TOKYO – Japan had only a few dozen confirmed coronavirus infections when the thirty-something nurse with a slight sore throat boarded a bus to Osaka, the country's third-largest city, to attend a weekend performance. Day of pop bands in a music club.
Less than two weeks later, he tested positive for the virus, and authorities quickly alerted others who had been to the club. As more infections emerged from three other music venues in the city, officials evaluated the concert goers and their close contacts, and urged others to stay home. In total, 106 cases were linked to the clubs and nine people are still hospitalized.
But less than a month after the nurse tested positive, the Governor of Osaka declared The outbreak is over.
Since the first case of coronavirus in Japan was confirmed in mid-January, health officials have assured the public that they have moved quickly to prevent the virus from spiraling out of control. At the same time, however, Japan has baffled epidemiologists as it has avoided grim situations in places like Italy and New York without draconian restrictions on movement, economically devastating blockades, or even widespread testing.
The puzzle may be about to gain some clarity. On Thursday, Katsunobu Kato, Japan's health minister, said he had informed Prime Minister Shinzo Abe that there was evidence that Japan now had a high risk of rampant infection.
On Wednesday night, just a day after Japan and the International Olympic Committee agreed delayed the Tokyo Summer Games for a year due to the coronavirus pandemic, Tokyo Governor Yuriko Koike warned citizens that the sprawling city of about 14 million people was in a "critical phase before a possible explosion of infection. "
Cases in Tokyo increased this week, setting records for four consecutive days, including an announcement of 47 cases on Thursday, when travelers returned from abroad. Limited tests for the virus have raised fears that many more will go undetected.
Ms. Koike implored the people of Tokyo to work from home, avoid unnecessary exits, and stay indoors for the weekend. On Thursday, the governors of four neighboring prefectures also requested that residents refrain over the weekend from leaving for anything other than urgent needs.
"If we leave without doing anything now," said Koike, "the situation will worsen. I ask for everyone's cooperation."
Until now, the public has not taken such warnings seriously. Although Schools have been closed for a month and the government has requested that major sports and cultural events be canceled or delayed, the rest of life has returned to normal. People have been traveling in crowded subways, gathering in parks to see cherry blossoms, shopping, drinking, and eating, comforted by the relatively low number of confirmed coronavirus cases and deaths in Japan.
Even at one of the Osaka clubs where the outbreak occurred earlier this month, a group of 40 young women attended a boy band performance on Wednesday, jumping and waving their hands in a small, unventilated space for nearly two hours.
As other parts of the world spiral into infections, hospital overflows, and deaths, Japan, a country of nearly 127 million people, has reported only 1,300 cases and 45 deaths, with one of the slowest progressing death rates in the world despite its aging population.
"Either they did something right," said Dr. Peter Rabinowitz, co-director of the MetaCenter for Pandemic Preparedness and Global Health Security at the University of Washington, "or they didn't, and we don't know yet."
As Japan appears to have accomplished a feat of infection containment, it has presented an intriguing contrast to other countries in Asia, where the pandemic began. It did not put cities into closure, as China did. Not deployed Modern surveillance technology as a growing number of countries, including Singapore. Nor did it adopt the kind of blanket test that helped South Korea isolate and treat people before they could spread the disease.
While South Korea, with a population less than half the size of Japan, has tested nearly 365,000 people, Japan has only tested about 25,000. Japan now has the capacity to perform around 7,500 tests a day, but its daily average is closer to 1,200 or 1,300.
Dr. Tomoya Saito, director of the health crisis management department at the National Institute of Public Health, said the limited tests were intentional. Those who are examined are referred by doctors, usually after patients have had a fever and other symptoms for two to four days. Japan's current policy is to admit anyone who tests positive to a hospital, so officials want to avoid depleting health care resources with less serious cases.
Dr. Saito said that part of Japan's apparent resistance to infection may be the result of common cultural measures, including frequent hand washing and bowing rather than shaking hands. People are also much more likely to wear masks on trains and in public spaces. "It is a kind of social distancing," said Dr. Saito.
But Jeffrey Shaman, an epidemiologist at Columbia University and lead author of a report that projected five to 10 undetected cases for every confirmed coronavirus infection based on data from China, said Japan's approach was a "gamble."
"The risk is that things are brewing below the surface that you won't recognize until it's too late," said Dr. Shaman.
In Osaka, a report prepared for the health ministry this month projected that in early April, the city could have about 3,400 infections, 227 of them serious. "It is possible that the provision of medical treatment to seriously ill patients will become difficult," the report said.
On Wednesday, Osaka Governor Hirofumi Yoshimura said he was working to secure an additional 600 beds in hospital isolation rooms that could accommodate patients with the most serious infections.
Dr. Masaya Yamato, head of infectious diseases at Rinku General Medical Center in Osaka, said the region was moving towards a model where coronavirus patients with mild symptoms could stay home to save hospital beds for the sick. serious.
In Tokyo, there are only 100 beds designated to care for people with serious infectious diseases. On Wednesday, the city government promised to secure 600 more.
The Tokyo governor's request to stay inside this weekend, Dr. Yamato said, may be too weak to postpone a crisis.
"It is better for Prime Minister Abe to decisively declare a closure in Tokyo," said Dr. Yamato. "Economic impact should not be a top priority. Tokyo should close for two to three weeks. Otherwise, the Tokyo medical system could collapse. "
Mr. Abe's administration has appointed a task force to determine whether to declare a state of emergency, a move it said was unnecessary earlier this month.
For now, the public is largely unmoved. Although some grocery store shelves in Tokyo were removed on Wednesday night after the governor's request, on Thursday everything went on as usual.
Near Shinbashi station in central Tokyo, men in black suits sat side by side at a restaurant counter offering a special fried noodle lunch for 500 yen, about $ 4.50. A long line formed outside a McDonald's, and smokers crowded a small corral near the station entrance.
At Shinjuku Gyoen Park in western Tokyo, where cherry blossoms were near the peak of flowering, a sign at the entrance informed visitors that as part of antivirus efforts, picnic blankets were banned and the alcohol. Security guards with megaphones toured groups of people taking pictures of the flowers, warning them to wash their hands.
In a store not far from the park, Kazuhisa Haraguchi, 36, stood in line for a chance to buy a pair of limited-edition Nike Air Max sneakers.
Mr. Haraguchi said he was concerned about how the virus was spreading in the United States and Europe, but was not overly concerned about the situation in Japan.
"It's scary, but there doesn't seem to be much here right now," he said. "If I die, at least I will die in my slippers."
Ben Dooley and Makiko Inoue contributed reports from Tokyo, and Hiroko Masuike from Osaka, Japan.