Remember that a lot of tourists from China visited Japan during Chinese New Year. There was also a case of Diamond Princess. However, they did not trigger catastrophe. So how did Japanese do? 7/
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Now, as an example, I'd like to explain a case in Hokkaido, where clusters of COVID-19 were detected from late January. 18/
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There was Sapporo Snow Festival held from 1/31 to 2/11, where 2M people visited, likely causing clustered infections at this period. A lot of closed, crowded temporal spaces without good ventilation where many tourists gathered, talked and ate foods were generated. 19/
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On 2/28, State of Emergency was declared in Hokkaido, after detecting 15 and 12 positive cases on 2/27 & 28, respectively. Total# was 66 at that point. 20/
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The mayor requested Hokkaido citizens to refrain from going outside during weekends. Public schools were closed from 2/28. Large-scale events were asked to be canceled. https://www.nikkei.com/article/DGXMZO56188700Y0A220C2L41000/ … 21/
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Meanwhile, cluster Response Team of Ministry of Health, Labour and Welfare (MHLW), National Institute of Infectious Diseases (NIID) and local public health center worked together to isolate patients and their close contacts through PCR testing. 22/
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Thanks to early detection and isolations of patients, a burst of infection in Hokkaido was successfully prevented, and now R0 is maintained below 1. On March 18, the mayor of Hokkaido declared State of Emergency to be terminated next day as has initially planned. 23/pic.twitter.com/qGeFDQHvGg
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So how the team was able to successfully detect infected cases? Population of Sapporo, capital of Hokkaido, is 2M. The size of Hokkaido is similar to Maine. I'd like to start with testing. 24/
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OK. Here comes the limit of max tweet numbers in a thread. I'll take some break, and will continue the thread this later. 25/
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I'm back. Please keep in mind that the strategy working for Japan may not be directly applicable to cities like NYC, which is facing hospital overloads. For us (New Yorkers), it is important now to do whatever possible to do to suppress the current burst of infections. 26/
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What I am hoping to do here is to see if we can learn some hints for a long term solution for COVID-19 from Japan, which is apparently handling the situation relatively well so far. 27/
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So, back to testing. I know that there has been some doubts on COVID-19 case counting in Japan due to low numbers of testing. I have limited information, but I can point out a few things. 28/
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First, different countries are using different PCR protocols and primers to detect SAR-CoV-2. What I heard from my microbiologist friend in Japan is that NIID made great efforts to establish a reliable protocol, which is now being used in Japan. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance … 29/
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Second, RT-PCR-based testing generates a lot of false negatives and also false positives. To effectively identify infected patients with limited resource, it is important to focus the testing on patients with high likelihood of COVID-19. https://twitter.com/Dr_yandel/status/1232463168422567937 … 30/
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The symptoms to meet SARS-CoV-2 testing are: patients who have fever >37.5°C/respiratory symptoms & had a close contact history with an infected patient, visited or contacted with those who visited to high risk countries, or may have pneumonia requiring hospitalization. 31/
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Then, after tests for influenza and other general infections come out negative, patients will get a PCR test for SARS-CoV-2/COVID-19. I don't know if this guideline has been broadly practiced, but this what MHLW has distributed. https://www.mhlw.go.jp/content/000609467.pdf … 32/
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Meanwhile, MHLW made a clear guideline for patients with suspicion of COVID-19 infection about when to call the designated consultation centers in each prefectures. This aimed to prevent people from rushing into hospitals with mild symptoms. https://www.mhlw.go.jp/content/10200000/000603610.pdf … 33/
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When the SARS-CoV-2 positive patients were identified, their contacted people are quickly noticed, and quarantined. Again, the key is how to effectively identify true infected patients with limited resources, and to prevent the spread from there. 34/
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Third, I know that many Japanese journalists are always looking for bad news, and often they exaggerate. However, no news about hospital overload in Japan has been reported so far. As of 3/21, total deaths by COVID-19 are 35 and 60 in Japan and NYC, respectively. 35/
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So, I highly doubt conspiracy theories, like Japan is suppressing COVID-19 cases to keep Tokyo Olympics alive. Priority was set to effectively detect infected patients, and this task was achieved without random broad testings in Japan. 36/
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I would like to end this thread by some cultural aspects that may have been helping Japan. These are pure speculation, but my microbiologist friend actually thinks that these factors may have been playing more important roles. 37/
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Face masks. Some argue that face masks are only useful for infected patients not to spread viruses, but they are not effective for protection. Two issues about this. First, since asymptomatic patients are likely to be infectious, masks could help spread viruses from them. 38/
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Second, we are asked not to touch our face, because mouth, nose, and eyes are major infection routes. So, why doesn't a mask help? However, the unfortunate practical reason why we discourage people from wearing masks is mainly to save masks for health care workers. 39/
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In Japan, thanks to widespread severe allergies to cedar pollens, it has been ordinary for Japanese to wear masks. Although there are shortage in masks in Japan as well, people are hand-making them at home to survive allergy season. Many youtube instructions are available. 40/
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Another cultural point is related to Ruth Benedict’s idea of Western guilt cultures and Japanese shame cultures. Few speaks in buses and trains in Japan. Cell phone talking is strictly discouraged. Many local habitual rules must be obeyed not to be ashamed in public. 41/
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Even in Tokyo where trains are packed everyday, spreading of COVID-19 appears to have been suppressed since it was first detected on 1/24. As of 3/21, total COVID-19 cases in Tokyo are only 136 in the city with 10M. This is remarkable to me. 42/
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Religious assemblies. Few Japanese “actively” engages in religious assemblies, except for funerals, weddings, and other special occasions. Even at these occasions, except for receptions, participants keep silence during ceremonies. 43/
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In contrast, in Christian masses, participants actively engage singing and speaking inside churches. A lot of handshakes and hugging as well. In Japan, body touching is still not common. 44/
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Finally, after COVID-19, I realized that to eat pieces of bread & pizza I must touch them with bare hands. In Japan, it is rare to use bare hands to eat foods generally except for sushi and some snacks. Many of snacks are individually wrapped like this photo. 45/pic.twitter.com/TtfMGh8YzY
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I wonder if these "no-contact" Japanese customs have evolved in relation to infectious diseases. I've learned some history of infectious diseases in Europe and consequence of European invasions, but know very little about history of infectious diseases in Japan and Asia. 46/
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The tactics taken in Japan may not be immediately useful in NYC, but may work for other cities where COVID-19 have not hit hard yet. There are many regions in US to protect. 47/
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