The Covid-19 metrics have changed and things look better already. Or do they?
Like many other countries, Japan has come through several phases in its novel coronavirus reporting. The first phase kicked off rockily when the government claimed that the Covid-19 cases aboard the Diamond Princess cruise ship anchored off Yokohama should not be included in the country’s then-minuscule count.
Japan installed highly restrictive prerequisites for polymerase chain reaction (PCR) testing, and as a result conducted fewer tests than neighboring South Korea, a rapid adopter of drive-through centers, which tested as many as 25,000 people per day.
Japan wanted the Olympics more than anything. It wanted Covid-19 to go away – and if tests were kept to a minimum, it might.
This phase ended on March 24, four months before the planned Olympic opening ceremony date of July 24, when Prime Minister Shinzo Abe finally announced what everyone had known for weeks: There would be no Olympics this year.
The second phase started and Japan tested much more, but the effort was still half-hearted. While the country supposedly had the capacity to conduct 7,500 PCR tests a day – and Abe announced this would soon be raised to 20,000 – nowhere near that many tests were being performed.
Amid reports of suspected Covid-19 patients being turned away by dozens of hospitals, it was still remarkably difficult to get a test at all. Companies puzzled over work-from-home. Teachers and students were at their wits’ end with the lack of clarity around school closings. And case numbers mounted.
Abe unwittingly provided comic relief with his widely ridiculed “Abenomask” program, a porkbarrel scheme to send two washable cloth masks to every Japanese household. The program cost the government several hundred million dollars to produce masks of substandard quality and the mailing has still not been completed.
One cartoonist borrowed the popular animated cartoon series Sazae-San to depict a family of seven stuffed into two masks. It was soon discovered that the Abenomask shrinks to the size of an eyepatch after a few washings, and today even the prime minister has stopped wearing his.
The climax of the second phase was the declaration of a state of emergency on April 16. This was serious stuff, and the Japanese showed their mettle as a people who can hunker down, follow the recommendations of experts, and work together better than most.
Yet the average number of PCR tests conducted from April 16 to May 25 when the state of emergency ended was only 4,229 per day. What of the pledge to increase the daily capacity to 20,000? Without a lot of tests, there weren’t many cases – hence, not a lot to report.
And now we’re in the third phase. Six metrics have been adopted to measure how serious the pandemic is.
More than one million Japanese have now been tested, recently as many as 40,000 to 50,000 per day. With saliva-based tests and rapid-result tests in place, there is talk of ramping up to 75,000 tests per day.
The six metrics are (1) hospital bed including ICU bed occupancy ratios; (2) the proportion of patients in the population; (3) the percentage of positive test results; (4) the seven-day rolling weekly count of new infections; (5) the growth rate of that number; and (6), the most open-ended, the percentage of new infections for which the route of infection is unknown.
Interestingly, neither the death rate nor the number of deaths is included in these metrics. Whatever the mechanism is that has kept the total number of deaths from the pandemic in Japan to just over 1,000, it’s the biggest gift the Abe administration could have hoped for.
Japan set the global standard very early on for meticulous contact tracing. For the first couple of months of the pandemic, the Ministry of Health, Labor and Welfare published daily a spreadsheet that explained exactly how every patient had been infected.
This spreadsheet has disappeared from the MHLW website, and with 1,000-odd new cases per day it’s understandable. The number of infected has burgeoned to a level where contact tracing at the micro-level would require thousands of staff.
The Tokyo Metropolitan Government’s “stopcovid19” website shows that in Tokyo alone, about 160 people each day are becoming infected from routes that are unknown, so I asked Enomoto-san of the Tokyo Metropolitan Health and Welfare Bureau what this “unknown” implies.
How are these cases being followed up? What sort of tracking is being done? The answer is noteworthy.
“That’s the job of the local public health centers,” he said. “That’s what they’re there for.”
An infected person is interviewed at a local health center, and if the person claims not to know how the infection was acquired, “that’s the end of the story.”
Once the public health centers report to the Tokyo Metropolitan Government that an infected person’s route of infection is unknown, the statistic is simply added to the metric. It’s “not the job” of Tokyo to dig any further into that statistic.
I suggested to Enomoto that these 160-odd individuals each day may well have some common attributes. Do these people wear masks and practice social distancing? How do they break down by age group and familial status?
Do they commute two hours a day on crowded trains? Are they members of Masayuki Hiratsuka’s Popular Sovereignty Party, which has adopted as part of its political platform that Covid-19 is “just a cold”?
By examining the commonalities, might it not be possible to make broad assumptions as to what behaviors lead to infection?
According to Enomoto, any further research into the numbers is purely the purview of the individual public health centers.
To be fair, “route unknown” simply means the route is unknown at this time, not that it will remain unknown forever. But the Tokyo Metropolitan Government does not set targets for the conversion of unknowns to knowns, nor is there a metric to track the conversion rate.
The metro government is loath to publish anything that isn’t conclusive. In the absence of conclusive evidence, the preference is for nothing at all. While the new metrics are an improvement, they still leave much to be desired.