12 APRIL 2020
DR. MOHAMED OUBIHI (CEO YAKUMED LIMITED)
CLUSTER DETECTION AND GOVERNMENT BOLD ACTIONS NEEDED
In my last article (25th March 2020), I reflected on the puzzling phenomenon of a startlingly low number of coronavirus infections in Japan, and the possibility of cultural and social traits (among other factors) having an influence on the containment of the virus. Today, I will discuss the role of cluster detection measures by the Japanese authorities and why drastic decisions are needed to avoid the collapse of the healthcare system.
In the midst of the coronavirus crisis, Japan showed a glimmer of hope in the fight against this global scourge as it managed to steer safely through the first stages of this crisis. As shown in figure 1 from the Ministry of Health Labour and Welfare (MHLW as of 7th April), the number of deaths has been surprisingly low compared with other countries. The total number of infections (not shown in the figure) and not including cases on Cruise ship was approximately 4000.
Figure 1: Situation of deaths in Japan due to Coronovirus compared with some countries
(Source: MHLW as of 7 April 2020)
However, the situation is constantly changing with a surge of new infections in the last two weeks especially in Tokyo and Osaka. The current number of infections (not including cases on Cruise ship) is 6748 and the death toll is 98 (as of 12th April 2020).
In hindsight, if any lesson could be gleaned from this crisis, it is that early and decisive interventions are critical in preventing public health disasters. A delay of merely days can cost thousands of lives. In this respect, credit should be given to Japan for having acted early by introducing cluster detection measures. Cluster detection is a central piece in the government strategy to fight the coronavirus outbreak. It is an effort led by Dr. Shigeru Omi (ex-Head of Western Pacific Office at WHO) and other prominent Japanese epidemiologists, infection disease scientists, and data analysts, in coordination with Japanese universities and research institutions. Cluster detection involves the identification and tracking of potentially infected people in order to isolate them and prevent the appearance of new clusters; it requires considerable resources and the support of government ministries. The thorough and meticulous detective work necessary, combined with government action to ban arrivals from China and Korea were arguably key decisions in containing the coronavirus outbreak in Japan until the end of March.
However, over the last two weeks Japan seems to be going through a second wave of new infections, especially in Tokyo and Osaka. What is alarming about this surge of new infections is not its growth rate, but it is the fact that over 40% of new infections in Japan are from unidentified sources (from mid-March until 14th April). In Tokyo and Osaka, the proportion of new infections with unknown sources rose up to 70% in the last week. In other words, the cluster detection strategy at this stage has reached its limit in tracing back the sources of thousands of new infections. The question is how Japan can slow the rate of infections and prevent an explosive spread of coronavirus. The answer lies in taking draconian actions, namely, city lockdowns akin to the ones implemented in Europe and some states in the US.
Interestingly, the Japanese authorities still seem to be reluctant to enforce the lockdown of major cities such as Tokyo and Osaka. In light of the recent rise in cases, leading scientists such as Shinya Nakayama, the Nobel-prize winner and the Japanese Medical Association, have requested the government to take bold and quick actions in order to avoid the collapse of the healthcare system. On 7th April 2020, the government issued a state of emergency in seven cities and prefectures and advised people to follow social distancing guidelines; these measures still do not amount to a strict lockdown. It is understandable that the central government in Japan has to tread carefully to balance public health with economic and social considerations. However, in these war-like circumstances, the Japanese government should prioritise the health of its citizens over financial considerations and should not be lulled into a false sense of complacency (especially since they proved to be particularly efficient in containing the outbreak during the first couple months).
It does not seem to be entirely coherent that whilst the government is urging its citizens to follow social distancing guidelines (avoid the four Cs: Closed spaces with no air flow, Crowded spaces, Conversation within a short distance), the trains are still operating as usual, cafes and restaurants are open for business (recently some restrictions from 5 am to 8 pm) and Japanese people are still going to work. How can a Tokyoite salaryman comply with social distance if they still have to commute to work in packed trains and continue to visit cafes and restaurants? In addition, many companies are not used to the concept of working from home or “telework” as it is dubbed in Japan. The Japanese excel in working physically as groups and enjoy face to face meetings. Telework is a new reality that many companies are still grappling with.
Japanese people are law-abiding and very disciplined. They have displayed resilience and courage as a nation in the face of natural disasters such as tsunamis and earthquakes. I am confident that with clear and bold instructions from the political leadership, the Japanese will cooperate in an exemplary manner and comply with the measures introduced, no matter how stringent they may be.
References
新型コロナウイルス感染症対策の基本的対処方針 令和 2 年 3 月 28 日(令和 2 年 4 月 11 日 変更) 新型コロナウイルス感染症対策本部決定
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000164708_00001.html
https://www.bousai.metro.tokyo.lg.jp/taisaku/saigai/1007288/1007655.html
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/covid19_qa_kanrenkigyou
_00001.html
