COVID-19 pandemic in Japan

The initial response of the Japanese government to the COVID-19 outbreak was a policy of containment that focused on the repatriation of Japanese citizens from Wuhan, the point of origin of the pandemic, and the introduction of new border control regulations.[22]

On 24 January 2020, Abe convened the Ministerial Meeting on Countermeasures Related to the Novel Coronavirus at the Prime Minister's Office with members of his Cabinet in response to a statement by the World Health Organization (WHO) confirming human-to-human transmission of the coronavirus. Abe announced that he would introduce appropriate countermeasures to the disease in coordination with the NIID.[23]

On 27 January 2020, Abe designated the new coronavirus as an "infectious disease" under the Infectious Diseases Control Law, which allows the government to order patients with COVID-19 to undergo hospitalization. He also designated the disease as a "quarantinable infectious disease" under the Quarantine Act, which allows the government to quarantine people suspected of infection and order them to undergo diagnosis and treatment.[24]

On 30 January 2020, Abe announced the establishment of the "Novel Coronavirus Response Headquarters" (新型コロナウイルス感染症対策本部), which meets at the Prime Minister's Official Residence and is run by a task force led by Deputy Chief Cabinet Secretary for Crisis Management Okita Yoshiki.[25][9] The initial roster of the task force includes 36 high-ranking bureaucrats from several of the Ministries of Japan. The headquarters acts as the site of Abe's decision-making process on the country's virus countermeasures.

On 31 January 2020, Abe announced that the government was prioritizing the repatriation of Japanese citizens from Hubei province. Officials negotiated with Chinese authorities to dispatch five chartered flights to Wuhan from 29 January 2020 to 17 February 2020.[22]

On 1 February 2020, the Japanese government enacted restrictions to deny entry to foreign citizens who had visited Hubei province within 14 days and to those with a Chinese passport issued from there.[26] On 12 February 2020, it expanded those restrictions to anyone who had a recent travel history to and from Zhejiang province or had a Chinese passport issued from there.[27]

On 5 February 2020, Abe invoked the Quarantine Act to place the cruise ship Diamond Princess under quarantine in Yokohama. Quarantine officers were dispatched to the ship to prevent the disembarkation of crew and passengers, and to escort infected patients to medical facilities.[28]

On 6 February 2020, Abe invoked the Immigration Control and Refugee Act to deny entry to the cruise ship MS Westerdam from Hong Kong after one of its passengers tested positive for COVID-19.[29]

Prime Minister Shinzo Abe convening the first Novel Coronavirus Expert Meeting on 16 February 2020

After the COVID-19 outbreak on the cruise ship Diamond Princess, the Japanese government shifted its focus from a policy of containment to one of prevention and treatment because it anticipated increasing community spread within Japan. This policy prioritized the creation of a COVID-19 testing and consultation system based on the National Institute of Infectious Diseases (NIID) and the government's 83 existing municipal and prefectural public health institutions that are separate from the civilian hospital system. The new system handles the transfer of COVID-19 patients to mainstream medical facilities to facilitate patient flow, triage, and the management of limited testing kits on their behalf to prevent a rush of infected and uninfected patients from overwhelming healthcare providers and transmitting diseases to them. By regulating COVID-19 testing at the national level, the Abe Administration integrated the activities of the national government, local governments, medical professionals, business operators, and the public in treating the disease.[24]

On 1 February 2020, the Ministry of Health, Labour and Welfare instructed municipal and prefectural governments to establish specialized COVID-19 consultation centers and outpatient wards at their local public health facilities within the first half of the month.[30] Such wards would provide medical examinations and testing for suspected carriers of the disease to protect general hospitals from infection.[30]

On 5 February 2020, Abe announced that the government would begin preparations to strengthen COVID-19 testing capabilities at the NIID and 83 municipal and prefectural public health institutions that are designated by the government as official testing sites. Without a uniform diagnosis kit for the disease, the government has relied on polymerase chain reaction (PCR) tests to check for infections. As few mainstream medical facilities in Japan can conduct PCR tests, Abe also promised to increase the number of institutions with such kits, including universities and private companies.[28]

On 12 February 2020, Abe announced that the government would expand the scope of COVID-19 testing to include patients with symptoms based on the discretion of local governments. Previously, testing was restricted to those with a history of traveling to Hubei Province.[31][32] On the same day, the Ministry of Health and NIID contracted SRL Inc to handle PCR clinical laboratory testing.[33] Since then, the government has partnered with additional private companies to expand laboratory testing capabilities and to work towards the development of a rapid testing kit.[34]

On 14 February 2020, Abe introduced the government's coronavirus consultation system to coordinate medical testing and responses with the public. The Ministry of Health, Labour, and Welfare worked with local governments to establish 536 consultation centers that covered every prefecture within the country to provide citizens with instructions on how to receive COVID-19 testing and treatment. The general public needs to contact a consultation center by phone to get tested at one of the government's specialized outpatient wards (帰国者・接触者外来).[35][36]

On 16 February 2020, Abe convened the government's first Novel Coronavirus Expert Meeting (新型コロナウイルス感染症対策専門家会議) at the Prime Minister's Office to draft national guidelines for COVID-19 testing and treatment.[37] The meeting was chaired by Dr. Wakita Takaji, Director of the NIID, who brought together ten public health experts and medical professionals from across Japan to coordinate a response to the virus with Abe and the government's coronavirus task force in a roundtable format. The main concern of the Japanese medical establishment was overcrowding of hospitals by uninfected patients with light cold symptoms who believed that they had COVID-19. Medical representatives claimed that such a panic would strain medical resources and risk exposing those uninfected patients to the disease.[38][39]

On 17 February 2020, the Ministry of Health, Labour, and Welfare released national guidelines for COVID-19 testing to each of the municipal and prefectural governments and their public health centers.[40][41] It instructed doctors and public health nurses who staff the consultation centers to limit consultations to people with the following conditions: (1) cold symptoms and a fever of at least 37.5 °C (or need to take antipyretic medication) for over four days; and (2) extreme fatigue and breathing difficulties. The elderly, people with pre-existing conditions, and pregnant women with cold symptoms can receive consultation if they have had them for two days.[40]

On 22 February 2020, Health Minister Katsunobu Kato announced that the Japanese government was looking into the use of favipiravir, an anti-influenza medication developed by Fujifilm, to treat patients with COVID-19.[42][43] The company responded by increasing production of the drug, providing technical support to clinical researchers, and distributing the drug to hospitals where its use has been approved by the government for emergency purposes.

On 23 February 2020, Abe instructed the government's coronavirus task force to quickly draft a comprehensive basic policy.[44] Health Minister Katsunobu Katō reconvened the medical experts from the first Novel Coronavirus Expert Meeting on 24 February 2020 to draft this policy.[45] During the meeting, the medical establishment presented its policy recommendations in the form of a views report (新型コロナウイルス感染症対策の基本方針の具体化に向けた見解), concluding that the most important objective must be the prevention of large-scale disease clusters and a decrease in outbreaks and deaths. They stated that it would not be possible for the government to prevent the spread of COVID-19 in Japan on a person-to-person basis, but that it might be possible to regulate the overall speed of infection.[46] They cited the next week or two as a "critical moment" determining whether the country would experience a large cluster that could result in the collapse of the medical system and socio-economic chaos. After reviewing and discussing the existing data on the disease, the committee stated that universal PCR testing was impossible due to a shortage of testing facilities and providers, and recommended that the government instead limit the application of available test kits to patients that are at a high risk of complications to stockpile for a large cluster. Participants also noted that Japan's medical facilities are vulnerable to "chaos," noting that many hospital beds and resources in the Tokyo area were already being used to care for the 700 infected patients from the Diamond Princess. They reiterated their warning that a rush of alarmed, uninfected outpatients with light symptoms of the disease could overwhelm hospitals and turn waiting rooms into "breeding grounds" for COVID-19.[47]

The objective of the Japanese government's basic policies for control is to "flatten the curve".

On 25 February 2020, the Abe Administration introduced the "Basic Policies for Novel Coronavirus Disease Control" (新型コロナウイルス感染症対策の基本方針) based on advice from the expert meeting.[48] After a spike of infections in Italy, Iran, and South Korea, Abe decided that the government's disease countermeasures would prioritize the prevention of large-scale clusters in Japan. This included controversial requests to suspend large-scale gatherings such as community events and school operations, as well as to limit patients with light cold symptoms from visiting medical facilities to prevent them from overwhelming hospital resources.[49]

First, the new policies advised local medical institutions that it is better for people with mild cold-like symptoms to rely on bed rest at home, rather than to seek medical help from clinics or hospitals. The policy also recommended that people at a higher risk of infection – including the elderly and patients with pre-existing conditions – avoid hospital visits for non-treatment purposes, such as by ordering prescriptions over the telephone instead of in person.[47]

Second, the new policies allowed general medical facilities in areas of a rapid COVID-19 outbreak to accept patients suspected of infection. Before this, patients could only get tested at specialized clinics after making an appointment with consultation centers to prevent the transmission of the disease. Government officials revised the previous policy after acknowledging that such specialized institutions would be overwhelmed during a large cluster.[47]

Third, the policy asked those with any cold symptoms to take time off from work and avoid leaving their homes. Government officials urged companies to let employees work from home and commute at off-peak hours. The Japanese government also made an official request to local governments and businesses to cancel large-scale events.[47]

On 27 February 2020, Abe requested the closure of all schools from 2 March 2020 to the end of spring vacations, which usually conclude in early April. The next day, the Japanese government announced plans to create a fund to help companies subsidize workers who need to take days off to look after their children while schools are closed.[50]

On 27 February 2020, the Japanese government also announced plans to expand the national health insurance system so that it covers COVID-19 tests.[51]

On 9 March 2020, the Ministry of Health reconvened the Expert Meeting after the two weeks "critical moment." The panel of medical experts concluded that Japan was currently not on track to experience a large-scale cluster, but stated that there is a two-week time lag in analyzing COVID-19 trends and that the country would continue to see more infections. Consequently, the participants asked the government to remain vigilant in quickly identifying and containing smaller clusters. With more COVID-19 outbreaks around the world, the panel also proposed that new infections from abroad could initiate a "second wave" of the disease in Japan.[52][53]

On 9 March 2020, the Health Ministry published a disease forecast for each prefecture and instructed local governments to prepare their hospitals to accommodate their patient estimates. It predicts that the virus peak in each prefecture would occur three months after the first reported case of local transmission. The Ministry estimates that at the peak Tokyo would see 45,400 outpatients and 20,500 inpatients per day, of whom 700 will be in severe condition. For Hokkaido, the figure is 18,300 outpatients and 10,200 inpatients daily, of whom about 340 will be in severe condition.[54]

On 5 February 2020, the Abe Administration's coronavirus task force initiated a political debate on the introduction of emergency measures to combat the COVID-19 outbreak a day after the British cruise ship Diamond Princess was asked to quarantine. The initial debate focused on constitutional reform due to the task force's apprehension that the Japanese Constitution may restrict the government's ability to enact such compulsory measures as quarantines on the grounds that it violated human rights. After lawmakers representing almost all of the major political parties – including the Jimintō, Rikken-minshutō, and Kokumin-minshutō – voiced their strong opposition towards this proposal and asserted that the Constitution allowed for emergency measures, the Abe administration moved forward with legislative reform instead.[55]

On 5 March 2020, Abe introduced a draft amendment to the Special Measures Act to Counter New Types of Influenza of 2012 to extend the law's emergency measures for an influenza outbreak to include COVID-19. He met separately with the heads of five opposition parties on 4 March 2020 to promote a "united front" in passing the reforms. The National Diet passed the amendment on 13 March 2020, making it effective for the next two years.[56][57] The amendment allows the Prime Minister to declare a "state of emergency" in specific areas where COVID-19 poses a grave threat to the lives and economic livelihood of residents. During such a period, governors of affected areas will receive the following powers: (1) to instruct residents to avoid unnecessary outings unless they are workers in such essential services like health care and public transportation; (2) to restrict the use or request the temporary closure of businesses and facilities, including schools, social welfare facilities, theatres, music venues, and sports stadiums; (3) to expropriate private land and buildings to erect new hospitals; and (4) to requisition medical supplies and food from companies that refuse to sell them, punish those that hoard or do not comply, and force firms to help transport emergency goods.[58]

Under the law, the Japanese government does not have the authority to enforce citywide lockdowns. Apart from individual quarantine measures, officials cannot restrict the movement of people to contain the virus. Consequently, compliance with government requests to restrict movements is based on "asking for public cooperation to ‘protect people’s lives’ and minimize further damage to [the economy]".[59]

On 25 March 2020, the Ministry of Health, Labour and Welfare announced that the daily number of confirmed cases in Tokyo increased from 17 to 41 cases compared to the day before.[60] Tokyo Governor Yuriko Koike held an emergency press conference in the late afternoon, stating that "the current situation is a serious situation where the number of infected people may explode." She requested residents to refrain from nonessential outings during the upcoming weekend.[61]

On 26 March 2020, the Ministry of Health reconvened the Novel Coronavirus Expert Meeting to review the new data. The panel of medical experts concluded that there was a "high probability of an expansion of infections" within the country due to an increase in the number of infected patients returning from Europe and the United States between 11 March 2020 and 23 March 2020.[4] In response to the statement, Abe instructed Economic Policy Minister Yasutoshi Nishimura to establish a special government task force to combat the spread of the virus.[62] The move cleared a prerequisite toward declaring a state of emergency because any request for one by the Prime Minister would have to be approved by such a task force under the revised law.

On 30 March 2020, Koike requested residents to refrain from nonessential outings for the next two weeks due to a continued increase in infections in Tokyo.[63] During a press conference held by the Japan Medical Association that same day, Kamayachi Satoshi of the government's panel of medical experts stated that his fellow panelists were divided over whether Abe should declare a state of emergency.[64]

On 1 April 2020, the Ministry of Health reconvened the Novel Coronavirus Expert Meeting to assess the current COVID-19 situation in Japan.[4] The medical experts discussed the data and concluded that although such urban areas as Tokyo and Osaka were witnessing a rapid increase in infection rates, they were not on a trajectory to experience a large-scale cluster seen in Europe and the United States. Experts were still concerned that infected patients could overwhelm the medical service system before an explosive spread of the virus as COVID-19 designated hospitals in major cities reached near capacity. They requested the government to secure more hospital beds for patients and transfer those with mild or no symptoms to outside housing facilities.

On 2 April 2020, the Ministry of Health issued a notice that urged non-critical COVID-19 patients to move out of hospitals and stay at home or facilities designated by local governments.[65] Prefectural governors across the country began arranging accommodation for such patients through hotel operators and dormitories and issued official requests to the Japan Self-Defense Force for transportation services.[66][67]

On 3 April 2020, Professor Nishiura Hiroshi of the Ministry of Health's Cluster Response Team presented the initial findings of his COVID-19 epidemiological models to the public.[68] He concluded that the government could prevent an explosive spread of the virus in Japan if it adopted strict restrictions on outings that reduced social interactions by 80 percent, while such a spread would occur if the government adopted no measures or reduced social interactions by only 20 percent. Nishiura added that Tokyo was about 10 days to two weeks away from a large-scale outbreak.[69]

On 7 April 2020, Abe proclaimed a one-month state of emergency from 8 April to 6 May for Tokyo and the prefectures of Kanagawa, Saitama, Chiba, Osaka, Hyogo and Fukuoka.[70] He stated that the number of patients would peak in two weeks if the number of person-to-person contacts was reduced by 70 to 80 percent, and urged the public to stay at home to achieve this goal.[71]

On 10 April 2020, Koike announced closure requests for six categories of businesses in Tokyo.[72] They include amusement facilities, universities and cram schools, sports and recreation facilities, theatres, event and exhibition venues. and commercial facilities. She also asked restaurants to limit opening hours to between 5 a.m. and 8 p.m. and to stop serving alcohol at 7 p.m. The request was to take effect on 12 April 2020 and promised government subsidies for businesses that cooperated with it.

On 11 April 2020, Professor Nishiura presented the remaining findings of his COVID-19 epidemiological models.[73][74] He determined that reducing social interactions by 80 percent would decrease the COVID-19 infection rate to a manageable level in 15 days; by 70 percent in 34 days; by 65 percent in 70 days; and by 50 percent in 3 months. Any rate below 60 percent would increase the number of cases.

On 16 April 2020, Abe expanded the state of emergency declaration to include every prefecture within the country.[14] Later on 4 May 2020, Abe said that Japanese Cabinet would expand the state of emergency declaration until end of May 2020.[75] Then on 14 May 2020, Abe and his cabinet declared that Japanese Government decided to relieve the state of emergency declaration, excluding 8 prefectures like Tokyo, Kyoto Prefecture.[76] Some media expressed doubts about why only some of the easing standards were released under the name of comprehensive judgment.

On 21 May 2020, the state of emergency is suspended in 3 prefectures in Kinki after they had cleared the threshold of having new infections below 0.5 per 100,000 people in the past week, resulting a total of 42 out of the 47 prefectures to be out of the state of emergency while 5 prefectures, such as Saitama, Kanagawa, Hokkaido, are waiting for lifting decision on 25 May 2020.[77][78]

On 16 February 2020, Abe convened the Novel Coronavirus Expert Meeting to incorporate members of the Japanese medical community into his decision-making process.[37] The panel acts as the main medical advisory body of the Japanese government during the COVID-19 crisis.[79]

Chair

• Wakita Takaji (Director-General of the NIID)

Vice Chair

• Omi Shigeru (President of the Japan Community Health Care Organization

Members

• Okabe Nobuhiko (Director of the Kawasaki Municipal Institute of Public Health)
• Oshitani Hitoshi (Former Infectious Disease Control Advisor at the WHO Western Pacific Regional Office)
• Kamayachi Satoshi (Executive Board Member of the Japan Medical Association)
• Kawaoka Yoshihiro (Professor of Virology at the University of Wisconsin-Madison and University of Tokyo)
• Kawana Akihiko (Professor of Internal Medicine at the National Defense Medical College)
• Suzuki Motoi (Director of the NIID Center of Infectious Disease Epidemiology)
• Tateda Kazuhiro (Professor of Microbiology and Infectious Disease at Toho University)
• Nakayama Hitomi (Social Worker and Lawyer at the Kasumigaseki-Sogo Law Offices)
• Muto Kaori (Professor of Cultural and Human Information Studies at the University of Tokyo)
• Yoshida Masaki (Professor of Internal Medicine at Jikei University School of Medicine)

On 12 February 2020, Abe announced that the government would secure 500 billion yen for emergency lending and loan guarantees to small and medium enterprises affected by the COVID-19 outbreak.[80] He also declared that his Cabinet would set aside 15.3 billion yen from contingency funds to facilitate the donation of isolated virus samples to relevant research institutions across the globe.[81]

On 1 March 2020, Abe evoked the Act on Emergency Measures for Stabilizing Living Conditions of the Public to regulate the sale and distribution of facial masks in Hokkaido. Under this policy, the Japanese government instructed manufacturers to sell facial masks directly to the government, which would then deliver them to residents.[26] On 5 March 2020, the Japanese government announced that it is organizing an emergency package by using a 270 billion yen ($2.5 billion) reserve fund for the current fiscal year through March to contain the virus and minimize its impact on the economy.[82]

Three Cs (3つの密, Mittsu no Mitsu, "Three 'Close's"), also written Three C's or 3密 (San Mitsu), is a slogan originated by the Japanese government in 2020 in combating the COVID-19 pandemic.[83] The Three Cs were announced by the office of the Prime Minister of Japan on Twitter on 17 March 2020.[84] This followed work by the Ministry of Health, Labour and Welfare on how to prevent superspreader events and other clusters (クラスター), including the 25 February 2020 establishment of a Cluster Countermeasures Group within the ministry.[85] The slogan warns people to avoid three factors that contribute to clusters of infection:[86] Closed spaces (密閉) with poor ventilation; Crowded places (密集) with many people nearby; and Close-contact settings (密接) such as close-range conversations. On 16 July 2020, the World Health Organization (WHO) posted a recommendation to "Avoid the Three Cs", in terms very similar to those used in English by the Japanese government.[87]

“Three Cs”

On 17 February 2020, the Ministry of Health, Labour and Welfare asked that those who have experienced fever over 37.5 °C for more than four days, in addition to those who experience severe symptoms such as lethargy and difficulty breathing, consult with the Return and Contact Consultation Centres immediately to determine whether testing is required.[88][89] However, some media outlets asserted that restrictive standards for testing would delay public health response to the pandemic, resulting in further spread of the disease.[90][91]

In early February, Masahiro Kami, a hematologist, chairman of the Institute for Healthcare Governance, and outside director of SBI Pharma Co., Ltd. and SBI Biotech Co., Ltd., criticized Japan's response to outbreaks of the disease onboard isolated cruise ships compared to that of Italy.[92]

In late February, several Japanese media outlets reported that there were people with fever or other symptoms who could not be tested through the consultation centre system and had become "test refugees" (Japanese: 検査難民).[93][94][95][96] Some of these cases involved patients with severe pneumonia.[97] Hematologist Masahiro Kami claimed that many patients were denied testing due to their mild symptoms and criticized the Japanese government for setting testing standards that were too high and for lacking a response to patient anxiety.[98]

On 26 February 2020, the Minister of Health Katsunobu Kato stated in the National Diet that 6,300 samples were tested between 18 and 24 February, averaging 900 samples per day. Some representatives questioned the discrepancy between the actual number of people tested and the claim in the prior week that 3,800 samples could be tested per day.[99]

On the same day, more doctors reported that public health centers had refused to test some patients. The Japan Medical Association announced that it would start a nationwide investigation and plan to cooperate with the government to improve the situation.[100] The Ministry of Health also stated that it would look into the situation with the local governments.[101]

The strict constraints on testing for the virus by Japanese health authorities drew accusations from critics such as Masahiro Kami that Abe wanted to "downplay the number of infections or patients because of the upcoming Olympics." It was reported that only a few public health facilities were authorized to test for the virus, after which the results could only be processed by five government-approved companies, which created a bottleneck forcing clinics to turn away even patients with high fevers. This has led some experts to question Japan's official case numbers. For example, Tobias Harris, of Teneo Intelligence in Washington, D.C., said: "You wonder, if they were testing nearly as much as South Korea is testing, what would the actual number be? How many cases are lurking and just aren't being caught?"[90][102] Fact-checking in several media later proved that the news that the government had reduced the number of tests to curb the increase in the number of infected people for the Olympics was not accurate at all.[103][104]

Testing was still restricted to large hospitals in March 2020, with 52,000 tests, or 16% of the South Korean amount, performed that month. A decision to expand testing was made on 13 April 2020.[105] There were many articles in March that criticized the number of PCR tests in Japan as very small compared to South Korea.[106][107] According to data released by the Ministry of Health, Labor and Welfare, Japanese authorities conducted a total of 15,655 PCR tests as of 17 March 2020, excluding tests conducted on those returning from China by charter flights and passengers on cruise ships.[108][109][110]

On 5 March 2020, Japan announced that it will strengthen quarantine for new entrants from China and South Korea, along with added areas of Iran to the target area. The Chinese government showed understanding for the decision, while the Korean government called the measures implemented by Japan "unreasonable and excessive."[111][112][113][114][115]

Various problems are arising in connection with the Emergency Supplementary Income policies promoted by the Japanese government. At first, there were many obstacles to the rapid driving force as the 300,000 yen per household policy was changed to the 100,000 yen per population policy. In addition, some uncomfortable parts make it easier to evaluate postal delivery applications faster than online applications. In the case of postal delivery, it is possible to apply for each household more smoothly, but when applying online, separate paperwork for inspection is required for each local government office. In addition, since the application process for management subsidies is complicated, there are also side effects of financial disadvantages for small business owners and individual business owners. The reason why the shortage of masks was difficult to eliminate and it took a long time to receive the benefits, was that the Individual Number system, which was well known as "My Personal ID Card Number System", was only used by about 16% of the population, meanwhile most of the work could be handled without Individual Number system due to people's hesitation against the privately problematic policy which gets into a troublesome settlement for protection of private problem without the supervision of the government.[116][117] The Individual Number is a system for the administration to identify individuals. Due to opposition from the opposition party and liberals who say that the national and local governments will get to know personal information, the Individual Number has not spread easily and is not obligatory to link with other personal information such as bank accounts.[118][119] On this topic, Representative Sanae Takaichi who leads Ministry of Internal Affairs and Communications commented that they are considering to connect every single personal ID card Number and each single bank account for comfort usage of every citizen.[120][121]

Moreover, Prime Minister Abe's cloth mask distribution policy is also problematic, leading to a lack of clarity in budgeting. Furthermore, one of the companies involved in mask production is suspected of ghost companies. Besides, the problem of maintaining quality, which was the trigger, remains under the government's burden, and the issue of tax waste is pointed out.[122][123] The company that was suspected to be a dummy company in some media was a broker of a sole proprietor, and he had masks manufactured in Vietnam using locally procured materials and imported them. Originally, he was promoting masks to Fukushima and Yamagata prefectures, but the Ministry of Health and Welfare, who had trouble finding a mask supplier due to a sudden decision, bought them.[122][123][124] Not only he, but also people and companies who were reported suspicious in the media or were rumored on social media were slandered online, and there were many nuisances to the company and their homes.[125][126][127]

Likewise, several news reports showed signs of missing numbers of infection statistics in Japan could be explained by other sources of statistics.[128][129][130] Furthermore, there would be differences among several statistics of departments since there were several standards for statistics among regional directors and departments of Japanese Authorities using those statistics with other standards.[131] As a result, despite the low death rate, there was some doubt that there would be missing fatality cases for COVID-19 pandemic among Japan due to low credibility of statistics in Japan as well as some medical professionals and media outlets have criticized the Japanese government for under-testing for COVID-19.

On 25 February 2020, the Ministry of Health, Labour and Welfare established the Cluster Response Team (クラスター対策班) in accordance with the Basic Policies for Novel Coronavirus Disease Control.[134] The purpose of the section is to identify and contain small-scale clusters of COVID-19 infections before they grow into mega-clusters. It is led by university professors Oshitani Hitoshi and Nishiura Hiroshi and consists of a contact tracing team and a surveillance team from the National Institute of Infectious Diseases (NIID), a data analysis team from Hokkaido University, a risk management team from Tohoku University, and an administration team.[135] Whenever a local government determines the existence of a cluster from hospital reports, the Ministry of Health dispatches the section to the area to conduct an epidemiological survey and contact tracing in coordination with members of the local public health center. After the teams determine the source of infection, the ministry and local government officials enact countermeasures to locate, test, and place under medical surveillance anybody who may have come into contact with an infected person. They can also file requests to suspend infected businesses or restrict events from taking place there.[135]

From its contract tracing findings, the Ministry of Health discovered that 80% of infected people did not transmit COVID-19 to another person. The Ministry also determined that patients that did infect another person tended to spread it to multiple people and form infection clusters when they were in certain environments.[136] According to one of the experts, Kawaoka Yoshihiro, "[This meant that] you don’t need to trace every single person who’s been infected if you can trace the cluster. If you do nothing, the cluster will grow out of control. But as long as you identify a cluster small enough to contain, then the virus will die out."[137]

On 9 March 2020, the medical experts reviewed the data from the Cluster Response Team's work and further refined its definition of a high-risk environment as a place with the overlapping "three Cs" (three close-contact situations (Japanese: 三つの密, Hepburn: mittsu no mitsu)): (1) closed spaces with poor ventilation; (2) crowded places with many people nearby; and (3) close-contact settings such as close-range conversations.[138] They identified gyms, live music clubs, exhibition conferences, social gatherings, and yakatabune as examples of such places. The experts also theorized that crowded trains did not form clusters because people riding public transportation in Japan usually do not engage in conversations.[138]

During times when the number of infected patients rises to such an extent that individual contract tracing alone cannot contain a COVID-19 outbreak, the government will request the broad closure of such high-risk businesses.[139]

During the initial stages of the outbreak, medical experts recommended the government to focus on COVID-19 testing for contact tracing purposes and patients with the following symptoms: (1) cold symptoms and a fever of at least 37.5 °C (or need to take antipyretic medication) for over four days; and (2) extreme fatigue and breathing difficulties.[41] The elderly, people with pre-existing conditions, and pregnant women with cold symptoms could be tested if they had them for two days.[41][40] The country's high number of computed tomography (CT) scanners (111.49 per million people) allows them to confirm suspicious pneumonia cases and begin treatment before testing them for COVID-19.

On 1 April 2020, medical experts requested the government to secure more hospital beds for patients and transfer those with mild or no symptoms to outside housing facilities to focus treatment on the severely-ill.[4]

An announcement urging travellers to wash their hands in Tokaido Shinkansen

The Japanese government's medical task-force anticipates multiple waves of COVID-19 to arrive in the country for at least the next three years, with each one prompting the public to engage in a cycle of restricting and easing movement.[137] Under the current law, the Prime Minister can restrict movement by declaring a "state of emergency" in specific areas where COVID-19 poses a grave threat to residents. During such periods, the governors of affected areas can request citizens to avoid unnecessary outings and temporarily close certain businesses and facilities. Since the government cannot enact compulsory measures to enforce these requests, it has instead embarked on a social engineering program to train its citizens to comply with them on a voluntary basis during current and future state of emergencies.[137]

To reduce person-to-person contact, the government has instructed the public to refrain from going to high-risk environments (the Three Cs: closed spaces, crowded places, and close-contact settings) and events involving movement between different areas of the country.[139] It emphasized extreme caution when coming in contact with the elderly. The government also promoted such work-style reforms as teleworking and staggering commuting hours, while improving the country's distance learning infrastructure for children.[139]

On 4 May 2020, the Ministry of Health, Labour and Welfare unveiled its program to create a "new lifestyle" ({{lang|ja|新しい生活様式)) for the country's citizenry that is to be practiced every day on a long-term basis.[140][141] Several elements of the lifestyle include behavior changes demanded under the state of emergency, such as avoiding high-risk environments and long-distance travelling. However, the program expands these precautions to cover more mundane activities by requesting people to engage in such activities as wearing masks during all conversations, refraining from talking when using public transportation, and eating next to one another rather than facing one another.[139][140]

The first case was identified in Hokkaido on 28 January 2020,[142][143] and the first case of an infected person in Hokkaido was on 14 February 2020.[142][144] To limit the spread of infection, the governor of Hokkaido, Naomichi Suzuki, announced the Declaration of a New Coronavirus Emergency on 28 February 2020, calling on locals to refrain from going out.[145]

The Tōhoku region has been relatively unaffected. As of 10 July 2020, Iwate prefecture has not reported any cases.[146]

On 13 February 2020, three confirmed cases were announced in the Kanto region, and one case was confirmed in each of Kanagawa, Tokyo, and Chiba. On 6 March 2020, it was confirmed that 121 infected people were reported in 5 prefectures, including Tochigi and Saitama. On 21 March 2020, a total of 136 people were identified as infected in Tokyo, and a total of 311 people were confirmed in the Kanto region.

The first case was identified in Aichi on 26 January 2020,[147] and the first case of an infected person in Aichi was on 14 February 2020.[147] As the virus spread, Governor Omura of recognized that there were two clusters in the prefecture, mainly in Nagoya.[148] He emphasised the need to work with the Nagoya City Government to prevent the spread of infection.[148]

The Osaka model (Japanese: 大阪モデル, Hepburn: Ōsaka moderu) of self-restraint (自粛, Jishuku) has been widely praised in Japan.[149] The proactive measures enacted by Governor Yoshimura in Osaka prefecture have been effective in mitigating the effects of the pandemic compared to other regions of Japan with minimal disruptions to education or the economy. Governors of other prefectures have followed this example. As the second-largest population center in Japan with the highest population density in the Kansai region, this has been effective to reduce the spread of the virus in this region. Reduced international tourism to Kyoto due to travel restrictions and cancellations of tour groups has also reduced the spread of the virus but the tourism sector is struggling as a result.[150]

On 24 May 2020, Fukuoka Prefecture announced a total of four confirmed cases, including one re-positive case confirmed in Fukuoka City, and three infected cases related to Kitakyushu City.[151] Unfortunately for Kyushu, Kagoshima announced on 2 July 2020 that it has newly confirmed the infection with coronavirus in 9 men and women.[152] On the other hand, Fukuoka Prefecture announced on the 2nd that four new coronavirus infections were confirmed.[152] In August 2020, Fukuoka remained most seriously affected with nearly four thousand cases and over forty deaths.[153] By January 2021, cases in Fukuoka had risen to over 13,000 and 150 deaths.[153]

The outbreak has affected professional sports in Japan. Nippon Professional Baseball's preseason games and the Haru Basho sumo tournament in Osaka were announced to be held behind closed doors, while the J.League football and Top League rugby suspended or postponed play entirely.[165] On the weekend of 29 February 2020, the Japan Racing Association closed its horse racing meets to spectators and off-track betting until further notice, but continued to offer wagering by phone and online.[166]

The outbreak has affected school sport in Japan. Health concerns led to sporting events such as baseball, basketball, and soccer in school being suspended or postponed, due to unexpected postponement of education generally.

Two Yomiuri Giants players have tested positive for the new coronavirus, the Central League team announced on 3 June 2020, casting a shadow over Nippon Professional Baseball's plan to start the 2020 season on 19 June 2020.[167]

The expansion of COVID-19 into a global pandemic led to concerns over the 2020 Summer Olympics and Paralympics in Tokyo. In March, it was announced that the Games would be postponed by a year, for the first time in the history of the modern Olympics.[168][169]

On 26 February 2020, Abe suggested that major sporting, cultural and other events should be cancelled, delayed or scaled down for about two weeks amid the new coronavirus outbreak.[170] As a result, J-pop groups Perfume and Exile cancelled their concerts scheduled that night at Tokyo Dome and Kyocera Dome Osaka, respectively, both of which have a capacity of 55,000.[171] On 27 February 2020, AnimeJapan 2020, originally scheduled to be held in Tokyo Big Sight in late March, was cancelled.[172]

A number of major amusement parks announced temporary closures. On 28 February 2020, Tokyo Disneyland, Tokyo DisneySea and Tokyo Disney Resort were temporarily closed from 29 February 2020.[173][174] Universal Studios Japan also announced a closure the same day.[175] By mid-March, some attractions began to partially reopen, with Huis Ten Bosch and Legoland Japan Resort reopening with limited services (outdoor attractions only, visitors subject to temperature checks before entering) on 23 March 2020.[176][177] However, the Disney parks and Universal Studios Japan delayed their re-openings until mid-to-late April.[175][178][179] Later on, at the beginning of July 2020, Tokyo DisneySea and Tokyo Disneyland reopened after they reported their plan on 25 June 2020.[180]

Affected by the shortage of outsourced staff due to the COVID-19 outbreak, many Japanese animated films and TV shows announced changes or postponed broadcasts due to production problems, including A Certain Scientific Railgun T (deferred for broadcast, changed to rebroadcast), Asteroid in Love, A3! (Delay extension), Kukuriraige -Sanxingdui Fantasy- (Delay extension), etc.[181][182] At the end of March 2020, TV Asahi announced that Rio Komiya, who plays Jūru Atsuta in the tokusatsu series Mashin Sentai Kiramager, had tested positive for COVID-19.[183][184] While production had been suspended, it was stated that there were enough completed episodes to last through 10 May.[185][186]

On 25 March 2020, it was announced that Japanese comedian Ken Shimura had tested positive for COVID-19.[187][188] Shimura died on 29 March 2020 at the age of 70.[189][190]

Not only anime series but also drama series have been silently refrained production to prevent the spread of infection, and most of telecasting stations are transmitting works from past years. In Nippon TV, the airing schedule of Haken no Hinkaku 2, starring Ryoko Shinohara and Yo Oizumi, has been postponed, as well as the airing schedule of Miman Keisatsu, starring Kento Nakajima and Sho Hirano, has been postponed.[191] In Tokyo Broadcasting System Television, the airing schedule of MIU404, starring Gen Hoshino and Gou Ayano, has been postponed, as well as the airing schedule for Hanzawa Naoki 2, starring Masato Sakai and Mitsuhiro Oikawa, has been postponed.[192] In Fuji TV, The schedule for airing the manga-based medical drama series in the second quarter, starring Satomi Ishihara and Nanase Nishino, has been postponed,[193] as well as the airing schedule for Suits Season 2, starring Yuto Nakajima and Yuko Araki, has been suspended.[194] Meanwhile, NHK announced that the schedule for three drama series would be postponed under the influence of the new coronavirus.[195] "The broadcast date will be announced on the program guide and website as soon as it is decided," said the station.[196]

On 19 April 2020, TV Tokyo, MediaNet & ShoPro announced that the Pokémon anime series would be going on hiatus, with production temporarily suspended. Reruns of old episodes began airing from 26 April 2020 to 31 May 2020; the staff announced that the new episodes would return on 7 June 2020.[197] In addition, production for the Toei Animation productions were suspended due to the pandemic after the following episodes aired including Healin' Good PreCure (Episode 12) and Digimon Adventure: (Episode 3).[198] As of 19 April 2020, Fuji TV, Toei Animation confirmed that the One Piece anime series will be going on recess, with production temporarily postponing new episodes and reruns of older episodes taking its place.[198] On 26 April 2020, Nippon Animation announced on Saturday that the broadcast of new anime episodes of Chibi Maruko-chan anime series has been suspended for the time being due to disease outbreak of COVID-19 occurred in Tokyo, Japan.[199] At the time of 26 April 2020, there were a number of anime series with production pauses due to difficulties in supply and production, including some series like Black Clover, Boruto: Naruto Next Generations, Duel Masters King, Kingdom (Season 3), Major 2nd Season 2.

On 27 February 2020, Prime Minister Shinzo Abe requested that all Japanese elementary, junior high, and high schools close until early April to help contain the virus.[6][200] This decision came days after the education board of Hokkaido called for the temporary closure of its 1,600 public and private schools.[201] Nursery schools were excluded from the nationwide closure request.[6] As of 5 March, 98.8 per cent of all municipally run elementary schools have complied with Abe's request, resulting in 18,923 school closures.[202]

Along with the school suspension, online education was being piloted in some areas where the health crisis was not severe, but there was a concern that the education gap was widening in each region due to the limited online environment in Japan. Due to the sudden public health crisis, school closures are taking place in the middle of school, and education gaps in each region and childcare problems in the home have led to difficulties in education. While there are promising plans to postpone the start of the new semester to September, centered on local politics, there are also opinions that some require a careful approach to changing the semester system. Those who promote semester change into September are pursuing a new semester change based on bridging regional gaps and meeting world standards, and those who ponder semester change argue that the online education environment needs to be rapidly updated by region before the semester change.[203][204]

Due to prejudice and ignorance, social harassment is expanding concerning infectious diseases. Because of their worries about being contracted, the number of cases where medical personnel's family commuting is restricted, or people around the infected person is disturbed has increased. In addition, there are increasing cases where small business owners, who were inevitably operating, are forced to take self-sufficiency by neighbors who feel anxious and deprived.[205]

While telecommuting is being encouraged, videoconferencing is also increasing the number of psychological pressures caused by authoritarian attitudes and sexual harassment. The negative effects of telecommuting also exacerbated the problem of privacy infringement, leading to exposure of privacy in the workplace and social pressure. Some companies have compulsory video conference participation rules, with the public request of active reactions and optimistic expressions.

As the number of telecommuting cases increased, the number of working hours in the homes of workers increased, causing conflicts between women and men. In some cases, the number of cases of domestic violence has also increased by increasing discord among families.

On 26 January 2020, Japanese people donated a batch of face masks to Wuhan.[206] According to the Liberty Times of Taiwan, these were actually purchased by China,[207] but Japanese media and the Japanese Consulate General in Chongqing stated that it was a donation.[208][209]

On 3 February 2020, four organizations, the Japan Pharmaceutical NPO Corporation, the Japan Hubei Federation, Huobi Global, and Incuba Alpha, donated materials to Hubei.[210]

On 10 February 2020, the Liberal Democratic Party's Secretary-General Toshihiro Nikai said that the party would deduct 5,000 yen from the March funds from members of the party to support mainland China.[211]

Between April and September 2020, restaurants accounted for 10% of all bankruptcies.[212] Ramen restaurants have been particularly affected, with 34 chains filing for bankruptcy by September. Ramen restaurants are typically narrow and seat customers closely, making social distancing difficult.[212]

The pandemic seems to be the reason for the abrupt end to the slowly declining trend in suicides in Japan for the last 10 years. Since July 2020 their number increased significantly to record highs. Women bear the major part of this increase.[213]

On 3 April 2020, foreign travelers who had been in any of the following countries and regions within the past 14 days were barred from entering Japan. This travel ban covers all foreign nationals, including those holding Permanent Resident status. Foreign nationals with Special Permanent Resident status are not subject to immigration control under Article 5 of the Immigration Control Act 1951 and are therefore exempt.[225]

Japanese citizens and holders of Special Permanent Resident status may return to Japan from these countries but must undergo quarantine upon arrival until testing negative for COVID-19.

The following countries and territories have restricted entry from Japan:[226]