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Why is Japan still a coronavirus outlier?

• m3kw9 7y ago
  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.
• nabla9 7y ago
  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.
  • kragen 7y ago
    There were 30 or so cases before the Shincheonji contagion, in which, yes, one cult member single-handedly tripled the number of cases in one day. But at the usual 33% per day intra-country contagion rate, even single-handedly tripling the number of cases only moves the calendar forward by about 4 days. I do agree that Japan probably has diagnosed a much smaller proportion of cases.
    • tooltalk 7y ago
      IIRC, there were no new case or low single digit cases for almost a full week before the ShinCheonJi outbreak, after which the number of cases increased to three digits new cases per day.
      • kragen 7y ago
        You're right about that, and that would amount to effective containment, so I guess I was wrong.
  • SpicyLemonZest 7y ago
    The outlier is that Japanese statistics don't seem to show an exponential curve at all. Their highest daily counts of new cases remain in mid-February, and they've been oscillating closely around 50 a day for over 2 weeks now. There's almost surely undertesting happening based on their testing criteria, but even with fixed testing criteria, exponential growth at any rate above like 10% per day should have been obvious in severe cases by now.
  • Reason077 7y ago
    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 7y ago
      >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 7y ago
        Indeed. Italy has among the highest rates of working adults living with their parents in the world for one.
        • why-oh-why 7y ago
          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_alcohol_report/msb_gsr_2014_3.pdf https://www.who.int/substance_abuse/publications/global_alco...
          • barry-cotter 7y ago
            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.
        • Reason077 7y ago
          That’s a very good point. There must be multiple social and environmental factors that have contributed to Italy being hit so hard (age of population, high rates of smoking and high levels of air pollution have also been suggested), but that could well be one of them.
  • daxfohl 7y ago
    Could be that social norms of Japan make the exponent approximately 1. It's a stretch, but not impossible.
  • tomcooks 7y ago
    Patient zero in Lombardy has never been found.
    • selimthegrim 7y ago
      The guy that that fellow in Codogno met could have brought back contaminated item from Wuhan
      • tomcooks 7y ago
        Have you got any source on this? If you do you should contact italian authorities.
    • kevin_thibedeau 7y ago
      Lots of Chinese staffed sweat shops are manufacturing "Made in Italy" products.
• ivalm 7y ago
  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 7y ago
    I think it will turn that wearing masks has a much bigger effect than anticipated. (I suppose that's a form of social distancing.)
    • knocte 7y ago
      Agree with this. I live in Hong Kong and there was no forced lockdown here either because 95% of the people wear them voluntarily.
      • joemi 7y ago
        It almost certainly has more to do with your society's overall approach to sickness than it does with just masks specifically. Here in NYC, loads of sick people have no qualms with squeezing in between two people on the subway, coughing into the same hand they're about to use to turn a doorknob with, and so on. Wearing masks might help a tiny bit against inconsiderate people like that, but not a lot. I'm sure such inconsiderate people exist in Hong Kong too, but I'd be willing to bet that there are fewer, and that wearing masks is an indicator that more people are actually considerate about their sicknesses in HK than in the US.
    • klipt 7y ago
      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 7y ago
        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.
• bruxis 7y ago
  > 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.
  • thelittleone 7y ago
    I spent some time in Japan for work and was always amazed how many people had face masks on (even when there is no pandemic) and the prevalent of wearing gloves (driving etc). With my limited time there it seemed to be one of the most proactively sanitary cultures I’ve seen. Also it seemed to me that at business meetings generally people bow instead of shaking hands. And I wonder if this reflects the general approach to person to person contact. Contrast that to Italy for example where kissing and embracing is not uncommon even when meeting someone for the first time.
    • ysw0 7y ago
      I think this is the case. Japanese (and other East Asians) already have a pre-existing mask culture. Wearing a mask is normal over there and is encouraged. They also do not hug, shake hands and have body contact with does that are not family or close friends. Another big factor is that they tend to follow the rules unlike in Italy or America where social distancing suggestions were not taken seriously by a large chunk of the population. Even with these explanation, I'm still perplexed as trains in Japan are always packed and it's impossible to stay 6-feet away from others when you're travelling in dense cities in Tokyo. You're also constantly touching poles/handles in the train or pushing elevator buttons.
      • hkmurakami 7y ago
        Also generally speaking the culture doesn't have too much "family style" eating habits which helps at the margins.
• baxtr 7y ago
  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 7y ago
    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.
    • l_davis 7y ago
      I'm sure PM Abe is sweating bullets. Japan has been in an economic slump for decades. The Olympics and associated tourism was supposed to fix that (and Japan has seen a big increase in tourists in recent years as they gear up). And now this?
    • pdr2020 7y ago
      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 7y ago
        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.
• scythe 7y ago
  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-mask-shortages-covid19/ https://www.japantimes.co.jp/news/2020/02/25/national/japan-... >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 7y ago
    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.
• sendos 7y ago
  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 7y ago
    The counterclaim is that Japan has an unusually high per capita number of ICU beds.
    • MikeAmelung 7y ago
      https://www.forbes.com/sites/niallmccarthy/2020/03/12/the-countries-with-the-most-critical-care-beds-per-capita-infographic/#3e76f8447f86 https://www.forbes.com/sites/niallmccarthy/2020/03/12/the-co... So is this nonsense?
    • SideburnsOfDoom 7y ago
      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_beds https://en.wikipedia.org/wiki/List_of_countries_by_hospital_...
      • nicoburns 7y ago
        Note: that article also lists number of ICU beds per 100000 population, and it seems that it's not that highly correlated. Turkey has the most ICU beds.
      • chmod775 7y ago
        > 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 7y ago
• justicezyx 7y ago
  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_ 7y ago
    > 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.
    • teyc 7y ago
      I wouldn't say the Chinese have a particularly penchant for being obedient any more any any one else. The countries which are winning against COVID are those who don't give loudspeakers to stupid people. Just saying.
    • justicezyx 7y ago
      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.
• Reedx 7y ago
  Healthier population and strong pre-existing social norms/habits conducive to limiting spread?
  • nostromo 7y ago
    Those are definitely some “pros” but a big “con” is they have the oldest general population of any country.
    • deleted 7y ago
      [deleted]
• daxfohl 7y ago
  I wonder if "no shoes in the house" plays a role.
  • saluki 7y ago
    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.
• proffeature8 7y ago
  More iodine in their diet?
  • narogab 7y ago
    and much more zinc (oyster, crab, lobster, etc.) than in a Western diet.
• Quarrelsome 7y ago
  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.
  • _6fmb 7y ago
    Factually the virus has not accidentally missed Japan. Japan has a substantial number of cases, on par with countries that are entering danger zones, just seems like there is no exponential spreading.
  • greedo 7y ago
    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.
    • pdr2020 7y ago
      This is the correct mode of thinking. Rationally consider what conditions could be creating the current scenario, and keep all of them in mind when considering any news/claims that Japan is an outlier. Also agree that COVID-19 will be fertile ground for dissertations in the future.
    • taeric 7y ago
      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.
• l_davis 7y ago
  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 7y ago
    I do wish US politicians would tell people to go back to work, but wear operation masks.
    • kube-system 7y ago
      Do you think people would actually wear them, and wear them correctly enough that it would be effective? I don't think the US can be culturally expected to handle the situation the same way east Asia does.
    • zrail 7y ago
      Where would we find operation masks? s far as I can tell they’re still sold out literally everywhere.
      • l_davis 7y ago
        I ordered cotton masks from Etsy. They are supposed to arrive by the end of the month. Select vendors in the US for speed. Amazon has lots of cotton masks, but they all seem to be shipped from China, which means they will take awhile to arrive. (Am assuming US buyers. Looks like Etsy vendors are all over though so you can probably find a vendor locally in many countries.) There are plenty of patterns for cotton masks online and I think ways to use a 3D printer to make one. I would much rather just buy one, myself.
        • 7y ago
• exegete 7y ago
  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-trajectories/ https://covid19dashboards.com/compare-country-death-trajecto... 2. https://covid19dashboards.com/compare-country-trajectories/ https://covid19dashboards.com/compare-country-trajectories/
• _9ijd 7y ago
  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.
  • _9ijd 7y ago
    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 7y ago
      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.
      • jiofih 7y ago
• kirubakaran 7y ago
  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 7y ago
    I don't think patio11 is a Japan expert.
    • spion 7y ago
      Yeah, he simply lives there.
• chvid 7y ago
  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 7y ago
    They really didn’t implement a China travel ban? I find that hard to believe
• tompccs 7y ago
  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.
• DoreenMichele 7y ago
  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-smoking-paradox-2248990 https://www.verywellhealth.com/the-japanese-lung-cancer-smok...
  • m3kw9 7y ago
    Maybe check how many smokes they usually do. I know some people in western countries will smoke a pack a day.
    • DoreenMichele 7y ago
      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 7y ago
        If iodine is the reason, probably from seaweed rather than shellfish.
    • catalogia 7y ago
      In western countries, a pack a day used to be considered moderate. Some people still smoke a ton more than that, chainsmoking every hour they're awake, but it's not as common as it used to be.
• adev_ 7y ago
  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.
  • xenospn 7y ago
    Counter point: My Japanese friends have been and still are going out to bars every night like nothing happened.
    • foota 7y ago
      Maybe this shows the relative importance of different measures? Not saying that we elsewhere should go out to bars, since we're thoroughly lacking in the other parts. Edit: downthread people suggest a lack of testing, probably a better explanation.
    • luspr 7y ago
      Why shouldn't they? There are probably no cases in the community.
    • kamikaz1k 7y ago
      I have heard the same from a Japanese friend, not in a major city either. Seems even families are going about normally with their children, to McDonald's and such.
      • SpicyLemonZest 7y ago
        What they're not doing is sending their children to school. Maybe that intervention alone is enough to suppress it.
• tosser0001 7y ago
  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 7y ago
    > 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 7y ago
      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 7y ago
        > 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.
• tarkin2 7y ago
  Re social distancing: Italians and Spanish kiss when they greet each other. They’re the worst hit in Europe.
• lemoncookiechip 7y ago
  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.
  • ljw1001 7y ago
    >EDIT: Lastly and this is a factor that none of us even suggested, is luck. Luck is important and impossible to control. Luck doesn't work with this kind of scenario. You'd have to be lucky hundreds of millions of times (every time there was a potential spread)
  • pldr2244 7y ago
    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.
• jccalhoun 7y ago
  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.
• gridlockd 7y ago
  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.
• cryptica 7y ago
  I'm getting tired of all the Coronavirus news. Did anyone realize that Bernie Sanders's campaign is over and now it's just Trump and Biden left? When I found that out, I thought it was fake news. But Googling around, it seems that his campaign is really on the rocks. WTF! Why is no one talking about that news??? Oh wait I know...
• pldr2244 7y ago
  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.
• pritovido 7y ago
  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.
• ljw1001 7y ago
  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.
• phkahler 7y ago
  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 7y ago
    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 7y ago
      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.
• ghesboro 7y ago
  Because of the Olympic games, isn't that obvious?
• K0SM0S 7y ago
  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 7y ago
    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.
• delhanty 7y ago
  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-can-reopen-april-after-coronavirus-shurtdown/ https://www.japantimes.co.jp/news/2020/03/20/national/school...
  • raybb 7y ago
    Do you know if there are slack workspaces for other regions?
    • delhanty 7y ago
      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
• corey_moncure 7y ago
  Isn't India the real elephant in the room here?
• vr46 7y ago
  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.)
  • sharken 7y ago
    At this point it will hardly matter what numbers Japan present to the world, it is the rest of the world that will decide. Continued lockdown will make it very hard to train properly, leading to a belief that the olympics should be moved. The show must go on does not seem to apply. Already now the European football championship has been postponed.
  • wolco 7y ago
    Why not wait until people will come and see it anyways? Rushing it seems foolish.
  • cmod 7y ago
    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.
• randcraw 7y ago
  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 7y ago
    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.
  • thegabriele 7y ago
    That wikipedia article makes no sense at all. Here's a good resource https://www.oecd.org/els/health-systems/obesityandtheeconomicsofpreventionfitnotfat-italykeyfacts.htm https://www.oecd.org/els/health-systems/obesityandtheeconomi... One out of 10 italians is obese. The 42% you're referring to is the data for children.
• timtim2020 7y ago
  points not discussed well in western media: 1) they do crashing clusters very well based on this paper. wellhttps://www.medrxiv.org/content/10.1101/2020.02.28.20029272v1 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-scanners.htm 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. 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.
• timtim2020 7y ago
  points not discussed well in western media: 1) they do crashing clusters very well based on this paper. wellhttps://www.medrxiv.org/content/10.1101/2020.02.28.20029272v1 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-scanners.htm 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.
• timtim2020 7y ago
  points not discussed well in western media: 1) they do crashing clusters very well based on this paper. wellhttps://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.
• mirimir 7y ago
  I wonder if there could be a genetic factor. Maybe something ~unique to Japanese?
  • tcbawo 7y ago
    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 7y ago
      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.
• nobody0 7y ago
  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-free-coronavirus-testing-initiative/ https://inc42.com/buzz/masayoshi-son-gets-criticised-for-his...
• narogab 7y ago
  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?
• philliphaydon 7y ago
  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 7y ago
    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.).
• billfor 7y ago
  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 7y ago
  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.
• zachguo 7y ago
  It's worthwhile to track whether there's suspicious spike in number of Kodokushi.