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Glad to see the safety of athletes and the public is being protected. I wonder why Japan seems to have such low numbers even though they had coronavirus very e

Glad to see the safety of athletes and the public is being protected. I wonder why Japan seems to have such low numbers even though they had coronavirus very early as well as many cases from the cruise ship.

afarrell 7y ago
I conjecture that since there is a cultural norm of wearing masks when sick, everyone had masks at home. Because of this, they put the masks on when apparently-healthy to avoid getting sick. Because of this, the asymptomatic people didn't spread the virus nearly as much.
- bitwize 7y ago
  I think that more than masks, Japanese are more fastidious about handwashing. For example, Japanese restaurants routinely supply a wet Handi-Wipe with your meal -- even McDonald's.
  - SAI_Peregrinus 7y ago
    And they don't shake hands. That's a very easy way to transfer germs, and endemic to Western culture.
- umanwizard 7y ago
  Masks also help you avoid getting the virus if you’re not infected. It’s a complete myth that they don’t; literally all research points in the same direction.
  - ChrisBland 7y ago
    Of course; we just can't say that part out loud otherwise there would be a run on masks and the healthcare workers would be in such a shortage it would further exacerbate the strain on the healthcare system.
    - mindslight 7y ago
      Is there not already a run on masks? More like the truth is not being said because then people would be more inclined to ask questions like why the "greatest country on earth" is unable to procure basic necessities for a crisis, especially with two months to prepare.
  - GuB-42 7y ago
    Yes, if we somehow manage to get a massive supply of masks, I expect all officials to do a 180 turn and ask everyone to wear them. The problem now is that we don't have enough, so we downplay their effectiveness, to limit panic buying and to make sure that people who need them the most get them. It is a perfectly understandable, though a little dishonest strategy. Also, we don't to give people a false sense of security, being close to someone with a mask is still worse than being far from someone without a mask.
    - xamuel 7y ago
      It runs the risk, though, of murdering the credibility of those officials. Who will trust anything they say, when they're right there on the record intentionally telling ridiculous lies? If masks should be diverted to hospitals, then the correct action would be to divert them to hospitals, not to lie to people.
    - kijin 7y ago
      You don't even need to wear a N95 mask, or wear it according to the book. Anything that can reduce the number of virus particles you are exposed to when someone nearby sneezes, or when you touch a surface that was recently sneezed on and then touch your face, can be helpful when millions of people do the same. A T-shirt over your mouth or a handkerchief tied around your head might not protect you personally. But if enough people wear them, even a small reduction of viral load in the community will compound over time and result in a meaningful difference in the total number of cases and the load it puts on a nation's health system. That's what ultimately matters, and that's what the Japanese and Koreans understand. Any country that has the guts to order their citizens to stay home should also have the sense to order them to cover their faces with something substantial whenever they have a valid reason to be outside, e.g. going to work.
    - Symmetry 7y ago
      I don't know if that's true. Surgical masks are pretty good at stopping droplets but they only stop 80% of virus sized particles and that's really not good enough for most medical use cases. It's a lot easier to teach new doctors and nurses "surgical masks don't protect you" than go into details. I expect health officials are just repeating the received wisdom which is close enough to true in their circumstances rather than deliberately being deceptive. People round off quantitative information to qualitative judgements all the time. Nate Silver still has people being angry at him for "Predicting Hillary would win" when he said at there was a 2/3 chance of that happening. It's such a pervasive phenomenon I don't see any reason to think it couldn't be happening here.
  - paranoidrobot 7y ago
    This is repeated a lot, however just like most things - there's more nuance to it than just "wear masks". In most places, there's simply not enough masks to protect those most at risk (eg: healthcare workers who are constantly in contact with infected patients) AND to have everyone in the community using them. Improper use of masks is at best pointless, at worst can actually make things worse. The vast majority of people are not used to wearing PPE or dealing with contaminated items. It requires some level of training to fit and wear a mask correctly, and how to properly dispose of them. You see this with a number of people touching the outside of their mask, and then scratching their face/nose/eyes. or pulling their mask down below their nose, or where it's not even properly sealed around their mouth.
    - endorphone 7y ago
      They didn't say just wear masks. You're beating on a strawman. Masks protect the wearer. This is blatantly obvious and scientific reality. Messages to the contrary are absolute propaganda (for instance a common line is "there is no evidence to show protection for civilians"[1] --- because there has never been a study for that case. Yet it's a specious, absurd claim because we know the masks are protective). Yes, masks are in short supply. This doesn't make misinformation acceptable (including the absurd, anti-reality claim that unless you're perfectly trained and certified perfectly fitted it is "pointless", which is just ridiculous noise). People already touch their face hundreds to thousands of times a day, so the other fear mongering "you'll adjust it" is another bit of nonsensical noise. As supplies ramp up and we have to return to some semblance of normal society, masks will not only be seen prevalently, they'll be encouraged as one mechanism of controlling spread. And at the time it'll be interesting how all of the propagandists change their tune. [1] Excluding the evidence in front of our eyes where countries where mask use is prevalent are seeing little spread.
    - tomp 7y ago
      Can you explain how improper use of masks can make things worse?
      - monkeywork 7y ago
Razengan 7y ago
An overall high level of urban hygiene and general cleanliness, some social distancing already being the norm (generally not touching each other, though there are severe exceptions like the overcrowded trains at rush hour) and a respect for public order.
- spuz 7y ago
  What is your source for this?
  - cm2012 7y ago
    Generally when people tell anecdotal stories/things they remember, there's no source. It's kind of silly to ask him for something like hand washing statistics for Japan vs the world, that's clearly not what he's providing.
    - spuz 7y ago
      Sorry I guess my question wasn't clear. I meant to ask, what is the source that those hygiene practices he mentioned are factors in the lower rates of spread of the virus given that other countries such as Italy and Spain have enacted stricter measures and yet show higher rates of spread? I am not asking for sources to show the difference in cultural practices.
      - Razengan 7y ago
        I have no source for that, and it was a guess/suggestion for your original question, that maybe because preventive measures were already in place in the culture, they may have slowed the spread before proactive measures were taken.
  - Razengan 7y ago
    Visiting, watching and talking. You can get some sense of it just from watching any of the street walks/tours on YouTube and other unscripted videos of daily life there.
brazzy 7y ago
Fairly early government measures for containment and mitigation: selective border closure or preventative quarantine for people from affected regions (much easier to implement as an island nation), closing of schools.
jariel 7y ago
What's interesting is that none of the answers seem definitive. 1) 'Mask wearing' - we know even cloth masks will help reduce spread, but not by what factor overall. We don't know the real vectors here. 2) Someone mentioned 'hygiene' - do the Japanese really wash their hands every time they enter the house? Or do they 'rinse their food' i.e. maybe package handling is a big vector. 3) 'Early border closing' - it only takes a handful of cases to cause the spread. Nobody has been able to 'keep it out' this way. 4) Some cynical commenters indicated it's due to low testing and governments wanton to 'keep the numbers down' which is hard to buy because the truth would hit hard when hospitals start to fill up. 5) Timing. Taking strong measures early may have made all the difference. If you can truly keep the numbers small, it becomes more manageable on a case by case basis. Or all of the above. I hope we are able to isolate the real transmission vectors that affect R0, but we may never really know.
- qiqitori 7y ago
  There are too many things that may or may not have some kind of effect. Adding to the brainstorming list: taking your shoes off at home, showering in the evening vs. in the morning. BTW I don't think people wash their hands more in Japan, but who knows. There definitely are places within Japan that have more cases despite having a lower population density. Okinawa (south) has very few cases, while Hokkaido (north) has a lot of cases. That seems to support the hypothesis that climate plays a major role.
  - jariel 7y ago
    Yes, literally showing at night might make a difference. So many things: maybe they regularly clean the handles on doors. Maybe the restaurants always use a disinfectant wipe. Maybe people 'stay at home' more regularly if they are sick. There's a really powerful EpiCurve calculator someone at OpenAI published - and the most interesting thing is how sensitive everything is to R0. R0 1.8 v. 2.2 is just a huge difference. If 'social distancing' brings it down some, but then 'showing at night' nudges it a little bit lower, voila, noticeably less spread. It's going to take a very keen measure of variables, in fact, it's going to take a keen observation of culture to even figure out what those variables are. Sadly, I don't have faith we'll ever get there.
lawn 7y ago
In addition to the other points they aren't testing as much.
williamscales 7y ago
I read yesterday that Japan had administered something like 16,000 COVID-19 tests in total. So I think they're basically not testing and hoping that it goes away.
- freetime2 7y ago
  I would be interested to read if you could share the source for the above. It’s true that Japan only seems to be testing people with serious symptoms at the moment. But we would expect hospitalizations and deaths to be higher if the number were really that high.
  - Hamuko 7y ago
    Doesn't Japan already have a pretty high number of death for the supposed amount of cases? Sweden for example has 36 deaths for 2286 cases whereas Japan has 42 deaths for 1140 cases. And South Korea has 9037 cases and 120 deaths, so about three times as many deaths but nine times as many cases.
  - summerlight 7y ago
    Japan actively avoids testing if those deaths are due to COVID-19. If someone recently dies with pneumonia, it's worth to test if this is the COVID-19 case. Japan doesn't and it claims that the public fear will overload and collapse their medical infrastructure. I don't really understand why this can even be the case, but this is a broadly accepted sentiment around Japan. And its annual death toll from typical pneumonia is around 100k, so Japan can easily hide it even if they had hundreds of the COVID-19 death cases by not testing it. https://www.japantimes.co.jp/news/2020/03/24/national/tokyo-governor-urges-cooperation-avoid-city-lockdown/ https://www.japantimes.co.jp/news/2020/03/24/national/tokyo-... Meanwhile, Tokyo's governor is actively considering lock-down due to a potential explosive rise. Lock-down for a city like Tokyo (which has roughly one third of their entire GDP) is clearly a nuclear option. If you really have only hundreds of the cases, this can (and should) be handled by comprehensive testing and tracing like S. Korea. Or perhaps their confidential COVID-19 projection doesn't agree with Japan's official stats...

afarrell 7y ago

I conjecture that since there is a cultural norm of wearing masks when sick, everyone had masks at home. Because of this, they put the masks on when apparently-healthy to avoid getting sick. Because of this, the asymptomatic people didn't spread the virus nearly as much.

bitwize 7y ago
I think that more than masks, Japanese are more fastidious about handwashing. For example, Japanese restaurants routinely supply a wet Handi-Wipe with your meal -- even McDonald's.
- SAI_Peregrinus 7y ago
  And they don't shake hands. That's a very easy way to transfer germs, and endemic to Western culture.
umanwizard 7y ago
Masks also help you avoid getting the virus if you’re not infected. It’s a complete myth that they don’t; literally all research points in the same direction.
- ChrisBland 7y ago
  Of course; we just can't say that part out loud otherwise there would be a run on masks and the healthcare workers would be in such a shortage it would further exacerbate the strain on the healthcare system.
  - mindslight 7y ago
    Is there not already a run on masks? More like the truth is not being said because then people would be more inclined to ask questions like why the "greatest country on earth" is unable to procure basic necessities for a crisis, especially with two months to prepare.
- GuB-42 7y ago
  Yes, if we somehow manage to get a massive supply of masks, I expect all officials to do a 180 turn and ask everyone to wear them. The problem now is that we don't have enough, so we downplay their effectiveness, to limit panic buying and to make sure that people who need them the most get them. It is a perfectly understandable, though a little dishonest strategy. Also, we don't to give people a false sense of security, being close to someone with a mask is still worse than being far from someone without a mask.
  - xamuel 7y ago
    It runs the risk, though, of murdering the credibility of those officials. Who will trust anything they say, when they're right there on the record intentionally telling ridiculous lies? If masks should be diverted to hospitals, then the correct action would be to divert them to hospitals, not to lie to people.
  - kijin 7y ago
    You don't even need to wear a N95 mask, or wear it according to the book. Anything that can reduce the number of virus particles you are exposed to when someone nearby sneezes, or when you touch a surface that was recently sneezed on and then touch your face, can be helpful when millions of people do the same. A T-shirt over your mouth or a handkerchief tied around your head might not protect you personally. But if enough people wear them, even a small reduction of viral load in the community will compound over time and result in a meaningful difference in the total number of cases and the load it puts on a nation's health system. That's what ultimately matters, and that's what the Japanese and Koreans understand. Any country that has the guts to order their citizens to stay home should also have the sense to order them to cover their faces with something substantial whenever they have a valid reason to be outside, e.g. going to work.
  - Symmetry 7y ago
    I don't know if that's true. Surgical masks are pretty good at stopping droplets but they only stop 80% of virus sized particles and that's really not good enough for most medical use cases. It's a lot easier to teach new doctors and nurses "surgical masks don't protect you" than go into details. I expect health officials are just repeating the received wisdom which is close enough to true in their circumstances rather than deliberately being deceptive. People round off quantitative information to qualitative judgements all the time. Nate Silver still has people being angry at him for "Predicting Hillary would win" when he said at there was a 2/3 chance of that happening. It's such a pervasive phenomenon I don't see any reason to think it couldn't be happening here.
- paranoidrobot 7y ago
  This is repeated a lot, however just like most things - there's more nuance to it than just "wear masks". In most places, there's simply not enough masks to protect those most at risk (eg: healthcare workers who are constantly in contact with infected patients) AND to have everyone in the community using them. Improper use of masks is at best pointless, at worst can actually make things worse. The vast majority of people are not used to wearing PPE or dealing with contaminated items. It requires some level of training to fit and wear a mask correctly, and how to properly dispose of them. You see this with a number of people touching the outside of their mask, and then scratching their face/nose/eyes. or pulling their mask down below their nose, or where it's not even properly sealed around their mouth.
  - endorphone 7y ago
    They didn't say just wear masks. You're beating on a strawman. Masks protect the wearer. This is blatantly obvious and scientific reality. Messages to the contrary are absolute propaganda (for instance a common line is "there is no evidence to show protection for civilians"[1] --- because there has never been a study for that case. Yet it's a specious, absurd claim because we know the masks are protective). Yes, masks are in short supply. This doesn't make misinformation acceptable (including the absurd, anti-reality claim that unless you're perfectly trained and certified perfectly fitted it is "pointless", which is just ridiculous noise). People already touch their face hundreds to thousands of times a day, so the other fear mongering "you'll adjust it" is another bit of nonsensical noise. As supplies ramp up and we have to return to some semblance of normal society, masks will not only be seen prevalently, they'll be encouraged as one mechanism of controlling spread. And at the time it'll be interesting how all of the propagandists change their tune. [1] Excluding the evidence in front of our eyes where countries where mask use is prevalent are seeing little spread.
  - tomp 7y ago
    Can you explain how improper use of masks can make things worse?
    - monkeywork 7y ago

Razengan 7y ago

An overall high level of urban hygiene and general cleanliness, some social distancing already being the norm (generally not touching each other, though there are severe exceptions like the overcrowded trains at rush hour) and a respect for public order.

spuz 7y ago
What is your source for this?
- cm2012 7y ago
  Generally when people tell anecdotal stories/things they remember, there's no source. It's kind of silly to ask him for something like hand washing statistics for Japan vs the world, that's clearly not what he's providing.
  - spuz 7y ago
    Sorry I guess my question wasn't clear. I meant to ask, what is the source that those hygiene practices he mentioned are factors in the lower rates of spread of the virus given that other countries such as Italy and Spain have enacted stricter measures and yet show higher rates of spread? I am not asking for sources to show the difference in cultural practices.
    - Razengan 7y ago
      I have no source for that, and it was a guess/suggestion for your original question, that maybe because preventive measures were already in place in the culture, they may have slowed the spread before proactive measures were taken.
- Razengan 7y ago
  Visiting, watching and talking. You can get some sense of it just from watching any of the street walks/tours on YouTube and other unscripted videos of daily life there.

brazzy 7y ago

Fairly early government measures for containment and mitigation: selective border closure or preventative quarantine for people from affected regions (much easier to implement as an island nation), closing of schools.

jariel 7y ago

What's interesting is that none of the answers seem definitive. 1) 'Mask wearing' - we know even cloth masks will help reduce spread, but not by what factor overall. We don't know the real vectors here. 2) Someone mentioned 'hygiene' - do the Japanese really wash their hands every time they enter the house? Or do they 'rinse their food' i.e. maybe package handling is a big vector. 3) 'Early border closing' - it only takes a handful of cases to cause the spread. Nobody has been able to 'keep it out' this way. 4) Some cynical commenters indicated it's due to low testing and governments wanton to 'keep the numbers down' which is hard to buy because the truth would hit hard when hospitals start to fill up. 5) Timing. Taking strong measures early may have made all the difference. If you can truly keep the numbers small, it becomes more manageable on a case by case basis. Or all of the above. I hope we are able to isolate the real transmission vectors that affect R0, but we may never really know.

qiqitori 7y ago
There are too many things that may or may not have some kind of effect. Adding to the brainstorming list: taking your shoes off at home, showering in the evening vs. in the morning. BTW I don't think people wash their hands more in Japan, but who knows. There definitely are places within Japan that have more cases despite having a lower population density. Okinawa (south) has very few cases, while Hokkaido (north) has a lot of cases. That seems to support the hypothesis that climate plays a major role.
- jariel 7y ago
  Yes, literally showing at night might make a difference. So many things: maybe they regularly clean the handles on doors. Maybe the restaurants always use a disinfectant wipe. Maybe people 'stay at home' more regularly if they are sick. There's a really powerful EpiCurve calculator someone at OpenAI published - and the most interesting thing is how sensitive everything is to R0. R0 1.8 v. 2.2 is just a huge difference. If 'social distancing' brings it down some, but then 'showing at night' nudges it a little bit lower, voila, noticeably less spread. It's going to take a very keen measure of variables, in fact, it's going to take a keen observation of culture to even figure out what those variables are. Sadly, I don't have faith we'll ever get there.

lawn 7y ago

In addition to the other points they aren't testing as much.

williamscales 7y ago

I read yesterday that Japan had administered something like 16,000 COVID-19 tests in total. So I think they're basically not testing and hoping that it goes away.

freetime2 7y ago
I would be interested to read if you could share the source for the above. It’s true that Japan only seems to be testing people with serious symptoms at the moment. But we would expect hospitalizations and deaths to be higher if the number were really that high.
- Hamuko 7y ago
  Doesn't Japan already have a pretty high number of death for the supposed amount of cases? Sweden for example has 36 deaths for 2286 cases whereas Japan has 42 deaths for 1140 cases. And South Korea has 9037 cases and 120 deaths, so about three times as many deaths but nine times as many cases.
- summerlight 7y ago
  Japan actively avoids testing if those deaths are due to COVID-19. If someone recently dies with pneumonia, it's worth to test if this is the COVID-19 case. Japan doesn't and it claims that the public fear will overload and collapse their medical infrastructure. I don't really understand why this can even be the case, but this is a broadly accepted sentiment around Japan. And its annual death toll from typical pneumonia is around 100k, so Japan can easily hide it even if they had hundreds of the COVID-19 death cases by not testing it. https://www.japantimes.co.jp/news/2020/03/24/national/tokyo-governor-urges-cooperation-avoid-city-lockdown/ https://www.japantimes.co.jp/news/2020/03/24/national/tokyo-... Meanwhile, Tokyo's governor is actively considering lock-down due to a potential explosive rise. Lock-down for a city like Tokyo (which has roughly one third of their entire GDP) is clearly a nuclear option. If you really have only hundreds of the cases, this can (and should) be handled by comprehensive testing and tracing like S. Korea. Or perhaps their confidential COVID-19 projection doesn't agree with Japan's official stats...