Omicron and Japan’s sixth COVID-19 wave

Three members of a family hospitalized with Covid-19 symptoms in Osaka have tested positive for the Omicron variant. They are the first cases reported in Japan without a travel history or linked to someone with travel history. All other cases were either detected at immigration inspections or in quarantine or linked to someone who had recently arrived from abroad.

It must be assumed however that there are many other cases that remained undetected and spreading under the radar screen. As the Washington Post reported on December 15, the Philippines had quarantined a man on December 1 who had tested positive on arrival from Japan and who was later confirmed to have been infected with Omicron. It therefore sounds likely that there was already some community spreading in Japan three weeks ago, soon after the variant was isolated by scientists in South Africa.

During the Delta-driven fifth wave in July/August, the 7-day average of cases peaked on August 24, with the health care system in crisis. At that point the reproduction rate fell below 1. For several weeks the fall was so steep, cases almost halved every week. The most likely explanation for that was increasing immunity in the population from a successful vaccination campaign in combination with continued wearing of masks and reduced mobility (e.g. working from home, less eating out in restaurants). After two months the reproduction rate slowly increased again but as long as it stayed below 1, it still resulted in a further reduction of cases. Weekly cases reached a temporary minimum on November 9. For about a week, cases slightly increased before sliding again at a somewhat slower rate than before. Since then the reproduction rate has been gradually drifting up. Since the minimum in late November/early, December Tokyo cases have been rising from a very small basis of about 100 cases per 7 days, 99.7 percent below the 33,000+ cases per 7 days in late August. They are now around 200 cases per 7 days, a doubling in three weeks.

For the last 4 days the 7-day average increase from a week earlier has been over 40 percent, which is equivalent to a doubling every two weeks. This is not really surprising. Once cases had dropped to less than one percent of the peak, people felt safe to resume activities that they had not been able to do for a very long time, such as enjoying year end parties or having wedding receptions with guests. They felt the risk was low enough.

However, Delta has not gone away. It is still around and as people’s level of antibodies from vaccines gradually wanes, they become more susceptible to infection again, even if they remain largely protected against hospitalization or death. This is compounded by greater risk-taking when cases are perceived to be “rare enough.”

We knew that Omicron would eventually spread in the community. When it does, it will not immediately replace Delta. For a while, both will be increasing but at different rates. A level of immunity and non-medical interventions (such as mask-wearing) that is only just about adequate to control Delta will be unable to halt the spread of much more infectious Omicron. Under the current conditions where even Delta cases are increasing, we would continue seeing Delta grow relatively slowly while Omicron cases would explode. Eventually, especially as hospitals start to fill, people will modify their behaviour to reduce exposure, for example by avoiding restaurants or by using KN95/KF94 masks instead of surgical masks or cloth masks. This would then push the reproduction rate of less infectious Delta below 1 and its cases would fall while cases of more infectious Omicron would still increase but at a slightly reduced rate. That is the point from which Omicron will start to replace Delta rather than spread in addition to it.

Third doses can reduce the exposure to Omicron, especially for the older generations who were first to get vaccinated this spring and summer but Japan has not taken any measures yet to speed up the additional shots. From the beginning of December to December 21, third shots averaged a mere 10,000 per day which is less than one percent of the rate achieved and maintained for several months in the Summer.

Japan is still running its booster campaign as if its only purpose was to prevent a resurgence of Delta (like in Israel last summer) rather than to protect the population as well as possible against the immunity escape that comes with the new Omicron variant. This has to change.

I can only hope that the first official case of community transmission of Omicron will galvanize the government into action for dramatically speeding up the distribution of third shots, especially to senior citizens and people with medical conditions that make them more vulnerable.

Waiting for Vaccine Boosters in Japan

In the spring of 2021 Japan was running about 4 months behind the US and much of Europe vaccinating its population against Covid-19. Vaccinations for senior citizens did not start ramping up significantly until May when other countries had started in December 2020 or January 2021.

After Israel and then the US decided to go for 3rd shots to boost immunity after antibody levels dropped months after 2nd shots of Pfizer and Moderna, Japan also negotiated for booster shots from Pfizer and Moderna. The government went for an 8-month interval and planned for 3rd shots for healthcare workers from December 2021 and the general population from January 2022, with eligibility starting 8 months after the second shot.

Then came Omicron which significantly escapes immune system responses from antibodies. Without boosters protection against symptomatic infection drops significantly with this new variant, as it takes a much higher concentration of antibodies in the blood serum to achieve sterilizing immunity. Long term T-cell immunity, which still protects against hospitalization and death, is much less affected.

In the city of Setagaya, Tokyo where I live, those who have received their second dose at the end of June will receive tickets by the end of January that will allow them to make vaccination appointments some time in February. So far no date has been announced for the group I’m in but having received my shots in July, I probably won’t be getting those tickets before late February and no booster appointment before March. It’s going to be a very long three months when some European countries are expecting to be Omicron-dominated by Christmas, within 4 weeks of the WHO having awarded B.1.1.529 its new name!

Japan is talking to Pfizer about moving part of the 78 million booster doses due for delivery in Q1 2022 forwarded so they can be dispenses sooner. However, former vaccine czar Kono Taro recently pointed out on his personal blog that Japan has enough leftover vaccines still in stock to give 56 million booster shots without waiting for any supplies from Pfizer or Moderna.

In order to protect the public from the new coronavirus, efficiency and speed are more important than equality and fairness.

Some people say that if the vaccine is brought forward, the supply of the vaccine will not be sufficient in time.

At present, Pfizer and Moderna have about 10 million doses of vaccine in stock in the market.

There may be a few doses that have been discarded, but there is no way that 1 million doses were discarded.

In addition, 4 million doses of Pfizer have already been distributed to local governments.

Another 12 million doses of Pfizer will be distributed next week and the week after.

In addition, we have 15 million doses of Moderna in stock for this year, and since the third dose of Moderna is only half the amount of the first and second doses, we will need 30 million doses for the third dose. This will be 30 million doses.

This means that 56 million doses of vaccine could be distributed by the end of the year.

In the first quarter of next year, Pfizer will distribute 30 million doses and Moderna will distribute 24 million doses. In the first quarter of next year, Pfizer will receive 30 million doses, Moderna will receive 24 million doses, and the third dose will be 48 million doses, for a total of 7.8 million doses. In the first quarter of next year, Pfizer will receive 30 million doses, Moderna 24 million doses, and 48 million doses for the third dose, for a total of 78 million doses.
(3回目のワクチン接種, 2021-12-09 [translation by DeepL])

The Japanese government can not blame a slow booster vaccination campaign on a lack of supplies. It needs to act as quickly as possible. The day before yesterday, Germany gave about 1.3 million booster shots in one day.

While officially no community spread of Omicron has been detected in Japan yet, that may simply being because they are not looking for it hard enough.

On Wednesday, 2021-12-15 the Philippine government reported its first Omicron case, a Philippine resident of Japan who had arrived from there on December 1 and tested positive. He had symptoms of a cold at the time. After the positive test the sample was sequenced and determined to be Omicron. This suggests that most likely Omicron was already circulating within Japan two weeks ago. Regardless, it will officially be here very soon.

Once it hits the hospitals, many nurses and doctors are likely to get infected and may have to quarantine. As of today, only about 149,884 of about 5 million healthcare workers (about 3 percent) who had been fully vaccinated have received a third shot. That’s after two weeks of booster campaign. 97 percent are yet to receive their booster. Only 0.11 percent of the Japanese population have received a 3rd shot. In many European countries it’s 20 percent and more.

The vaccination of the elderly is not even due to start until another two weeks from now. There are 52 million people in Japan who have received two doses and are age 50 or above. We should use the doses that we have now as soon as we can.

We really have no time to lose.

Toyota Hydrogen Combustion Engine Cars

Since 2014 Toyota has sold a little over 10,000 Toyota Mirai, a hydrogen fuel cell vehicle (FCV). The starting price of this 4 seat sedan model in Japan is about 7.1 million yen (currently about US$63,000) which is more than 50% more expensive than a battery electric Tesla Model 3 which seats 5 adults. And it seems unlikely that Toyota can make a profit on a car being made in such small numbers as the Mirai, unlike Tesla does with the cars it makes in large numbers in its plants on three continents.

Tesla sold about half a million battery electric vehicles (BEVs) last year and looks set to sell somewhere between 900,000 and 1 million cars in 2021. This means Tesla will have sold twice as many BEVs every week in 2021 than the total number of FCVs Toyota has sold since 2014. The sales gap between BEVs and FCVs is getting bigger and bigger.

Recognizing that the high cost of fuel cells makes it difficult to compete, Toyota has announced that it sees a market for cars with internal combustion engines (ICE) that burn hydrogen instead of gasoline. They should be cheaper to make than fuel cell cars and will not produce any CO2 if hydrogen is made from non-fossil energy sources.

It’s not a novel idea though. BMW tried it in its BMW Hydrogen 7 technology carrier based on its 7-series back in 2005-2007. It never went anywhere. Besides the absence of a fuel supply network, there were also issues with emissions. Hydrogen flames burn extremely hot, which means you end up with a lot of smog-forming NOX emissions — worse than diesels.

In terms of efficiency, hydrogen ICEs are worse than FCVs which are much worse than BEVs. While BMW used cryogenic tanks with liquefied hydrogen at -253 °C, Toyota most likely will use high pressure tanks like in its Mirai for its hydrogen ICEs. They hold hydrogen gas at pressures of up to 700 bar. Both liquefaction and compression require huge amounts of electricity that can not be used for propulsion but is effectively wasted. An FCV consumes three times more electricity for electrolysis to make the hydrogen fuel it consumes than a BEV uses to charge a battery to drive the same distance. A hydrogen combustion engine is even less efficient. Where will this hydrogen come from? We don’t currently have a surplus of solar panels or wind turbines to produce this electricity. That means a hydrogen economy will need significantly larger investments in renewable energy than with battery vehicles. Hydrogen for cars makes no economic sense whatsoever.

It makes even less sense for hydrogen ICEs than for hydrogen FCVs. Fundamentally, it’s no more than an excuse for not giving up on building internal combustion engines, pretending that nothing has changed even in a world that is facing climate change that wee need to address as soon as possible.

I am afraid Toyota will not make a turn-around and face the reality that the industry is switching to BEVs within the shortest time possible until it replaces Toyoda Akio, its current company president. Mr Toyoda is the grandson of the founder of the company and a keen race car driver. He lacks the vision that Toyota will need in the transition to a carbon free future. Mr Toyoda needs to retire, along with the dead-end technologies he is committed to.