Interview with Professor Rajib Shaw at the Graduate School of Media and Governance at Keio University, Japan.
What do you see as the most important part of your research on COVID-19 clusters in Japan?
Rajib Shaw: I think it was that the cluster-based approach was very important to identify the initial surge in numbers. In January and February, at the very initial stage, some clusters were identified in places including Osaka, Tokyo and Hokkaido. That prompted two or three government policy decisions.
For example, in the north of Hokkaido there were quite a few tourists because of its snow festival. As early as late February, the Hokkaido governor announced a provincial emergency due to the specific cluster located there. Then, at the national level, the central government started border control measures.
In late March and early April, some clusters were reported in different hospitals in Tokyo, including in the hospital at my university, Keio University. These cases prompted new regulation to have preventive provisions for not only doctors and nurses, but all support staff.
These clusters were highly publicised in all different types of media, which also helps bring awareness among people so that they avoid these types of cluster areas. Furthermore, on public transport there are continuous announcements to keep the windows open and for people not to talk – because when you talk you can possibly infect other people.
How successful do you think Japan’s cluster-based approach has been overall?
Rajib Shaw: The cluster-based approach has really worked for Japan. Its urban density and ageing population make it more vulnerable than many other countries, but in spite of that it was able to reduce the death and infection rate. If you see Japan’s fatality number, the total is still only just about 1,000.
The preparation has been done quite well. The Tokyo metropolitan government is, for instance, quite confident that even if we have a few hundred cases per day, our healthcare capacity is good enough to respond – so has been loosening up restrictions.
The benefit of having the cluster approach at the initial stage is that, firstly, you can make your healthcare facilities a little better so that they can absorb the second wave. Number two is that you can continue your business and keep the economy running. It’s a balancing act of making healthcare robust, but also making the economy run.
Hopefully, with all our key lessons from the first peak, I think we will be able to at least address some of this second peak.
How much has this relied on technology? And how can technology now boost the cluster approach for the second peak?
Rajib Shaw: Interestingly, Japan did all its contact tracing at the peak time manually, not using apps like in Singapore. The important things when you do this type of contact tracing are that you need enough trained professionals and you put in strict regulatory measures or ensure responsible citizen behaviour – because unless people actually report cases, it’s very difficult to do manual tracing.
Only in the third week of June, Japan introduced COCOA, a contact-tracing app. In Japan, the privacy-of-information issue is very serious and sensitive, so there has been quite a bit of discussion to make it transparent and to communicate that after 14 days all the information will be erased.
It’s difficult to predict how things will go with the improved technology, but we’ve had lots of learnings and innovations. These make things easier, especially for the younger population, who are getting more infected now because they are the ones going for drinks or going out.
Can other countries follow Japan’s example, even if some of the success is down to cultural reasons and relying on citizens to be responsible?
Rajib Shaw: I think every country has its own responsible citizens, so it’s just possibly that the way of risk communication is different from country to country. Japan has a mask culture during the three or four months of the regular influenza season, so the risk communication process possibly was much easier there.
But possibly in some countries where there is no mask culture, like the UK, the US or India, there is a different way of communicating this risk and trying to make them understand the importance of masks. I think this communication is very culture-specific, and that really matters – how we communicate the same message with a different group, ethnicity, background or age group.
Has earlier tracking helped to reduce the issue, despite the reported surge in infections in Japan in the past few weeks?
Yes, I am still of the same opinion that the original cluster approach worked. It seems that we are having the second peak now, but when you open the economy it is obvious that the number will increase. The government is providing caution, but is not in panic. This was an expected scenario.
The new cases are coming mainly in the age group of 20s, 30s, 40s and 50s, and due to their high immunity, the recovery rate is high. A few clusters were identified in theatres, cinemas and nightclubs, which now have compulsory testing for staff members. And even if the number of reported cases is 1,000 to 1,200 per day, the number of deaths reported per day is in the range of just three to five.
The key point is that the detailed contact tracing and cluster identification at the earlier stage helped Japan to flatten its initial curve, and gave enough time to public health and medical facilities to prepare themselves. So there is no collapse in the healthcare system, unlike in several other countries.
Much of the media are after numbers, but at this stage, eight months from the first reports of the coronavirus, we need to go beyond the number of affected people, focus on the economy, reduce the number of serious patients – and, most importantly, reduce the number of deaths.