The low-tech way that Japan managed to tackle coronavirus quickly

ON our 110th day of different degrees of lockdown, any unbiased observer would rationally conclude this administration’s response to the Covid-19 pandemic could be graded 7 to 8, in a scale in which 10 is perfect.

I didn’t pull this grading from out of the blue. Going by worldometers.info’s data and tabulation, the number of Covid-19 cases for the planet’s 7.7 billion population is 1,386 per 1 million population. That’s four times of ours, which is 351. For deaths per 1 million population, it is 67 for the world; ours is just 12.

Check out the accompanying table and we’re obviously doing much, much better than the United States, United Kingdom, Italy as well as most of Western and Eastern European countries.

We’re doing better than Indonesia. But Thailand, Malaysia, Japan and, of course, Vietnam’s performance have been spectacular. Can you believe that Vietnam has only 355 cases and no deaths?

These figures, however, all mean that the government’s performance is not just average but at least two notches higher than average, which would be 7 to 8. The 9 and 10 grades are obviously for Thailand, Malaysia, Japan and Vietnam.

Which brings up to what should be the top concern now of the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF-EID), which is to determine — and tell the public — why we still haven’t been able to contain Covid-19 on the level that Malaysia, Thailand, Japan and Vietnam have done.

Reprinted below is a June 24 article from the Japan Times titled “The low-tech way that Japan managed to tackle the virus quickly” which I hope could contribute to the IATF-EID’s efforts.

What I found promising is that the “low-tech” way discussed in this article is simply contact-tracing, undertaken through Japan’s 450 community-level “public health centers.”

We have a similar institution, called the Barangay Health Center, which had been mandated to be set up in each of our over 40,000 barangay by a Marcos letter of instruction in 1973. While I cannot find data on how many such centers have been set up and actually running, these are ubiquitous in Metro Manila and its adjacent provinces, functioning as most barangay residents’ first point of health service.

Covid-19, July 2, 2020 Source: worldometers.info

Japan Times article

“The virus might have been new, but for Yuko Koizumi the work was still the same.
“In Kawasaki, nearly 300 people had tested positive for the coronavirus by early June. But Koizumi was unperturbed. As head of infectious disease response for the city’s network of over seven public health centers, she was able to draw on a familiar strategy used in past pandemics and seasonal outbreaks: trace infection routes via close contacts, check on recuperating patients and arrange treatment where needed.

“It’s a playbook that may have made all the difference in Japan’s unorthodox, though largely successful, virus response.

“Kawasaki’s seven public health centers are part of a web of over 450 such institutions across Japan which played a crucial role in limiting the nation’s outbreak. The centers meant Japan already had an army of trained contact tracers when the virus struck and may provide a model for other countries as they look to build systems that will future-proof them for the next pandemic.

“Experts contend that the existence of these centers, which implement and execute central public health policy from giving elderly diet advice to investigating child abuse, are one of the key reasons Japan was able to avoid an explosion in coronavirus cases.

“‘I don’t think I would have been able to do it if it wasn’t something I already knew how to handle,’ Koizumi said. ‘We also already had a team of people that could communicate and work together.’

“Center staff played a crucial role in quick contact tracing, serving as early gatekeepers when the first cases of the disease in Japan were identified in January. They asked people infected with the virus to detail their movements, share personal information and disclose the details of people they had met to trace who needed to be tested and isolated.

“While largely unknown outside of the medical community prior to the Covid-19 pandemic, trained contact tracers are now recognized to be the cornerstone of a successful virus response, used effectively in nations from South Korea to Germany.

Communal glue

“Unlike in some Asian cities such as Hong Kong, where authorities have published detailed accounts of the workplaces, residences and restaurants and bars visited by infected people to get others to come forward for testing, officials in Japan have studiously avoided publicly identifying businesses or even the regions hit.

“With privacy paramount, public health center workers have been able to conduct tracing while maintaining the anonymity of their patients.

“The public health centers perform a myriad of functions in local neighborhoods, serving as a communal glue of sorts. In addition to infectious disease response, they oversee a wide range of health concerns, from advising the elderly on diet and exercise and conducting health check-ups on newborns, to issuing licenses for bars and restaurants and investigating cases of child abuse or food poisoning.

“That in-built connection to the community helped with the initial coronavirus response, which involved tracking the disease and informing citizens of the right precautions to take. Even now, the work of contact tracing, arranging tests and identifying clusters is still being done across the centers as the country continues to reopen.

Tuberculosis 

“Japan’s public health centers trace their roots back to a program in the 1930s to fight tuberculosis, a disease that, like Covid-19, requires a trace-and-track response, said Toshio Takatorige, a public health professor at Kansai University in Osaka. In contrast, public health systems in Western nations stem from an earlier fight against cholera in the 19th century, he said — a very different type of pandemic that can be solved by improving water and sewage systems.

“‘The tuberculosis problem was more serious than coronavirus is now,’Takatorige said. It was also a serious issue for the Imperial Army, ensuring a well-funded response. To this day, containing TB remains one of the public health centers’ core functions, with Japan having one of the higher rates among OECD nations.

“Similarly, experience with past epidemics — Hong Kong’s bruising encounter with SARS in 2003, South Korea’s 2015 struggle with MERS — has helped other Asian countries also weather the pandemic better than Western nations.

“Public health centers have also provided data that was integral to Japan’s understanding of the virus, Hitoshi Oshitani, a professor of infectious diseases at Tohoku University and member of a panel of experts advising the Japanese government on its virus response, said at a news conference on June 1.

“A 41-year-old man who contracted the coronavirus in Tokyo in April said that staff from the local public health center called him without fail every day while self-isolating at home — asking him to describe his condition, and providing advice on when it was appropriate for him to leave the house after his symptoms subsided. The man was also asked to log his temperature and condition on a website daily, as well as questioned over who he may have been in close contact with.

“‘Everyone is captivated by potential treatments and vaccines, because if they’re successful there will be money for pharmaceutical companies,’ said Takatorige, the public health professor in Osaka. ‘No one thinks about the system that’s already a part of daily life.’”


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