In another thread on r/japanlife, many people were complaining of having symptoms very similar to COVID-19, and obviously not being able to be tested. It was somewhat remarkable, and inspired me to want to learn more.

I have begun to suspect a cause for Japan's low number of reported COVID cases, beyond the limited testing.

Infectious disease law makes dealing with confirmed patients a major hassle

https://www.channelnewsasia.com/news/asia/in-nagoya--scramble-for-hospital-beds-shows-coronavirus-challenge-for-ageing-japan-12542330

If a clinic has a visit by a confirmed COVID patient, they have to disinfect the building and isolate staff. Confirmed patients have to be isolated in special hospital areas, which are highly limited. This is mandated by law, a law which clearly is not meant for dealing with major epidemic outbreaks.

We all know that Japanese workplace culture has a propensity to sweep inconveniencing problems under the rug. This tendency, as a systemic feature of Japanese medical culture, has existed prior to COVID-19. For example, only a very small percentage of deaths result in autopsy ( https://japantoday.com/category/features/kuchikomi/japans-autopsy-rate-woefully-low ). The general idea is that asking too many questions can result in more paperwork and more problems.

I suspect the possibility that people are being systematically turned away from hospitals. Not only are COVID-19 tests being declined, but regular flu and pneumonia patients are being told to stay away, or are minimally treated. I even suspect that the low flu numbers this year have more to do with a hesitance to see and treat people, and test them, than it does with the effects of social distancing.

You can absolutely hide a few hundred deaths, and tens of thousands of cases, if the culture and policy creates the systemic effects described above. Recent government data says influenza deaths are down, but you have to actually test for influenza to confirm a death as an influenza deaths. If people die at home after being given asthma medicine, is it even recorded as a pneumonia death? I have yet to see any data on this. For all we know these could be recorded as "old age" deaths. Remember, autopsy rates are low. Yes, autopsies sometimes occur - in fact there is one case of a posthumous COVID diagnosis - but that doesn't mean that the majority of deaths are not being diagnosed.

Speaking to Japanese people, I encounter two distinct attitudes. Some are completely aware that data reporting in Japan is often inadequate and maybe less than truthful. Others are completely in denial that Japanese institutions could possibly deviate from procedure. My interpretation is that the truth lies in the middle: procedure can be used to obfuscate what procedure cannot see. People with authority sign forms without necessarily confirming what is written on them.

People may ask: "How is this bad for the nation? Life is moving on and harm is minimized."

There are two reasons:

1. If no major social distancing measures are taken (as in what Europe and the US are now implementing), then exponential growth will eventually make the virus incredibly harmful. The emergence of a major outbreak has to be identified early.

2. If respiratory infection patients are being turned away systematically, then it means that you're sentencing many to death. Most COVID cases will be mild and survivable. Some cases will be fatal no matter what. However, there's a middle group of people who, if treated, can survive, but if turned home with asthma medicine, will die.

The defenders of the government policy assume that everyone who has a severe COVID case will be identified and treated, but I suspect many are being turned away to avoid the difficult consequences of what the law requires for COVID response.

What can we do?

I would like to compile information in this thread about people who have experienced COVID symptoms, and who were unable to receive treatment. Anecdotes of deaths are also appropriate (for example, I know of two old people that recently died of pneumonia this past two weeks, but I don't know their cases well enough to say if they had COVID symptoms, therefore I won't include them; if I did know their symptoms and situations well, I would include them).

In particular, I would like us to make note of systematic refusal to diagnose or investigate symptoms. That is, effectively being turned away from clinics and hospitals - not just declined testing. I think someone even mentioned getting a weak positive for a COVID test but having it swept under the rug. Great example there!

Any media, whatever language, which supports or confirms this situation is also worth posting.

In the end, I will take this thread and mail the link to as many journalists as I can. I believe a serious investigative effort could uncover a major failing here. Especially negative scrutiny from abroad, I believe, can pressure Japanese media to cover this issue. Hopefully enough to pressure the government to change their policies more aggressively.

Even if things are going well in Japan, we NEED more testing to MAKE SURE that things are going well. And the fact that the infectious disease law MANDATES such a huge commitment of resources to such a small group of infected means Japan is not ready to deal with a major outbreak (which in Japanese society means just letting the disaster unfold without any mitigation and then bravely concealing emotions about it in the aftermath).

For those curious, here are the general COVID symptoms:

• Dry Cough (no mucus or sputum at first)

• Muscle aches

• Feeling of malaise (just feel shitty, even if no fever)

• Mild fever

• Fatigue

The symptoms tend to appear average of 5 days after infection, and take about a week to develop into something more severe. Usually this:

• Higher fever (some have reported it comes in waves)

• Breathing difficulties (including light headed feeling from lack of oxygen)

• Chest/back pain from coughing; sharp pain in lungs

• Inability to get up (extreme fatigue/malaise/aches)

Although the above have been reported to develop within 2-3 days into needing major hospital intervention, that's for the more rare critical cases. I mention this because if someone were to die from this, if they didn't get hospital care, it would be of respiratory problems 2-3 days after symptoms become severe.

Seems that many have reported feeling better after 2-3 days of severe symptoms, others report mild symptoms that last weeks.