A Tale of Two Nations: Why Coronavirus Showed Mercy on One and Gave No Quarter to the Other
There are very few countries that can claim the title of the world’s oldest population. More accurately, these states are the fastest aging countries by percentage of their populations entering retirement age 65. Countries that are in the midst of this demographic transformation face both economic slowdown and increased demand on healthcare services for geriatric care. The top nations that rank first and second on the list are none other than Japan (28.2%) and Italy (22.8%) according to PRB.org. Contrary to people’s beliefs, early data has shown that the Coronavirus infection was not indiscriminate with respect to severity and prevalence after the wake of the COVID-19 pandemic originating in Wuhan, China in November 2019. We know that the virus targets the elderly, sick and immunocompromised at far greater rates than younger individuals. In the case of Japan and Italy, two very similar demographically aged populations, the stark contrast of Coronavirus’ morbidity and mortality rates could not be more eye-opening. This case study’s goal is to elucidate the possible reasons for why Coronavirus showed mercy on Japan and gave no quarter to Italy so that nations can be better equipped for future novel virus pandemics.
Italy’s first confirmed cases were on January 31st, 2020 and Japan’s first confirmed case was on January 3rd, 2020. Japan had about a month’s head start in terms of planning for this pandemic compared to Italy. Italy took action to declare quarantine in the effected regions on February 22nd, 2020 less than a month after its first cases. Within 1-2 months after its first infections, Japan instituted the Quarantine Act to quarantine infected people on January 28th and instituted policies to prevent large gatherings on February 25th. Clearly, timing and preparation plays a crucial role in combating or delaying the spread of COVID-19. However, it can be argued that there may be endogenous or exogenous factors that come into play when comparing the response of Italy and Japan to Coronavirus.
Unlike developing countries, Japan has not had serious cases of malaria since its eradication in the country in 1961. Shortly after, Italy was also declared malaria free in 1970. This much is clear, neither of these countries have had a prophylactic or therapeutic need for the now popularly touted anti-malaria drug, hydroxychloroquine, except for cases of Lupus and rheumatoid arthritis. Yet, there have been far fewer Coronavirus cases and deaths in Japan than Italy. Can there be some other internal, medical reason for this divergence? Scientists have theorized that nations like Japan that have mandatory tuberculosis (TB) vaccine policies also had less cases among their population (morbidity) and less deaths (mortality). Clinical trials are currently underway in several countries to give the vaccine (BCG bacillus Calmette- Guerin) to frontline workers and elderly patients to see if there is some prophylactic effect against COVID-19.
On April 7, 2020, Japan declared a state of emergency requesting all citizens to stay-at-home. This is nearly 3 months after its first confirmed cases. COVID-19 cases are indeed increasing in their nation as well but at a much slower rate. One headwind that Japan does face includes lack of national Coronavirus testing, that has been touted for controlling the spread in neighboring country South Korea. Another problem would be its lack of ICU beds as a proportion of its population, which is less than that of even Italy’s. Tailwinds that Japan does have include its central planning ability- the nation has secured hotel rooms and other quarantine sites for mildly sick patients. Even beyond its vast administrative powers, Japan has a culture of preparing for epidemics much like other eastern countries: no one is seen without a surgical mask in public spaces and its citizens prepare at a grassroots level early on.
In the case of Italy, with over 17,000 deaths and some signs there is stabilization, possibly even a peak, any talk of moving on after Coronavirus is wishful thinking at best and perilous at worst. Their government is in discussions of moving to Phase 2 where citizens must learn to “live with the virus”. Early on in this pandemic, Italy’s healthcare system did not raise any alarms and was quite frankly taken by surprise when COVID-19 infiltrated the heart of its country like the Trojan horse of classical mythology. Heart-wrenching scenes of overflowed ICU units and hospital wards with patients struggling to breathe became the headlines. Lack of central planning, a culture of communication unfettered by masks, glass windows and gloves, and their signature “closeness” are what allowed Coronavirus to take the most vulnerable population in Italy without quarter.
There may be no treatment or therapy for Coronavirus for either of these countries to truly combat the virus head on. There are, however, common sense measures that both countries have instituted to prevent further or future calamity. I would implore Italy to not be too rash when instituting Phase 2, for precautionary measures are what will keep them alive and ready for future battles. Japan, on the other hand, is still starting to see its rise in cases. I would recommend they remain steadfast like the Samurai, but cunning like the Ninja. The rest of the world must watch and wait as the story unfolds for these two great cultures, but also take heed in this cautionary tale of two nations.
Citations
https://www.prb.org/countries-with-the-oldest-populations/
http://www.cidrap.umn.edu/news-perspective/2020/01/japan-has-1st-novel-coronavirus-case-china-reports-another-death
https://nypost.com/2020/04/07/japan-declares-state-of-emergency-as-coronavirus-cases-soar/
https://www.nytimes.com/2020/04/07/world/asia/japan-coronavirus-emergency.html
https://www.aljazeera.com/indepth/features/phase-italy-considers-move-coronavirus-peak-200408090958504.html
https://www.bloomberg.com/news/articles/2020-04-02/fewer-coronavirus-deaths-seen-in-countries-that-mandate-tb-vaccine