1 Most of what I'm about to write is no different from what I've said and done in the past. However, I have been asked the same question repeatedly, so I would like to reiterate it. We have received many inquiries from overseas as well, so we should have prepared the same content in English, but due to time constraints, I'm afraid I'll have to skip it. This article is designed to be read without basic knowledge of infectious diseases and jargon, but it is rather difficult to understand. Please forgive me for that.
2 The fact that the number of COVID-19 reports in Japan is very low compared to other countries is attracting attention from home and abroad. Is it true? It has been pointed out that the number of tests is so small that we may be misreading the actual number of infected people.
3 However, this point is wrong at various layers. In the first place, Japan does not aim to capture all the numbers of COVID-19. Whether it's administrative testing or insured care, the state basically has a testing strategy in mind to diagnose, hospitalize, and isolate critically ill patients who need to be hospitalized. It is natural that they "haven't figured it out" and they don't intend to. That's not a bad thing.In fact, the situation is the same in every country, large or small, and no country, whether in the United States, Europe, or Asia, is aiming to "capture the whole number.
The WHO is not asking for such a thing. But instead, Japan gives PCR to asymptomatic returnees and isolates asymptomatic test-positive people in hospital (wasn't it home for people with minor illnesses?). It has not been coherent in its principles. So, people get anxious because "we're not sure what they want to do". It's a failure in the press.
4 The difference between Korea and Japan is the "result" and not the "purpose". In South Korea, where the number of infected people had surged in one place, we had to focus on inspections in and around the area. If such a phenomenon (let's call it an overshoot) occurs in Japan, the number of inspections will increase. When the situation is different, arguing only on the basis of the number of tests without observing the situation is like trying to say, "That team made 50 sliding tackles while this team made only one," without watching a football game. In games where you don't have to slide (e.g., when you're in possession the whole time), even 0 times isn't a "mistake," and of course 50 times isn't a mistake.
There are many diseases for which the total number of patients is not known. In Japan, we do not have a "total" number of influenza cases, but only a fixed-point observation. Because that's enough information, both epidemiologically and in terms of infection control. There is no accurate data on how many cases of the common cold occur each year in Japan. It's also a mistake to say that you can tell by looking at the receipt data, because many cold patients (like me) don't see a doctor and wait until they are cured naturally. Not only in medicine, but also in economics and political science, data are mostly based on sampling to estimate population numbers, and "whole numbers" is an inefficient way of grasping the situation.
6 We have not seen the devastation in Japan as in Italy, Spain or New York City. There is no medical collapse in a critically ill patient, no use of the operating room as an ICU, no piling up of bodies on a skating rink with no place to put them. Even if the "numbers" are not known, it is a fact that the current situation in Japan (including Tokyo) is much better controlled than in other countries.
7 Even so, you may be interested in "Well, what about the actual situation? There are estimates. For example, Dr. Hiroshi Nishiura and his group estimate that the number of mild illnesses in Japan may be twice the reported number. The catch rate is 0.44, with a 95% confidence interval of 0.37-0.50.
8 Although the study was based on data from China, there is no guarantee that the Chinese COVID-19 demographic is the same as the Japanese one. Also, since the original study did not include asymptomatic patients or those with minor illnesses that did not require hospitalization, the number of infected patients estimated on that basis would inevitably be an underestimate. If you are more paranoid, it's not unreasonable to believe that "the Japanese and Chinese viruses are different because of the mutation" (although I don't think so).
9 This does not diminish the value of the paper itself. The model must always use existing parameters, and it is often impossible to prove the external validity of these parameters. If the underlying parameters are not reasonable, the predictions will not be correct. A model assumes a simplified world insofar as it is a model. A model without simplification, which is an adjectival contradiction.
To complain about these "assumptions" of the mathematical model is like complaining, for example, "You can't explain disease B," when a randomized controlled trial is conducted for disease A. This is a meaningless tirade against the honor of the industry.
A mathematical model that assumes a certain hypothesis should have internal academic validity, but it is the responsibility of the reader, as a resident of the real world, to appraise it in the real world.
Just as the RCT findings for disease A should not be used for disease B, it is natural to understand the limitations of the mathematical model and to be careful when applying it to the real world. For example, it would be wrong to read the paper and conclude that the total number of infected people in Tokyo is about 500 as of March 26.
11 People make mistakes. The models are also wrong. Being wrong is not a big deal. The problem is to notice your mistakes and make corrections. Already, a group at Imperial College London has admitted that its original estimate that the peak of the infection should be moderated was "wrong" and has revised its prediction that the ICU will soon fail if it does not fight the virus fairly aggressively.
16 March 2020
If they test positive, isolate them and find out who they have been in close contact with up to 2 days before they developed symptoms, and test those people too. [NOTE: WHO recommends testing contacts of confirmed cases only if they show symptoms of COVID-19]
Washing your hands will help to reduce your risk of infection. But it’s also an act of solidarity because it reduces the risk you will infect others in your community and around the world. Do it for yourself, do it for others.
This afternoon WHO and the International Chamber of Commerce issued a joint call to action to the global business community. The ICC will send regular advice to its network of more than 45 million businesses, to protect their workers, customers and local communities, and to support the production and distribution of essential supplies.
Like me, I’m sure you have been touched by the videos of people applauding health workers from their balconies, or the stories of people offering to do grocery shopping for older people in their community.
This amazing spirit of human solidarity must become even more infectious than the virus itself. Although we may have to be physically apart from each other for a while, we can come together in ways we never have before.
Speaking at a Pentagon briefing Thursday, Nelson Michael, the director for infectious disease research at Walter Reed Army Institute of Research, said that efforts to develop vaccines and an effective treatment plan might not be quick enough to wipe out the virus before the "second wave" next winter.
英語版 文字起こし (自動生成）のコピペを、英語として読める文章にした。いくつか聞き取れていないところがあるので、わかる人がいたらトラバで教えてほしい。聞き取れていないところは「(inaudible01)」みたいに番号をふって記載してあるので、
I was very concerned of the number of the people who got infected with the COVID-19 disease infections. Then I was wondering why this is[sic](was)*2 happening. I wanted to enter into the cruise ship and wanted to be useful in helping to containing infection there.
I spoke with several people and finally one officer at working for Ministry of Health and Labor called me yesterday, saying that well you can come and enter into a cruise ship and do the infection control works.
On the way to go to Yokohama I got another call from the same officer, saying, "Somebody didn't like me. So you can't get into the cruise ship." He was not able to say who, and he was not able to say why, but certainly some power over him affected his decision and I was blocked from entering into the ship.
Then after several discussions he found another way that if you could come as a DMAT member, you can come into the the cruise ship. DMAT is the disaster management medical team in Japan and usually deals with a disaster not infectious diseases, but because of the lack of the people who could help people inside a cruise ship to get out of the ship, or the managing of people, and so on, DMAT was requested to enter into the cruise ship.
Additionally, I got another call that some people didn't like me getting into the cruise ship present even as a DMAT member. So another discussion happened then the I waited about one hour in Shin Yokohama Station, and finally the officer find a way. [He said] that "If you work for DMAT not as an infection prevention specialist but as an ordinary routine DMAT officer working under (inaudible01) DMAT doctor doing a routine job, then you could come into the cruise ship."
I entered the ship. Then I found the chief officer of the DMAT and spoke with him. I said, "Well I was assigned to the DMAT members (inaudible02) out whatever you want to say." Then he said, "Well, you don't have to work DMAT work because that's not your specialty. You are an infection prevention specialist, so why don't you do the infection control." Then I said, "Fine, I spoke with the superior of him who is[sic](was) in charge of the all the DMAT operations, and he also said, "You are an infection control person, so you should do infection control." I said, "Fine." But he said, "Well, you shouldn't be here as a DMAT member. You should come as (inaudible03) infection control specialist." He was not very happy about that while I was inside the DMAT. But because that was not my decision, there was no other way. So I said, "Well I have to do it."
So the people could come and go, (inaudible04) a PPE, off PPE. Crews were just walking around, the officers of the Ministry Health and Labor were walking around, DMAT people were walking around, psychiatrists were walking around.
Anyways I (have) dealt with a lots of infections (for) more than twenty years. I was in Africa dealing with the Ebola outbreak. I was in another country dealing with the cholera outbreak. I was in China in 2003 to deal with the SARS, and I saw many febrile patients there. I never had fear of getting infection myself for Ebola, SARS, (and) cholera, because I know[sic](knew) how to protect myself and how to protect others, and how the infection control should be. So I could do the adequate infection control; protect myself, and protect others.
But inside (the) Princess Diamond, I was so scared. I was so scared of getting COVID-19 because there was no way to tell where the virus is. No Green Zone, no Red Zone. Everywhere could have the virus and everybody was not careful about it.
I spoke with the head officer of the Ministry of Health and Labor and he was very unhappy with my suggestion of protecting DMAT people and other staffs so that no other secondary transmission would occur.
Then after several hours of talking to people and finding problems, I found a lot of issues there. For example, informed consent of getting a PCR from the people in the ship whereas(? inaudible05) on a paper, and that paper was going back and forth, back and forth with the room of the infection from the paper, by touching there[sic](it). So I suggested that maybe it's better to abandon the paper-type informed consent but rather getting the informed consent verbally would be more protective, and so on and so on.
I think I was reasonable. I never yell at anybody, I never criticize anybody personally, but I was trying to be constructive that we try to seek the constructive but immediate improvement to protect everybody inside the ship.
Then about five o'clock, the person from the quarantine office came in and approaced. (He) said, "Well you have to be out because you'll not be allowed inside the ship." Because I was inside the ship as a temporary officer of the quarantine. Apparently my bank(? inaudible06) was removed by somebody, and nobody said who, and then I was out.
The officer who offered me the job of infection control said he was sorry. Then I asked him, "So what do you wanna do? Do you want to infect everybody in the ship? It will be thousands of people who could potentially get COVID-19.
I don't criticize DMAT people. They were infection control specialists. Society of Infection Prevention entered, a lot of specialists came in, but they spent only a few days and they left. And they said they were fearful of getting infections themwelves.
I'll be out of my medical services at Kobe University Hospital for maybe next two weeks to avoid further infections to occur. That is very likely to occur if you keep zero infection control inside the ship, the Diamond Princess, like this.
You might know that there is no CDC*3 in Japan, but I thought there must be some specialists called on and was[sic](were) in charge of infection control in ship. It's not expecting[sic](expected) (that) nobody was a professional infection control specialist, and (that) only the bureaucrats were doing the jobs, completely layman's work, violatiing all the infection control principles and risking people inside (of*4) further infections, so I'm not very surprised to see many new positive PCR to be broadcasted every day.
Hundreds of people got infected and a lot of people from outside Japan decided to take the people away from the ship and bring them to their home countries by airplane and offered them another 14 days of quarantine. I hope this will be an opportunity to raise a question (about) what is happening inside the ship.
I wish all the international bodies to request Japan to change. I wish everybody to call for the protection of people inside the Diamond Princess. Otherwise there'll be far more infections for passengers, for crews, for DMAT members, for psychiatrists, for officer(s) of the Ministry of Health and Labor. DMAT members consist of nurses and doctors and that they will go back to the hospital they work routinely and they might infect their patients further to spread the disease. I can't bear with it. I can't bear with it.