The Final Countdown, Part 4


The medical community must take the lead against COVID-19

   It’s January 2021, and the New Year has begun. The number of new coronavirus infections in Tokyo on December 31, 2020, when I wrote the last installment in this series, was 1,337; on January 7, 2021, it stood at 2,447, marking the largest single-day increase in new infections in this city.

   Indeed, the virus seems to be waxing ever stronger in Tokyo. A New Year’s Day without dinner parties and other celebrations had a wistful air about it, but perhaps because of the smaller number of people venturing out-of-doors, the air seemed somewhat cleaner, and the quiet of the streets and the stillness of the blue winter skies had something soul-stirring about them. In 2020, humanity was utterly at the mercy of the coronavirus. Reflecting on this, I vowed that I would make 2021 a good year, whatever the virus had in store.

   The tragedy that confronts us today is the entirely predictable result of half-baked, unscientific, infection-containment measures whose only justification was the need to maintain economic activity. Prematurely lifting the emergency declaration in May revived the infection rate, which had been on the wane. The GoTo Travel campaign, which was launched in October and included Tokyo, succeeded in disseminating the virus throughout the nation while the GoTo Eat campaign in late September delivered the coup-de-grace, so to speak, by conducing to the entrenchment of the virus in all the major cities of Japan. As a result, even the economy, which these measures were designed to protect, has continued to erode.

   On January 7, the national government issued another emergency declaration, this time targeting Tokyo and three prefectures—needless to say, an extremely limited scope. Whatever the action, it’s too little, too late. The prime minister insists on a one-month limit to the current state of emergency, but this estimate is rather hopeful, given the extent to which the situation has been allowed to deteriorate. Moreover, the statement that lifting the emergency would be considered if the situation progressed to Stage 3, the stage of rapid increases in infections, defies logic. “We will continue the necessary measures,” said the prime minister, “until Stage 2 (the stage at which that infection rate begins to increase markedly) is achieved.” How will such statements sit with the people of this nation, who are on the point of exhaustion, having suffered continuous pummeling by this crisis? Whether they will follow the dictates of the government remains to be seen.

   If the state of emergency is lifted, it is clear as day that people will relax their social behaviors and propel us back to Stage 4. Reports of the prime minister banqueting with celebrities and of politicians of local councils holding large, year-end parties while the members of parliament, one and all, urge that restaurants stop serving at 8 PM and that parties be limited to four—all this has a corrosive effect on people’s morale and invites them to relax their vigilance against infection, thus reducing the efficacy of anti-infection measures by half.

   The responsibility of government officials for the current state of affairs is beyond question. But the medical community also bears a large portion of the blame. No doubt there were many debates and conflicting views among the advisory councils assembled by the national and metropolitan governments. Nonetheless, those dissenting voices are not being heeded in a timely fashion, and the expert panels organized by the government bodies are in many cases merely there to add their imprimatur to policies prepared in advance by politicians and bureaucrats, an experience that I am all too familiar with on a personal level.

   If an adviser were to make the claim outside parliament of being ignored by government officials for having a dissenting view, he or she would be relieved of their place on the council. Being labeled a reckless dissenter and losing one’s say in these weighty matters are also hardly laudable in the eyes of the world. Nonetheless, in the current crisis the very lives of Japanese citizens are at stake. The virus is not the only thing to have claimed so many souls; the morass of hardships in which people have become mired has also robbed many young people of their life. It would be ideal if there were a place in government for experts charged with the responsibility of rectifying the situation and the authority to execute their policies, but in Japan today, where this is not possible, another expedient is urgently needed.

   What the citizens of Japan need right now is correct information about COVID-19, which continues to keep this nation in a state of turmoil. Yet the only information to reach the citizens now is an incoherent medley of opinions issued by a motley crew of experts and non-experts after they have been strained through the filter of government censorship. It is no surprise that the average citizen has no access to reliable information. The audience naturally latch onto the bits that are most convenient to themselves while blithely ignoring all else, thereby sowing confusion in society and undermining anti-infection measures.

   We can still take decisive action. Academic bodies relevant to public health and infectious diseases can form working groups independent of the government to analyze data, propose constructive strategies, and hold daily press conferences to announce the latest, correct, medical information about the disease. It would be vital that they respond fully to the questions put to them by journalists. The questions asked by the average citizen contain many hints as to the kind of information that the public so urgently requires. Equally important is that these experts understand that by addressing journalists they are in fact speaking to all those who are outside the viewfinder with the purpose of informing them correctly. The questions of today tell us what needs to be communicated tomorrow; they tell us what citizens want to know. The same ideas apply to the situation surrounding hospitals. Instead of complaining that there are not enough beds or that the medical system is on the verge of collapse, healthcare workers who are “on the ground” and “on site” need to discern where the problems lie and how a solution can be found by coordinating with each other to sort through the data and by issuing daily, public reports. I include myself and all the physicians who are privately or publicly in some form or other involved in battling the pandemic. It is patently not a simple issue of the availability of hospital beds. Merely increasing the number of hospital beds without commensurately increasing the number of healthcare staff or logistical capabilities will only add to the stress of already overburdened healthcare workers and contribute to an actual collapse of the medical system. It goes without saying that healthcare workers in a hospital must care for their patients. But in times of emergency, it is crucial that we prepare an environment where we healthcare workers can operate effectively. To this end, the understanding and cooperation of all those who have recourse to our services are indispensable. For our part, we need to continue to make information pertaining to the medical services of our respective region public in objective language bolstered by concrete figures.

   We are all up against extremely trying circumstances. However, the situation is not entirely devoid of hope. The current Ministry of Health, Labour and Welfare criteria for hospital discharge of infected patients require at least ten days to have lapsed after the onset of symptoms followed by a negative PCR test result 72 hours after symptoms improvement and ten more days of hospitalization from the date of the test. In other words, apart from the treatment of severe cases, the lapse of ten days after symptom onset usually lowers the risk of infection considerably regardless of the PCR test results. The virus can be transmitted two or three days after symptom onset but even if I were somehow to become infected, so long as I avoided acting in ways that could infect others for two weeks, I could avoid infecting others. Even if two more weeks were added to this regimen, the total period would be not much longer than a month. If all citizens were to imagine that they were infected and minimized their social contact with others for four weeks, we would be able to contain the virus dramatically.

   The point about the current declaration of emergency that cries out for caution is that the government’s policies may have the effect of actually increasing the spread of COVD-19. While touting a 70% reduction in the number of commuters, the government is at the same time allowing events with audiences of up to 5000 to be held. Even if social distancing measures are put into practice in stadiums, people will be forced together into close quarters on public transport. The notion of organizing an orderly transport of 5000 spectators to and from an event is idle fantasy. The suggestion that establishments serving alcoholic drinks limit their operating hours to 11 AM to 7 PM also defies understanding; the risk of transmission exists even if only two or three individuals sit together for a drink and a meal regardless of the time of day. On the other hand, if patrons are willing to sit quietly by themselves and eat alone with none but the wall to keep them company, they may do so at any time of day. The same applies to shopping. As long as one avoids crowded public transport, one should be able to go shopping wearing a mask without any risk of infection. We must therefore make an effort to avoid altogether risky activities without senselessly restricting activities that can be done safely.

   Our goal is to contain the spread of infection to the greatest extent possible in one month so as to make the pandemic tractable. If we all wear a mask and maintain an appropriate distance from each other, the risk of spreading the infection will be low. Frequent handwashing will further lower the risk. We must also refrain from dining out with those who are not already living with us. Events which require the use of crowded public transport should be avoided even if the venues have implemented adequate anti-infection measures. And let’s not travel outside the city; this applies to pleasure and business-related trips. All these restrictions must be implemented nationwide; there’s no point in merely placing one city and three prefectures under them. The folks in Osaka should also heed this advice.

   There’s one more important point: we have to take good care of our own health. If we get a fever, develop a cough, notice any change in our health at all, we should absent ourselves from our workplace or classroom. In such an event, our family should also refrain from unnecessarily venturing out-of-doors; if one person in a family is infected, there is a strong likelihood that the other members are, too. If we continue to feel ill, we should inform our physician by telephone. The social pressure to continue working or attending school despite ill health is no laudable display of industry or virtue—it’s simply immoral.

   Finally, to make 2021 a good year, let us all take to heart the many lessons that his pandemic has taught us. The current explosion of infections has brought into relief various issues related not only to the medical establishment but also to the Japanese social system, our social habits as a nation, and other problems. Even after the pandemic has subsided, let’s all not forget the current impotence of the government and the medical establishment as well as the fragility of our own moral outlook. If we can do this, a day may come when we might be able to reflect on our current hardships with confident detachment.

   Let’s all make 2021 a successful year.