Making sense of COVID-19 numbers in Japan

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Last week we wrote an article about COVID-19 testing in Japan. We’ve also been publishing an (almost) daily newsletter, which we hope you’ll subscribe to here. For several weeks we’ve been pointing out that it’s difficult to find clear information about important aspects of the COVID-19 crisis. In the case of Japan, there has been continuing confusion about who qualifies for tests. We continue to hear many reports about people in Japan being denied testing or being persuaded by medical staff not to get tests, despite feeling they truly qualified based on their symptoms. This is leading to increased frustration and suspicion. As we pointed out last week, Japan has been an outlier so far among countries which appear to have “flattened the curve,” such as Korea, Taiwan, and Singapore. In every other country that has done so, intensive testing has been essential. Japan has not been doing that, and continues to have one of the lowest COVID-19 testing percentages among developed nations. This, as we noted, is by policy. Where is it leading us?

The narrative that Japan has beaten the virus thanks to mask-wearing, good hygiene, no-handshaking, and cooperation with social distancing programs seems to be gaining currency in many corners lately. We agree that masks and regular hand washing, as well as the relative lack of skin-to-skin contact, may be helping to keep the contagion rate here low so far. But social distancing has been very lax, despite the closure of schools, cancellation of large events, and many people working from home. Parks are full every day with crowds enjoying cherry blossom viewing parties, and trains are pretty full too, as are bars and restaurants. We think that Japan has been lucky so far, while many can’t shake the suspicion that a much higher infection count is being obscured by the lack of testing and the miscategorization of COVID-19 deaths simply as pneumonia.

Prefectures and municipalities in Japan have a fair amount of autonomy when planning emergency response. A recent news report described a town in Wakayama Prefecture that implemented a thorough COVID-19 testing program with results good enough that it is now considered a model. A few days ago, the Governor of Osaka, Hiro Yoshimura, publicized task force findings (in Japanese) which indicated that by the first week of April, Osaka and Hyogo prefectures could have a combined COVID-19 case count of over 3300 people. The Tokyo Municipal Government is securing 4000 hotel rooms to use for additional hospital beds. I suspect we will hear of similar preparations in other Japanese locales in coming days. Though we can’t prove it, the Ministry of Health, Labor, and Welfare (MHLW) seems to have preferred that these deliberations not be made public until a coordinated policy could be announced. Governor Yoshimura deserves credit for setting a precedent for transparency by going public when he did. He was followed by Kanako Otsuji, a Representative from Osaka Prefecture, who provided helpful detail on Twitter (Japanese).

COVID-19 test data for Japan remains maddeningly ambiguous. As we noted previously, the government regularly presents two sets of numbers, one generally almost double of the other. The most recent numbers, as of March 23, are 20,340 (obtained from this chart) and 38,954 (this chart). We discussed with journalists and other knowledgeable people exactly what these numbers indicate, and many had concluded that the higher number refers to the actual number of tests, the lower number, to “official” tests. Osaka Representative Otsuji thankfully clarified in a March 18 tweet that although the larger number is listed as “cases,” in fact it refers to “samples.” Consequently, 20,340 is the number of individuals who have been tested in Japan as of March 23, many of whom were tested more than once. It was unacceptably difficult to resolve this ambiguity. If we had a hard time figuring it out, the general public would not be able to either. Back in 2013, when discussing the obscurity of Fukushima radiation monitoring data, we termed it “ADAP” — As Difficult As Possible to find and use. We think that remains the case here as well.

There is also a difficulty in obtaining data about the death rate from pneumonia in Japan. Because of the concern that the lack of testing means some deaths recorded simply as pneumonia might actually be due to COVID-19, there have been calls for MHLW to clarify the recent pneumonia case and death rates. Unlike influenza data, which is published weekly, similar pneumonia data seems to be unavailable. Writer Jake Adelstein recently tweeted that he contacted the ministry directly and was told that the pneumonia reporting period was every three years, and they had no intention of making an exception now. Again, this kind of inflexibility and lack of transparency only increases mistrust and suspicion. We don’t know why the Japanese government doesn’t realize that.

Ultimately, as Safecaster Joe Moross said the other day, though so far it looks like Japan has bent the curve, we’re still in round one of what will likely be a ten-round fight against the coronavirus. It’s way too early to ease off and declare victory.