Japan Reconsiders COVID-19 Rules as Omicron Fills Hospitals

Tokyo’s policies have been strikingly successful but may now be outdated.

By , a journalist based in Tokyo, and , a Tokyo-based journalist.
People line up for COVID-19 testing in Tokyo.
People line up for COVID-19 testing in Tokyo.
People line up for COVID-19 testing at Tokyo’s Haneda International Airport on Jan. 25. Philip Fong/AFP via Getty Images

Japan is the latest country to face the omicron paradox as infections soar but serious illness proportionally declines. It’s a challenge for a country that has dodged the worst of the coronavirus thus far, leaving Japanese officials scrambling to catch up even as some restrictions are being scaled back.

Japan is now seeing caseloads soar to record levels. The latest figures show an average of 76,800 new cases each day, double the number from two weeks ago and up from less than 1,000 new cases each day at the start of the year. This is pushing up hospital admissions even as a record 264,000 people nationwide are being told to recover at home. In Tokyo, the COVID-19 hospitalization rate is just below the 50 percent benchmark for declaring a full state of emergency, although the occupancy rate for wards housing the most critical cases is less than 5 percent.

By almost any measure, Japan’s response to the pandemic so far has been a success. The number of deaths from COVID-19 has been just 2 percent of the level of the United States on a per capita basis and, by some measures, there have actually been fewer deaths than normal in the country as other causes of death, notably influenza, pneumonia, and other respiratory diseases, decline.

Japan is the latest country to face the omicron paradox as infections soar but serious illness proportionally declines. It’s a challenge for a country that has dodged the worst of the coronavirus thus far, leaving Japanese officials scrambling to catch up even as some restrictions are being scaled back.

Japan is now seeing caseloads soar to record levels. The latest figures show an average of 76,800 new cases each day, double the number from two weeks ago and up from less than 1,000 new cases each day at the start of the year. This is pushing up hospital admissions even as a record 264,000 people nationwide are being told to recover at home. In Tokyo, the COVID-19 hospitalization rate is just below the 50 percent benchmark for declaring a full state of emergency, although the occupancy rate for wards housing the most critical cases is less than 5 percent.

By almost any measure, Japan’s response to the pandemic so far has been a success. The number of deaths from COVID-19 has been just 2 percent of the level of the United States on a per capita basis and, by some measures, there have actually been fewer deaths than normal in the country as other causes of death, notably influenza, pneumonia, and other respiratory diseases, decline.

This has led to a new version of the long-held belief among many that Japan is “different” than other countries. Senior politician Taro Aso, a former prime minister and now a vice president in the ruling Liberal Democratic Party, has claimed the small number of COVID-19 deaths is due to “the superiority of its people,” using language harkening back to Japan’s pre-war imperialism. The Sankei Shimbun, the furthest right wing of Japan’s major newspapers, said Japan’s success was linked to Shinto rituals and “the experience and wisdom of their ancestors.” Others have pointed to what they say are genetic differences. According to a study by Japan’s Riken research institute, an “x-factor” in the white blood cells of 60 percent of Japanese people may also have played a role.

Experts believe that more mundane reasons may be responsible. There is almost no resistance to wearing masks in public, even when outdoors. Even before the pandemic, it was normal practice to wear a mask to avoid giving your cold to others or to ward off allergies from tree pollen. Japanese peer pressure also appears to be playing a role. In addition, there has been wide acceptance of the coronavirus vaccines. After a slow start, nearly 80 percent of people in Japan have received two doses, although the figure for booster shots has trailed badly at just 20 percent. In an opinion piece for the New York Times, Hitoshi Oshitani, who advises the Japanese government on its COVID-19 response, ascribes Japan’s success to a focus on the “Three Cs” of closed spaces, crowded places, and close contacts.

Contact tracing has been a central part of the government’s program, but like other aspects of Japan’s health care system, it is highly bureaucratized and labor intensive. This approach is hardly unique to the pandemic. Ambulances in Japan must get permission to bring a patient to the emergency room, with some highly publicized stories of hours-long waits as the ambulance drives around. Taro Kono, the minister in charge of vaccinations, said that his biggest challenge in the job was arguing with bureaucrats at the Health Ministry.

But in the face of omicron, the tracing program appears overloaded and ineffective. Yugo Shobugawa, a professor at Niigata University specializing in infectious diseases, doubts Japan’s contact tracing can cope with the spread of the coronavirus. He notes the omicron variant is highly contagious, making transmission possible without being defined as a close contact. “If you remove your mask during a meal, almost everyone could be infected,” said Takemasa Sakaguchi, a professor of virology at Hiroshima University.

This appears to be common sense but the government has been criticized over some cases in which people died under tragic circumstances while in isolation at home. Last September, Takarajimasha, a Japanese publisher known for social commentary, ran a double-page advertising spread in three major national newspapers that said “citizens are being left to die at home.” In some cases, even patients experiencing respiratory failure and in need of oxygen administration were being forced to undergo medical treatment at home. The number of deaths under such circumstances remains obscure.

Prime Minister Fumio Kishida has emphasized that aggressive measures are in place and has promised to speed up the program of booster shots that has seen just 20 percent of the eligible population receiving their third dose. At the same time, his administration has shown a willingness to ease constraints in a bid to help businesses, an approach that has suggested flexibility or indecisiveness depending on who is talking.

As part of this approach, residents returning from overseas will have their isolation period cut to just seven days from the previous 10, which itself was a reduction from the 14-day quarantine in place last year. The head of Japan’s powerful Keidanren business lobby is pushing for further moves, saying the limit on foreigners had little purpose when there were so many domestic cases. He isn’t alone in this.

A group called Stop Japan’s Ban has staged protests in a number of countries in an attempt to persuade the Japanese government to rethink its ban. Throughout the pandemic, Japan has had among the most severe restrictions on inbound travel. Almost all entries by foreigners, even those with visas, have been halted, affecting those who are taking up work in Japan or arriving to study. Early in the crisis, even foreigners with permanent resident status were banned, although that rule has now been lifted.

Omicron has also proved to be another public relations disaster for the U.S. military in Japan, where any misstep is sure to spark renewed complaints in the southern prefecture of Okinawa, which plays uneasy host to the foreigners who enjoy an unusual amount of privilege. Under the U.S.-Japan agreement, the U.S. military personnel were not required to be tested in order to enter Japan. As a result, Okinawa saw a wave of infections linked to U.S. personnel. This has all brought new calls for changes to the rules.

“This is a structural problem of the U.S.-Japan Status of Forces Agreement that creates a situation where sufficient information on infection prevention cannot be provided,” said Okinawa Governor Denny Tamaki. He called for a revision of the deal, a move quickly rejected by Kishida, although the idea appears to have broad public appeal, at least for now. In a national poll conducted by the Mainichi Shimbun newspaper and the Social Survey Research Center, 74 percent of respondents said the agreement “needed to be reassessed.”

While Okinawa was in the lead, omicron has proven to be a national phenomenon. What are delicately called “quasi-states of emergency” are now in place in 34 of the 47 prefectures in Japan. The regions can impose restrictions on restaurant hours and the size of public gatherings that are modest by global standards as they seek to avoid yet more damage to small businesses.

So far, none of this has damaged the Kishida administration, even though public displeasure over the government’s COVID-19 response was the main reason for the downfall of his predecessor Yoshihide Suga, who left office in September with a 32 percent approval rating. Kishida had a 52 percent approval rating in January, according to a survey by the Mainichi Shimbun, little changed from December. Even the potentially risky “stay-at-home” policy appears to have broad support with 71 percent of respondents in the same survey saying it was “appropriate” against 18 percent saying it was “problematic.”

But it is still early as some experts warn the worst is yet to come. According to Professor Takeshi Terashima of Tokyo Medical and Dental University, there is a high chance the coronavirus infection rate in Japan will shoot up to around 100,000 or even 360,000 new cases each day. With the slow booster rollout and limited closures unlikely to have much impact on the trajectory, Kishida may still join the pantheon of global leaders who have found that the pandemic ailment is a political condition.

Kathleen Benoza is a journalist based in Tokyo.

William Sposato is a Tokyo-based journalist who has been a contributor to Foreign Policy since 2015. He has been following Japan’s politics and economics for more than 20 years, working at Reuters and the Wall Street Journal. He is also the co-author of a 2021 book on the Carlos Ghosn affair and its impact on Japan.

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