Calls are growing in Japan to treat Covid-19 as endemic, adding to a global chorus pushing for a return to normal life as people tire of pandemic restrictions, vaccines become more accessible and virus deaths remain low.
Drawing on data that shows omicron posing a less severe risk than previous variants, public figures from Tokyo’s governor to former Prime Minister Shinzo Abe have signalled their support for downgrading the legal status of the virus in Japan. The change would widen health care access for patients, effectively casting the virus as no different than the flu.
It is a debate playing out around the world, particularly in the West. Spanish Prime Minister Pedro Sanchez called on Europe to treat the virus as a constant of everyday life in a recent interview on the radio station Cadena Ser. And countries everywhere from India to the UK are resisting reverting to lockdowns despite the swift onset of omicron as politicians lose appetite for mass disruptions.
In Asia, which has generally been far tougher on containment of the virus since the pandemic began, Japan is in many ways the most likely to shift. Officials never deployed mandatory lockdowns, in part because the constitution doesn’t include the right to take emergency measures during crises. Even as infections climbed, Japan distinguished its policies from iron-fisted ones in places like China. Many of the requests for businesses to restrict opening hours or require vaccination can simply be ignored.
Downgrading Covid’s status would also have the immediate impact of freeing up medical resources for Japanese patients in hospitals currently refusing to treat Covid patients because they’re not equipped to manage infectious diseases.
Even so, Prime Minister Fumio Kishida has urged caution and pushed back against his predecessor, who made the call for going endemic in an interview earlier this month with a local news outlet. Kishida told reporters last week that it’s still too early to downgrade the virus given the omicron caseload.
Japan reported more than 30 000 new cases on Tuesday, though “severe” ones rose by just 18, according to national broadcaster NHK. And broadly speaking, the public has also supported efforts to keep the virus out: After the government barred new foreign arrivals in November, an opinion poll found that almost 90% of people supported the measure.
Nevertheless, the topic has growing resonance in Japan, with Abe one of the highest-profile backers of softening curbs.
“Why don’t we go further this year and change the legal position of the coronavirus,” he said in an interview with Yomiuri. “As hospitalisation is the principle treatment, the burden on medical institutions and health centres is heavy. We need to be cautious of omicron, but if drugs and vaccines can prevent the disease from becoming severe, we could treat Covid like seasonal influenza.”
Finding a middle ground
A bigger shift in how Japan treats the virus may change public perception about the threat of infection, as well as help to diffuse the impact of future mutations.
Currently, Japan draws on 450 or so public health centres to contact trace and hospitalise people with the virus. Space is limited because hospitals, especially small or privately owned ones, can refuse to take patients unless they are severely ill.
Though deaths have remained low in Japan throughout the pandemic, despite the country’s large elderly population, scores of people have still been turned away from hospitals during previous waves. Hundreds were left to die at home without seeing a doctor.
Some countries have already started to see omicron waves peak. In South Africa, where the variant was first reported almost two months ago, the omicron death rate topped out at 15% of the delta wave, according to the National Institute of Communicable Diseases. The strain causes less severe disease, even in those who are unvaccinated or who haven’t had a prior infection, according to the latest South African research.
Japanese officials seem aware that forcing the infected into hospitals or quarantines might do more harm than good. As health facilities continue to fill up, Japan plans to impose a state of quasi emergency in Tokyo and several other parts of the country starting Friday, but requests for bars and restaurants to shorten their hours are still non-compulsory.
“We will stop the infection. We will not stop the society,” Yuriko Koike, Tokyo’s governor, told reporters last week. “We have to do both.”
Financial woes have weighed on Japan. The country’s economy was projected to grow by 1.8% in 2021, compared to 5.9% globally. Over the course of the pandemic, Japan has declared a state of emergency four other times, slowing the recovery of the world’s third-largest economy.
Japan has sent mixed messages about a broader relaxation, partly because the previous administration was ousted for a slow response to tackling infections. Kishida’s administration may be worried that downgrading the legal status of the virus could be perceived as weak. The dilution would also free the government from covering the cost of Covid hospital stays, putting the burden of payment on patients, a potentially unpopular proposition.
The government banned all foreign arrivals until the end of February — one of the most aggressive travel responses enacted globally due to omicron — but also cut the self-isolation period for close contacts to 10 days from 14 days. For medical workers, the rules were scrapped entirely last week.
While Western countries worry that removing the Covid stigma will discourage people from taking precautions like mask-wearing, that’s unlikely in Japan: Broad public cooperation and cultural norms have meant that people never stopped sanitising their hands or wearing masks in public, even when new cases dropped.
During virus surges, many people canceled travel plans voluntarily, perhaps partly explaining why the country has escaped high fatalities. Almost 80% of residents are fully vaccinated with two shots, making Japan one of the most immunised among developed nations.
As Japan weighs its next move, Kishida has signaled that his government’s priority is finding a middle ground.
“The virus repeatedly mutates and we must take that into account,” he told reporters last Thursday. “We can’t keep changing the status every time the virus changes its form.”