TOKYO – As the Tokyo 2020 Paralympic Games gets underway, the first gold medals are going to Covid-19 for its ability to leap over all obstacles Japan puts in its way.
Even though 144 Paralympic personnel including athletes have tested positive so far, the government is still planning to bus in thousands of school pupils to watch the events, even though children are among those going down with the Delta variant.
Beyond the stadia, Japan’s medical resources are being stretched to breaking point, as the world’s third-richest nation reels from the news that a baby died after its mother could not be admitted to a maternity ward.
Meanwhile, the government seems incapable of coming up with new strategies and some Tokyo businesses are indulging in a very un-Japanese form of behavior by openly defying governmental guidelines.
All these issues likely have ramifications for post-Games politics and the political life of besieged Prime Minister Yoshihide Suga.
His leadership of the Liberal Democratic Party expires on September 30, and on August 26 the party will announce the date of the leadership race. Whoever wins that race will lead the party into a national election for the lower house of the Diet that must be held by November 28.
With the pandemic breaking the capital’s caseload records daily and the Delta variant making up 98% of infections, hospitals may well be submerged by Japan’s fifth and most rampant coronavirus infection wave.
Since August 21, Tokyo has been at Stage 4 social distancing guidelines, the severest status assigned by the Japanese government. At this “Infection Explosion Stage,” the medical health care system could collapse if the government does not take preventive action. Some argue that is already happening.
The situation is on a knife-edge. In Tokyo, approximately 90% of hospital beds reserved for those experiencing severe symptoms are occupied. More than 60% of all Covid-19 reserved beds are full – even though only about 4,000 of the 45,400 infected patients in the capital are now receiving inpatient care.
Hospitals are now turning away patients, and even pregnant mothers who are Covid-positive are struggling to be admitted.
In a widely reported case that shocked the nation, on August 17 a premature child died after his mother went into preterm labor and had an unassisted home birth in Chiba prefecture adjacent to Tokyo. The mother was rejected from every nearby medical facility in the two days leading to the delivery, despite her worsening Covid-19 symptoms.
More than 1,000 Covid-19 patients who called for an emergency ambulance service during the first week of August were turned away by hospitals. There were 1,668 people isolated at home or designated facilities that needed hospitalization. However, medical institutions did not accept 959 of them.
Children at risk
Although the Olympics Games banned venue spectators, the Japanese government still has plans to allow school children to attend the tournament.
On August 21, Kyodo News reported that approximately 172,000 students from Tokyo and its two neighboring prefectures of Saitama and Chiba would be eligible to attend under the “School Cooperation Spectation Program.”
All three prefectures are under states of emergency that are – perhaps ambitiously – scheduled to conclude on September 12, a week after the Paralympics finish. The program allows schools to purchase Games tickets using course credit. According to Paralympic organizers, this exchange is rooted in the program’s primary objective of educating children about the disabled community.
“I would like them to view the Paralympics from an educational perspective and experience the diversity and harmony essential for human growth through,” Seiko Hashimoto, the chair of the Tokyo Organising Committee of the Olympic and Paralympic Games, said in an August 23 press conference.
A laudable idea – in normal times. But amid Covid-19, local newspapers and experts are questioning whether the program will increase clusters among participating students.
In an August 18 editorial, the Mainichi Shimbun criticized the organizing committee for what the newspaper saw as its lack of ownership and responsibility. In the article, the paper said leaving the decision to participate to local governments and schools left those parties – especially the latter – confused about the right course of action.
“It is essential to evaluate not only the educational effect but also the risk of infection and what kind of preventative measures are effective in deciding whether or not to participate,” the Mainichi argued. “However, such knowledge is scarce on the school side.”
There is no overarching consensus that young people, especially children below the age of vaccination eligibility, are more likely to contract the Delta variant than previous variants of Sars-Cov-2.
However, there has been a correlation across Japan between increasing Delta variant infections and a rise in children testing positive for Covid-19 and developing symptoms.
On August 22, a Toyama prefecture broadcast news channel interviewed two local doctors about children infected with the Delta variant. Both experts agreed more children were displaying mild symptoms than in the past.
“We are beginning to see changes in the infection situation for children. And although previously many infected were asymptomatic, there is no doubt that more children are developing fevers,” said Dr Hirosora Taneichi in the department of Pediatrics at Toyama University Hospital.
In a Yale Medicine article, Dr Inci Yildirim, MD, a Yale Medicine pediatric infectious diseases specialist and a vaccinologist, said the Delta variant might present a greater risk to younger demographics than earlier Covid-19 strains.
“A recent study from the United Kingdom showed that children and adults under 50 were 2.5 times more likely to become infected with Delta,” Yildirim wrote in the article.
As most countries are yet to approve vaccines for children below the initial eligible age, 12 years old and up for both Japan and the United States, they are statistically at a higher risk of infection than older, vaccinated people.
“But Delta seems to be impacting younger age groups more than previous variants,” Yildirim noted.
In response to the exponential growth in new cases, the city of Yokohama announced on August 21 it would close its schools from elementary through high school for the rest of the month.
In the past month of summer vacation, beginning from mid-July, roughly 800 school children in the city tested positive for Covid-19. The vast majority are unvaccinated.
Current concerns seem even more valid in the aftermath of the Olympic Games, as the buzz wears off.
The International Olympic Committee, Prime Minister Suga and most experts, including Japan’s top medical adviser, have argued that the Olympics did not cause the domestic Covid-19 explosion.
However, others say the event poured fuel on the fire and provided a distraction that made people take precautions lightly. In the end, more than 500 Olympic personnel tested positive by the end of the Summer Games.
And one of them brought the Lambda variant. The latter is considered by a not yet peer-reviewed report by a Tokyo University research team to be highly infectious and relatively resistant to vaccine-induced immunity.
A senior researcher on the project and a virology specialist, Dr Kei Sato of the University of Tokyo, said that he believes “Lambda can be a potential threat to the human race.”
The infected passenger, a woman in her 30s who arrived at Haneda International Airport from Peru on July 20, was later identified as Olympic personnel. Three days after she tested positive for Covid-19 at the airport, the Ministry of Health, Labor and Welfare genome sequenced her sample and found it was the first case of the Lambda variant identified in Japan.
The Lambda variant was the dominant variant in Peru, where in early August, it accounted for up to 90% of new Covid-19 cases. Peru has the highest per capita coronavirus death rate in the world, but how much of that is due to the Lambda variant is unclear.
Yet Japan’s Ministry of Health only acknowledged the Lambda variant’s entry into the country on August 6, after inquiries from the media.
On August 18, the ministry announced it had failed to alert local governments or the Olympic Organising Committee about people in close contact with the carrier. They only realized this on August 16. Typically, the ministry sends a seating chart of the airplane, showing who was close to the infected person, to all related parties.
The opacity over the Lambda patient has generated distrust towards authorities. The Suga administration had grimly pressed ahead with the Olympics despite strong public misgivings, in the likely hope that it would benefit from post-Games feel-good factor.
Granted, the Games did not become the much-feared super-spreader event. Moreover, Team Japan boosted national morale by delivering its best Olympic medal haul ever – 27, compared with 16 in Rio – and a third-place finish overall.
But they failed to boost support for the Suga administration. The latest polls put his approval ratings below 31%.
Suga under fire
There is no end in sight to the current wave. And Tokyo’s repetitive cycle of issuing state-of-emergency declarations and extensions, together with “guidelines” for the public and food-service industry, is wearing thin.
For example, bars and restaurants are not allowed to serve alcohol all day. Though the broad rationale is to prevent people going out and socializing, no scientific basis has been proclaimed. An estimated 40% of Tokyo’s bars, according to reports, are defying the decision, which is not being enforced.
All this has left many Japanese disillusioned with the government’s ability to slow the pandemic.
In an August 18 editorial, the Mainichi Shimbun said more medical accommodation is needed to combat the increasing number of household transmissions.
“But many are forced to stay at home, and some of these have even taken a sudden turn for the worse and died while waiting for a spot to open up,” said the article. “To create more recovery accommodation facilities where patients’ health can be monitored in one place, the government and local authorities should exercise their full powers.”
Moreover, the key hope of overcoming the pandemic – vaccinations – may not be enough.”The more infectious Delta strain is spreading, and a strategy reliant on vaccines cannot catch up with it,” said the Mainichi, demanding a more “comprehensive response.”
Fingers, naturally, are being pointed at a prime minister who replaced the previous incumbent, Shinzo Abe – who last year retired on grounds of ill health – via internal, party machinations rather than any national plebiscite. Indeed, Suga has appeared ineffectual from the get-go.
Hitoshi Igarashi, Professor Emeritus of Political Science at Hosei University, agrees that Suga’s leadership is to blame for Japan’s current failures.
“Japan’s medical system did not break down because of problems in its health centers or medical institutions. Prime Minister Suga, who has spoken with optimism from beginning to end, has full responsibility,” Igarashi said in an August 21 interview with Nikkan Gendai.
“He also boasted that ‘protecting the lives of the people is the responsibility of the country and the highest priority.’ But it was all a big lie. If even one of his promises were true, the country’s medical system would not have fallen this far. In short, he didn’t do anything.”
Still, the Paralympics have already brought some benefits to the disabled in Japan, leading some to praise the decision to go forward with the event.
And disabled issues haunt Japan’s conscience, for the ongoing Games are linked to the management of another catastrophe that remains traumatically fresh in the public memory.
The 2020 Olympics were supposed to celebrate the revival of Fukushima and North Eastern Japan from the tragedy of the Great East Japan Earthquake of March 11, 2011.
During that catastrophe, 25% of all fatalities were disabled persons who could not access help in time, according to Dr Mark Bookman, a postdoctoral fellow at the University of Tokyo and a historian of disability in Japan and the world.
Although some progress towards improving accessibility for disabled commuters in public transportation started in 2000, Japan’s critical shift into hard changes was catalyzed by the 2013 confirmation of Tokyo as the 2020 Olympic host city.
Prime Minister Abe and Japan’s delegates to the IOC heavily campaigned that the Games would represent the nation’s recovery from 3/11.
Yet special risks await Paralympians in Tokyo. Bookman says Japan’s present labor shortage in caregivers exacerbates accessibility obstacles the disabled community faces.
For the Paralympics, each athlete will be supported by staff who may be unfamiliar with Japanese resources. Language and physical barriers – like the width of doors and hallways for athletes using wheelchairs – can place Paralympians at increased risk of infection, particularly given the requirements of Japanese medical bureaucracy.
“If Covid has shown us anything, it is that if you leave one person behind, then everyone is at risk for infection, right? If one athlete is put at risk, then everyone is potentially put at risk,” he said.
“I’m not saying that it will be impossible for a Paralympic athlete who has been impacted to find treatment. But it will certainly be difficult to make sure that you are in the exact right place for the exact right person because there are so many types of diversity that have to be accounted for: nationality, age, race, gender, class. All these things factor into how a person needs to be treated at a medical center.”