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Why Japan has one of the lowest COVID death rates in the world without mandates


Masks

Japan’s virus-fighting strategy relied on the population complying willingly with social-distancing guidance, particularly when cases were rising. This proved more effective than top-down measures in other places, which in some cases made people resistant and defiant.

“People are using their own judgment to avoid risk and modify their behaviour and this plays an extremely important role,” said Ohmagari.

That includes wearing masks. They were embraced during the early days of the pandemic and the practice remains almost universal even as the government relaxed its recommendation to wear one outdoors. Mask use in Japan has typically held above 90 per cent, a threshold other G7 countries have only occasionally neared, according to Institute for Health Metrics and Evaluation data.

Close to 90 per cent of people in Japan choose to war masks still, even though it is not compulsory in many circumstances.

Close to 90 per cent of people in Japan choose to war masks still, even though it is not compulsory in many circumstances. Credit:AP

The government’s “Three Cs” slogan – which touts avoiding closed spaces, crowded places and close-contact situations – has also reinforced how it wants the population to act.

In addition, buildings to taxis have undertaken efforts to improve ventilation, including the use of carbon-dioxide monitors to show that indoor air is being exchanged.

The relatively light nature of restrictions also meant that Japan didn’t face the extensive disruption to daily life of a harsh lockdown, deployed in countries from Italy to China and Australia at various times. That may have helped people comply with restrictions for longer and saw the nation avert the kind of social unrest seen overseas.

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And even as other populations have rushed back to life as normal, Japanese people appear to remain cautious: activities in Tokyo’s nighttime entertainment district is still down almost 40 per cent from 2019, according to one estimate.

Vaccination

Before the pandemic, Japanese people had one of the lowest rates of vaccine confidence globally. But they’re now among the best-protected populations in the G7, swiftly catching up to countries like the US that had started their inoculation programs months earlier and doing it without a mandate.

Experts have pointed to the initial slow roll out of vaccinations and an early shortage as creating a sense of urgency, especially among the elderly, while the act of inoculation wasn’t politicised like it was in the US.

While vaccine hesitancy was high in Japan when the pandemic began, it now has one of the world;s highest vaccination rates - without a mandate.

While vaccine hesitancy was high in Japan when the pandemic began, it now has one of the world;s highest vaccination rates – without a mandate. Credit:Bloomberg

About 93 per cent of Japanese aged 65 and older have had two shots, and 90 per cent have had a booster, according to data from the Prime Minister’s office. That compares with 81 per cent of the total population having had two doses, and 61 per cent receiving a third.

“Thanks to the protection Japanese people gained through vaccination and natural infection, I don’t expect Japan’s hospitalisation or deaths to increase dramatically any time soon,” said Kenji Shibuya, an epidemiologist at the Tokyo Foundation for Policy Research.

Health

A core pillar supporting the low death rate was the underlying good health of Japan’s population. The country has the longest life expectancy in the world, and was one of only six OECD members not to see a reduction in 2020. Just 5 per cent of Japanese people are obese, one of the conditions that increases the risk of severe illness from Covid, versus 36 per cent of the population in the US and 28 per cent in the UK, according to the World Obesity Federation.

Widely adopted actions like mask wearing and handwashing also wiped out other illnesses like influenza, which typically killed more than 10,000 Japanese people per year.

The country’s deaths were almost entirely in over-60s, indicating a solid baseline of health for middle-aged and younger cohorts. That contrasts with a wider distribution of fatalities in the US, where about a quarter of deaths were in people younger than 65, according to government figures.

Contact tracing

Like most of the world, Japan’s health-care system has been strained during surges of infections. But it’s managed to maintain a strong level of contact-tracing during the pandemic that means resources can be sent where they’re needed, for free.

Tokyo governor Yuriko Koike, with one of the cleaning robots deployed in a hotel for COVID patients with mild symptoms, May 2020.

Tokyo governor Yuriko Koike, with one of the cleaning robots deployed in a hotel for COVID patients with mild symptoms, May 2020. Credit:AP

A web of local public health centres trace cases and find positive patients a hospital or hotel room which are free of charge. Those isolating at home are constantly contacted by the health centre staff, who send out nurses and doctors if needed.

“We know that early intervention saves more lives,” said Ohmagari. “Although I feel there’s more we can do, Japan’s system tries to not leave anyone behind, monitors patients thoroughly and intervenes early.”

Bloomberg



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