Read on Twitter
1/30 In two forthcoming pieces, I examine #Japan& #39;s response to the #COVID19 #coronavirus #pandemic. I& #39;ll summarize the main non-theoretical points here (long thread alert!).
2/30 #Japan’s figures have always looked good compared to many other countries, which initially led to suspicion that the ‘real’ numbers of #COVID19 #coronavirus infections & death were being played down.
3/30 #Tokyo Metropolitan Government at least has now released full #COVID19 figures, including general death rates, seeming to put this argument to rest (but these figures are also now being challenged). https://www.japantimes.co.jp/news/2020/05/09/national/tokyo-releases-covid-19-data/">https://www.japantimes.co.jp/news/2020...
4/30 #pcrtesting & collection of data by local health bodies was discouraged by central government because it would & #39;overwhelm& #39; them. Deep cuts made from 1994 Community Health Law onwards have affected the ability of local governments & hospitals to cope. https://hatarakikata.net/11189/ ">https://hatarakikata.net/11189/&qu...
5/30 The February #COVID19 outbreak in #Hokkaido was contained through a state of emergency & cluster-tracing, but was not followed up with widespread testing, resulting in a second wave. This lesson was also not learned on a national scale. https://news.yahoo.com/coronavirus-lockdown-lessons-hokkaidos-second-081728538.html">https://news.yahoo.com/coronavir...
6/30 The #DiamondPrincess debacle pushed the government into taking the #pandemic more seriously, but #Abe also responded with a state #propaganda campaign to counter stories about #Japan’s response, widening the rift with the foreign press. https://www.washingtonpost.com/world/asia_pacific/japan-coronavirus-image-abe/2020/04/15/73bf1dee-7f00-11ea-84c2-0792d8591911_story.html">https://www.washingtonpost.com/world/asi...
7/30 The effect of the 2020 Tokyo #Olympics was twofold: a pre- #COVID19 shift in resources away from pandemic preparation to terrorism that happened just when the reverse was needed; and during the early outbreak, a paralyzing fear that the Games would be postponed or cancelled.
8/30 Critics claimed #Abe’s stance on #pcrtesting was motivated by the #Olympics. However government argued their approach was entirely based on #cluster #tracing not individual diagnosis & normal pneumonia surveillance picked up #COVID19 deaths. https://asia.nikkei.com/Spotlight/Coronavirus/Coronavirus-Why-Japan-tested-so-few-people">https://asia.nikkei.com/Spotlight...
9/30 After the announcement of the postponing of the #Olympics to 2021, the infection rates for #COVID19 in #Japan did suddenly jump and the pattern of increase thereafter assumed a more ‘typical’ pattern, although death rates remained low.
10/30 #pcrtesting remained discouraged and accounts of attempts to obtain a test show patients being moved from clinic to clinic, entering by back doors, & being told by nurses not to reveal the location of the testing site. This carousel could be fatal: https://mainichi.jp/english/articles/20200511/p2a/00m/0dm/011000c">https://mainichi.jp/english/a...
11/30 State #compensation following voluntary #lockdown policies were ludicrous and the ridicule over $40 meat and fish vouchers was deserved, especially in comparison to what was provided by countries like Canada.
12/30 Many observers have put forward a "cultural hypothesis", which proposes that #Japan has several sociocultural traits that make #infectiousdisease spread less rapidly and widely. These include:
13/30 A propensity towards #socialdistancing and reserve. #Japanese people generally try to avoid touching each other in public, and especially not skin-to-skin, for example holding hands, kissing, touching each others faces etc.
14/30 Everyday #hygiene. It is argued that #handwashing 
https://abs.twimg.com/hashflags... draggable="false" alt="">, even it is often perfunctory, is frequent; taking off shoes before entering the house in #Japan is normal etc.
15/30 Citizen #responsibility for #infectionprevention. Wearing of non-medical #facemasks is normal in #Japan, not to stop the wearer from being infected, but for anyone with a cough, cold and so on, to protect others.
16/30 At worst this cultural hypothesis is combined with a #xenophobia / #nationalism that posits #Japanese people as stronger than or #Japan as morally superior to the rest of the world. https://japan-forward.com/speaking-out-the-power-of-the-japanese-in-avoiding-a-coronavirus-explosion/">https://japan-forward.com/speaking-...
17/30 Some of the elements are exaggerated or even completely wrong – e.g. research actually shows that #Japan has amongst the lowest rates of #handwashing https://abs.twimg.com/hashflags... draggable="false" alt="">, even in hospitals, in the world. https://www.journalofhospitalmedicine.com/jhospmed/article/126977/hand-hygiene-intervention-japan">https://www.journalofhospitalmedicine.com/jhospmed/...
18/30 Some elements are looking increasingly irrelevant – e.g. shoe-removal is shared by many countries with varying infection figures, and in any case, it seems that object-to-object transmission of #COVID19 is now considered unlikely. https://www.cbsnews.com/news/cdc-coronavirus-doesnt-spread-easily-on-surfaces-transmission-before-symptoms/">https://www.cbsnews.com/news/cdc-...
19/30 What remains is the lack of skin-to-skin touching, and the use of #facemasks. It is no exaggeration to say that the non-medical facemask may be the most important everyday technology deployed in #Japan and other East Asian countries to fight #COVID19.
20/30 However, studies of #facemasks and #infectiousdisease have often been unable to convincingly explain the effectiveness of mask without resorting to broader ‘cultural’ explanations (usually outside the formal study). A paradox that needs resolving. https://doi.org/10.1186/1471-2458-12-1065">https://doi.org/10.1186/1...
21/30 Cultural factors are not all positive. #Japan has seen widespread #bullying of those (suspected of being) infected with, #COVID19, and even of #healthcareworkers, in a complete reversal of the celebratory attitude in most other countries. http://www.asahi.com/ajw/articles/13362712">https://www.asahi.com/ajw/artic...
22/30 In addition, while #Japan has a reputation for social compliance, the broadly voluntary #lockdown measures to control movement, encourage people to work from home and not to go out to entertainment centres, have been far from universally observed.
23/30 #workingfromhome has not taken off in #Japan as in other countries, partly for bureaucratic-technological reasons: office workers have had to go into work physically because they have to use official hanko (ink stamps) on their documents. https://www3.nhk.or.jp/nhkworld/en/news/backstories/1088/">https://www3.nhk.or.jp/nhkworld/...
24/30 Until recently, #Japan had not showcased any novel #technologies of #pandemic containment or monitoring. Unlike some neighbouring countries, there is no real case to be made for #surveillance overreach in Japan’s response to #COVID19 (so far).
25/30 A lot of #datacollection & collation in local government in #Japan is low-tech & uses pencils, paper, the fax-machine & hanko. There has been no change in these practices during the #pandemic. This had led to problems with both speed & mistakes in the copying of figures.
26/30 Japan is now backing a & #39;contact confirmation& #39; #app, #Mamoriai (“Protect Together”), produced by a national “civic hacking” organization, Code for Japan. https://www.nikkei.com/article/DGXMZO58928290R10C20A5000000/">https://www.nikkei.com/article/D...
27/30 According to the developers, #Mamoriai is based the #AppleGoogleAPI, will be #decentralized, only hold data on phones and share it as the user wants & will not track the user beyond actual moments of localized ( #bluetooth) contact between users. https://jxpress.net/contact-tracing-apps-japan/">https://jxpress.net/contact-t...
28/30 #contactracingapps are probably unnecessary and ineffective, however if an app is to be used, then a limited, #anonymized, #decentralized, #opensource app would be the most #privacy-respecting #technology. #Mamoriai appears to be among the less privacy-invasive approaches.
29/30 #Japan is now progressively lifting the #stateofemergency, based on expert advice. It is claimed that #pcrtesting will increase, and in addition, #antibody #testing is being proposed. https://www.japantimes.co.jp/news/2020/05/14/national/japan-coronavirus-emergency-39-prefectures/">https://www.japantimes.co.jp/news/2020...
30/30 No-one knows for sure why #Japan has ‘done well’. Early #cluster #tracing, cultural #hygiene factors and luck have all played a part. One thing that has not helped has been the shambolic performance of PM #Abe and cabinet. That& #39;s it (for now) https://foreignpolicy.com/2020/05/14/japan-coronavirus-pandemic-lockdown-testing/">https://foreignpolicy.com/2020/05/1...
