Experts’ input vital to successful coronavirus response

As Japan prepares for the prospect of a second wave of coronavirus infections, its relatively low death and infection rates compared to many other countries globally has been touted as the success of a government COVID-19 policy closely guided by health experts, including public health officials and academics providing evidence-based advice.

Heading the many steps adopted to combat the pandemic was the setting up of the first ever emergency task force of experts in the country. It comprised the nation’s leading epidemiologists and virologists and was based at the Ministry of Health, Labour and Welfare, with the aim of providing swift evidence-based advice to the government, sometimes in the face of resistance from politicians.

It reported directly to Prime Minister Shinzo Abe, who was criticised for a late start in tackling the COVID-19 outbreak. Based on their advice, the country avoided a tight lockdown, a step taken by many other governments with damaging economic consequences.

“Japan did not resort to harsh lockdown measures as adopted in the West,” wrote the Mainichi Shimbun newspaper on 14 May. Instead the policy of identifying infection clusters as risk areas “reduced the spread of the virus, so should be commended”.

On 7 April, referring to advice from the Advisory Committee on the Basic Action Policy on Coronavirus, as the task force was officially called, Abe declared a month-long state of emergency, later extended until 25 May, as the number of new infections were reduced to a few dozen from a peak of over a 100 per day in Tokyo alone.

The mathematics of using an infection rate of 0.5% for every 100,000 people referred to by the task force continues to be quoted officially as a benchmark as infections spike – Tokyo is now reporting more than 50 daily infections in what could become a second wave.

In mid-April Tokyo reported 206 cases, just 10 days after Abe declared the state of emergency in Tokyo and seven other prefectures.

At a press conference on 25 May, Abe said: “With the cooperation of experts, we intend to provide support so that relevant guidelines are complied with.”

Financial subsidies were extended for businesses considered at risk. The funds will support the steps they need to make to reduce infection risk, such as minimising crowds.

Cluster-based approach

Led by Takaji Wakita, head of Japan’s National Institute of Infectious Diseases, and including Shigeru Omi, head of the Japan Community Healthcare Organization in Tokyo and an immunologist, Nobuhiko Okabe, head of the Kawasaki City Institute for Public Health, and Hitoshi Oshitani, professor of virology at Tohoku University School of Medicine, the task force held press conferences from the start and expressed their ideas and proposals, including prioritising infection clusters and lifestyle changes.

The cluster-based approach is based on identifying areas and sectors where the virus is detected, leading to closure and stringent isolation of those areas.

“A key aspect of Japan’s COVID-19 containment policy was identifying clusters in communities that led to containing the infection spread. This approach worked well and prevented a situation that could have overwhelmed healthcare services like hospitals,” explained Kazuaki Jindai, researcher and medical epidemiologist at Kyoto University and a member of the national COVID-19 cluster task force that also advised government.

PCR testing, which detects the presence of the virus, and was widely used in South Korea for tracking possible COVID-19 cases, was not pursued in Japan. Instead, local governments in Japan emphasised the importance of social distancing and shutting access to indoor and crowded spaces.

Tokyo, the densely populated capital of 14 million residents recorded the worst cases in the country with 6,000 infections and 325 deaths out of a total of 18,000 cases and nearly 1,000 deaths reported by the end of May. That number is way below deaths in Europe and the United States. New York City reported more than 200,000 cases during May.

Kouichi Morita, professor at the Graduate School of Biomedical Sciences at Nagasaki University, said Japan’s containment success can also be traced to the public response.

“I would thank the diligent public. By taking precautionary steps such as avoiding contact, the numbers of infections could be controlled,” he said.

Lessons learned

Despite high public approval for the evidence-based approach of the task force, experts also pointed to lessons learned. During a 24 June press conference, Wakita, the task force head, conceded the importance of expanding the group to include diverse experts, needed to balance health impacts with economic issues in advance of an expected second wave of infections.

Second wave clusters have emerged in China, Singapore, South Korea and Hong Kong in the past month, highlighting the need for constant vigilance.

“As the [economic] demands widen under the ongoing coronavirus threat, the government must base its decisions on advice from diverse sectors. The task force should include experts from local government, economic and business backgrounds,” he said.

Wakita was addressing the public preference for advice from health experts over government policy that resulted in friction with economic concerns in Japan.

“The government makes the final decision on policy while we play the role of advisors. Sometimes the borderline is not clear,” he said.

Originally advice focused on the emergence of an unknown virus, with researchers struggling to analyse and understand new information. Experts say they continue, despite the experience of the first wave, to be hesitant to predict or sound the alarm for a second wave.

“An outbreak can happen anytime. The precautions we take now will determine what happens next,” said task force member Koji Wada, professor of public health at the International University of Health and Welfare, speaking at a press conference on 26 June.

He was referring to a possible second wave.