Relatively unscathed by the pandemic: Curious cases of Germany and Japan

In a world decapitated by Covid-19, there are two countries which have conspicuously and intriguingly bucked the trend — Germany and Japan. In the first case, the number of deaths as a percentage of confirmed cases has been less than 0.5%; in the second the number of confirmed cases and deaths has also been astonishingly low. Let’s examine the European theatre. At one point, Italy was recording 10% mortality compared to people testing positive, Spain 7%, France more than 4% and Britain over 5%. Yet, Germany, in spite of having a common border with France, being very much in the vicinity of the hotspots of Italy and Spain and notwithstanding reporting cases in the tens of thousands, has returned that comparatively few have succumbed to the disease. Some query Germany’s data, citing that unlike Italy, it has not undertaken extensive post-mortem testing for the novel coronavirus.

Germany has about the same percentage of citizens or residents above the age of 65 as Italy. The elderly profile of its people has been attributed by analysts to be the cause of Italy’s alarmingly high death rate in the coronavirus epidemic. Spain and Italy are ranked in the Bloomberg Global Health Index as the top two nations in the world. In the same table Germany comes 23rd with a life expectancy nearly 10 years lower than either. Yet, Germany has so far withstood the battering from the epidemic.

This is perhaps because the illness has not as yet inflicted the aged as it has in Italy. 82% of infections in Germany have affected people below 60. It is of course too early to pass a definitive judgement. However, Marylyn Addo, head of the Department of Infectiology at Hamburg’s University Medical Centre, was quoted by The Guardian as saying: “We started doing professional contact tracing when the first cases were reported. It bought us some time to prepare our clinics for the coming storm.”

The first person to be hit by the virus in Japan was a man who had returned from Wuhan, China – the original source of the epidemic. This was nearly two weeks before Italy detected its first case. Yet, the number who have tested positive in Italy is now 60 times that of Japan; and the death toll nearly 160 times higher. Normally over 1,000 flights a week operate between Japan and China. Several Japanese cities are densely populated, people live in small apartments and the metro is invariably quite packed at peak times. Japan is also endowed with the world’s oldest population; and the highest rate of smoking among men among G7 countries. Spectator sport has come to a standstill, schools have closed, but the entertainment sector remains open for business, as do bars, clubs and restaurants; and there is no quarantine, only a voluntary self-isolation for 14 days

According to The Japan Times: “The cynical answer points to the country’s low testing rates…” The Washington Post quoted critics as claiming: “The government has undercounted the number of infections and lulled the country into a false sense of security.” The country has stuck to a policy of testing those with symptoms, a history of contact with people who have tested positive and have had fever for at least four days. A cover-up would have got exposed quite easily.

Bowing rather than shaking hands is the cultural norm in Japan. Wearing of masks has been an age-old, routine practice among the Japanese and the elderly tend to socially self-isolate and maintain a distance. These are helpful in a unique situation. It would appear, the Japanese government foresaw the threat and consequently took preventive measures – such as advocating the 2-3-week containment - as early as February. But with winter turning to spring, people have begun to throw caution to the winds. This could prove to be too much, too early. Hitoshi Oshitani, a professor of virology, warned a “second wave (of the outbreak) has already started”.

As cases surge, Yuriko Koike, Tokyo’s Governor, felt a citywide lockdown may become “the only option left”. The Olympic flame arrived near Japanese capital from Greece. But this summer’s Olympiad has fallen a victim and been postponed to next year. Meanwhile, Imperial College, London has been at the forefront of modelling the spread and impact of the pandemic as well as developing a prototype vaccine. It estimated “only about 1 in 19 people infected with COVID-19 in Wuhan are being tested for the infection and therefore being reported as confirmed cases”.

This could apply to most other countries. Indeed, the ratio could be higher in developing countries with scarce resources. Professor Robin Shattock from the Department of Infectious Disease stated a “vaccine candidate” in the laboratory has already been experimented on animals and “could enter into clinical studies (with human participants) in early summer”.