Japan can make it through the winter without lockdowns or mass screening for Covid-19 but the public will have to socialise — and drink — with care, according to the doctor leading the country’s response.

Dr Shigeru Omi, chair of the government’s expert committee on the virus, told the Financial Times in an interview that Japan was determined to keep the economy open even as case numbers were rising.

Japan has been relatively successful in living with the virus — rather than seeking near elimination as has been pursued in Australia, New Zealand, China and Taiwan — making it a potential model for Europe and the US.

Dr Omi said Japan’s strategy required continuous control rather than pursuing a speedy return to normality. The country has sought to balance economic activity with control throughout the summer. Infections were stable at about 500 a day in September and October. However, recent days have brought a fresh outbreak on the northern island of Hokkaido, with case numbers rising to more than 1,500 a day since Dr Omi spoke to the FT.

Japan did not impose a compulsory lockdown in the early stage of the pandemic. Instead, it made a call for voluntary business closures that was widely respected. However, Japan did impose difficult measures: its international border has remained largely closed while Europe went on holiday; people who tested positive were quarantined in hotels; and Japanese citizens kept up almost universal wearing of face masks in public.

Dr Omi said he did not believe there was any background factor limiting infections in Japan, such as a genetic difference or prior immunity. Rather, the return to offices, schools and domestic tourism had pushed case numbers upwards but effective contact-tracing and public caution had pushed them down.

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As a result, the country had managed until recently to maintain a reproduction rate, or R number, of almost exactly one, meaning the number of cases was neither increasing nor decreasing. With case numbers rising again, Dr Omi said Japan must now strengthen the downward pressure.

To do that, the government has issued a list of five high-risk situations — where people may let down their guard — to avoid. It may also request business closures in areas with high infections, such as the nightlife district of Hokkaido’s capital, Sapporo.

The high-risk situations include drinking parties, university dormitories and office smoking rooms. “Drinking alcohol is one of the very important elements for increasing infection,” said Dr Omi. If people were going to drink, he urged them to stick with the same companions rather than meeting different people.

The government is also upgrading its cluster-based tracing approach, which aims to find the source of infections and stop superspreaders. Japan has focused on this kind of backward-looking tracing rather than tracking the close contacts of newly infected people in case they develop the disease.

“Some of the clusters are easy to control and detect — in the workplace it’s easy, because everyone knows each other,” said Dr Omi. He added that Japan had become faster at spotting clusters in hospitals and nursing homes.

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But he said the nature of clusters was becoming more varied and those linked to red-light districts or immigrant communities were much harder to track and control.

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Japan has increased its testing capacity since the spring, and aims to test all those who are symptomatic or at high risk of exposure, but it still has no plans for mass screening of the general public.

“If you are ready to use an excessively large amount of money then [mass testing] is possible, but it’s not really practical,” said Dr Omi. He added that the tests were imperfect so there would be a significant level of false positives — people forced to isolate even though they did not have the virus — and false negatives who were infected but would believe themselves to be safe.

“Does [mass screening] lead to decreasing the level of infection?” he said. “No. It’s very minimal. If you screen this very low-risk population it will not result in a reduction in cases.”

Via Financial Times