Thread by @murakamiwood

1/30 In two forthcoming pieces, I examine #Japan's response to the #COVID19 #coronavirus #pandemic. I'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). japantimes.co.jp/news/2020/05/0…

4/30 #pcrtesting & collection of data by local health bodies was discouraged by central government because it would 'overwhelm' them. Deep cuts made from 1994 Community Health Law onwards have affected the ability of local governments & hospitals to cope. hatarakikata.net/11189/

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. news.yahoo.com/coronavirus-lo…

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. washingtonpost.com/world/asia_pac…

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. asia.nikkei.com/Spotlight/Coro…

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: mainichi.jp/english/articl…

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, 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. japan-forward.com/speaking-out-t…

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, even in hospitals, in the world. journalofhospitalmedicine.com/jhospmed/artic…

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. cbsnews.com/news/cdc-coron…

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. doi.org/10.1186/1471-2…

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. asahi.com/ajw/articles/1…

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. www3.nhk.or.jp/nhkworld/en/ne…

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 'contact confirmation' #app, #Mamoriai (“Protect Together”), produced by a national “civic hacking” organization, Code for Japan. nikkei.com/article/DGXMZO…

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. jxpress.net/contact-tracin…

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. japantimes.co.jp/news/2020/05/1…

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's it (for now) foreignpolicy.com/2020/05/14/jap…

I should say that there are quite a few other things not in these tweets notably the possibility of the #BCG vaccination being protective; and the role of the Line app, which is ubiquitous in #Japan and increasingly difficult to live without...