Dissembling by Disassembling? 

The Case of Japan

by Fabio Gygi

For more than three months we have been following the spread of the coronavirus across the world. For those of us who are not working on the frontlines, the experience has been surreal, to say the least. If you are self-isolating and lucky enough to know no one who has been taken ill, the world outside looks incongruously peaceful and very much at odds with the anxiety that many experience. Only the daily broadcast of updated statistics pierces the complacency of splendid spring days. The most visceral reality of the pandemic reveals itself to us in its most abstract form: the number of deaths.

The first person who tested positive for Covid-19 in Japan was a traveller who returned from Wuhan to Kanagawa on January 6. He was admitted to hospital from January 10 to January 15. Later that month, a bus driver who had chauffeured a group of Chinese tourists from Wuhan was the first one to get infected without having left Japan. The Japanese government under Abe Shinzō reacted by restricting travel to and from Hubei province and banned anyone with a Hubei-issued passport from entering. Although it quickly became clear that infections were happening domestically, the Prime Minister drew on his strongest political instinct and focussed on drawing a strong boundary between a contaminated outside and a ‘clean’ inside. Some commentators and critics initially even toyed with the idea of a “close-the-country” policy (sakoku), the precedent of which kept Japan ’safe’ from much foreign influence from 1636-1853. For weeks, the news was dominated by the story of the Diamond Princess, the ill-fated cruise ship that was quarantined in Yokohama on February 2 after ten passengers tested positive. Although the passengers and crew in need for treatment were brought to shore and some of the 14 fatalities happened after passengers had been repatriated, the Japanese authorities still account for the number of deaths related to the ship with a special, “exterritorial” category.

It took a while for the language to settle, too: initially many media outlets spoke of shin-gata haien (new-type pneumonia), which is a familiar term because of the influenza waves that threaten Japan’s ageing population every year. The last such epidemic happened in 2009 with “new-type influenza” (shin-gata infuruenza), which in 2014 led to the roll out of an annual vaccination programme against streptococcus pneumoniae for the over-65. It was only in the second half of February when shin-gata coronavirus became the universally used term.
Despite all this, everybody kept going about their business as usual: wearing surgical masks is common in Japan in winter and during hay fever season; washing hands after returning home is assumed to be widely practiced. The consensus was that a population already well versed in public hygiene would find it easy to simply intensify the measures already in place. The Asahi newspaper even optimistically suggested that because of increased hygiene the normal seasonal flu numbers were going down at the beginning of February, usually the peak time for influenza hospitalisations. The influenza epidemic that Japan was on the verge of declaring in December 2019 had simply vanished. An eerie silence descended. Abe made the controversial decision to close down all schools on February 27, with a view of reopening on April 1, the traditional beginning of the school year; but apart from that no emergency measures were taken.

As the world witnessed the horror that first descended on Northern Italy and then on Spain, the unease in Tokyo grew. Distrust in the government is rife in Japan – the Edelman trust barometer 2018 indicates that only 37% of the public trust in the government to do the right thing – especially since the 3/11 triple disaster in 2011. It is widely understood that whatever happens, the government will be more interested in avoiding a mass panic than to take drastic measures. Cautiously positive voices pointed towards ‘culture’ to explain the different impact of Covid-19: Italians, who in the Japanese imagination are invariably friendly and excitable, thus constantly hugging and kissing, are naturally more prone to catch the virus than the Japanese, who are courteous and deferential, and thus more aloof and distant. But one only needs to take a rush hour train in Tokyo to be disabused of the illusion that cultural proxemics offer a convincing explanation. Critical voices argued that the Abe administration was downplaying the real extent of infections to keep the 2020 Olympics on track rather than to derail the massive financial and symbolic investment already made.

Fast forward to April 26: the Olympics have now been postponed and a state of emergency, first declared for Tokyo and the hardest-hit prefectures on April 7, has been extended to the whole of the country on April 16. Yet the reported numbers – 360 fatalities so far – remain suspiciously low (according to the Johns Hopkins coronavirus resource center on April 26).

One core insight of the anthropology of science is that in order to gain traction as a ‘reality’ in the world, an entity invisible to the eye such as a virus needs to be ‘assembled’. Symptoms and their distribution, tissue samples, microscopes, models of causality, genetic sequences, trajectories of contagion, testing regimes, tracking of patients etc. create data streams that together form the notion of the pathogen as the one possible element that connects all these different objects and procedures. My suspicion is that the Japanese case does not indicate straight-forward deception, but rather a more passive omission: if the virus has to be assembled in order to gain traction, it can also be taken apart. The key is to keep data streams separate. The rules that the Japanese health authorities have put into place contribute directly to this compartmentalisation: the capacity to run tests is very low and testing is actively discouraged; people are only tested for Covid-19 if they have had a fever for four days, thus delaying the identification of the underlying cause. If the patient passes away before a test has been administered, the death is likely to be counted simply as ‘pneumonia’ rather than as ‘Covid-19-related’. The approach appears to be “treat the symptoms rather than the disease” and not to bother with testing at all. Autopsies are rarely performed and require the consent of family members or relatives; Covid-19 tests are not administered post-mortem. Furthermore, comprehensive pneumonia statistics produced by the Japanese Ministry of Health, Labour and Welfare are published only every three years; the most recent set is from November 2019, meaning that any spike in pneumonia-related deaths will only become evident three years down the road.

‘Disassembling’ the virus may thus be a strategy to ‘dissemble’ how many people have actually died from the pandemic in Japan. “Why trigger a panic when there is no vaccine or cure in sight?” seems to be the rationale. Japan’s healthcare system is extremely well equipped to deal with the main cause of Covid-19-related death, viral pneumonia. It has the highest number of CT scanners, which can identify infected parts of the lungs early on (101 per 100’000 people), and the highest number of hospital beds worldwide (13 per 1000 people). As the number of fatalities starts to increase, we can only hope that this strategy works.

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