This article is from WeChat public account: Cross Japan (ID: zhrb2019) , author: Dong Jian Jun, from the head of FIG: IC photo

In the article published on March 10, we have used data to reveal Japan ’s outstanding anti-epidemic achievements, which should not only be ridiculed, but even worth learning and reference from other countries. Shortly after the article was published, Japanese Prime Minister Abe also announced that the country does not have to enter a state of emergency, and the previous tensions in Japanese society have quickly dissipated.

Let’s use a picture to briefly review the main points of the previous article:

The creator of this analysis map of global infection data is still UCL Professor Mark Handley. The infection data was taken on March 18. We can clearly see that the new crown pneumonia virus, which is raging and rising in other countries, can’t hold up in Japan from the beginning. As a country with the highest number of infected people, Japan’s infection development is the slowest in the world. (except for some countries bordering the Chinese border) .

So in this article, let’s analyze why Japan didn’t fall into the hell that was mocked and pessimistically predicted by the outside world two or three weeks ago. Instead, it was followed by SARS infection in 2003 and H1N1 death in 2009. The lowest rate among developed countries in the worldLater, in 2020, New Crown Pneumonia once again passed through at a relatively low cost, surrendering a completely different epidemiological answer from other major countries.

What did this country do right?

Lessons from 11 years ago

In 2009, H1N1 swine flu was endemic throughout the world, and Japan has not been able to survive alone. Since three returning high school students tested positive, H1N1 has also spread rapidly in Japan, eventually causing tens of millions of people. disease.

The Japanese government, who has been ridiculed of “Buddhas” and “grassing lives for the Olympics,” has a completely different face 11 years ago: At airports such as Narita and Kansai, epidemic prevention personnel boarded flights from American countries to Japan In the passenger cabin of the passenger plane, all personnel are quarantined and the aircraft can be disembarked after inspection. In Yokohama, Kobe and other ports, the epidemic prevention personnel boarded the passenger ship for real-time inspection. The doctors were short of staff, and the Self-Defense Force came together immediately. Japan implemented almost all-dimensional three-dimensional border inspections. Even pigs imported from foreign countries must undergo special medical examinations before they can enter the country.

In addition to strict external controls, the Japanese government has not relaxed internally. All suspected cases have to be recorded. Checkpoints have been set up everywhere and people have lined up to test. At its peak, the Japanese government registered and monitored 130,000 people.

This approach is almost the pinnacle of state power for a multiparty parliamentary country.

However, medical experts such as Nobuhiko Okabe, who was responsible for the epidemic prevention at the National Institute of Infectious Diseases in Japan, later pointed out that border surveillance and national quarantine have caused two huge counter-effects:

  • First of all, ordinary people expect the effects of border surveillance too much. However, when highly infectious viruses are not transferred to the country with the will of the quarantine force, manyPeople are panic-stricken, not to mention the media that has always scolded the government. Although the virus has not killed a few people, there is already a “doomsday” scene in Japan.


  • The second is the indiscriminate national quarantine and national registration. (almost what this South Korea is doing) The medical system quickly collapsed. People flock to the hospital for testing. No matter who you are, I just have to say I have a cold and fever, and even if I feel uncomfortable, I can ask for a virus test.

    What’s more terrible is that in Japan, where almost 100% of the nation’s medical insurance is available, once this “designated infection” is tested positive, regardless of the severity of the symptoms, it is necessary to enter the hospital to occupy the bed. Not to mention the limited resources of the medical system. At the time, there were still a large number of medical staff checking aircraft and ships on the border, and the run-up crisis in the hospital broke out.

    So from May of that year, the Japanese government gradually abandoned the unrealistic dream of “blocking the virus out of national borders”, and in July it stopped the nationwide large-scale inspections and no longer opened a large number of fever clinics. . Concentrate medical resources on the treatment of critically ill patients, and carry out general diagnosis and treatment or recuperate at home.

    A year later, the Japanese government conducted an inventory. The number of deaths due to H1N1 in Japan was 203, with a death rate of 0.2 per 100,000, which is the lowest among almost all developed countries in the world.

    Let netizens scold it

    On February 16, 2020, the Ministry of Health, Labour and Welfare of Japan held the first expert meeting on new coronary pneumonia. Some experts took everyone to review the lessons of 11 years ago.

    Japan has absolute respect for knowledge, expertise and experience on specific technical issues. Although this country gives the media and netizens the right to speak freely, it will hardly be taken away by public opinion. This fight against epidemics is the best embodiment of this concept.

    The situation facing Japan at that time was that it was too late to fortify the border-from December 30 to January 22, there were 9080 people from Wuhan Tianhe Airport to Daedian Airport; 6272 people arrived at Kansai International Airport There were 2,656 people at the central Nagoya airport, and a total of 18,008 people. Domestic patients, such as patients from China, as well as Japanese drivers and tour guides who have been in contact with the Chinese, have begun to bloom everywhere.

    Not to mention the failure lesson 11 years ago, JapanFrom the beginning, it was not intended to bet on the border prevention and control, let alone to conduct the kind of nationwide quarantine that followed in South Korea.

    As early as the end of January, some Japanese experts stated that “if the infection spreads, it may be necessary to focus on reducing mortality compared with stopping the spread of the infection.” Former WHO Director of Western Pacific Affairs Shigeru Omi directly pointed out that “the important thing is to minimize the number of deaths, and the international evaluation is also determined by the mortality rate.” Ichida Tateichi, director of the Japan Society of Infectious Diseases and professor of Toho University, even said In response to the opinion that “the new virus is not terrible, you can deal with the flu measures” (It is conceivable that many Internet users have sprayed it) .

    The set of opinions of experts such as Obi Shige, “Patients who are not seriously ill can also go to general medical institutions, and patients with mild illnesses are on standby at home, and do not stick to intensified quarantine, but receive appropriate diagnosis and treatment.” Later, the Japanese government’s overall anti-epidemic guidance spirit.

    Nobuhiko Okabe, Shigeru Omi, Takahiro Tate

    At present, we can basically sort out the real corresponding strategies of the Japanese government and experts more than a month ago. A brief summary is the following:

    • Abandon unrealistic dreams: It is impossible to clear the pneumonia virus quickly, to leave Japan alone, and to prevent all infected people from being tested and treated. It does not consume resources at all in these areas. And energy (In fact, the voice of many netizens is to dream these dreams).


    • Swap time for space: Persistent transmission of pneumonia is allowed, but the possibility of concentrated outbreaks in a short time is fully reduced. As in the case of a flood, try to reduce the crests and dams as much as possible, but allow the current to hit slowly. Prolong the time of the disaster, reduce the intensity of the disaster, and fight protracted war.


    • The medical system must not be allowed to collapse: Limiting the number of people who can be examined and treated, not to waste manpower on national borders, asymptomatic patients, and universal search. Focus on treating severe illness to reduce mortality. Don’t let the medical system get exhausted and lack of resources, let alone the medical ability to be wasted.

      This diagram from Nihon Keizai Shimbun is a clear indication of the “Peak Reduction Strategy”

      Of course, all these measures have been accompanied by insults and ridicule from Internet users, the media and “foreign friends”. Many people have questioned the measures of “fever to apply for hospital examinations within 4 days” based on instinct and common sense. And conspiracy theories are flying all over the sky …

      Fortunately, this country is not governed by “instinct and common sense.”

      Take South Korea, which many Internet users and media have regarded as successful cases, as an example: Because South Korea has implemented a nationwide pop-up inspection, the detection volume is nearly 30 times higher than that of Japan. Japan ’s “incompetence” and South Korea ’s “power” A sharp contrast has formed in the hearts of netizens.

      However, the PCR check (the current general inspection method) itself is not 100% accurate, and there are many mistakes and omissions in the practice of various countries It happened that some Japanese experts believed that the accuracy might only be 70%. What’s more, in the face of a new type of virus, its accuracy is even more questionable. Pulling down the net to use it without reducing the conditions of the test object will definitely increase the error rate greatly.

      So there are two phenomena in South Korea: One is the “positiveThe “diagnostic rate” is extremely high, but there are few deaths. If you compare the number of deaths with the number of discharges, South Korea ’s death recovery ratio is almost the lowest in the world, and it ’s ridiculously low. What does this mean? The highest physical fitness?

      Of course, there are a large number of mild asymptomatic and non-serious patients who have increased the number of diagnoses and discharges. In addition, there are “false positive” cases in the middle, that is, no new coronary pneumonia infection, but because of detection errors, they were treated as patients. (Reference data: With strict Japanese inspection standards, asymptomatic patients account for one-ninth of positive patients.)

      All of this led to the second phenomenon: Until the government changed its approach in early March, South Korea’s medical resources were a precursor to the collapse-in Daegu, where collective infection occurred, many light and asymptomatic people occupied In the case of hospital and isolation facility beds, the critically ill patients cannot be hospitalized, and some patients cannot find beds all night. There are also reports that the number of deaths in the emergency treatment room of his home or hospital reached 17 and the number of waiting patients waiting for admission reached 2,000. Doctors have to fall into the painful choice of “treating or waiting to die.”

      How accurate is this Korean method of rapidly increasing the number of detections?

      The Korean government quickly changed its strategy in early March: dividing patients into four categories, patients with moderate or higher hospitalization, and isolation of mild patients in living treatment centers or their own homes …

      A number that decides whether to go to hell

      In the prevention and control of epidemic diseases, there is a very critical data, that is, “R0” (basic number of infections: the average number of infected people infected by other people ) .

      It is not difficult to imagine that if R0 is greater than 1, such as 2, then each patient will be infected with two new patients after being sick. It will not take long for the whole area to be free of healthy people. If R0 = 1, it means that the infectious disease has basically entered a stable phase, and there will be no large-scale outbreaks and no face-to-face transmission. If R0 is less than 1, the end of the epidemic is just around the corner.

      So, what is the R0 of new coronary pneumonia?

      Research published by the China National Centers for Disease Control and other research shows that R0 is 3.77; data from other institutions around the world vary, ranging from 3.3 to 3.8 and low to 2 to 2.5. In short, this is a virus that is recognized to be more infectious than H1N1 and ordinary seasonal influenza, and comparable to SARS.

      However, at a press conference on March 1, the Japanese Ministry of Health, Labour and Welfare announced that in Japan, 80% of people infected with pneumonia are not transmitted to others. This is confusing data and even a bit unbelievable. Subsequently, many media and netizens speculated about Japan’s R0.

      On March 19th, a Japanese expert meeting specifically released detailed data on Japan R0.

      The cyan line in the figure is the Japanese R0 data. It can be clearly found that since the end of February and the beginning of March, Japan’s R0 data has been lower than 1, and the trend is obviously declining.

      This is the fundamental reason why the growth rate of infected persons in Japan is significantly lower than the international average, and they have presented epidemiological answers that are completely different from those in other major countries.

      In fact, the Japanese government ’s response described above is not positive enough, let alone timely and smart. Compared to many countries that have rapidly blocked cities and declared emergency situations, the Abe government has no legal basis for even “recommending school breaks across the country” before amending the bill. However, the Japanese government can only make “requests” to local governments and organizations, that is, requests