After a year of the pandemic caused by the Sars-Cov-2 virus, Japan has an official total of 8,861 deaths attributed to the virus, as of March 24, 2021, in a population of 126.5 million people that has a large demographic of elderly people. The total number of deaths in Japan in 2019 was 1,381,093. Thus those 8,861 deaths represent about 0.6% of total annual deaths. Furthermore, among the total number of deaths every year, a large number of them are elderly people who succumb to pneumonia after being weakened by various other ailments over a long period of decline. Thus the deaths caused by the coronavirus may be statistically insignificant. In all previous years, thousands of people died of pneumonia and no one ever thought this was a national crisis.

The total number of covid cases so far in Japan is 457,754 (2021/03/24) and the number of people recovered is 435,361. With little testing of the general population having occurred, it may be safe to say that the virus has circulated widely and millions of people have had contact with it and never developed a noticeable infection, or they had minor symptoms and never got diagnosed or recorded in the official statistics.

The total number of deaths is extremely low compared to figures in the UK and the US, and this was the result in a nation that had a rather delayed, contradictory and haphazard approach to dealing with the virus. The actual number of deaths might be much higher in Japan or much lower in the US where 500,000 people are said to have died. It depends upon the methods used for categorizing “covid” as a cause of death. In any case, even if we revised the figure upward in Japan and downward in the US, there would still be a remarkable disparity in the mortality of the same virus in two different populations. What accounts for the difference? Japanese media has speculated about various “X factors” that might account for it. I list them below and add that this is my interpretation and best summary of all the factors I have heard discussed over the past year.

Tulips and cherry blossom, Sakura, Chiba, Japan, 2021/03/27

1. Recent prior infection. A nasty, widespread cold or flu season was underway in November-December 2019. I noticed it at the university where I work. Several people remarked on it as being particularly severe, but this was before anyone had heard of a new SARS virus in Wuhan. When cold viruses spread in Tokyo, they spread fast because of the population density and the fact that most people commute on crowded trains. If this wasn’t covid, it might have been a similar virus that primed everyone’s immune system and gave them some crossover immunity. In many countries there have been reports of early detection of Sars-Cov-2 in the months before the outbreak in Wuhan, but in Japan there has been a conspicuous silence around this question. However, in the year preceding the pandemic, air travel to and from China was at an all-time high. More than one airline had direct daily flights from Wuhan. To me it has always been curious that this wave of a bad “seasonal cold” is never remarked upon. I had some of the covid symptoms for a couple weeks in Nov-Dec 2019, but I recovered in blissful ignorance of a dangerous new corona virus emerging in Wuhan, and I think millions of Japanese people might have done the same.

2. Diet. Prebiotic and probiotic foods in the Japanese diet foster a healthy immune system. Vegetables and fibers are the pre-biotic foods that feed the gut biome. Bacteria that thrive of the pre-biotic foods come in common elements of the Japanese diet such as yogurt, natto, miso and kimchi. On a recent evening, there was a one-hour variety show on commercial prime time TV about yogurt! It featured celebrity guests, an esteemed doctor, and scientists from the yogurt makers telling us the intricate details of various lactic acid bacteria strains and their effects on immunity and health. Another nutritious food that needs to be mentioned is green tea, which is consumed in large quantities in Japan. The health benefits are numerous and well documented. Japanese people also eat a lot of fish, so they consume more of the omega-3 fatty acids that are necessary for building healthy cell walls. When the bilipid layer of cell walls is weak, viruses can more easily infect the cells.

3. Socialized medical care. People have government health insurance and they are in the habit of going to the neighborhood clinic for the slightest fever. The great tragedy of the covid crisis in some countries was that people lacked health insurance, and even if they had it, they stayed home, or were even told to stay home by health care professionals. During this delay their blood oxygen levels fell too low. Covid is unique in the way it lowers oxygen without the victim feeling shortness of breath. It induces what is called “happy hypoxia.” The patient doesn’t sense stress in the lungs, but the virus causes blood coagulation in the vessels of the lung, and this reduces the amount of oxygen getting into the blood.

4. Low levels of chronic disease. Japan has low rates of chronic disease. Nations with high rates of chronic disease fared the worst. The virus was really only a proximate cause of death. Many of the frightened unhealthy people looking to the vaccine as a savior and condemning the “vaccine hesitant” need to reflect on their wild demands for punishment of healthy people who decline the new experimental vaccines.

People with chronic diseases might have known they were unhealthy, but they lacked a sense of urgency to get healthy. They knew their lives might be shortened, but that was a concern for someday, ten or twenty years later. No one thought a chronic condition would open the door to an infection that would kill within two weeks. The same attitude prevailed in the established policy response to chronic disease. No immediate danger. No need for urgent action in reform of health care, food regulation, environmental safety etc.

5. Staying calm. People in Japan sleep through earthquakes that elsewhere would have a whole country going on high alert. Health authorities here know that panic would have an effect on immunity. They acted in ways that made sure the public stayed calm, and that may have involved also keeping them ignorant about certain things. Another significant factor that reduced stress was that police never got involved in enforcement of counter-measures against the virus. Almost everyone complied with directives and advice, but those who didn’t were patiently tolerated, perhaps shamed into changing their ways, but, for the most part, they were just ignored.

6. Less trauma and stress. This relates to number 5 above. For many decades Japan has ranked favorably in all measures of social well-being: employment, poverty, health care, education, crime, infant mortality, longevity and so on. In societies that rank poorly in these measures, children grow up under chronic stress, and this creates permanent health problems for them as adults. Their childhood traumas set them up for a lifetime of dealing badly with the stresses of adult life—stressful things like pandemics and mass media telling them to panic and give up things they hold as important. Thus societies that were doing well physically and emotionally before the pandemic are likely to be the most resilient to it. 

7. CT scans are important for detecting pneumonia early, and Japan is well supplied with CT scanners.

8. Japan has a large elderly population, so Japanese doctors have experience in treating pneumonia in the elderly. Recently, Japan has developed new treatments of pneumonia, and recent vaccinations of the elderly may have given some crossover immunity to coronavirus infection.

9. Vitamin D insufficiency is a common denominator among covid patients who end up hospitalized. Japan has the lowest rate of vitamin D insufficiency among the elderly.

10. The Neanderthals were never here. Seriously. There is research on this. A certain proportion of the European population has Neanderthal genes, but among the covid victims who didn’t fare well, the proportion was much higher.

11. Treatments. Japanese doctors were treating patients with hydroxychloroquine from the beginning, among other treatments they knew to be useful.

12. Masks. Wearing a mask has been an established custom in Japan for a long time. It’s possible that this was a factor in stopping the spread of the virus, but throughout the world people wore masks and the results were mixed. In some places people didn’t wear masks and they didn’t fare worse than people who did in other places. Could it be that masks were just a talisman that calmed people down and let them carry on with some essential activities? All the research “proving” the effectiveness of masks were “weak retrospective observational studies,” so the methods were likely designed to give the desired conclusions. Many research papers on this question written before the pandemic conclude that wearing masks is without benefit or even harmful.

During this year in Japan there has been such an inconsistent approach to social distancing and shutdowns that the virus must have touched everyone by now. People really didn’t change their habits about shopping and dining out too much, and for families it was impossible to put up a barrier at the front door. The schools were open and most of life’s activities went on as they always did. On the other hand, some activities were shut down. As a result, a lot of small businesses went bankrupt, and international travel and domestic tourism collapsed.

13. Physical activity. In residential areas, it is common to see parents and senior citizens doing their shopping by bicycle. Most people in urban areas commute on public transportation. This involves a walk to the local station, walking through stations and transfer points, going up and down several staircases along the way, then walking to the workplace. It’s enough physical exercise to keep an adult adequately fit. In combination with the Japanese diet, this level of fitness gives a pretty good level of overall health. Exercise and a healthy diet increase levels of nitric oxide, which plays a role in the immune system, improving circulation and controlling inflammation.

14. Previous vaccinations. There is a hypothesis that the BCG vaccine given universally in Japan may have provided some cross-over immunity to the Sars-Cov-2 virus, but this remains as a matter of speculation.

15. School lunch programs. From pre-school to the last year of middle school, Japanese children receive lunches made fresh daily by regional suppliers working under contract with school boards. Families pay about $30 a month for the service. The lunches consist of fish, meat, vegetables, miso soup and rice. Where similar school lunch programs once existed in the United States, they were gradually eliminated and turned over to the fast food industry, after which time the common fare became burgers, fries and pizza, with ketchup famously classified as a vegetable. The Japanese school lunch program has the obvious benefits of setting children on a path toward healthy eating throughout their lives, thereby avoiding obesity and vulnerability to infectious diseases.

The article below from March 2020 is striking to read now because the comments in it given by an unnamed Ministry of Health official indicate that Japan was coping well in the first weeks of the pandemic by giving effective treatment and sparing the public from knowing certain things that would only cause panic and lead to loss of immunity, loss of jobs and to other social ills unrelated to viral infection. Japan changed its approach only when the summer Olympics were cancelled in late March 2020. Japan felt it had to go along with the way the WHO, the UK and the US (the two countries that ended up with the worst fatality rates) told them to manage the crisis. Yet even after getting that call, Japan seemed to continue doing things its own way while paying lip service to the international “best practices” being dictated to them by the leading nations that were the most dismal failures in protecting their own citizens.

Some of the issues mentioned above appeared in this article. It appeared at the time when everyone was told just to sit tight for two weeks so that they could “flatten the curve.” At this time, Japan had been exposed to the virus for longer because of the outbreak on a cruise ship in January, yet Japan was panicking less and managing in a distinctly different way than the “leading nations” wanted the whole world to react. This article reveals that Japan was quietly dealing with the spread of the disease with a “don’t ask, don’t tell” approach meant to calm the public and provide care as efficiently as possible. With this policy, they hoped to keep the economy humming and open the Olympic games four months later on schedule. How were the Japanese supposed to know that their global partners would go to such extremes over a kind of viral pneumonia that was under control in Japan? They seemed to have been working on the assumptions that a vaccine would be impractical against a cold virus and herd immunity would soon be reached naturally. How were they to know that all the emphasis would be placed on vaccine development and the long-standing definition of herd immunity would be re-written as coming only from vaccination?

Excerpts from the article follow. Keep in mind this article is dated March 2020. It is all the more interesting to read now with one year of hindsight on the crisis.

The statistics were actually worse in Japan in the winter of 2021 during the second wave. Death statistics were still relatively low compared to other countries, but there were stories of people dying at home and not receiving timely care from local clinics and hospitals. Special covid treatment hospitals were designated, but they were overwhelmed. There were stories of staff quitting or getting overworked and sick. As a result, Japan had to go into another period of emergency closures. This all seemed to be happening because Japan lost its way with the “don’t ask, don’t tell” policy and had gone along to a certain extent with the failed approach used in the US and the UK. Panic and fear spread, then local clinics and hospitals, being privately owned and not forced to accept covid patients, abandoned medical ethics and refused to diagnose and treat, and this is what created the crisis in the designated covid treatment hospitals. They were now making the same deadly mistakes made by doctors in the United States—explained very well in the recent testimony of Dr. Peter McCullough. All of this might have been avoided if doctors in local clinics had known how to diagnose patients and give them early treatment, providing oxygen and prescribing anti-viral drugs, antibiotics, zinc, vitamin D, and anticoagulants—whatever was right for the individual patient.

Japan’s winning its quiet fight against Covid-19

by Jake Adelstein, March 25, 2020

Highlights from the article:

… a Japanese official who gave an off-the-record briefing to Asia Times suggested that a “don’t ask, don’t tell” strategy, based on minimal testing and buttressed by information massage, has been quietly emplaced.

That may sound opaque—even inhuman. But it has ensured national calm and continued economic activity. It has kept the medical system from being overwhelmed and rests on a strong foundation: world-class treatment of the disease’s main symptomatic killer, pneumonia…

A poster put out by the Ministry of Health, Labor and Welfare warned people to avoid “the three densities” – poorly ventilated areas, crowds and close contact…

there is little objective data to show how widespread infections have truly become…

A recent study from the very extensive testing done in South Korea, where nearly 4,000 tests per million people were carried out, shows the mortality among those infected was only 0.6%…

The Japanese Society for Infection Prevention and Control (JSIPC) updated their coronavirus manual on March 10 [2020]. 

The tone is calm. “Japan is moving from containment measures to a period of spreading infection and we must adjust accordingly,” it says. Since March 6, Covid-19 testing won coverage under national health insurance—ergo, “as public money is being used for the coronavirus testing, it is necessary to carefully screen who gets tested.”

It gently chides anyone who seeks “needless” testing and urges medical professionals to prevent overcrowding at hospitals by instructing patients with light symptoms to stay home and avoid others…

Japan has an excellent public health care system. Care is affordable, so most people see a physician when they are beginning to feel ill, rather than when conditions have worsened…

In 2018, pneumonia went from the third most common cause of death for Japanese of all ages to number five. The decline may be due to the way the Ministry of Health tabulates the data, but the use of new medicines and widespread use of CT (computed tomography) scans to catch pneumonia early have certainly contributed to cutting fatalities.

When it comes to CT scanners, Japan may have the most diagnostic imaging devices in the world—the number per 100,000 people is 101. Australia, with 44, is a distant second. In addition, according to the Center for Disease Control, CT scanners are wonderfully adept at finding “ground glass opacities”—a technical term for hazy patches that indicate viral pneumonia, such as Covid-19…

Japanese doctors may also be finding novel treatments… For example, there has been success using hydroxychloroquine, a malaria medication, to treat patients with advanced states of the illness. An asthma medicine sold here has also seemingly worked wonders. Reportedly, a woman in her 70s not only had her fever go down, but her severe pneumonia alleviated. Two other elderly patients were taken off respirators after receiving a regular dosage and recovered… [NOTE: emphasis added—this was before the propaganda campaign against the use of hydroxychloroquine]

The current “treat the symptoms approach” seems to be working. If you go to the doctor in Japan with symptoms of pneumonia or breathing difficulties, they are very unlikely to give you a test for the novel coronavirus, but are likely to give you a CT scan or X-ray.

If medical pros find you have pneumonia, they will begin treating you. There is a very good chance you will be cured. And if you are cured, they probably will not test you for coronavirus. So a case of Covid-19 vanishes—literally and statistically…

Japan appears to be severely and deliberately under-testing for the coronavirus, although it has stepped it up in recent weeks. On March 2, the number of tests per million people in neighboring South Korea averaged 4,099. In Japan, that figure was a mere 72.

Stats are murkier for the dead. Japan only does autopsies in 10% of suspicious deaths. If someone dies of pneumonia in a hospital, the odds of an autopsy are low. Japan has not released data on the number of autopsies performed to verify whether coronavirus was the cause of death. There is occasionally a post-mortem analysis of tissue samples—but rarely…

Possibly, coronavirus deaths are being hidden among pneumonia fatalities. South Korea has had 120 deaths from Covid-19, but Japan only 49. So, it is possible that the more populous Japan is sweeping Covid-19 fatalities under the rug? …

So what are the latest figures for pneumonia deaths? …

The Ministry of Health, Labor and Welfare told Asia Times: “We only issue those numbers [in a comprehensive survey] every three years.” And the ministry’s latest nationwide hospital admissions data date back to November, before the pandemic struck…

Still, there are no reports of mass, secret burials. And an official at the ministry—speaking on condition of anonymity—offered Asia Times an unauthorized explanation of Japan’s approach.

“We are in a period where containment is probably not realistic,” the official said. “We need to focus on treating the serious cases and most experts would quietly agree. If everyone is urged to get testing, then medical institutions will overflow with people who do not need to be there. This not only detracts from taking care of more critical cases. It could indirectly result in a greater health crisis.”

While South Korea and other countries have established off-site, drive-thru test stations, that is not the case in Japan. But the official also made clear that hospitals can be dangerous places.

“Please consider that people and patients would also be exposed to higher risks of infection in crowded hospitals and clinics—and secondary infections as well. How does this sound? ‘Come in for a coronavirus test and leave with the flu!’ Unnecessary spending on tests is a waste of government resources, time and fiscals reserves. There is no specific treatment for Covid-19 yet.”

At a time when other countries are in a panicked lockdown, with virtually all economic activity suspended indefinitely, the official went to the crux of what may be Japan’s unspoken strategy.

“Ask yourself, ‘What is the value of wisdom when it brings no benefit to those who are the wiser?’ Most of the infected will recover on their own, thanks to their own immune systems. We need to first take care of those whose immune systems are failing them, or the health care system itself will fail.”

That appears to have kept the medical sector from being overwhelmed.

However, one tantalizing possibility—that the vaccination program for pneumonia which Japan has been enacting for the elderly since 2014 may be acting as a shield against Covid-19—has not yet been scrutinized.

“Frankly, I have not considered it,” said the official.