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People wear masks as they commute during the morning rush hour in Chuo district. Photo: AP

Fears in Japan that limited coronavirus testing is masking true scale of infections

  • As neighbours such as South Korea are identifying more cases through large-scale testing, Japan’s comparatively relaxed response has concerned citizens
  • People with mild symptoms are not required to test for the virus, leading experts to believe the number of confirmed cases is under-reported
Japan is becoming a centre of concern as the coronavirus spreads globally, with the country’s official infection tally suspected to be the tip of the iceberg of a much wider outbreak.

As of Friday, the virus had infected more than 180 people and was linked to four deaths, excluding the cases from the Diamond Princess cruise ship which was quarantined for weeks in Yokohama harbour.

In neighbouring South Korea however, the number of infections has swelled rapidly to cross 2,000, after the government tested tens of thousands of people to get a clearer picture of the deadly outbreak.

That divergence has experts and members of the public concerned about Japan’s approach to diagnosis.

“For every one who tests positive, there are probably hundreds with mild symptoms,” said Masahiro Kami, chair of the Medical Governance Research Institute in Tokyo, and a practising doctor. “Those with mild symptoms are not being tested.”

While the government says it has the capacity to conduct 3,800 tests a day, only 5,700 were carried out between February 18 to 23, Japanese Health Minister Katsunobu Kato told parliament on Wednesday. That included the tests taken by passengers and crew of the Diamond Princess, where Japan’s attempt to quarantine the boat resulted in an explosion in infections to more than 700 cases.

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Japan’s low level of confirmed infections has enabled Prime Minister Shinzo Abe to maintain a relatively relaxed stance on the outbreak compared with South Korea and mainland China, where more than 78,000 cases and over 2,700 deaths have been recorded.
Unlike other countries in the region, Japan has not imposed travel bans on citizens from highly infected nations – including China – and Abe has encouraged, but not enforced, the cancellation of major public events. Many people in Tokyo continued to commute to work in packed trains.

As public criticism of his seeming lack of leadership mounted, Abe on Thursday announced that schools would be shut from March to April, although childcare facilities, nurseries and after-school clubs would remain open.

On Friday, after the government urged the private sector to take measures to limit the spread of the virus, the operator of Disneyland and DisneySea said the two parks would be shut for about two weeks and would aim to reopen on March 16.

Jeff Kingston, director of Asian studies at Temple University’s Japan campus, said Abe’s move on school closures was a response to growing public dissatisfaction over the handling of the outbreak.

“Suddenly, he sees the political consequences of being seen as missing in action,” Kingston said, noting Abe’s support had fallen to around 36 per cent in a weekend poll.

A visitor poses for a photo with Mickey Mouse at Tokyo Disneyland in Urayasu on April 17, 2011. Photo: EPA-EFE

Japan had already come under fire for not testing the Diamond Princess passengers more extensively, with at least two Japanese testing positive for the virus after they returned home. Both had used public transport and been out in the general public after disembarking from the ship.

There was also rising anxiety over the number of Japanese virus patients whose infection routes cannot be traced. For example, authorities have not yet been able to identify connections between those who got infected in the northern island of Hokkaido, which has now grown to become the biggest outbreak in Japan with 54 cases.

Coronavirus: how Diamond Princess became a ‘super spreading’ site

Unlike some other Asian countries, Japan did not see a widespread local outbreak during the Sars and Mers virus epidemics. That lack of experience may have left it ill-equipped for dealing with the novel coronavirus, which is thought to be more infectious than those diseases, though less deadly.

For instance, Japan does not have a Centre for Disease Control, meaning virus prevention and outbreak control is in the hands of bureaucrats from the health ministry, aided by a group of experts.

While there is a national benchmark for how testing for the virus should be undertaken, some cities and regions are applying different standards.

The official guidance is for anyone with mild symptoms to stay at home. Those with serious conditions are told to contact a hotline, where they can be linked to an appropriate medical facility. Doctors can recommend testing at Japan’s local public health centres if they suspect a Covid-19 infection.

“In order to grasp the current situation, we should test,” said Kazuhiro Haraguchi, a lawmaker with Japan’s opposition Democratic Party for the People. “Tests are not 100 per cent reliable, but we need to know the facts.”

A health worker checks the temperature of a Diamond Princess passenger in Yokohama on February 21, 2020. Photo: Reuters

Some public health centres say they have not had consistent supplies of coronavirus testing kits to meet requirements. Wakayama prefecture, which has confirmed 11 infections, is using its own parameters to decide when testing is needed.

Hospitals and clinics could also be concerned that if a case is confirmed on site, they’ll be forced to shut down for disinfection, according to opposition lawmaker Haraguchi, who wants the government to compensate operators in these cases.

Japan scientist stands by ‘chaotic’ criticism of cruise ship quarantine

Even a member of the government’s expert panel on the coronavirus has criticised its efforts on diagnosis. Hitoshi Oshitani, a professor at Tohoku University Graduate School of Medicine, said last week that Japan’s initial efforts at testing were like using a pen light to hunt for a ping pong ball in the Tokyo Dome baseball stadium.

Health minister Kato told parliament this week the government was working on a system to support the private sector to conducts tests so that more people could be tested.

Kenji Shibuya, director of the Institute for Population Health at King’s College London, said: “Scientifically we should target and prioritise the patients.

“But it is now beyond that – we are dealing with public fear, and to tackle it, we need to give people an opportunity to get tested,” said Shibuya, the former chief of health policy at the World Health Organisation.

School for primary and secondary pupils will be shut from March 2 until the end of the annual spring break. Photo: Kyodo

But as the government now boosts its response to the virus parents and school administrators say they have been caught off-guard.

“This is shocking news,” tweeted Toshihito Kumagai, mayor of the city of Chiba, east of Tokyo. “How will parents who are medical workers or doing other jobs that support society manage? Society could collapse.”

Aichi Governor Hideaki Omura said he was “stunned” by the “sudden decision”, although he expressed some understanding for the move.

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“All of Japan has to deal with this infectious disease. It must be Prime Minister Abe’s strong determination and he will take responsibility,” he said.

Tobias Harris of Teneo Consultancy described the school closures as a “drastic decision” taken by the government.

It was “not mentioned in the basic policy adopted Tuesday, and appears to go beyond what the government’s own experts were recommending”, he added in a note.

But some experts have recommended closures, with one member of the government panel previously pointing to smaller-scale school closures that he said helped contain a new flu outbreak in 2009.

Authorities say the coming two to three weeks will be crucial in determining whether the outbreak can be contained, a major concern particularly for Japan in the run-up to the Olympics, which open in Tokyo in July. The government is also preparing for Chinese President Xi Jinping to visit in the coming months.

But parents are mostly feeling panic and anger at the duration of the school closures.

One Twitter user fumed about “how incompetent this country’s government is”. Another, tweeting as @Ayu49Sweetfish said: “We’ll just have to get our revenge at the next elections.”

This article appeared in the South China Morning Post print edition as: Japan’s limited testing may mask bigger crisis
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