What you need to know about the omicron surge in Japan

Nagoya – By now you’ve seen the news: The omicron variant of the coronavirus is spreading rapidly throughout Japan, with case numbers in almost every prefecture and major city sharply on the rise since the new year.

Also on the rise? A massive volume of information and speculation, often in Japanese, about how the country is planning to deal with the new variant. It’s times like these that a summary of what’s going on can be helpful — though it’s important to remember that the situation is fluid and likely to change.

Estimates show that upward of 80% to 90% of new cases throughout the country are, at present, the more infectious omicron variant of COVID-19. While the science and data point to an alarming trajectory, there are safe, consistent practices that you can take to protect yourself and your family.

What is omicron?

First identified in Botswana and South Africa in November, omicron has spread around the world faster than any previous

COVID-19 variant. Now, enough scientific research has come in that we know a lot more about omicron than when Prime Minister Fumio Kishida tightened Japan’s border controls on Nov. 30.

The first thing that we know is that omicron spreads quickly. In fact, it is two to three times as likely to spread as delta, the previous variant of concern. This has proven true indoors — household members were three times as likely to get infected from each other compared to delta — and across whole nations, as the omicron variant has swept across the United Kingdom, the United States and Australia.

We also know that omicron is typically less severe, especially for vaccinated individuals. It has a significantly reduced risk of hospitalization, but can still cause deadly infections in some people.

Finally, COVID-19 vaccines are still effective against omicron — but with a huge caveat: Two doses from a vaccine administered more than three months ago help protect against severe illness, but not a symptomatic one. Booster shots protect from symptomatic infection up to 80% of the time. However, boosters are just being rolled out in Japan, and it’s unlikely that anywhere close to a majority of the public will be able to get theirs in time to protect themselves from the current winter surge. Immunity from previous infection also does little to hinder omicron.

What is the spread like?

Case numbers indicate that COVID-19 is once again spreading rapidly all across the nation. On Saturday, the national tally of new coronavirus cases recorded in a day hit 25,742, closer to the record 25,992 total Japan registered on Aug. 20 last year.

While case numbers here have remained a degree of magnitude lower than those in other developed nations throughout the pandemic, experts suggest there is nothing in particular about Japan that will halt the spread of an omicron wave. Rather, Japan’s large elderly population could contribute to greater rates of hospitalization than were seen in a country with a younger population such as South Africa.

Fortunately, Japan has counted less than three dozen COVID-19 deaths since December and still posts a relatively low death rate of just over 1%. In Okinawa, where an estimated 97% of new cases are due to omicron, most of the hospital patients were elderly people with underlying conditions and unvaccinated young people. Late last week, however, the government confirmed its first deaths among people infected with omicron: an older man and older woman in Shizuoka and Chiba prefectures, respectively, both with pre-existing conditions from other diseases.

Yugo Shobugawa, a professor in the department of active aging at Niigata University, says it’s too early to say whether or not omicron will be less severe in Japan.

“In the data from the West, we saw few severe cases, but many have received their booster shots,” he says. “In Japan, most high-risk individuals will start their third vaccinations in February, so it’s unclear these shots will come in time.”

On Jan. 11, Kishida gave a speech detailing his full plans for omicron measures this year. The government plans to maintain its current border measures, preventing new entry of foreign nationals, which appears to have delayed but not stopped the entry of omicron into Japan. However, foreign residents and Japanese nationals will see their quarantine period after returning drop from 14 days to 10 days.

The government is also working to secure more vaccine stock, administer vaccines to children over 12 and accelerate the booster vaccine schedule for older people by setting up mass-vaccination sites in cities. Other measures focus on keeping hospital beds available: Japan has worked to expand the number of institutions that support home treatment. While the government is aiming to expand free COVID-19 testing, critics continue to emphasize that not rolling out mass testing will make the spread harder to keep in check.

Based on case trajectories abroad, Mitsuyoshi Urashima, a practicing pediatrician and professor of medicine at Jikei University in Tokyo, suspects that Japan should expect to see cases peak around Jan. 25 at an estimated 100,000 cases per day.

“There are many mild and asymptomatic cases, so many people won’t take PCR tests,” he says. “Since it’s more difficult to get tested for free in Japan, the number of COVID-positive patients may be underestimated.”

Shobugawa says it is unlikely that Japan’s contact tracing will be able to keep up with the spread.

“As essential workers fall ill or are isolated as close contacts, social services will experience disruptions unless the government changes its current isolation policy,” he says.

No large urban area has announced any new state of emergency. So far, Tokyo has done little but to request restaurants restrict dining to groups of four and under.

What should you do?

So omicron is more infectious, but less severe. There are more border measures, but no lockdown. How does this change the decision calculus for an individual? American doctor Amita Sudhir writing for Slate suggests it’s worthwhile to take a full step up in terms of caution: being more strict about mask-wearing and handwashing, and avoiding crowded bars and restaurants.

“The societal risk from omicron is quite high,” writes Sudhir. “Hospitals could fill up, even with a small percentage of vulnerable people who will all get sick at once, and health systems will be more likely to be overwhelmed as staff call in sick.”

Experts in Japan recommend sticking to the basics for dealing with omicron. That means continuing to stay at home when possible, avoid the “three Cs” (closed spaces, crowded places, and close-contact settings), wear masks, ensure ventilation and disinfect frequently. It may also be worth investing in N95 masks, which experts say are much better at blocking the spread of omicron compared to cloth masks. If you can’t get your hands on those, any mask is better than no mask.

“Omicron may be more infectious, but that doesn’t change the basic infection controls,” says Urashima. “However, due to the cold weather, closed windows will reduce ventilation, so be especially wary of poor ventilation.”

What if you get symptoms?

Omicron’s high level of infectiousness means that you’re much more likely to catch it without necessarily having close contact with a known infected person, says Shobugawa.

COVID-19 symptoms include: cough, shortness of breath, chills, muscle/joint pain and a loss of smell and taste. With omicron, experts are reporting that those infected are complaining more of a sore throat and less of smell and taste abnormalities. The incubation period seems to be shorter, with symptoms showing on the third day of infection rather than the fifth — however, the period is not as short as with the flu, which also features sneezing as a symptom.

If you are experiencing symptoms or find out you were in contact with someone who is COVID-positive, assume you’ve contracted omicron and immediately call the appropriate local call center. From there, a doctor will determine if you need to be tested or not. In the meantime, remain at home until the test results come back.

In the case that you are positive, depending on your symptoms, an interview about your health condition will determine whether you will remain at home, move to a hotel or visit a hospital. At the very least, stay at home and isolate yourself from the rest of your household if possible.

If you are staying at home with omicron, doctors recommend masking indoors, opening windows to improve ventilation when possible, drinking plenty of liquids, and taking cold or flu medicine with painkillers to reduce symptoms. Severe chest pains, shortness of breath and persistent fever are signs to seek hospital care immediately.

Since the unvaccinated are particularly likely to contract COVID-19, they should make a special effort to prepare for how to manage their illness as well as contingency plans for managing work, family and child care. And with how infectious omicron is, this is a worthwhile exercise even for fully vaccinated individuals.

“Infections have been very low from October to December, so many have started to let their guard down,” says Shobugawa. “People should once again be conscious of safety measures. Most importantly, high-risk people should get their vaccines and boosters as soon as possible.”

The unique differences between omicron and previous variants can make deciding what action to take, if any, feel confusing. But the public safety message is clear: Take up your level of caution with increased social distancing and mask diligence, and prepare a contingency plan for you and your family in case of infection.