The 4th Covid Wave Demonstrated the Limits of the Japanese System

⏱ 7 minutes

📈 New confirmed cases, victims…Japan’s record figures in a less-affected Asia

The peak of the fourth wave of Covid in Japan was reached in mid-May and is now considered past. However the spring 🌸 2021 uptick has been the strongest and the hardest to date in the archipelago, with per day up to:

More than 7,000 new confirmed cases,
A number of patients exceeding 80,000,
A death toll peak at 216.

As a matter of fact, in May alone, Japan has declared:

~150,000 new cases, in other words 1/4 of the total number of confirmed cases until now,
~3,000 deaths to add to the 10,000 previously registered.

Disheartening figures for the country, where testing is slow in comparison to other developed countries: about 8 times less than France - and despite a raise to more than 100,000 daily tests!

The only "positive aspect", although the expression is inappropriate when people are dying, is the limited number of victims: it seems that most of the deaths due to Covid-19 were included in the mortality rate (even so, this has yet to be confirmed in a few months ahead when definitive statistics are available).

To be fair: a large part of East Asian countries are affected by the spring wave (Taiwan, Thailand, Singapore, Hong-Kong...), whereas they were globally spared last year.

🚫 A long but little coercive spring state of emergency

The Japanese government has been reluctant to declare a nationwide state of emergency and only includes prefectures one by one, but actually the 10 prefectures concerned over 47 (Tokyo, Kyoto, Osaka, Hyogo, Aichi, Fukuoka, Hokkaido, Okayama, Fukushima and Okinawa) represent 70% of the overall Japanese population. In other words, most of the archipelago is living under the state of emergency between March 21 and June 20.

Even so, the state of emergency is not very restraining. The prominent measures are:

Closedown of all department stores (now only on the weekend),
Closedown of non-essential shops, restaurants, bars and karaokes at 8 p.m. (not always implemented),
Legal closing of establishment serving alcohols, cinema, game arcades and amusement parks,
Encouragement to teleworking, however not really successful due to the paperwork habits (and facsimile!),
A 5,000 spectators limit in stadiums, and,
Extinction of neon lights at night in largest cities.

The curfew Japanese-style is far from being as restrictive as the various lock downs imposed in the world and especially in western countries, with limited travel possibilities and certificates to move around. As a consequence, it is less efficient (and over time, it tends to be less accepted).

Fortunately and for the time being, the Japanese government has put aside the domestic tourism incentive campaign "GoTo Travel" since it was paused in the beginning of last winter.

🏥 An insufficiently sized, and above all inadequate, healthcare infrastructure

In mid-May’s peak, more than 1,000 Japanese were hospitalized in intensive care or resuscitation units. Compared to the nearly 6,000 in April in France whose population is twice less, this figure should not be so worrying. However, it demonstrated the limits of the Japanese healthcare system, beside what is already known, such as:

Paid PCR tests, or,
Public healthcare centers (hokenjo) unable to efficiently track the contact cases.

In Japan, about 2/3 of the 4,255 hospitals are private. The healthcare economy is very liberal and ruled by clinics (there is no individual doctor practice per se, physicians work in clinics), so the government can not enlist private hospitals. Therefore, many establishments, despite having resuscitation beds available, choose to refuse medical care to those who are not already their clients, and even to become "Corona-free hospitals" to reassure their usual patients! The other hospitals (less than half the total) are naturally overwhelmed.

Consequently, Covid-19 patients with worsened condition end up dying without access to an ICU: they pass away in ambulances that have looked several hours for a clinic willing to treat them, or merely at home. Moreover, the British variant is now the prominent Coronavirus 🦠 strain in Japan, with more than 80% of the cases, and the average age of the affected population has greatly lowered compared to 2020 statistics. It has certainly impacted patients with preexisting conditions not related to Covid, who could face difficulties to receive their usual healthcare if they just had fever.

💉 A cumbersome vaccination campaign affected by a very slow start

Let us not dwell on the subject, as we already wrote an article about it on Kanpai-Japan:

To sum things up, Japan’s anti-Covid vaccination campaign did not only start very late (mid-February, which is 2 months after the United States or Europe), but wrong strategic choices were also made (initial preference for AstraZeneca’s vaccine but exclusive vaccination with Pfizer’s). Moreover, the campaign is struggling to gain momentum: after nearly 4 months of inoculations, vaccination in Japan is about 10% slower than in France, whereas it population is double and much older!

Thus, on June 1, less than 8% of the Japanese had received their first jab, whereas they were 40% in France and 50% in the United States… Another downside is the lack of an app or website in Japan to help book an appointment (the country is not as technologically advanced as what we usually expect): vaccination tickets are sent by postal mail, and it is only after receiving them that one is allowed to call one after the other the places where vaccination is available to book an appointment! Meanwhile, a few dignitaries, including mayors, have tried bypassing the system without a second thought (front picture).

Fortunately, the Japanese government and its apathetic Prime Minister Suga seem to have understood the importance of this "sanitary crisis inside the sanitary crisis" and have set the target of one million inoculations per day as soon as mid-June. If Japan can reach this goal, herd immunity will be effective in the archipelago before the end of 2021.

Want to know when Japan will reopen its borders to international tourists? Subscribe to Kanpai’s Newsletter and get information on real time:

To be fair again, in the same manner as the 4th wave, a large part of Asia faces a lagging vaccination campaign.

🛂 Borders still tightly closed, with the Olympics on sight

After an easing of entry restrictions between August-September and December 2020 (all visas were admitted on the territory, except tourists naturally), Japan closed again its borders at the end of last year.

The expatriates benefiting from a residence permit aside, the delivery of new visas has been close to zero since then and requires specific conditions, such as a marriage previously contracted with a Japanese citizen. Even language schools have relinquished the hope of starting their new school year in autumn 🍁 2021 with foreign students. It does not necessary mean that it will be impossible, but only that as of today, it is not possible to guarantee the opening of schools and consequently to prepare it. Thus, many universities have already canceled exchange programs for September.

The only exception: the 100,000 athletes, staff and medias related to Tokyo 2021 Olympic Games 🏅 this summer, that have already been postponed by a year. An extremely sensitive topic, inasmuch as hostility towards the staging of the Olympics grew stronger in the Japanese population, and is even back by the powerful newspaper Asahi Shimbun. And even if cancellation of the Olympics is unlikely (the final decision belongs to a greedy IOC), populism has won and the government decided in March that overseas spectators, even if they had bought expensive tickets and received their vaccine shots, will not be allowed in Japan to attend to the sport event!

A decision that can be considered a retaliation : in the end of May, the United States have indeed raised the travel alert to its highest level and warned its citizens against traveling in Japan, especially due to its lack of recognition of vaccination and the quarantine enforced on every arrival.

While still failing to confirm the respect of self-isolation by travelers newly arrived in the archipelago, Japanese authorities continue their witch hunt on gaijin. In the last episode to date, and not the least, Ibaraki prefecture’s healthcare center issued an official Covid-19 prevention document in the end of May that recommended not to eat with foreigners (you know, the people who have been barred from entry in Japan for 6 months now!)

😓 Our thoughts at Kanpai

The team at Kanpai sincerely regrets this situation:

The team based in France can not travel to Japan anymore since March 2020 (and international tourism as a whole is likely put on hold for several months more!),
Our team in Japan would like to retrieve the "life before Covid" and feels abandoned as their country of origin has entered the vaccine rollout for months.

The last events only confirm what we already knew: however great and well-organized Japan may be, it does not have flexibility to face the unplanned. Hopefully, Japan will be able to react and learn from the difficulties and mistakes made during the pandemic to further improve in the future !