Will Japan be Vaccinated by November?

“I want vaccines to have been given to all residents who want to receive them by the October-November period,” Japanese prime minister Suga Yoshihide said in a parliamentary debate on Wednesday, June 9, 2021. He also estimated, the grand total of doses could “exceed at least 40 million by the end of this month.”

As of June 8 the count on the Prime Minister’s Office (Kantei) website stood at 19.4 million doses, so to hit 40 million doses by the end of June requires a little more than 900,000 a day (20.6 m doses in 22 days). From the published numbers it looks like we may already be in that vicinity for the daily rate.

Even though the number of doses per day for residents age 65 and above (“koreisha”) for the most recent date added is still coming in at under 500,000 the day it’s released, but many of the local counts arrive delayed. The daily counts will later increase through daily retroactive updates. By the time all numbers for a given date have trickled in over the course of several weeks, the total often doubles. For example, the May 30 “koreisha” total was originally released as 200,187 but within 10 days it had grown to 405,165.

Let’s do a quick back of the envelope calculation to see if the projection for vaccinating all adult residents of Japan who want to get vaccinated by the end of November is realistic.

If they hit 40 million doses by end of June (which as I mentioned above requires an average of 900,000 doses a day until then) and we take a figure of 110 million adults of a a population of 126 million: assuming 80 percent of them would opt to get vaccinated, we end up with 88 million people times two doses per person, i.e. 176 million doses. Subtracting 40 million done by the end of June leaves 136 million doses to be injected between July and November (5 months). Divide the total by the roughly 150 days and it becomes clear that if they maintain about 900,000 a day for the next half a year they will indeed be done by the end of November.

However this ignores that the vaccinations are proceeding at vastly different speeds in different cities and prefectures. All things staying the way they are, once the most efficient places are done (which would happen before November) and only the laggards remain in the race, the 900,000 a day average would no longer be sustained. So the key will be to speed up the places that are lagging behind others right now.

How realistic is the 900,000 a day goal if daily vaccine counts still pop up on the Kantei website at less than 500,000? What’s the real number right now?

We can make a rough guess of what percentage of the actual daily vaccinations are represented in the initial count that gets published for a given date by looking at past data.

For example, the count for June 9 published today (June 10) for 65+ is 474,484. The actual number is likely to be over a million, as I’ll explain below. The published number is a partial count, as only about 50 percent of the vaccinations are reported via VRS (Vaccine Recording System) within one day. The rest arrives later. Another 10 percent or so arrive the next day, then another 5 percent, etc, etc until we get to over 99 percent of the total after a month or so.

I looked at the 28 days ending on June 8 and how they had changed on June 10 vs. June 9 in the Excel spreadsheets. They increased by factors of 1.0015 to 1.1845. Multiplying all these increases by each other to get the cumulative 28 day growth yields a factor of 2.27.

I repeated the same exercise for one day earlier, i.e. 28 days ending on June 7 and their change between June 9 vs. June 8. The daily increases range from 1.0058 to 1.1885. Multiplying 4 weeks’ worth of increases gives a factor of 2.47.

If we apply the lower of these factor values to today’s addition, on the assumption that the spread of what percentage of reports comes in after how many days is consistent, that would suggest an actual figure of 1.08 million vaccinations of residents 65+ done yesterday whose total count will be known by July 7 (after 28 days of reports still arriving). That’s on top of another 160,000 or so vaccinations of healthcare workers, by the way.

While it’s disgraceful that we have to figure out the state of the campaign so indirectly (because of a broken IT system built using 385 million yen of our taxes), this exercise at least gives us a good guess of how things are really going.

On that basis I’d say the government’s outline is plausible: Japan is likely to reach a goal of 40 million doses deployed by the end of June and full vaccination of willing adults by the end of November.

Setagaya Vaccination Update

I live in Setagaya, the most populous of the 23 Special Wards (ku) of Tokyo. Out of about 195,000 residents aged 65 and over, about 141,000 have made reservations for vaccinations. Of those 73,000 have received at least one vaccine dose and 8,000 of these have received both doses. There are vacant reservation slots for another 54,000 people.

Starting from next Tuesday (June 15), tickets will be sent to the next group, including people with medical conditions and people aged 60-64. That includes my wife and myself. Note that it’s not your age today that counts but age on March 31, 2022. So anyone born before April 1, 1962 counts as age 60 and up! This is consistent with the system used for elementary school enrollment in Japan.

The next groups after that will be:

  • Age 50-59 (born before April 1, 1972): from June 30, 2021
  • Age 40-49 (born before April 1, 1982): from July 5, 2021
  • Age 30-39 (born before April 1, 1992): from July 12, 2021
  • Age 16-29: from July 20, 2021

Currently there is a published list of vaccination sites with available slots per day for each date until the end of August. At the moment free slots are available starting from early July (i.e. with a 3 week wait list). The wait list most likely will grow significantly, seeing the rate at which age groups will be added vs. the rate at which people are currently getting vaccinated.

Online reservations can be made 24 hours a day, except for website maintenance periods. Reservations can also be made by phone during daytime, but the number used is a 0570 number not covered by flat rate mobile phone plans and unreachable by IP telephony services such as Skype or Google Voice. For people who only have a mobile phone and who don’t have internet access this is not very convenient.

For the senior citizens the city has been offering a service where they can visit city run facilities who will help them make an online reservation using a smartphone. This service was further publicised via the jichikai (neighbourhood associations) in Setagaya.

Meanwhile the number of shots given to senior citizens has surpassed the number of shots to healthcare workers (10.7 vs 8.7 million doses) and first doses given to healthcare workers are exceeding 5 million, more than the 4.8 million previously quoted as the total number of healthcare workers eligible for them. Compliance seems exceptionally high.

In total, about 14.5 million out of 126 million residents have received at least one doses. The Olympic Games will begin in 44 days.

Vaccination Progress in Japan

The City of Setagaya (東京都世田谷区) has announced the dates when vaccination will be expanded beyond the current group 2 (residents aged 65 and above). Between June 15-19, coupons will be mailed to group 3 which includes:

  • people with existing medical conditions
  • people aged 60-64 (anyone born no later than March 31, 1962)
  • people working in elderly care

Group 1 were the health care workers, if you are wondering!

Currently about half a million vaccinations are happening in Japan per day, about 2/3 of them aged 65 and above, 1/3 health care workers. As of Friday, 2021-05-28, over 92 percent of healthcare workers had received at least one shot and over 60 percent had received both. That leaves them only about 350,000 shots short of full coverage for first shots. About 1.55 million healthcare workers have only received one shot, so fully vaccinating them with a second shot in the next three weeks will be the bulk of the remaining vaccinations for this group.
Of the people aged 65 and above, 12.46 percent have received at least one shot and 0.86 percent have received both. Meanwhile the Olympics start in 52 days…

Setagaya also announced that more reservation slots would be opened at mass vaccination sites for people aged 65 and above, recommending people in that group who currently have dates in August to move them to July (i.e. cancel in August, make new reservation in July). This will then free up those slots for the next group.
This means there’s a good chance that both my wife and I (who were born before the March 1962 deadline for age 60-64) will get vaccinated in August.

In my last post I had pointed out that daily vaccination totals for healthcare workers and people above 65 was being handled differently. One set was being updated retroactively, the other set only once per listed date.

Basically, for healthcare workers the government publishes daily numbers (on weekdays, excluding public holidays) of the number of total shots given since the previous published total. That’s why numbers only get added for the final date, once a day. It is also why no vaccinations are listed on Saturday, Sundays and holidays — not because no healthcare workers were vaccinated on those days, but because no results are published on those days. Consequently, healthcare worker stats do not show how many healthcare workers were actually vaccinated on a particular day.

For people aged 65 and over, they precisely track the totals by the date the doses are used. So there are entries for Saturdays and Sundays, even though it may take until Tuesday for them to be listed on the website. Furthermore, unpublished counts of shots already given weeks ago are still finding their way to the Prime Minister’s Office and are then added. Here’s the total given for April 14, as listed on the day the numbers for a given recent date were also added:

May 18: 2,533
May 20: 2,666
May 27: 2,793
May 30: 3,078

A near 20 percent increase for vaccinations that already took place over a month ago is quite surprising, considering that vaccinations are tracked with Android tablets with software specifically developed for the purpose. How can a computer-based system be so slow? It actually makes fax machines look good by comparison (yes, they are still widely used here in Japan)!


Tracking Vaccination Numbers in Japan

The website of the Prime Minister’s Office in Japan (Kantei) is providing a daily update of vaccination progress in two categories: medical staff (doctors and nurses) and senior residents (age 65 and above).

To track these vaccinations, the government has issued tablet computers running software known as the Vaccine Recording System (ワクチン接種記録システム, VRS). It was developed by Milabo, a small privately held company founded in 2013. It describes itself as:

A start-up that provides child-rearing support services such as DX, immunization, health checkup, checkup scheduler, electronic maternal and child notebook, health center reservation system, mainly for local governments.

It had previously worked with the cabinet secretariat on the “MyNumber” personal ID system that assigns a personal identification number to every resident of the country. The budget for developing VRS was 385 million yen (about US$3.5 million).

The software in the tablets is used to scan bar codes and forms when people receive their vaccine doses. Theoretically this should allow the government to accurately track the progress being made.

However, the numbers published on the website keep changing even after they are published. For example, on Monday, May 17 the Kantei website listed a total of 69,526 doses (first and second doses) given to seniors on Monday, May 10 and 57,172 on Saturday, May 15. Two days later, on Wednesday, May 19 the numbers for those two days had been revised to 71,543 and 83,311 doses, respectively. That is an increase of 2.9 percent and 45.7 percent several days after publication.

What this suggests is that the software does not track the numbers and automatically uploads them to a government server at the end of the day (say, via a mobile data connection with a SIM card). Instead, there must be manual steps involved. Comparing the results published two days apart and looking back across 4 weeks worth of data, it turns out that daily totals still change after a whole month, for example by 46 doses from 2,533 to 2,579 for Wednesday, April 14 between May 17 and 19. I mean, really?

In rare cases the numbers have also decreased by 2 or 3 doses from the previously reported totals, which would be hard to explain by late reporting: the numbers should go up but not down! This could be cases were mistakes were made that made vaccination unreliable and so the cases were purged from the total.

The good news is that currently about 77 percent of healthcare workers have received at least one dose while 42 percent have received both doses. At the current pace of second doses it should take less than two weeks for all remaining healthcare workers to have received their first shots and three weeks after that anyone willing to get the first shot will have had their second shot too. For some strange reason, the healthcare worker counts seem unaffected by the late count updates and I don’t understand why.

One thing to look forward to is for the Moderna vaccine (mRNA-1273) to receive approval in Japan at the end end of this week. It is very similar to the Pfizer/BioNTech vaccine in terms of safety and efficacy. It has already been imported into Japan since the end of last month.

There are about 7 times more senior citizens than there are health care workers, so the number will have to increase much more. There should be enough vaccine by the end of June/early July to vaccinate about 36 million of them, but will the local governments be able to keep up with setting up vaccination sites? Each prefecture and city has been left to figure it out on its own. There is no national vaccination reservation system, each local government was left to build its own system. If the bottleneck is not vaccine supplies but organisation then the Moderna vaccine will not help all that much.

If Japan manages to vaccinate all its doctors and nurses by early June and most of its people aged 65 and above by the end of July, that still leaves about 70 million people to be vaccinated after that, with no date yet when this is expected to start and how long it is expected to take. It looks like a long road ahead to herd immunity and for life to return to normal.

Covid Vaccinations in Japan

Japan has been lagging other rich countries on the number of vaccine shots delivered per 100 people. It reportedly comes 37th out of 37 OECD countries. Other countries already started vaccinating in December or early January while Japan didn’t approve of the its first vaccine until February. Vaccinations of doctors and nurses started in initially small numbers in March. The elderly were added starting from April 12, but again numbers were initially very small.

My 81-year old mother in Germany got her second shot before the end of March. My 86-year old mother-in-law in Japan was not even able to make an application before yesterday (May 14) and is now waiting for the vaccination date to come. Tokyo is currently in its third state of emergency, struggling with its fourth wave of infections.

For the last 7 days with published numbers for vaccinations of healthcare workers and elderly residents (2021-05-05 to 2021-05-13) the daily average is about 193,000 doses per day. At that rate it would take 3 1/2 years to finish vaccinating the entire population.

Even other rich countries in the Pacific region that (unlike Japan) currently have few new Covid cases have vaccinated far more of their population. For example, with only 5 Covid-19 deaths in the past 12 months New Zealand has been virtually Covid-free, yet it has vaccinated proportionally twice as much of its population than has Japan. The same is true for Australia and South Korea, which both have proportionally fewer cases but more vaccinations.

Like other countries, Japan has struggled to secure sufficient vaccine supplies, but that is not the whole picture. Starting from April, far more vaccine doses have been arriving than were being used, leaving 24 of 28 million doses imported by the end of April still unused in early May.

According to the Ministry of Health, Labour and Welfare (MHLW) the expected vaccine supply in May and June should allow for bringing in enough Pfizer/BioNTech vaccine for the entire 36 million residents aged 65 and above by the week starting 2021-06-28, which should allow giving everyone the first shot in early July, knowing there will be enough vaccine for the second shot three weeks later, thereby finishing to vaccinate the 65+ population by the end of July.

As an aside, Japan rigidly adheres to the 3 week interval set by the manufacturer, unlike the UK and Germany which had lengthened the interval between shots to maximize early partial immunity by giving as many people as possible a first shot: The protection given by the first shot is considerably stronger than half the final protection from both shots, so fewer people will become ill or die in a population of 10 million if 1 million are half-vaccinated than if 500,000 are fully vaccinated but the rest non-vaccinated.

Shipments arrive in boxes of 195 vials. Starting from the week of 2021-05-10, all boxes will be paired with low dead space syringes needed for 6 doses per vial = 1,170 shots per box. Previously only 5 doses could be extracted with the available syringes (975 shots per box).

2021-05-10 + 2021-05-17: 16,000 boxes = 18,720,000 doses total
2021-05-24 + 2021-05-31: 13,000 boxes or more = 15,210,000 doses or more
2021-06-07 + 2021-06-14: 13,435 boxes or more = 15,718,950 doses or more
2021-06-21 + 2021-06-28: 13,434 boxes or more = 15,717,780 doses or more

The “or more” in the numbers above refers to extra supplies that may be released from the central government’s stockpile whose size they don’t normally talk about.

Combined with the much smaller numbers in April that’s a total of 62,710 boxes, enough for two doses each for 35,490,000 residents aged 65 or above.

With supplies secured, the big question will be how fast the vaccine can actually be distributed. With the national government only taking care of import and distribution of vaccines, the actual vaccinations are left to local governments and are happening in a patchwork of different approaches. For example, in Setagaya where I live, the city website lists quite a few public vaccination sites to be set up at event halls, gymnasims, etc. in the next couple of weeks and months. There’s a website to make online reservations, once your mailed coupon arrives. This is similar to the approach in Germany. In my mother-in-law’s city in Saitama prefecture however, the city lists hospitals and small clinics, none of which can be reserved online yet (reservations are by telephone only) and many of them will currently only accept people already on their patient register. That approach is not very encouraging for cranking up the volume.

The central government-run vaccination sites to be set up in Tokyo and Osaka that are supposed to handle 10,000 and 5,000 vaccinations per day respectively will not be a game changer unless there will be many more such sites operating everywhere for the rest of the year. 10,000 shots a day for 3 months (the planned operating time of the Tokyo/Kanto site) will cover 2 shots for 450,000 people, a mere 5% of the 65+ population of Tokyo+3 (Kanagawa, Saitama and Chiba) of 9 million and then there will be the much larger under-65 population still to take care of.

The next group in line will be the under-65 with pre-existing conditions, then everybody else (probably in decreasing age order). Japan will need many more mass vaccination sites, it will need to recruit and train staff (both people with a medical background and volunteers) and maybe also change some regulations to widen the circle of people qualified to give injections. Otherwise the vaccination process could drag on far into next year. Another winter with another wave of infections and an unpredictable cost in lives and economic pain would be disastrous.

See also:

U.S. Politicians infected with COVID-19

Covid-19 seems to have had a disproportionate impact both amongst politicians in some countries and amongst low income groups. Many workers have no choice of how to protect themselves if they want to make a living and pay the rent. Politicians however have much more power to actively change the conditions that put themselves and their compatriots at risk. So it seems strange if they don’t use it that way.

Particularly in the US, the wearing of masks and social distancing have been politicised instead of simply following the advice of health care experts and scientists. This has lead to peculiar outcomes.

From the beginning of the SARS-CoV-2 pandemic a total of 18 US Senators have had to self-quarantine after they had been exposed to an infected person (usually a colleague or member of staff). Amazingly, all 18 of these Senators were Republicans. Five of them either tested positive for or were assumed have Covid-19. Republicans currently hold 53 of 100 senate seats. None of the 45 Democrats or 2 Independents have been affected so far.

From April 3, when the CDC started recommending non-medical face covers in public even for people not infected with Covid-19 until September 3, a total of 20 Representatives in the House had to self-quarantine. 13 of them were Republicans, only 7 were Democrats. 9 of them tested positive or were assumed to have Covid-19. 7 of them were Republicans and 2 were Democrats. The Democrats hold 235 seats in the House vs. 199 Republicans. That’s an odds ratio of more than 4 to 1 for Republicans.

Frankly, I am not surprised that Donald Trump was infected with SARS-Cov-2 given his reckless attitude to mask wearing and protecting others in general. I was just surprised that it happened as late as October. I do wish Melania and him a speedy recovery, followed by retirement from politics.

The virus doesn’t care about politics. It will take advantage of any opportunities for spreading, which the inaction and sabotage of Trump and his party have amply provided, killing 210,000 Americans so far. It saddens me to see the US in its present state and it could still get far worse — unless Joe Biden and Kamala Harris win a decisive victory on November 3.

See also:
How The Coronavirus Has Affected Individual Members Of Congress (NPR, 2020-10-04)

“There has never been a successful vaccine for any coronavirus” — Is that true and what does it mean?

Vaccine skeptics sometimes will raise doubts on the likelihood of a viable vaccine for SARS-CoV-2 becoming available late in 2020 or during the first half of 2021 based on the statement that we have “never had a successful vaccine for any coronavirus.” As you probably know, SARS-CoV-2 the virus that causes COVID-19 is one of several kinds of coronaviruses that can infect humans.

While it’s technically true that there has not yet been any vaccine approved for treatment for a coronavirus, that doesn’t mean there won’t be one soon. Given the motivation we have with almost a million deaths worldwide from COVID-19 as I am writing this and the billions of dollars firmly committed to dozens of projects worldwide, I fully expect that we will have multiple successful vaccines for SARS-CoV-2 within a year.

To put it simply, the main reason we don’t have vaccines for other coronaviruses is that they never killed anywhere near as many people as COVID-19 has. Some human coronaviruses cause the common cold (along with rhinoviruses) but those are not a viable target for a vaccine because there are simply too many strains of them for any one vaccine to be effective against the majority of them. The diseases they cause are not particularly serious either. Nobody is going to spend billions to help fight diseases that at worst give you a running nose, not when there still are diseases like malaria around that kill vast numbers of people every year.

There are really only two other human coronaviruses that would have called for a vaccine, the one that causes Severe Acute Respiratory Syndrome (SARS) and the one that causes Middle East respiratory syndrome (MERS, also known as camel flu). The SARS epidemic in 2002-2004 killed about 800 people worldwide while MERS killed fewer than 900 over the past decade.

There was vaccine development for SARS (e.g. the Russian Sputnik V virus effort is an offshoot of that work), but when the SARS epidemic ended before the vaccine made it to market, funding for the safety trials still needed for final approval of the vaccine became unavailable. So it’s not that we couldn’t figure out how to make a vaccine that works against this close cousin of the latest coronavirus, we just didn’t have the vaccine approved by the time the virus stopped killing people.

The current vaccine projects use many different approaches, from using inactivated viruses to RNA vaccines to Viral vector vaccines. Some of these are tried and tested, others are pretty revolutionary new technology. Several of these projects are likely to be successful, which will bring us closer to herd immunity without having to let the forest fire of the pandemic rip through the entire population and the unacceptable death toll that would bring.

Japan Allows Foreign Residents to Leave and Come Back

Imagine having permanent residency in a country, owning a home there and paying a mortgage on it, having a job and paying taxes, your kids were born in the country and go to school there and you’ve been paying health insurance and pension contributions. Yet, once you leave you are not allowed back into the country where you live. That is what Japan has been like for the last five months for any resident holding a non-Japanese passport. Meanwhile Japanese citizens where free to travel to Europe and come back to Japan. Also, Japanese citizens living in the EU, the US, Canada, Australia and New Zealand were able to travel to Japan and then return to their homes in the respective countries as long as they observed applicable quarantine rules.

Japan was the only G7 country treating permanent resident different from its citizens with regards to returning after a trip abroad. This policy led to criticism by the international community but also by Japanese businesses who understand how this discrimination hurts Japanese prospects as a country to invest in and do business with. Because of this discrimination, Germany suspended non-resident Japanese from being able to visit Germany until Japan grants the same travel rights to resident EU citizens as the EU grants to resident Japanese citizen.

The criticism and sanctions worked and Japan has finally announced a change in their policy. From September 1, foreign residents of Japan will be able to travel abroad and later return to Japan again, provided they follow some regulations. Before they depart they will have to agree to comply with enhanced quarantine regulations on return. Before they return they will have to take a PCR test and provide a negative test result. Besides the test result, they will need to provide a form filled in and signed or stamped by the hospital or doctor conducting the test (link, Microsft Word .docx format). They will be tested again on arrival. If the test is negative, they can go home to quarantine themselves for 14 days, provided they don’t use public transport (i.e. they must use a hire car or be picked up in a private vehicle).

Here is a PDF with details of the new policy.

Permanent Residents Still Banned from Reentering Japan

It’s been more than a year since I last visited my mother, who is 80 years old. I am a permanent resident of Japan, but if I go and see her in Germany, I will not be able to return to the country where I live with my wife and kids, own a home, run a business and have been paying taxes for the last 27 years.

Japan is currently the only G7 country that discriminates between citizens and permanent residents on their right to return to their place of residence. While EU countries, the United States, Britain, Canada and Australia exempt not only citizens but also legal permanent residents and other long-term visa holders from the current SARS-CoV-2 related travel restrictions, Japan does not. Once you leave, you can’t come back.

Japanese citizens may still enter Japan if they have spent time in any of 119 countries on the banned list during the last 14 days. They are expected to take a PCR test when they arrive back at the Narita or Haneda airport but if the test is negative, they can travel to their home as long as they avoid public transport (i.e. they can get picked up by family or hire a car and driver). They are then expected to self-quarantine for two weeks. Apparently it’s still OK for them to buy their own groceries while in quarantine. Unlike quarantines in Taiwan their movements are not monitored in any way (e.g. no GPS tracking, no random phone calls).

At this time, foreign Permanent Residents and spouses of Japanese Nationals may only enter Japan if they had already left before the ban on the country they visited was imposed (April 3 for EU countries). In this case they are expected to self-quarantine the same way as Japanese citizens.

If they leave after the ban was imposed, for example now, then they will only be readmitted if they have left for specific humanitarian reasons, such as visiting a dying close relative or attending their funeral or for urgent medical reasons. They will have to show evidence of this to an immigration officer when they leave and even then they will not be guaranteed that they will be re-admitted. They will actually have to sign a disclaimer telling them as much. The decision is always up to the immigration officer when they re-enter.

Holders of other Japanese visa, such as people on student visas, can not enter Japan, even if they had traveled abroad before the entry ban was imposed. They are stuck outside, though this may get addressed in coming weeks.

EU countries and all other G7 countries will admit both their citizens and legal long-term residents (with appropriate quarantine rules). If you are a Japanese citizen who is resident in Düsseldorf or London or Los Angeles, you will be able to travel freely between your home and Japan, for whatever reason, as long as you observe quarantine regulations. If however you are a non-Japanese Permanent Resident of Japan who lives there, owns a home there, pays taxes there and has lived there for decades, if you were to travel back to your native country for business or to visit your family, you would be indefinitely prevented from re-entering Japan, regardless of any Covid-19 tests or quarantine period you are willing to submit yourself to.

The Japanese government is talking about opening Japan to business travellers from selected countries in the region, followed by students on student visas and finally tourists. No mention is being made in this plan of the fate of residents based in Japan, as if they did not exist.

In July the European Union opened the EU for travel from a selected list of countries with relatively low prevalence of Covid-19, including Australia, New Zealand and Canada. However, the German government announced that China, South Korea and Japan will only be added to this list once they reciprocate and treat EU citizens the same as the EU treats their citizens. Let’s hope that Japan will soon amend its rules.

Covid-19 in Japan: Numbers vs. Testing

Every day Tokyoites are anxiously waiting for the latest daily count of new confirmed Covid cases: Is it less than 200 or more than 200? It was a big thing when it first exceeded 100. On April 11, it barely missed the next big number with 197 cases. But what does it really mean?

“Cases of Covid-19 confirmed with PCR tests” depends as much on the number of tests conducted as the actual number of people newly infected. Anyone not tested is by definition not included in the count. Until now, anyone testing positive has been sent to a hospital, which supposedly is legally required (only recently have light cases been moved out to specially rented hotel rooms). Therefore hospitals have been reserving tests to people with the most severe symptoms or with pre-existing conditions so that the most deserving patients will occupy the limited hospital beds they can take up.

It may seem counter-intuitive, but the primary purpose of testing has not been to track the growth of infections but to allocate hospital beds. The number does not reflect reality as it is artificially throttled. As long as this policy continues, new confirmed cases will basically only be allowed to grow at a rate at which hospital beds are found for them, which is becoming increasingly difficult, as more and more hospitals are turning away new patients to avoid healthcare associated infections (HAI). There have been a number of cases of infection hotspots in hospitals.

An article in the The Atlantic discusses positivity, the rate of confirmed infections found as a share of tests conducted in different states and countries (please don’t confuse this with prevalence, the rate of infected people as a percentage of the population).

Basically, the higher the percentage of tests that come out positive, the more likely a country or region is to be undercounting infections, for example because of limited lab capacities or limited access to hospitals that can do testing:

“[W]hile the U.S. has a 20 percent positivity rate, South Korea’s is only about 2 percent—a full order of magnitude smaller.

South Korea is not alone in bringing its positivity rate down: America’s figure dwarfs that of almost every other developed country. Canada, Germany and Denmark have positivity rates from 6 to 8 percent. Australia and New Zealand have 2 percent positivity rates. Even Italy—which faced one of the world’s most ravaging outbreaks—has a 15 percent rate. It has found nearly 160,000 cases and conducted more than a million tests. Virtually the only wealthy country with a larger positivity rate than the U.S. is the United Kingdom, where more than 30 percent of people tested for the virus have been positive.

Comparing American states to regions in other countries results in the same general pattern. In Lombardy, the hardest hit part of Italy, the positive rate today stands at about 28 percent. That’s comparable to the rate in Connecticut. But New York, so far the hardest hit state in the U.S., has an even higher rate of 41 percent. And in New Jersey, an astounding one in two people tested for the virus are found to have it.”

(The Atlantic, 2020-04-16)

So what this tells us is that a high positive rate in the tests conducted indicates a higher rate of uncounted cases that the system can’t keep up with.

What does that mean about the potential undercounting of explosive infection growth in Japan and specifically in Tokyo? According to statistics published by the Tokyo Metropolitan government on its website, by yesterday (April 16) Tokyo had 2,595 confirmed Covid-19 cases out of 7,244 cases tested. That’s a positivity of 36%, higher than the positivity for the UK (30%), Lombardy and Connecticut (28%), the US overall (20%), Italy (15%) and Canada, Germany or Denmark (6-8%). Only New York and New Jersey are worse.

Recently, Germany has been running 350,000 tests per week and is capable of running up to 500,000 tests per week. Tests are analyzed 7 days a week, 24 hours a day using shift work in the labs. Japan, with a population 52% larger, has averaged 22,000 tested individuals per week over the past two weeks (Apr 2-15).

Don’t take any comfort from numbers staying flat or growing moderately unless testing is also expanded exponentially to keep up with and exceed the growth rate of virus cases. Without greatly expanded testing, we’re like a pilot flying blind in a cloud without radar. Beware of the mountains ahead.

See also: