Overseas media and specialists alike have struggled to explain the pandemic in Japan. There has even been conspiracy talk, with allegations that numbers in Japan were deliberately being kept low to keep the Tokyo Olympic Games on schedule. Indeed, the number of PCR tests has been very small, at fewer than 10,000 a day even now. The government has said its goal is to double the number of tests, albeit to a number that would still be comparatively low. Yet while it is almost certainly the case that many infected persons have not been tested, masking the number of deaths would be an altogether more difficult task.

So what is the Japan model? First, it is a cluster-based approach, derived from a hypothesis obtained from an epidemiological study based on Chinese data and conducted on the Diamond Princess cruise ship that entered the port of Yokohama on February 3, 2020. This hypothesis accounts for the many passengers who were not infected with the coronavirus despite having had close contact with infected persons. It posits that the explosive increase in infected persons is a result of the high transmissibility of certain infected individuals, which forms a cluster. Infected individuals with even higher transmissibility appear from these clusters to form more clusters and infect many others. Based on this hypothesis, under the cluster-based approach, each cluster is tracked to the original infection source and persons with high transmissibility are isolated to prevent the spread of infection. For this reason, pinpoint testing is carried out and  broad testing of the population is not required, in contrast to the approaches taken in other counties.

For the cluster-based approach to be effective, protective measures at airports and ports are important. On February 28, 2020, acting without legal basis, Hokkaido Governor Naomichi Suzuki declared a state of emergency and called on residents to refrain from going outside. Residents took the call seriously, and are responsible for the success of the cluster-based approach.

Another key to the Japan model is the social distancing method known as “the three Cs,” referring to closed spaces with poor ventilation, crowded places with many people nearby and close-contact settings such as close-range conversations. In the city of Wuhan, China, in its efforts to contain the coronavirus outbreak, the government imposed a lockdown to forcibly limit human movement. This method was also adopted in Italy, where the epidemic became unmanageable and became standard practice in Western countries. In addition, having a two-meter distance between people is becoming a social norm, to prevent the spread of the disease by droplets. In Japan, however, this social distancing is considered a secondary measure.

Underlying the Japan model are factors such as the habit of wearing masks. This habit is widespread in Japan, where many people suffer from hay fever, making the possibility of contraction by droplets comparatively small. Behaviours like shaking hands, hugging and kissing, and other forms of physical contact are not part of traditional Japanese greetings. Another factor may be that conversing on crowded commuter trains, where there is close physical contact, is considered poor etiquette. This also helps limit the possibility that people will contract the virus by droplets. In contrast, karaoke and Japanese style pubs, where conversations are at high volume, are known sources of infection and clusters. This cluster-based approach and the three Cs measure may seem strange to the eyes of people in countries where strict lockdowns have been adopted. Similar approaches are being taken by South Korea and Singapore but can Pakistan adopt this too? There is a question mark.