Does Japan’s Culture Explain Its Low COVID-19 Numbers?

As the COVID-19 pandemic spreads and the number of people infected and deaths skyrocket in various parts of the world, a continuing headache has been the relatively slow increase in those numbers in Japan. (Although as of this writing, the numbers here have started to increase worryingly.)

One of the main reasons for the low number of infections recorded is that Japan has imposed strict criteria to be eligible for testing, focusing on administering tests only to people who have had a fever for more than four years. days combined with travel abroad, close contact with an infected person, or pulmonary symptoms severe enough to warrant hospitalization. The aim of this approach has not been to identify all those infected, but rather to focus resources on those most in need of treatment and to trace the foci of infection.

This was also reported that Japanese doctors have used the country’s plentiful supply of CT scanners to identify pneumonia which is a common result of the novel coronavirus, which is then treated but often without a COVID-19 test being performed. Thus, some people treated for what is likely COVID-19 will not be counted as confirmed cases in the statistics.

Could culture be the explanation?

A further explanation for the numbers has taken shape in the public sphere, however, that Japanese cultural practices may be behind the relatively slow pace of the outbreak here. An example of this view is a viral tweet from @ sctm_27 on March 25, which has racked up over 42,000 likes at the time of writing. It lists the culture of wearing masks, very little skinship (such as shaking hands or shaking hands), not wearing shoes in the house, cleanliness of public toilets and restaurants, as well as clean water and air as potential explanations for the puzzle of Japan’s decline. coronavirus numbers. Likewise, a popular blog post on Japan’s COVID-19 strategy mentions hand washing and wearing masks, as well as a lack of handshakes and hugs as possible reasons for Japan’s outlier status. In a recent Twitter feed, cell biologist Hironori Funabiki cites the masks, the lack of speech in public transport, the few religious assemblies and the fact that little food is consumed with bare hands as weapons in the Japanese arsenal of fight against the diseases.

Many commentators from outside the country have pointed to the widespread use of masks in Japan and other Asian countries which appear to have been more successful in controlling the spread of COVID-19. Despite continued advice from the World Health Organization that healthy people do not need to wear masks, many experts in the United States now recommend considering widespread use of masks, based on of data showing their effectiveness in blocking airborne droplets that carry the virus and the fact that many people infected with COVID-19 are asymptomatic.

While masks can indeed be useful and Japan’s overall cleanliness is certainly something to admire, it is still unclear whether these alone are responsible for the low number of COVID-19 in Japan. University of Kobe infectious disease specialist Kentaro Iwata, for his part, rejects the culture-based approach when it comes to discovering the novel coronavirus.

“I don’t think you can assign attributes based on culture,” he says. “No matter what the culture, if you let your guard down, you get wide circulation quickly. “

Japanese exceptionalism theories could indeed be dangerous if they engender a sense of complacency (or even invincibility) that prompts people to let go of social distancing, paving the way for an upsurge in infections.

Cultural factors against testing

Another way that cultural factors might be at work in relation to the low numbers of COVID-19 in Japan is how they might cause the Japanese to avoid getting tested.

A cultural element that runs counter to testing may be that some people might fear that a positive diagnosis of COVID-19 will cause them to cause meiwaku (problem) for others, which is strongly frowned upon in Japanese culture. For example, no one wants to be that person who got sick and was therefore responsible for forcing the entire factory or office where they worked to shut down and everyone to quarantine themselves. Or for linking their employer’s name to the virus, which could scare customers off.

The Japanese may also fear that the capture of COVID-19 will lead to being viewed negatively by others. This is because in Japan there is often a tendency to blame people for being sick, assuming it was somehow their fault. For example, a Japanese friend told me that when she was a child, her mother feared that she would catch a cold, for fear that she would be taken to task by the teacher for inadequacy. kenko kanri (health management). I experienced this firsthand while teaching a seminary a few years ago. I had persistent throat problems from a bad cold and coughed a little too much during the conference, and one of the Japanese attendees berated me on an evaluation form while writing, “Currency kenko kanri o shiro” (“You should manage your health better”).

Given this tendency to blame people for their health problems, you can imagine what someone would say if they caught the novel coronavirus: “It’s your fault you went abroad. “,” You should have worn a mask, “” Do you wash your hands properly? Who would want to get tested just to get a positive result and an unhealthy dose of judgment?

Some people may also fear being discriminated against after being diagnosed with COVID-19. Unfortunately, there are many examples in Japanese history of intense discrimination and ostracism against sick people, including those with Hansen’s disease and tuberculosis, and against hibakusha (survivors of atomic bombings). People with Hansen’s disease were separated from society and unable to return even after being cured, and family members of people with tuberculosis were excluded from marriage. Employment opportunities were denied to the hibakusha and their children.

Azby Brown, senior researcher at Safecast, an organization founded after the Fukushima nuclear disaster, notes: “I think there is a strong stigma against people with contagious diseases or conditions or feared. to be. This was the case after Fukushima regarding radiation exposure. It’s not contagious, but a lot of people have reacted as if they think (or fear) it is. We have heard of numerous cases of intimidation and ostracism of evacuees from Fukushima.

Brown goes on to note that these attitudes are often linked to ideals of purity and the traditional aversion to spiritual or physical “pollution”.

“Maybe in terms of sickness there is also a residual notion of karma at work: that people who get sick have drawn it onto them in some way, being receptive to bad ones. influences, and the people around them need to be careful not to be “infected” with their bad karma, ”he says.

Safecast recently implemented a tool for people to share their experiences of being tested successfully or unsuccessfully for COVID-19. Taking into account that the Japanese may fear stigma and thus prefer to keep the fact that they have been tested for COVID-19 a secret even if the result is negative, they will add a language in the planned Japanese version to reassure users that The information submitted is anonymous. It is this ability to adapt to cultural factors that may be necessary to ensure the best quality of information and, ultimately, to control the spread of the virus.