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TOKYO — The blame game can go only so far.
For weeks, as Japan faced a troubling rise in coronavirus cases, officials pointed fingers at Tokyo’s nightlife districts, especially the so-called host and hostess bars on the periphery of the country’s sex industry. The message was clear: The rest of Japan was still doing fine, so its economic reopening should continue uninterrupted.
But that facade is quickly melting away. On Friday, Japan reported close to 1,000 new infections — the most in a single day since the pandemic began — with cases surfacing across the country. This month, clusters have been found in nursing homes, schools and a Tokyo theater. And, in a worrisome sign, an increasing number have no traceable links.
Despite the growing outbreaks, the Japanese government has so far resisted a return to the kinds of restrictions being imposed in places like Hong Kong and Australia as their caseloads, which had previously subsided, spiral up again.
Tokyo officials — who announced a record total of 366 cases on Thursday — have not asked karaoke bars or nightclubs to close as they did under a state of emergency in April. The central government has pressed ahead with a domestic tourism campaign, although it bowed to pressure to exclude travelers to and from Tokyo.
Officials have maintained this no-going-back approach even as the nation reached a total of 27,956 active cases on Friday, a figure nearly 50 percent higher than at the beginning of the month.
“We are seeing the early phase of exponential growth,” said Kenji Shibuya, director of the Institute for Population Health at King’s College London and a member of a coronavirus task force assembled by the Japan Medical Association. “If they don’t act promptly and try to contain it as fast as possible,” he said, the virus could spin out of control.
When Tokyo announced its record case count on Thursday, Gov. Yuriko Koike acknowledged that infections had been detected across the city and were not limited to the nightlife hot spots that have been the subject of hectoring media coverage.
Yet in what business owners describe as scapegoating, the central government and Ms. Koike have talked of dispatching police officers to bars and nightclubs to help monitor social distancing and other hygiene measures.
On a balmy night this week in Kabukicho, a nerve center of Tokyo nightlife, Yuto Hara, 21, and his girlfriend, Ami Kaneko, 21, expressed little concern about the possibility of contracting the virus.
“I am not worried,” Mr. Hara said as the couple paused on Godzilla Road, the main artery into a neon-lit neighborhood of bars, nightclubs and host and hostess clubs, where young workers are paid to spend time in conversation — and more — with drinking customers. “With young people, there is very little possibility of actually dying.”
Part of the reason the government remains sanguine about the uptick in cases is that deaths have remained relatively low: just over 1,000 in a country of close to 127 million people. Japan has been held up as a model of infection control, with most residents wearing masks everywhere. Offices and stores put bottles of hand sanitizer at entrances and make efforts to shield workers and customers behind plastic sheeting.
The majority of recent cases — as in other countries that have experienced a rebound in infections — have been among people in their 20s and 30s, who tend to suffer only mild symptoms. On Thursday, Ms. Koike said that about one in seven of the Tokyo cases were asymptomatic.
But other indicators are more unsettling. The number of serious cases — patients requiring ventilators — has doubled in less than a week in Tokyo. And experts say that the young may eventually spread the virus to older people and others at risk of getting seriously ill.
Now, the virus “is mainly among young populations, but it will shift toward people in their 40s and 50s, and may even end up in the more vulnerable populations such as those in their 70s and 80s,” said Kentaro Iwata, an infectious disease specialist at Kobe University Hospital.
“You can’t really isolate the younger population from elderly people,” he said.
This pattern of the young passing the virus on to older populations, Dr. Iwata said, “was evidently seen in many parts of the United States,” where communities opened up and younger people hit the bars, restaurants and beaches, sparking outbreaks.
Until recently, Japan has been viewed as something of an outlier in the pandemic. Despite having the world’s highest proportion of elderly people and contending with a severe early outbreak on the Diamond Princess cruise ship, Japan has puzzled experts as it managed to contain the virus and avoid huge death tolls without imposing strict lockdowns.
Some physicians say they see no reason that the latest outbreaks will change that, in part because of the underlying health of the population.
“Compared to other countries, we don’t have as many ‘fatties,’” said Dr. Hiroyuki Kunishima, professor of infectious diseases at St. Marianna University School of Medicine in Tokyo. “The people who will have the heaviest conditions after contracting the virus are the fat people, smokers and people with pre-existing conditions.” He said that the seasonal flu was a much bigger concern in Japan.
Japan’s obesity rate is about 4 percent, compared to more than 40 percent in the United States. But 18 percent of the adult population in Japan smokes regularly, compared with about 14 percent in the United States. And Japan actually has a slightly higher rate of diabetes, one of the underlying conditions that have been associated with coronavirus morbidity.
The Japanese public has grown increasingly concerned about the recent record-setting caseloads. According to a poll by Kyodo News, two-thirds of the public wants the government to impose another state of emergency, under which businesses were asked to restrict operations and people were asked to work from home and make only essential trips.
On Friday, Prime Minister Shinzo Abe said there was no reason for the government to do so again. In some ways, it has gone in the opposite direction. In a speech about the contentious travel campaign this week, Mr. Abe cited the importance of reviving the economy, as the slowdown in international travel has severely hobbled Japan’s tourism industry.
The government also announced this month that sports and music venues could allow up to 5,000 people to attend events, as long as capacity was limited to 50 percent.
Officials say that the public health authorities can control the spread of the virus by quickly isolating clusters. When a positive case is identified, the patient is asked to list recent contacts, who are then tested. If any of them test positive, they are either hospitalized or asked to quarantine at home for 14 days, if they have a mild case.
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Frequently Asked Questions
Updated July 23, 2020
What is school going to look like in September?
- It is unlikely that many schools will return to a normal schedule this fall, requiring the grind of online learning, makeshift child care and stunted workdays to continue. California’s two largest public school districts — Los Angeles and San Diego — said on July 13, that instruction will be remote-only in the fall, citing concerns that surging coronavirus infections in their areas pose too dire a risk for students and teachers. Together, the two districts enroll some 825,000 students. They are the largest in the country so far to abandon plans for even a partial physical return to classrooms when they reopen in August. For other districts, the solution won’t be an all-or-nothing approach. Many systems, including the nation’s largest, New York City, are devising hybrid plans that involve spending some days in classrooms and other days online. There’s no national policy on this yet, so check with your municipal school system regularly to see what is happening in your community.
Is the coronavirus airborne?
- The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
What are the symptoms of coronavirus?
What’s the best material for a mask?
Does asymptomatic transmission of Covid-19 happen?
- So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Dr. Shibuya said that such retrospective testing may have worked in the early days of the pandemic, but that a broader approach was now necessary. Japan has consistently performed tests at well under its stated capacity: It says it can conduct as many as 30,000 a day, but it has more recently conducted fewer than 15,000 on a daily basis, and some days much fewer.
Without more testing, “you can’t separate those who are infected from those who are not,” Dr. Shibuya said. “If you delay testing until the onset of major symptoms, it’s too late.”
The authorities have stepped up targeted testing in some of the nightlife districts. Kaori Kohga, head of the Nightlife Business Association, which represents hostess clubs, said it was unfair of the government to single out the industry.
“I would like to urge politicians, instead of stirring up such divisive ideas, to instead look for fundamental solutions,” Ms. Kohga said.
She said national guidelines for how to protect workers and customers were unrealistic, such as asking customers to stay six feet from hostesses or other customers. Many of the clubs, Ms. Kohga said, operate in small spaces and could have no more than two customers at a time under the recommendations.
As a result of the negative attention, she said, business has dropped significantly, and some clubs have had to close, throwing employees — many of whom are young women with few other options — out of work.
On one evening this week, the normally heaving Kabukicho district was decidedly subdued.
At the Orange Terrace Girls Club, which displayed an official sign to certify that the business was implementing infection control measures, a worker standing outside pulled out a fever-checking thermometer from his back pocket.
At Kirin City, a bar and restaurant, fewer than half of the tables and bar stools were occupied. “Please refrain from speaking very loudly,” read a sign hanging by the door, reflecting evidence that the virus can be spread that way.
Dr. Shibuya said he was worried that the government was downplaying the risks that the country could be facing a more severe contagion. “Japan shouldn’t be so complacent,” he said, “because we have been lucky.”