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The perplexing case of Japan - Printable Version

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The perplexing case of Japan - magnus - 05-24-2020

In the early months...January and February, Japan had a very low case and death count.  Some thought they were doing something right.  Others complained that they were hiding their numbers through lack of testing and other slow moving governmental action.  A drop in numbers early in March led to hope, before a spike in numbers in April caused a declaration of emergency.  Naysaysers, me included, were predicting the worst for Japan (or at least similar fates to what "leading" Western cultures were facing).

But look at the numbers now...they've dropped tremendously...without any government lockdown.  Under 100 daily new cases and 20 daily deaths. The case to death ratio is a bit high (perhaps due to the continued low testing), but 20 daily deaths (if as accurate as other western countries) is still pretty good relative to a month ago.

So how did it happen?  A couple different articles touch on what might be the reason:

https://www.theguardian.com/world/2020/may/22/from-near-disaster-to-success-story-how-japan-has-tackled-coronavirus

https://www.bloomberg.com/news/articles/2020-05-22/did-japan-just-beat-the-virus-without-lockdowns-or-mass-testing

They seem to indicate that there was no single silver bullet but that a collection of things helped Japan without having to declare a lockdown.

The prevailing theme seems to suggest that people's behavior was a strong factor.  And perhaps the early siren that was the Diamond Princess spotlight.  The government did not (or was not allowed to) enforce any lockdowns.

That's not to say that Japan escaped unscathed.  I guess one could argue that even though a lockdown was never declared, the country did go into a virtual lockdown as evidenced by the tanking of the economy.  

Anyway, I'm wondering if there's any silverlinings in Japan's experience that might offer hope for the US.

RE: The perplexing case of Japan - Mick - 05-25-2020

(05-24-2020, 12:27 PM)magnus Wrote:  So how did it happen?  A couple different articles touch on what might be the reason:

https://www.theguardian.com/world/2020/may/22/from-near-disaster-to-success-story-how-japan-has-tackled-coronavirus
https://www.bloomberg.com/news/articles/2020-05-22/did-japan-just-beat-the-virus-without-lockdowns-or-mass-testing

They seem to indicate that there was no single silver bullet but that a collection of things helped Japan without having to declare a lockdown.

The prevailing theme seems to suggest that people's behavior was a strong factor.  

Anyway, I'm wondering if there's any silver linings in Japan's experience that might offer hope for the US.

I spent a few hours on Saturday with my 84 year old in laws.  Mrs. Mick spends a few days a month cleaning their house since my wife and her sisters don't want cleaning people in their house due to the pandemic.  We both wear N95 masks and gloves while we're there, and I stay outside.

It was exhausting.  I suspect this might be true for many/most senior citizens, but it's been very, very difficult for them to abandon the habits of a lifetime in favor of the augmented hygiene necessary to survive COVID-19.  They treat social distancing as an irritant, and I stopped counting at a dozen the number of times they did something (or wanted to do something) that was fundamentally unsafe, and I know that we irritated them by insisting on proper behavior.  They are both smart, accomplished people.  My father in law (Stanford '57 and '60) was a NASA scientist.  They find it very hard to pay attention to the myriad minute behavioral changes to ensure safety.

RE: The perplexing case of Japan - BostonCard - 05-25-2020

I think the biggest challenge is that we don't yet have a really good grasp of what activities drive infection and which do not.  I remember in March, this one guy put a youtube video on how to decontaminate groceries where he basically used aseptic technique, with a "dirty zone" and a "clean zone" and really thorough cleaning with dilute bleach, and proper disposal and cleaning of anything that had been in the "dirty zone".  At the time it seemed like an overkill, but I remember wondering whether maybe it wasn't, if fomite transmission was common and easy.

At the same time, we think masks are effective at mitigating infection transmission, but we don't know how effective they are.  Do they reduce infection by 25%, 90%, or 99.9%?  So, if you are with someone wearing a mask, are you basically safe, or are you still at risk?

I think we have a better feel for what is risky and what is safe, but it is still not perfect.  We are probably doing some things (or avoiding some things) that don't material reduce our risk, but unfortunately, we don't know for sure which activities these are.

BC

RE: The perplexing case of Japan - Goose - 05-25-2020

(05-25-2020, 09:10 AM)BostonCard Wrote:  I think we have a better feel for what is risky and what is safe, but it is still not perfect.  We are probably doing some things (or avoiding some things) that don't material reduce our risk, but unfortunately, we don't know for sure which activities these are.


BC

I am not so sure our views of what is "risky" and what is "safe" are really formed by data, but rather by some form of consensus among the population based at least partly on doing what we can and ignoring everything else. It really worries me that at this late date we have no insight into where the remaining cases in Santa Clara  and San Mateo county are coming from. Is it mostly medical people, or is it grocery workers, superspreaders, visitors from other areas, or something else? If these cases are being traced, the counties should know by now where we are "leaking". If they aren't being traced, we have no idea what activities are causing our residual spread and it will persist indefinitely (and perhaps grow exponentially as we open up). We really need more data here, and it should be available.

RE: The perplexing case of Japan - Mick - 05-25-2020

(05-25-2020, 09:10 AM)BostonCard Wrote:  At the same time, we think masks are effective at mitigating infection transmission, but we don't know how effective they are.  Do they reduce infection by 25%, 90%, or 99.9%?  So, if you are with someone wearing a mask, are you basically safe, or are you still at risk?

I think we have a better feel for what is risky and what is safe, but it is still not perfect.  We are probably doing some things (or avoiding some things) that don't material reduce our risk, but unfortunately, we don't know for sure which activities these are.

BC

I don't know enough to say, and I've done a fair amount of reading. I laugh at most masks. I've seen plenty examples of flimsy masks, improperly-worn masks which do not cover the wearer's nose, and -- my personal favorite -- people who pull down their masks to cough or sneeze (at which point, I make a beeline in the other direction, particularly if I'm indoors). I've come to the conclusion that, outside of medical-grade masks, wearing masks is largely cosmetic, to make us feel better. Other than my house, I still won't go indoors if I don't absolutely have to.

RE: The perplexing case of Japan - Snorlax94 - 05-25-2020

(05-25-2020, 10:28 AM)Goose Wrote:  
(05-25-2020, 09:10 AM)BostonCard Wrote:  I think we have a better feel for what is risky and what is safe, but it is still not perfect.  We are probably doing some things (or avoiding some things) that don't material reduce our risk, but unfortunately, we don't know for sure which activities these are.





BC



I am not so sure our views of what is "risky" and what is "safe" are really formed by data, but rather by some form of consensus among the population based at least partly on doing what we can and ignoring everything else. It really worries me that at this late date we have no insight into where the remaining cases in Santa Clara  and San Mateo county are coming from. Is it mostly medical people, or is it grocery workers, superspreaders, visitors from other areas, or something else? If these cases are being traced, the counties should know by now where we are "leaking". If they aren't being traced, we have no idea what activities are causing our residual spread and it will persist indefinitely (and perhaps grow exponentially as we open up). We really need more data here, and it should be available.
+1 and this has been a source of frustration for me, as well. I wish they would release more data. So here is all I have found to go on:
1) https://www.sfgate.com/news/editorspicks/article/90-of-people-who-tested-positive-for-COVID-19-in-15247476.php
A study in the Mission district of SF found 90% of those who tested positive were essential workers who "reported being unable to work from home." If 30% of people are essential workers, the prevalence of essential workers is 20x more frequent than for non-essential workers. If 10% are essential workers, essential workers are 80x more likely than non-essential workers.

2) We can just look at zip codes
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These would reinforce that it's essential workers, high-density living and poverty. Areas with a high-concentration of "work from home" tech workers (Foster City, Cupertino, etc.) consistently have the lowest concentrations

I don't reduce any of my precautions, but virtually 0 new confirmed cases have been reported in my zip code for the past week, and only 1 in 10,000 residents per week for the last 6 weeks. Almost all of the growth (in SCC) is in San Jose. Almost one-third the confirmed cases are in LTCFs. From what I can tell, it's mostly workplaces that are currently spreading Covid in the Bay Area, which is why I get so frustrated there isn't more guidance, assistance and enforcement at those locations.  From the very limited data that's made public, essential businesses are what is driving continuing cases, and NOT healthcare settings (now) because doctors and nurses have the training, the best practices, the information and the PPE. Let's give essential businesses thermometers and screening interviews, free sentinel testing, sneeze guards, ventilation reviews, masks, face shields, and best practices, then monitor them and, in rare instances, shut down non-complying repeat offenders. (Or, if I'm wrong, someone needs to share more data showing what is driving growth)

RE: The perplexing case of Japan - M T - 05-25-2020

I agree that we need more data.  We shouldn't just look at our individual counties; we have the whole world as our laboratory.  Here in the US, I believe the laws about privacy, while well-intentioned, are hampering the collection and distribution of knowledge we need.

I haven't seen one yet, but I hope someone is putting together profiles of jobs and infection rates.  One of the problems is that job situations may be like collections of flammable materials.  It may seem ok until a spark is introduced, at which point it all burns up until it hits a fire break.
In addition, the risk of bad outcomes (in particular, age of individuals) needs to be a factor.

It isn't clear to me that the current "essential" workers (except HCW) have employment exposures that differ from many non-essential workers.  To me the difference is that the essential workers are being exposed now, while the non-essential workers generally aren't.  To use Snorlax94's Mission District numbers, if 10% are essential workers and have 90% of the cases, then opening up all the jobs would suggest a 9x increase in cases.

I hope elsewhere in the world, people have now realized that meat processing plants are dangerous and need to be changed.
We believe that health care workers can be protected.

What is it about congregate housing (retirement homes, prisons, military(incl. naval) barracks, fire houses) that makes it such a tinder box?  Yet, SCC is allowing summer camps???  Is it the eating together?  the spending idle time together indoors?  Something about sleeping?  Perhaps the repeated day-after-day exposure.
I would expect rehab centers (high turnover) may be more risky than retirement homes.  Jails more risky than prisons.

Police & prison-guard work has gotten even more hazardous.
I think certain sports (basketball, maybe wrestling) are going to be found too hazardous.  Arena sports fans are at risk.
I have to believe that schools, in the form as we grew up with, will be hazardous.  Indoor physical education may be very risky.
Choir singing is risky.  I wouldn't be surprised if opera and/or ballet might be found risky.  Theatrical actors may be at risk.  

I don't know that the traditional view of stock markets (people in close quarters, shouting over one another) is valid still, but that would have been risky.
I would expect that recreational "swimming" (ie, playing) in a pool will be risky.  It is unclear to me whether lap swimming will be.


Regarding congregate housing at Long Term Care Facilities, I have to say I'm relatively happy with what I see in Santa Clara County statistics.  Unfortunately, there was a very fast growth period in cases (and eventual deaths) in the first half of April.  But, since May 1, the curve has really flattened out.  Just 25 new cases in the first 21 days of May.  It seems the facilities have instituted procedures to block the rapid spread.   Currently, LTCF represent 18% of the cases (42% of deaths).

RE: The perplexing case of Japan - Goose - 05-25-2020

If it is true that the largest source of cases is essential workers who contract the virus in the workplace the county should go to those workplaces and quarantine the contacts of the person who got sick. The county should also figure out who the source of the infection was and trace them. It can be done. Korea is doing it. If the Bay Area Counties haven't been blowing smoke for the last two+ months, they can do likewise. If they can't, this whole situation just got a lot worse, because when we open things up there will be lots more workers out there, essential or not.

While it would be nice to say that we can re-design workplaces so that COVID-19 transmission will be minimal, it isn't going to happen in the short term. It also probably won't happen while the economy is reducing demand for most things. The way ahead is known. We either figure out a way to track and trace or accept lots of unnecessary deaths. The "hammer" part of the equation can only go on for so long. People now want to see the "dance". If it isn't there it won't be a dance, it will be a riot.