He saved Japan from the worst coronavirus. But has the magic worn off?

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Having first made fun of him for his theories on the spread of the novel coronavirus, the world has come to recognize the effectiveness of scientist Hitoshi Oshitani’s “Three Cs” approach to the pandemic: avoiding spaces closed, crowds and close contact situations where the virus thrives.

It’s a strategy that has helped the country avert thousands of deaths without lockdown – but one that is now being questioned, with infections rapidly escalating as the cold sets in.

Oshitani fears the nation is not ready.

“People’s worries are decreasing,” Oshitani, a virologist and infectious disease specialist, said in an interview. “We can see a sudden increase in severe cases and deaths.”

Oshitani has become a global ambassador for the ‘Japanese model’, thanks to his astute insight into how the COVID-19 virus was transmitted. While most public health experts have focused on handwashing and surface transmission, and other countries have debated wearing masks, Oshitani focused in March on tracking down clusters of disease. infections and make sure people avoid the Three Cs.

As a result, the virus toll here has been only a fraction of that of the United States and many European countries, even as life has largely returned to normal.

Japan has recorded around 124,000 cases in total and the country, which has the world’s oldest population, has faced fewer than 2,000 deaths.

Now the country faces a resurgent and growing epidemic, with cases reaching another record high on Thursday and Tokyo posting its all-time highs two days in a row.

Local officials across the country have started to consider more stringent measures to restrict working hours, although authorities are limited in the measures they can take given the limits of their legal power to enforce the restrictions on work. locking.

Oshitani is concerned that it will become more difficult to influence behavior compared to spring, when the unknown threat of the pandemic forced people to change their own habits.

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While many countries grapple with lockdown fatigue, Japan’s position is unusually perilous – lacking in its ability to enforce the restrictions, the nation depends on people’s cooperation with voluntary measures.

“I don’t think this virus will go away in the coming months, and probably in the years to come, so we have to find the best way to live with it,” he said. “And that’s what we always struggle with: finding the best way.”

Early realization

From the start, Oshitani took the approach that the new virus was a virus that could not be eliminated, only controlled.

This contrasted with the SARS outbreak, the Asian response he coordinated while working in the Western Pacific office of the World Health Organization.

“At the very beginning he said there was no way to crush this virus – rather that humanity had to rethink its current way of life from the very heart,” said Kaori Muto, professor at the University. from Tokyo, who worked with Oshitani in a government advisory group.

Analyzing preliminary data from the country’s health centers and the Diamond Princess cruise ship, as well as speaking with his WHO contacts, Oshitani quickly focused on possible transmission trends of the new virus, in collaboration with Hiroshi Nishiura, an expert in mathematics. modeling of infectious diseases currently at Kyoto University.

Pedestrians in the Shinjuku district of Tokyo on Thursday, the day the capital raised its COVID-19 alert to the highest of four levels | BLOOMBERG

Oshitani also drew on the intuition developed during his earlier work – recalling a research meeting at the WHO where it was documented that influenza, usually transmitted by droplets and by contact, can also be airborne over short distances. This led him to speculate that the same could apply to the virus that had just emerged from Wuhan.

Months before their peers, Oshitani and Nishiura realized that the virus would spread more easily in poorly ventilated indoor environments and devised the Three Cs strategy to tackle this source of transmission. WHO only recognized airborne transmission in July.

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Most infected people would not pass the coronavirus on to others, scientists observed, when – unlike the flu – a small group of super-spreaders could be responsible for a large number of infections.

Instead of rushing to step up testing and identify every infected person, as Japanese authorities have done in other countries, Japanese authorities have instead focused on separating the clusters of the disease. And they noted how the virus could spread among carriers without symptoms, probably not even knowing they were infectious.

While many of these ideas are now common among public health officials, they were not generally accepted at the time.

“Most people thought that she spread like the flu and that Oshitani’s theories were just her imagination – or her delusion,” said Tomoya Saito, director of the Department of Health Crisis Management at the National Institute of Public Health.

SARS experience

While the outlier response meant that Japan’s initial success was met with bewilderment, skepticism, or treated as a mystery, Oshitani has since become a regular speaker in the public health circuit.

Last week, he spoke to more than 200 state and local officials across the United States at a Harvard University webinar to share data on contact tracing methods in Japan, and is taking interviews from around the world almost every day.

“It is through his efforts and the way he presents his data that we understand so much what can be done in the COVID situation today,” said David Heymann, professor of infectious disease epidemiology at the London School of Hygiene & Tropical Medicine which has worked with WHO for decades.

Oshitani, an unassuming, bespectacled 61-year-old man, can hardly be distinguished from the average employee at times. A trained field epidemiologist, Oshitani first cut his teeth working for the Japanese Development Agency in Zambia and spent most of his career as an academic, currently affiliated with Tohoku University. He is much less well known in his home country than other top infectious disease officials like Anthony Fauci in the US, and unlike Swede Anders Tegnell, no one gets his image tattooed on their body.

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But those who worked with Oshitani say his first sense of urgency, constantly prompting government officials to do more, was crucial to Japan’s response.

Oshitani remains an iconoclast in some of his thoughts. He’s not afraid to find each individual case of the virus in Japan – he has criticized Western countries for their mass testing approach, arguing that it makes contact tracing impossible.

It is likely, he says, that the number of cases in Japan reflects only a third to half of the actual number of infections, and could even be closer to a million.

Oshitani’s real fear is missing a cluster of infections that could trigger the virus to spread out of control in the country; that would affect nearly a third of the country’s population over 65 and overwhelm the health system. This becomes more and more plausible as clusters appear in several parts of the country, threatening to stretch its model to the breaking point.

And should that happen, with authorities extremely limited in how far they can enforce cooperation, Japan must hope that its residents can emerge from pandemic fatigue and that voluntary compliance can put things back under control.

“The number of cases can increase at any time in a week or two,” Oshitani said. “If we wait until the number of cases reaches a certain point, it may be too late.”

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