Hundreds of Cases, But No Lockdown: What’s Changed in Japan?

(Bloomberg) -- In Japan, it might seem like the bad old days of the pandemic, with cases jumping to more than 100 for six consecutive days in Tokyo. The rise has some asking when the government will again declare a state of emergency.

But this isn’t April, when businesses shut their doors and workers stayed home, as government officials argue that another emergency declaration isn’t necessary for now.

While some countries have responded to a resurgence of infections with stricter measures -- Australia’s second-largest city plunged into lockdown for the second time in four months, and Beijing confined whole neighborhoods to their homes to bring an outbreak under control -- Tokyo is taking a more muted approach, arguing that this time is different.

A look at the data goes some way to back that up:

As of Monday, the ratio of cases in Tokyo whose infection path can’t be identified stood at 39%, compared with more than 70% at the height of the pandemic. That’s significant because contact tracing and cluster-busting has been the core of Japan’s response to the virus -- identifying and shutting down locations where multiple people were infected, and aggressively testing those linked to these clusters.

Another crucial difference is the age group. Nearly half of those infected in Tokyo since May 25, when the state of emergency was lifted, are in their 20s who are less likely to fall severely ill than elderly patients. Cases have predominantly affected what authorities have euphemistically referred to as “yoru no machi” -- the nighttime entertainment districts that house host clubs, “girl’s bars” and various levels of prostitution.

The mortality rate also shows the lower likelihood of younger patients dying from the coronavirus. Of the almost 1,000 virus deaths in Japan, just five were in their 20s and 30s, while more than half were in their 80s or older, the most vulnerable group in Japan’s graying society.

Deaths are a lagging indicator of the scale of the infection, and hospitalizations have begun to increase in Tokyo. The number of those in treatment has doubled to more than 400 as of Monday, after falling to as low as around 200. However, those listed as serious -- requiring treatment in an ICU or with a ventilator -- are still just a small fraction. There were only eight such cases in Tokyo as of Tuesday, the lowest since the government began tracking the data in late April. The capital hasn’t reported a death from Covid-19 in two weeks.

Tokyo last month revised its method of monitoring the state of virus infections to place more emphasis on the condition of the medical system to handle more patients.

In a reflection of Tokyo’s shift to more virus testing, the positive test rate has plunged through May and June -- though it has slightly ticked up again over the past week. The capital is currently conducting an average of about 2,000 tests a day, with mass testing of host clubs in the Shinjuku area.

The city previously tested only those with symptoms. Experts including Tohoku University professor Hitoshi Oshitani chose to deliberately limit testing, citing the experience of the H1N1 outbreak in 2009 when people got infected waiting to be tested in crowded hospital rooms, as well as the low accuracy of initial testing kits. This decision has even been hailed as one of the reasons for the country’s success in containing the initial pandemic.

Targeted testing has contributed to more cases, and medical facilities are not under pressure from the pathogen, Yasutoshi Nishimura, the minister in charge of coordinating the nation’s coronavirus response, has said.

“We’ll make any decision looking at the three criteria of infections, the state of the health system and the testing set-up,” Nishimura said on Wednesday. Nishimura spoke before Tokyo reported 75 new coronavirus cases, the first time in a week for cases in the capital to drop below 100.

©2020 Bloomberg L.P.