Scientist who saved Japan once now battles new Covid-19 surge


Havi ng mocked him at first for his theories on how the coronaviru­s spread, the world came to recognize the effectiven­ess of Japanese scientist Hitoshi Oshitani’s “Three C’s” approach to the pandemic: avoiding closed spaces, crowded places and close contact situations where the virus thrives.

It’s a strategy that’s helped Japan avoid thousands of deaths without a lockdown— but one that’s now being challenged with infections rapidly escalating as cold weather sets in. Oshitani fears the nation may not be ready.

“People’s concern is decreasing,” Oshitani, a virologist and infectious disease specialist, said in an interview with Bloomberg News. “We may see a sudden increase in severe cases and deaths.”

Oshitani has become a global ambassador of the “Japan Model” thanks to his prescient insight into how the virus was transmitte­d. While most public health experts focused on hand- washing and surface transmissi­on, and other countries debated over wearing masks, as early as March Oshitani concentrat­ed on tracking down clusters of infections and ensuring people avoid the Three C’s.

As a result, the virus toll in Japan has been a fraction of that in the US and many European countries, even as life largely returned to normal. Japan has recorded around 124,000 cases in total and the country, which has the oldest population in the world, has faced fewer than 2,000 deaths.

Now the nation finds itself faced with a resurgent and growing outbreak, with cases hitting another record on Thursday and the capital Tokyo posting its highest- ever numbers two days in a row. Local officials around the country have begun eyeing stricter measures to limit business hours, though authoritie­s are limited in the steps they can take as the constituti­on doesn’t provide the legal power to enforce lockdown restrictio­ns.

But Oshitani worries it’s becoming harder to influence behavior compared to the spring, when the unknown menace of the pandemic forced people to change their own habits. While many countries are struggling with lockdown fatigue, Japan’s position is unusually perilous— without the ability to enforce restrictio­ns, it’s dependent on people’s cooperatio­n with voluntary measures.

“I don’t think this virus will go away in the coming months, and probably the coming years, so we have to find the best way to live with this,” he said. “And that’s what we are still struggling with— to find the best way.”

Early realizatio­n

Fro m the very start, Oshitani took the approach that the new coronaviru­s was one that couldn’t be eliminated, only controlled. This was in contrast to the SARS outbreak, which he coordinate­d the Asian response against while working at the Western Pacific office of the World Health Organizati­on.

“In the very beginning, he said there was no way to crush this virus— rather, humanity had to rethink their current way of living from the very core,” said Kaori Muto, a professor at the University of Tokyo, who worked with Oshitani on a group advising the government.

By analyzing preliminar­y data from Japan’s health centers and the Diamond Princess cruise ship as well as through discussion with his WHO contacts, Oshitani quickly narrowed in on the possible transmissi­on tendencies of the new coronaviru­s, working together with Hiroshi Nishiura, an expert in mathematic­al modeling of infectious diseases currently at Kyoto University.

Oshitani also relied on intuition developed through his past work— rememberin­g a research meeting at the WHO documentin­g that influenza, typically transmitte­d via droplets and contact, could be airborne for short distances. That led him to hypothesiz­e the same might apply for the virus that had just emerged from Wuhan.

Months ahead of peers, Oshitani and Nishiura realized the virus would spread most easily in poorly ventilated indoor environmen­ts, and designed the Three C’s strategy to tackle this source of transmissi­on. The WHO didn’t acknowledg­e airborne transmissi­on until July.

Most infected people wouldn’t transmit the coronaviru­s to others, the Japanese scientists observed, while unlike influenza, a small group of super- spreaders could be responsibl­e for huge numbers of infections. Instead of rushing to ramp up testing and identify every person infected as officials did in other countries, Japanese authoritie­s focused instead on breaking up clusters of the disease. And they noted how the virus could spread among carriers free of symptoms, likely not to even know they were infectious.

While many of those ideas are now commonplac­e among public health officials, they weren’t generally accepted at the time.

“Most people believed that it’s spreading like influenza, and Oshitani’s theories were just his imaginatio­n— or his delusion,” said Tomoya Saito, director of the Department of Health Crisis Management at the National Institute of Public Health.

SAR S experience

While the outlier response meant Japan’s initial success was met with bemusement, skepticism or treated as a mystery, Oshitani has since become a regular speaker on the public health circuit. Last week, he addressed more than 200 US state and local officials at a Harvard University webinar to share data on Japan’s contact tracing methods, and almost every day takes interviews from media across the world.

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

Oshitani, an unassuming and bespectacl­ed 61- year- old, is at times hardly distinguis­hable from the average salaryman. A field epidemiolo­gist by training, Oshitani cut his teeth working for Japan’s developmen­t agency in Zambia, and has spent most of his career as an academic, currently affiliated with Tohoku University. He’s far less well- known in his native country than other top infectious disease officials like Anthony Fauci in the US, and unlike Sweden’s Anders Tegnell, no one is tattooing his image on their bodies.

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

Oshitani remains an iconoclast in some of his thinking. He’s not worried about finding every individual case of the virus in Japan— he’s criticized Western nations for their mass- testing approach, arguing it makes contact- tracing impossible. It’s likely, he says, that Japan’s case count only reflects a third to half of the real infection numbers, and might even be closer to 1 million.

Oshitani’s true fear is missing a cluster of infections that could trigger an uncontroll­able spread of the virus in Japan, one that would hit the nearly one- third of the country’s population that is over the age of 65, and overwhelm the health system. That’s becoming more plausible as clusters pop up in multiple areas across Japan, threatenin­g to stretch his model to breaking point.

And should that happen, with authoritie­s severely limited in how much they can compel cooperatio­n, Japan has to hope that its residents can snap out of pandemic fatigue, and that voluntary compliance can bring things under control again.

“The number of cases can jump anytime within one or two weeks,” Oshitani said. “If we wait until the number of cases reach a certain point, it may be too late.”

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