the virus:
* avoid places with poor ventilation
* avoid places where there are crowds
* Avoid closed places where people speak loudly.
As part of this principle, sporting events, for example, are allowed, but people cannot shout. In many bars and restaurants, customers are asked to speak quietly or listen to music instead of chatting.
The cultural theme
According to Oshitani, various cultural and idiosyncratic aspects of Japan have also contributed to the local response to learning how to live a “normal” life during the pandemic.
“It is known that the Japanese are more likely to maintain physical distance than in the West and another element that has had a great impact is social pressure, nobody in Japan likes to be singled out as responsible for transmitting the virus,” he says.
Not wearing a mask in Japan can lead to strong social pressure.
According to a study by the Faculty of Psychology of the University of Doshisha, the widespread use of the mask in the country is not due to the desire to prevent the spread of the coronavirus, but to social pressure: the majority of Japanese prefer not to be questioned for not wearing it.
“Social pressure has undoubtedly helped contain the virus in Japan, but it has also created situations of discrimination for the sick or for workers in the health sector,” Oshitani says.
The dark side
The strategy, however, has been unpopular: opinion polls show a general dissatisfaction of the population with the central government, which they say has given a slow and confused response .
The low level of tests to detect the virus in the beginning and the obstacles that still exist for its access have also led many press media and local experts to assure that it has been an impediment to effectively track the disease.
And with the Olympics postponed until, ideally, 2021, the eyes of the world will follow for months to come how the country continues to fight the pandemic.
Oshitani doubts that holding the games will be possible even in 2021.
However, Oshitni doubts that, despite its results and its strategy of living with the virus, Japan can hold a sporting event of this magnitude next year.
“We are not fighting this virus for the Olympics, because we know that for something like this, we must also consider what other countries do. That is, we know that without the control of this virus in most of the world it is not possible to have the Olympics” he points out.
“If we celebrate them, we have to do it in a safe way and find the best way to do it. And at this moment, I'm not very sure that we have the capacity to do that,” he adds.