Low immunity against Covid-19 and a growing population of the frail elderly are leading to a surge in coronavirus deaths in Japan, which has long maintained some of the strictest pandemic restrictions.
Feb 3 – Japan once had one of the lowest Covid-19 death rates, but the number has been trending upwards since late 2022.
It reached an all-time high on January 20 this year, surpassing the UK, US and South Korea, according to Harvard University’s Covid database, Our World in Data.
Japan was largely closed to foreign visitors from 2020 until mid-June last year. It opened its borders cautiously: At first, travelers had to be part of a package tour, buy health insurance and wear face masks in all public places.
Some schoolchildren ate in silence for more than two years as schools placed bans on lunchtime conversation.
However, as restrictions are eased, low population immunity to covid-19 may be causing an increase in infections, local health experts told the BBC.
Most of the latest Covid-19 deaths are older people with underlying medical conditions, experts said. This is in contrast to the initial series of deaths that were due to pneumonia and were often treated in intensive care.
“It is also difficult to prevent these deaths through treatment,” says Hitoshi Oshitani, one of Japan’s leading virologists, adding that Covid was only the trigger.
“Due to the emergence of variants and subvariants that escape the immune system and waning immunity, it is becoming increasingly difficult to prevent infections,” he says.
“Immune escape” is when the human host’s immune system becomes incapable of responding against an infectious agent. New versions of the Omicron variant are known to be masters of immune evasion.
Before the Omicron variant appeared, deaths from covid-19 occurred mainly in cities like Tokyo and Osaka, but now there are cases all over the country, said Dr. Oshitani, who was once a WHO regional adviser on surveillance and response to communicable diseases.
“In smaller prefectures and rural areas, the proportion of the elderly population is even higher than the national average. This changing geographic pattern may also contribute to the increasing trend of deaths,” he said.
Japan is the oldest society in the world by various measures, and its proportion of older people has increased every year since 1950.
Older people who become infected in nursing homes or community groups do not receive timely treatment, says epidemiologist Kenji Shibuya, director of the Tokyo Foundation for Policy Research.
Faster treatment can help, he says, but because of Japan’s classification of Covid as a Class 2 or “very dangerous” disease, only government-designated hospitals can treat those infected. And they have been overwhelmed by the growing number of cases.
Dr. Shibuya has called for covid to be downgraded and treated like a form of influenza, allowing all clinics and hospitals to treat patients who have the virus.
Prime Minister Fumio Kishida announced earlier this month that the ranking would be lowered, but only on May 8. Experts, including Japan’s top coronavirus adviser, Shigeru Omi, have been calling for this since last year.
Dr Oshitani and Dr Shibuya also say the death rate could have been inflated by underreporting of covid-19 cases due to asymptomatic infections and adjustments to physician reporting requirements last year. Having said that, Japan is one of the few countries that still provides daily counts of Covid-19.
Yasuharu Tokuda, a physician at the Institute for Global Health and Policy, noted that the natural immunity of the Japanese population, acquired through infection, had been low before the middle of last year.
He says natural immunity is stronger than what you get with vaccination, so low infection rates have led to low immunity in Japan, which in turn is causing more deaths.
Dr. Oshitani pointed to a similar phenomenon in Australia, where the death rate from covid-19 has been rising since it reopened the borders in early 2022 after keeping them closed for two years.
Experts are divided on the trajectory of Covid in Japan. Dr. Tokuda, for example, believes that future infection and death rates will be lower.
Dr. Oshitani, on the other hand, expects a further increase in deaths in the coming months, as affordable antiviral drugs are not yet widely available.
