We have been Close Contact to a Covid-19 Case in Japan
Our Experience and Analysis of the Situation
The ideal image of civic-minded Japan
We often say that Japanese people are deferent to the group and respectful of the law, which is naturally true, but only to a certain extent. Based on this premise, one tends to think that, a Japanese person will do their best to avoid spreading the Coronavirus 🦠, and in case of any symptom of infection will dutifully:
- Self-isolate for a strict 14-day quarantine,
- Report their condition in the Cocoa App (the Japanese contact-confirming application),
- Take a PCR test as soon as possible.
However, the supposed Japanese civic mind is nonetheless troubled by the need to not be a nuisance to the group (迷惑 meiwaku) and to avoid embarrassment for oneself (恥ずかしい hazukashii). As a consequence, many, who feel light symptoms such as the loss of taste or sense of smell, have not notified their relatives and their colleagues, at the risk of becoming super-spreaders.
At the end of 2020, the rise of Covid-19 cases in Japan was largely attributed to "GoTo Travel" and "GoTo Eat," the Japanese government campaigns to sponsor domestic tourism since summer. However, we do think this is not the only cause for the third Japanese Covid wave, which, while relatively mild compared to the second wave in western countries, is breaking new records for the archipelago.
We came to this conclusion after the unpleasant experience of being a contact to a Covid-confirmed case in Japan in late November. We have decided to tell our story and highlight the surprising loopholes we discovered in the Japanese system.
Circumstances of the possible contamination
On Saturday November 28, we participated to a birthday party. As usual in Japan, all the details were given via the application Line, to a group including all guests.
The house was big, even by western standards, and we were about 20 persons dispatched between the living room, the kitchen and a room used as a bar.
To protect his privacy, we will use a pseudonym to talk about the person who was a confirmed case, especially since we are talking about a work partner. He will call him "Hajio" in the story that follows.
Hajio was indeed one of the guests and arrived near 5 p.m. After about 1h30, he noticed that he had lost the sense of taste and left the party around 7 p.m. We and other guests were informed coincidentally by our host and were asked not to spread the word…
We nonetheless decided to notify a friend and his pregnant wife, who left immediately. We also left along with two other guest friends.
It is worth noting that we have not been notified by Cocoa, that does not take into account contact cases and only sends notifications when the suspected case was at a distance less than one meter during at least 15 minutes.
Contact case report and tracing in Japan
Hajio announced his ageusia on Line only the next evening around 9 p.m., in a lighthearted message… We called and convinced him to take a PCR test on the next day at the latest.
The test result came out positive on Tuesday December 1, and Hajio was called by the local public health center (保健所 hokenjo) later the same day. He was told he would be called again the next day by the contact case tracing team. In the meantime, Hajio sent a message on the party’s Line group to inquire who did not want to be "outed" for personal or professional reasons…
Surprisingly, the health center only asked a list of the persons with whom he had chatted, and not of all the guests at the party. A procedure that naturally makes it complicated to fully trace all the actual contact cases! It can be easy to think that Japan may alleviate its statistics on Covid…
The guests who accepted to be traced were called on Wednesday, me included. During the call, the person in charge of the tracing asked our personal details:
- Name and first name,
- Birth date,
- Postal address.
We asked with insistence to be tested, to which the hokenjo reluctantly agreed, stating that positive or not, the quarantine period was compulsory.
A PCR saliva testing kit was to be sent at home 2 to 3 days later. We were asked to stay in self-isolation even if the test turns out negative, and to notify the health center at the first symptom.
Covid PCR test and results
On Friday, December 4, we were notified our kit would be delivered the next day. We were told to go to a specific address that must be kept confidential (!), to proceed to the test with the kit on Sunday December 6, on a half hour slot.
We were told we could take public transportation to the test center, without knowing if the test could be positive! When we came back from overseas after 2 negative PCR tests performed on a 72 hours span, we were yet forbidden to ride public transportation during 15 days…
On Sunday, we thus went (on bicycle) to the designated place. The test center was in fact a parking lot, hidden behind two tourism buses and vegetation hedges, and guarded by a specific staff who secured arrivals. The place was voluntarily concealed from outside.
We were asked to sanitize hands before "coming in," and again between the buses, before handing in the saliva swab in a tube that has been checked and sanitized by medical staff.
The result was to be announced within 2 days, but we were called the next day. The test was negative, but we were asked to continue quarantine and to confirm the absence of symptoms or fever.
We had to tell that we were required to leave Japan on December 10, three days later and during the quarantine period, to come back to France for Christmas holidays. We were called on the same day to check the absence of symptoms and fever.
With a QR code (provided with the kit), we had to log to a website each day to input our temperature and the presence or not of symptoms. However, unlike the immigration’s control, the tracing of the health center is not very consistent and if you are late to make your daily declaration, you will not be called.
This "contact-case" test was free and paid for by the Japanese government. Guests who could afford it have paid their own tests as they deemed it was faster and less complicated. As a reminder, in Japan:
- An antigenic test costs about ¥7,500 (~US$50.24), with a 75% reliability;
- A RT-PCR test costs at least ¥30,000 (~US$201.00), with a 90% reliability.
Japan’s management of contact case tracing
This article is not intended as free criticism of Japan, but to highlight a less glamourous aspect of the country that is naturally overlooked by Japan’s politics and communication.
In comparison with France where Covid testing centers are clearly indicated with visible signs, in Japan they are hidden from view.
Additionally, and with no connection with the story we told above, a Japanese friend who suffered a 39 to 40°C fever during 3 days had a hard time finding a doctor: they all refused to see him in fear of Covid-19 contamination.
On a global scale, and despite very low testing, Japan does not have to be ashamed of its management of the Coronavirus crisis, in a country where customs 🛂 encourage physical distancing as a rule and that people tend to respect the rules (whereas in western countries, the rule is something to bypass or sometimes to break).
Let us remind that in Japan:
- There never was a lockdown, or a curfew nor any need for any kind of document to go out,
- The government has been funding the GoTo Travel campaign, a stimulation for domestic tourism since July, which meets a great success despite recent resistances,
- 120 million AstraZeneca’s vaccine doses have been reserved by the state as soon as this summer,
- The total number of deaths from Covid-19 since early 2020 in Japan is equivalent to the United States’ daily Coronavirus death toll in December,
- Tokyo Olympic games are still scheduled in July and August 2021, and all organizing parties, including IOC, keep checking and approving the sanitary measures.
Even South Korea, a country considered very efficient at handling the epidemic since the beginning, is currently facing an unexpected third winter wave.