Abstract
The COVID-19 pandemic has spread to many countries around the world, but the infection and death rates vary widely. One country that appeared to have kept the infection under control despite limited societal restrictions is Japan. This commentary explores why Japan may have, up to now, been spared an escalation of the SARS-CoV-2 infections.
Highlights
Despite early exposure, its dense and aging population, and little social distancing measures, Japan reports low infection and low death from COVID-19
Japan has not engaged in expansive testing, contact tracing, or strict quarantine measures and yet is reporting a slow growth rate of infected persons and a death rate that is currently just 1/10th of world average
There are many other theories to explain the low number of COVID-19 cases in Japan, yet we still do not have enough information to determine the cause of this striking discrepancy
Summary
Its dense and aging population, and little social distancing measures, Japan reports low infection and low death from COVID-19. There is a lot of interest brewing as to why Japan has such low numbers of confirmed infected cases of the COVID-19 disease, caused by the SARS-CoV2 virus (Fig 1), despite its high population density (over 6,100 persons/sqkm in Tokyo, 2.4 times higher than New York City) and large percentage of high-risk individuals over 65 years of age (about 26%, compared with 15% in the USA). The social practice culture of Japan and mask use may explain to some extent the lower number of observed COVID-19 cases, but is unlikely the only explanation.
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