The Japan model

So what is the Japan model? First, it is a cluster-based approach, derived from a hypothesis obtained from an epidemiological study based on Chinese data and conducted on the Diamond Princess cruise ship that entered the port of Yokohama on February 3, 2020. This hypothesis accounts for the many passengers who were not infected with the coronavirus despite having had close contact with infected persons. It posits that the explosive increase in infected persons is a result of the high transmissibility of certain infected individuals, which forms a cluster. Infected individuals with even higher transmissibility appear from these clusters to form more clusters and infect many others. Based on this hypothesis, under the cluster-based approach, each cluster is tracked to the original infection source and persons with high transmissibility are isolated to prevent the spread of infection. For this reason, pinpoint testing is carried out and broad testing of the population is not required, in contrast to the approaches taken in other counties.

This cluster-based approach is conditioned on an environment in which there are only a few infected persons and clusters are detectable at an early stage. In February 2020, when the spread of infection was observed in Hokkaido, a cluster-based approach was adopted. As a result, Hokkaido was successfully able to contain its outbreak.

For the cluster-based approach to be effective, protective measures at airports and ports are important. Hokkaido has the advantage of being an island, making it comparatively easy to control the inflow of infected people. Behavioral changes are also required. On February 28, 2020, acting without legal basis, Hokkaido Governor Naomichi Suzuki declared a state of emergency and called on residents to refrain from going outside. Residents took the call seriously, and are responsible for the success of the cluster-based approach. Following its success in Hokkaido, the cluster-based approach was adopted nationally. On February 25, 2020, a Cluster Response Team was established in the Ministry of Health, Labour and Welfare.

Here is more from Kazuto Suzuki, with other points of note.

Comments

So Japanese leadership was smarter than American leadership because Japanese people are smarter than Americans?

Japan was masked up 8 weeks before the CDC changed its recommendation from “do not wear or purchase masks” to “maybe try masks, meh probably won’t do much”

And who knows how many months or years before the CDC switches to “everyone should wear a N95”

The west continues to embarrass itself

It blows watching how competently-run countries do things and then seeing America suck.

Your boy, setting the tone

https://amp.theguardian.com/world/2020/apr/03/im-not-going-to-do-it-trump-refutes-his-own-administrations-advice-on-masks

"masks as a voluntary public health measure"

Your link once again undermines your message. BTW, masks are for the sick, and Trump gets tested everyday.

Are you dumb? Is that why you're the last Trump supporter in the pool?

The more mask wearing, the less disease everywhere. The President of the United States, as the principal role model just wears one, then more people do, then less people die.

This is not rocket science.

Oh silly, don’t you know that conservatives only worry about the president being a role model when he’s a Democrat who does or might do scandalous things. The public isn’t influenced by the good or bad example set by a Republican. Come on. This is poli sci 101 right here.

You're lucky Obama was never a role model, or Trump would be spying on Biden's campaign and framing his people.

Speaking of

https://www.washingtonpost.com/health/2020/05/22/hydroxychloroquine-coronavirus-study/

But sure, having an idiot president doesn't affect us at all.

Well having an idiot President sure helped get Iran billions, but I'm not sure how that's relevant.

Anyways, this study was 'not a controlled study' from your link. They have been giving hydroxychloroquine to only the sickest of patients, where it hasn't been useful. When give earlier on and seemingly only with zinc, it has been useful.
https://townhall.com/tipsheet/katiepavlich/2020/04/06/here-are-five-doctors-whose-patients-have-seen-recovery-with-hydroxy-chloroquine-n2566409

Anybody smart knows where those "billions" came from. And "lol" at the whole Trump-supporter-supports-hydroxychloroquine action.

Funny: https://www.lifezette.com/2020/05/senator-amy-klobuchar-reluctantly-admits-hydroxychloroquine-saved-her-husbands-life/

This isn't about how countries are run so much as how countries are. This thing was nowhere near the center of American or Western consciousness at the end of February. First US death was February 29.

Because we didn't act by the end of February and were never gonna act this early under any conceivable scenario, the Japanese solution was off the table. Even for countries like Norway and Germany, who later threw the full court press at this thing. Norway's death totals are less than half of German levels, which themselves are one third of American levels, which are about half of Spain's levels, but all of these countries look like tragedies compared to Japan. Norway, the pride of European response, has seven times the per capita deaths as Japan.

Japan and most of Asia knew it was SARS all along and acted right away. Having experience with SARS probably helped a lot. Being delicate about how to name a virus hurt.

Look, it ain't the end of the world, parts of Europe have been hit very hard, large parts of America have suffered very little, Central/South America (Mexico, Peru, Brazil) are hotting up but hopefully it doesn't spin out of control there.

The thing is, we'll probably have a chance to show what we've learned in the fall/winter, assuming cases fall to minuscule levels this summer. If we screw the pooch this fall, that's a failure of leadership. In the flu a century ago, the second wave was the real killer.

I agree about the fall, but I think a lot of people are having trouble with the math in the here-and-now:

https://www.cnn.com/2020/05/21/us/california-church-pastors-coronavirus-trnd/index.html

Possibly they've over-hyped their numbers, by letting anyone click the link and sign.

> Being delicate about how to name a virus hurt.

Naming the new disease SARS-2 wouldn't have scared anyone outside of Asia. On the contrary, it would have created even greater complacency.

SARS killed less than 800 people worldwide. Except for Toronto, only three of those deaths were outside Asia.

Yeah, this is fair. Underscores the point that there was no way any Western country was gonna do what needed to be done when it needed to be done in time to achieve a Japanese outcome.

You claim that Japan acted right away, but they were criticized for weeks for having very little testing and no lockdown. Japan took no more action than Sweden from what I can tell. The author of the article may have a point about cluster testing but notice he provides hardly any detail. He calls it that "Japan Model" but there really hasn't been a model beyond this political scientist's assertion that there is.

Brian says “yyyyytt Underscores the point that there was no way any Western country was gonna do what needed to be done when it needed to be done in time to achieve a Japanese outcome.” Except Australia which was better equipped for contact tracing, and NZ which used a harsher lockdown but now has zero virus with just 21 deaths, because it wasn’t prepped for contact tracing.

No, Japanese leadership was smarter than American leadership because America elects dumbasses to office. Mediocre beats stupid any day of the week.

Will those blue states ever learn?

Before drawing conclusions I suggest that you read the updated entry

https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Japan

Tyler's post refers to a 4/24 article that in turn relies on "the model" as of 3/12.

By now, we know how wrong it is to conclude without paying attention to the dynamic of the pandemic in political jurisdictions given the apparent relevance of differences in their government responses. It's a big mistake to compare the U.S. as if it were just one jurisdiction with countries that are just one jurisdiction. Anyway it may be that the dynamic of the pandemic has been following the same pattern in all jurisdictions regardless of differences in government responses and that superspreaders have been the key difference among jurisdictions.

So I guess that people from Ghana are smarter than Americans too then? After all they have lower rates of infection...

From the article: "According to Ministry of Health, Labour and Welfare statistics, 11,772 Japanese had been infected with the COVID-19 coronavirus as of April 23, with 287 total deaths. These numbers have been rising somewhat more rapidly in recent weeks,"

Nope, the opposite.

increase in Covid-19 deaths per day in Japan:

Apr 16 to Apr 22......8%
Apr 23 to Apr 29......6%
Apr 30 to May 6.......4%
May 7 to May 13......4%
May 14 to May 20....2%

"This habit is widespread in Japan, where many people suffer from hay fever, making the possibility of contraction by droplets comparatively small."

The percentage of Japanese who wear masks in the winter and spring isn't that high. a Yougov poll stated 67% wore masks in February, though, which is much higher than normal. In Taiwan, Hong Kong and China close to 90% were wearing masks in February.

..with specific claims and data, but never links or attribution. Not trying to be a d-bag but you need to provide those.

Wiki has Japan's Ministry of Health, Labor and Welfare data on the "Japan coronavirus pandemic page" and there is worldometer where I've tracked Japan's cases and deaths since March.

You couldn't just provide a link?

... the "U.S. Model" is to quarantine all the healthy people
(crazy Lockdown)

And to send elderly Covid patients back into nursing homes. Talk about ass-backwards.

That's the NY model. FL tried to move Covid out of the nursing homes: [https://www.nationalreview.com/2020/05/coronavirus-crisis-ron-desantis-florida-covid-19-strategy/]. (Ignore the politically provocative headline if it provokes you. There is interesting discussion about Florida's targeted strategy towards nursing homes.)

I like how you provide the trigger warning so that some of the sensitive souls here are not injured by accidental exposure to truth.

Does anyone know of a good source of information about those jurisdictions (national, state, local, whatever) that required nursing homes or similar institutions to accept Covid-infectious persons? So far, I'm aware only of the following, and I don't have many details even about these: NY, NJ, PA, CA, and I believe also the UK (or England?). Ideally, I'd find a single source that even briefly describes the policies, outcomes, and revocations of the mandates--but I'll take what i can get. Thanks for any suggestions.

How about the province of Quebec? Sweden?

I get the impression that the deaths in Lombardy were mainly in hospitals rather than care homes. How about Spain?

England, yes; about the rest of the UK I don't know.

The hospitals in Quebec and Sweden were never overwhelmed, unlike Italy or New York. So there would have been no need to send people back to nursing homes if they were not recovered.

Nursing homes still accounted for a huge percentage of total Covid deaths in Quebec. At it takes is one asymptomatic staff member and a shortage of PPE.

It may be, however, that the nursing homes in Quebec and Sweden essentially let Covid patients die in place instead of sending them to hospitals at all. They probably wanted to preserve hospital capacity for a wave of younger patients that never materialized.

Not only Hokkaido has the Japanese characteristic of being an island.

Hokkaido is currently a big red zone of intense COV. Guess that technique didn't work after all. Would be interesting to look into why.

The article is dated April 24, and Hokkaido like the rest of Japan was declared in a state of emergency -- and like Tokyo has remained there even as the rest of the country is lifting restrictions. So Hokkaido was a hot spot, not a success story.
https://english.kyodonews.net/news/2020/05/3d7b544c27f9-urgent-tokyo-area-hokkaido-to-remain-under-virus-emergency-beyond-thurs.html

I also question their model, which assumes that there are a small number of people who are inherently super-spreaders (and everybody else is not) -- and that they can be identified. I think that's a lot like assuming a few of us have exactly 7 freckles on our left foot and all we have to do is identify and isolate those people and that will solve the pandemic.

So that article was over-optimistic and over-confident in Japan's especially Hokkaido's response to the pandemic.

OTOH, that guy who Tyler keeps citing who raised the alarm about Japan's undercounting of cases (probably valid), and that Japan's case count would soon start rising exponentially (turned out to be correct), and that Japan's health system would be overwhelmed by the tens of thousands of cases that would be flooding in ... his predictions are looking increasingly way off base in the opposite direction.

All models are wrong. Some models are useful. The useful ones have yet to be identified -- if there are any. They seem to be in short supply.

"I also question their model, which assumes that there are a small number of people who are inherently super-spreaders"

You can certainly identify them after the fact. But the problem with the claim that Japan is able to identify clusters and super-spreaders is that Japan has not been testing very rigorously. It was giving the same advice to people that the U.S. was in telling people not to go to the doctor but simply self-isolate at home if they felt sick. South Korea pursued a testing and tracing strategy with a lot of success but it had actual testing capacity and was proactive about testing early on.

Yet despite South Korea having "a lot of success" with testing, it has had the same number of Covid-19 deaths per capita as Japan with relatively little testing.

South Korea: 0.000005
Japan: 0.000006
U.S.: 0.0003

Growth in cases since March 31:

South Korea - 13.9%
Japan - 746%

South Korea was one of the hardest hit countries early on which makes their performance in not just slowing the virus but almost suppressing it entirely since March all the more impressive.

Why would you start the clock on March 31st instead of Feb 28th after the outbreak in the church happened in mid March? That gives a 630% rise in South Korean cases.

Japan is showing that it has gotten the same outcome as South Korea without almost suppressing it entirely.

That should be: "the outbreak in the church happened in mid February"

It's deja vu all over again. In the run-up to health care reform, many economists criticized the U.S. health care system as too "fragmented", meaning many small, independent, distinct health care providers. What was needed was more coordination, accomplished through large networks and, alas, through consolidation. And consolidation we got, as hospital companies merged and large health care systems acquired both independent hospitals and physician practices, while physicians either consolidated in large group practices or went to work for hospitals and health care systems; indeed, well over 50% of physicians are now employed by hospitals. Does that mean the U.S. health care system is no longer "fragmented"? Apparently it is, for there is a surfeit of recent articles blaming the slow, inadequate response to the novel coronavirus to, yes, the "fragmented" health care system. Here we go again.

The article also states: "The number of new confirmed cases in Tokyo fell from 197 on April 11 to 132 on April 22. It is too early to link that to the state of emergency, but we can say that the calls by Tokyo Governor Yuriko Koike for people to stay home, which she made prior to the national government’s declaration of a state of emergency, are having an impact."

Probably not. On March 25, Koike asked "if possible, work at home and refrain from going out at night as much as possible on weekdays."

In Japan, it was almost impossible to work from home based on the culture of work there. According to a couple of Japanese and American friends in Tokyo there was almost no difference in the capacity of commuter trains the week after Koike announced that. But sometime in early April Tokyo was much less active on weekends and especially at night and movie theaters were empty. Then two weeks after Koike's request there was a big difference in people not going out as much and hours at restaurants were being reduced. After that week of much more social distancing, Prime Minister Abe called a national emergency.

As someone who works in a Japanese office, ours went from "almost impossible to work from home" to "everyone is working from home" in a week or so.

Although it was never enforced, the Japanese government signaled that it planned to declare an emergency and then did it, and it got very good compliance. However, there is a notable difference that people did not listen to the government when it asked them to refrain from cherry blossom viewing in March but they did comply when it asked them not to travel during Golden Week in May.

The Japanese government has mastered the statistics of covid-19 but people knew to panic anyways by seeing NHK report on frightening numbers in the US and UK.

"OTOH, that guy who Tyler keeps citing who raised the alarm about Japan's under counting of cases (probably valid), and that Japan's case count would soon start rising exponentially (turned out to be correct), "

The first is not at obvious and even if there was under counting, it wouldn't have been significant enough to come close to closing the gap between Japan and Western countries. Japan had 100 H1N1 swine flu deaths in 2009, Korea had 200 and the U.S. had between 8,000 and 18,000 such deaths according to the CDC. There were no claims of under counting then.

Cowen wasn't correct about cases "soon starting to rise exponentially" since they had been already, and you can see this on Wikipedia's "Japan coronavirus pandemic" page.

Mar 1 to Mar 6: 8% increase in cases a day on average
Mar 7 to Mar 13: 9%
Mar 14 to Mar 25: 5% (12 days lower but increasing exponentially)
Mar 26 to Apr 1: 9% (back to early March increase rate)
Apr 2 to Apr 8: 10%
Apr 9 to Apr 15: 9%
Apr 16 to Apr 22: 5%
Apr 23 to Apr 29: 3%
Apr 30 to May 6: 1%
May 7 to May 13: 0.8%
May 14 to May 20: 0.3%

It's kind of sad that so many people read this example of proactive government-led action to crush COVID, and then just say "it's the masks."

People will see what they want to see, I guess.

By the way, do the math on how many masks you actually need for 300 million people. Say flu-level 100 masks in everyone's closet?

As time goes on, and masks are still not offered at Trader Joe's in 50 packs, I get the government's dilemma. If they endorsed masks early on, it was going to rapidly devolve to DIY, and I could see them being slow to go out in that limb.

We had to be in a bit of a spot before they actually said "this is how you fold the t-shirt."

I have read your post a couple of times and I'm not sure what your point is.

Incremental change or changes on the margin can have a large impact. If you have a disease that can grow exponentially than small steps can have large impacts.

One area of potential dangerous growth is asymptomatic individuals spreading the disease. If you get a large number of them to wear masks you slow the spread.

Such steps require collective action. Achieving such collective action isn't easy. A have a few contacts in Sweden and they tell me that even if the government isn't enforcing lockdowns, a majority of Swedes are doing it out of self-interest. And their slowing economy reflects this. However, they also have a higher death rate than America because compliance with safety protocols are uneven.

In my area things like masks and hand sanitizers are becoming easier to obtain. Although the use of masks has brought an extremely hostile reaction from a significant sector of the population. Again in my community, many responded by making masks for health care workers that In some cases were very close to N95 standards.

The comments by the government against masks were a mistake. Given the risk of spread by asymptomatic individuals, mask use in New York could have had a significant reduction in the spread. Encouraging innovation and steps to meet demand for a needed item seems like the proper path.

I think you demonstrate my point.

Tyler linked to a story of government success, and you do as others on this page, ignore that and talk about masks and voluntary action.

"On February 28, 2020, acting without legal basis, Hokkaido Governor Naomichi Suzuki declared a state of emergency and called on residents to refrain from going outside. Residents took the call seriously, and are responsible for the success of the cluster-based approach."

But yay Sweden? Give me a break.

By the way, if the CDC had said "everyone wear a mask," do you think the free market would have magic'd 30 billion (good, disposable) masks into existence?

Many good people do wear masks, but they're usually sewn by family members, or bought off Etsy. Mask wearing is still very suboptimal. I don't think many people wash them, and there are probably a fair number who don't remember which is the outside.

I agree with you here, but have a hard time reconciling this message with the one above criticizing Trump, a guy who gets tested everyday, for not wearing one. The cognitive dissonance is amazing.

I'll be less abusive this time, but really just think it through.

What you wanted first was a photo op of Melania lovingly handsewing a mask.

Then you wanted a second photo up of Trump wearing his loving mask.

Then more people wear masks, and less people die.

Because of course, wearing bad masks is still better than wearing no mask.

Ah, so, theatre is what you are interested in. Fine, but stop saying 'science'. You look foolish. (In general and for contradicting yourself).

It is not at all theater. If someone in the supermarket with me is a non-symptomatic transmitter, wearing an inside out bad mask, I am still safer.

Or conversely, if I am the transmitter, with an inside out bad mask, you are safer.

If Trump does it, it's pointless theater. If Obama did it, it's poor leadership for the nation.

Got it.

Obama = leadership? Poor or otherwise I'd say no. Definitely theatre. X2

Obama, the Chad he is, was the best president of the last 30 years at least...

Or if you need any clarification...
https://me.me/i/virgin-trump-penguins-of-thadagascar-chad-obama-generously-shares-his-236bb4d3dc2e482b935750e065805516

Health Care supply firms are now offering cloth masks in quantity. Think of the masks as worn by those in the surgical areas in the TV series M.A.S.H.

With shipping and taxes about $4 each.

We wear them once and then wash them. They fit snuggly even over my increasingly unkempt beard.

It is certainly reasonable to assume that if the government immediately told everyone to wear masks a few things would happen:

1. There would be even LESS masks for front line care providers and critical workers because ordinary people would have started hoarding sooner (f there can be less than zero).

2. The administration's spin that the virus will go away on it's own would be undermined.

3. The massive failure to plan or prepare would be revealed sooner.

4. Right wingers would go even more apoplectic and being told what to do.

I think that if Trump had bought into mask-wearing at the hand-sewing state I think we'd have had the best of both worlds.

We'd have MAGA-masks and not fights with clerks for "freedom."

There is no doubt that Trump's utterly bizarre and sociopathic abdication and ongoing disruptive and divisive conduct was immensely costly to our national response.

Reduced now only to historian's 'what if' speculation.

"What if" the President of the United States had provided leadership and demonstrated depth of character? What if the President had ably and coherently deployed the vast resources his disposal? What if the President of the United States had acted Presidential?

Trump runs on compare red vs blue state response and wins forty states. this is what’s coming and it’s why you are acting like a bitch on the rag. Rofl. In the next four years when you summon the courage to end it all please don’t take others with you. Be a man.

I hate to disappoint you, but I'm not despondent that 20% of the voting males of the nation devolved into infantile dickheads, and found a pied piper who makes them feel like they're not losers after all.

It happens. Its not that different from middle school really. It will pass.

While I'm sure you don't care, as I am also sure Trump does care, but in either case, history will judge you and your ilk quite harshly.

"People will see what they want to see, I guess."

Just as there are people who keep insisting that it's just coincidence that all of the countries with the best virus response are islands.

lol, I think we have a few more miles of ocean between us and China.

And they distrust the Chinese even more than we do.

lessee...

- widespread rapid testing
- thorough rapid contact tracing
- a proactive government that takes the virus seriously
- a compliant populace that will wear masks willingly and voluntarily self quarantine
- a comparatively homogeneous island nation

what’s the takeaway here?

Yet you have people like Ingraham on Fox News attacking any such steps while claiming that the much of the cautions are based on a hoax.

I stopped watching CNN because the bias in their political reporting was out of control.

Now Fox News has become even more insane.

The wearing of a mask is an attack on civil liberties and a mark of subservience or the beginnings of a police state. Contact tracing is the government having details on the most intimate details of your life.

Simple steps can have an impact on getting us back to normal. But the fringes in this country make collective action almost impossible. To the detriment of the larger society.

Maybe we are on the same page after all.

As usual the middle ground is likely the best. Take the practical precautions that help and give up the theatre that errodes confidence in the medical and politcal communities.

Isn't the whole point of the current discussion that the first three don't apply to Japan and they still had almost no impact from the virus?

Is there a point to these discussions?

There's so much BS, spin, cherry-picking, biases, shifting goalposts, non sequiturs, logical fallacies, assumptions, estimates, and evolving actual facts that - to tell the truth - I sorta lost track of whose point du jour is whose this morning.

Changing the subject when your argument is invalidated could be considered a kind of non sequitur.

Actually I have no idea what But is talking about. It appears to be a non sequitur itself

You seem to be saying that
"
- widespread rapid testing
- thorough rapid contact tracing
- a proactive government that takes the virus seriously"

Are key to preventing large outbreaks of the coronavirus, but the very subject of the entry your commenting on is ex post facto rationalizations of why Japan did not suffer serious consequences despite not following the prescription.

i wasnt saying that. i was paraphrasing our host’s too post. and asking if that pointed to any conclusions

Well my point was that collective action in the United Staes is almost impossible given the political climate

"... individuals with even higher transmissibility ... "

What does this mean? Is this behavioural (as in super-spreaders), or something physiological that contributes to "high transmissability"?

So much we don't know still: https://www.washingtontimes.com/news/2020/may/21/australian-researchers-see-virus-design-manipulati/

"A forthcoming Australian scientific study concludes that the coronavirus causing the global pandemic contains unique properties suggesting it was manipulated in a Chinese laboratory and was not the result of a natural occurrence."

Not sure which is better, if its true or not. Might be comforting to know this didn't happen naturally.

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