Tokyo – Japan is remarkablePandemic resilience has spawned myriad possible explanations, from the country’s preference to go shoeless indoors, to the supposedly low-aerosol nature of Japan’s quiet entertainment, to its citizens’ beneficial gut bacteria. Even irreligiousness — which is said to have saved the Japanese from being exposed to overcrowded places of worship — has been touted as a virtue in the age of COVID-19. Despite having the world’s oldest population, with almost one in three residents 65 or older, Japan has had fewer COVID deaths per capita than almost any other developed nation. As of Thursday, Japan had registered just 246 COVID-19 deaths per million people, surpassing even New Zealand (263), which originally had a zero-COVID-maximum-suppression strategy. In comparison, the US has a cumulative figure of 3,045 deaths per million population. But COVID mortality statistics alone, often based on inconsistent and/or incomplete records, don’t tell the whole story. Researchers estimate Japan had 111,000 “excess deaths,” more than five times the number of reported COVID deaths when mortality from disrupted medical care and social dislocation are accounted for.
Japan’s excess mortality rate, at 44 per 100,000, is far higher than South Korea (4), Singapore (-15), Australia (-37), New Zealand (-9); China (0.6) and Taiwan (-5). Even less prosperous Vietnam and Thailand fared better. But compared to the US (179) and Europe (140), Japan still comes out on top. Some experts believe that credit for this relative success goes primarily to Japanese citizens. “Japan’s approach to the COVID response has relied primarily on people’s efforts,” not on the imposition of mandates, Kenji Shibuya, research director at the Tokyo Foundation for Policy Research, told CBS News. “That kind of voluntary effort, rather than top-down, draconian measures, has worked.” Peer pressure to wear face masks remains such a powerful force in Japan — even as heatstroke season looms — that the national health ministry has been forced to issue a pamphlet urging people not to wear masks when walking their dogs , bike, jog or just walk to work.
In addition to the almost ubiquitous use of masks, Japan’s vaccination program, initially delayed but then quickly implemented, is saving lives. Despite initial concerns about vaccine hesitancy, two-thirds of all citizens and around 90% of seniors have now received a booster shot. Japan’s generally healthy population also helped weather the pandemic. Lifespans have continued to increase over four decades, giving the Japanese the highest average life expectancy in the world at 87 for women and 81 for men. While the US obesity rate skyrocketed to nearly 42% in 2020, Japan enjoys one of the lowest obesity rates in the world at around 4%.
Also thanks to the universal health insurance system, cancer and heart disease rates are low. Like obesity, these diseases are important underlying risk factors for complications from coronavirus infection.
Scientists, meanwhile, have been investigating a theory that the Japanese may have an inherent advantage at the cellular level when it comes to fighting COVID.
Researchers at the government-funded RIKEN Center for Integrative Medical Sciences have focused on human leukocyte antigens (HLA), proteins found on most cells throughout our body, as a potential antiviral defense. HLA markers are well known in the field of organ transplantation, where matching HLA types, not just blood types, is critical to reducing the likelihood of organ rejection.
Riken’s study found that Japanese subjects with HLA type A24, common here and in some other parts of Asia, develop “cross-reactive” T cells in response to seasonal coronaviruses or the common cold, which can be redeployed to kill COVID-19 infection a lot faster and more effectively than those lacking this specific marker. Shin-ichiro Fujii, who is leading the study, told CBS News that he has applied to conduct clinical trials of a vaccine for immunocompromised cancer patients that would simulate the benefits of HLA-type A24 proteins in people who are unable are to develop neutralizing antibodies from the existing vaccines. “The real hope,” he said in a statement, “is that we can develop vaccines that can stimulate a highly targeted T-cell response against infection.” We’ve shown that this might be possible in this particular HLA group, but now we need to look at other types.”
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