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Coronavirus: Why Japan chose to test fewer people

  • March 12, 2020
  • , Nikkei Asian Review , 3:36 p.m.
  • English Press

HISAHIKO YANO, Nikkei senior staff writer


TOKYO — Why is the number of novel coronavirus tests in Japan low compared with other countries? It is not that there have been problems with Japan’s polymerase chain reaction (PCR) testing ability. PCR tests are used for the diagnosis of infections.


The reason for the relatively low number of coronavirus tests is that the Ministry of Health, Labor and Welfare initially chose PCR testing, not as “a medical practice,” but as “an epidemiological investigation” to curb the spread of the outbreak.


But Japan has failed to contain the virus outbreak as expected. The outbreak has also spread around the world. A perception gap between experts and ordinary people has arisen in Japan, resulting in fears and discontent in its society over “undertesting.”


Whether it is cancer or lifestyle-related diseases, an important factor in modern medical care is “early detection.”


If people are diagnosed with diseases as early as possible, the number of choices for treatment will increase and the risk of their conditions worsening or leading to death will also decline.

But that is not the case when it comes to diseases for which there are no cures, like pneumonia caused by the new coronavirus. Even if such diseases are detected early, they do not necessarily lead to “early treatment.” If it is seen as medical care, the meaning of testing declines.


The National Institute of Infectious Diseases, which has been in charge of PCR tests, published a statement by its head Takaji Wakita addressed to “the public” on its website on March 1.

In response to criticism that the NIID is trying to make the number of infections look small by curbing tests, the NIID counterargued in the document that the allegation is based on a factual error.


The medical term “active epidemiological investigation” appears many times in the document. It is the keyword to know why the Ministry of Health, Labor and Welfare and the NIID have proceeded with tests carefully.


When a new infectious disease breaks out, an epidemiological investigation is conducted to get a full picture of infection, including the features and spread of the disease.


The epidemiological investigation examines the health conditions of infected people, those who have had close contact with them and those who are suspected of becoming infected.

It is not the medical practice of testing and treating each patient. It is based on the public health idea of protecting the entire society from diseases, including by exploring infection prevention measures.


The NIID’s initial epidemiological response to the outbreak motivated the institute to adhere to the testing procedures it has established on its own, which involve using specific reagents and equipment of its choice. The NIID feared that if private sector companies started conducting tests using the test kits provided by pharmaceutical giant Roche and used also in the Chinese city of Wuhan, the epicenter of the epidemic, it would become difficult to gather accurate data vital for epidemiological research due to varied quality of testing. This concern hobbled the body’s efforts to ramp up the nation’s capacity to test for the coronavirus.


In fact, the shortage of tests for the virus was quite uncharacteristic of Japan, where patients usually receive a plethora of medical tests when they are treated for health problems, even if they are not serious. Some experts argue that too many tests are performed at Japanese hospitals and clinics.


Thanks to the nation’s universal health care system, patients do not have to pay much out of their own pockets for most medical tests. As a result, clinical tests are widely and readily used in Japan in treating all kinds of patients. Japan probably conducts more medical tests per patient than most other nations.


The government’s border-control efforts to prevent COVID-19 — which is highly contagious and difficult to detect — from entering the nation have failed, allowing the virus to go into community transmission in Japan, which means it is spreading undetected among people.


There are no signs that the infection is slowing. Concerns about the growing epidemic have focused public attention on the fact diagnostic tests are available only though public health centers and involve much red tape. Since the reason for the unusual testing regime was unclear, the situation first bred distrust and then discontent within the public.


After news reports emerged about how South Korea was performing thousands of PCR tests in a “drive-through” approach, the Japanese public became leery of the health ministry and the NIID, beginning to suspect that they were trying to make the situation look better than it actually was by restricting the number of tests conducted. Part of the blame should be placed on the ministry and the institute, which have done a poor job of communicating the purpose of the tests to the public.


Until mid-February, the government treated coronavirus testing as a matter of epidemiology. But under growing political pressure, the ministry decided to change the approach, treating it more as a medical issue, and decided to make testing covered under the public health insurance program.


Even though the reagent provided by Roche has not been clinically tested in Japan and is intended basically for academic research, the ministry has endorsed it to be as reliably as the method used by the NIID. Coronavirus tests using Roche’s product became officially eligible for the public health care insurance program on March 6.


PCR tests on the new coronavirus have stated being treated as clinical tests covered by public health care insurance. That means the number of tests conducted will increase significantly as public health centers are no longer involved in the process.


For the time being, however, potential coronavirus patients are required to see doctors at one of the some 860 newly established coronavirus counseling centers across the nation for evaluation of their need to be tested. This is a reasonable policy given the principal objective of performing these clinical tests at a time when there is no cure yet for the disease caused by the virus.


The 10 to 30% of the cost patients are supposed to pay out of their pockets for the test under the health care insurance program will be covered by taxpayers’ money for the time being.

This is because the ministry plans to continue gathering data for the epidemiological research. But it is clearly at odds with the decision to cover the tests with the health care insurance program.


About 80% of people who have become infected with the new coronavirus recover without developing any serious symptoms. Patients showing symptoms of pneumonia that may have been caused by the virus should be tested swiftly.


But experts in infectious disease tend not to favor overly broad testing simply to reassure patients, arguing that making tests available to everyone would tax limited medical resources and make it harder to treat those already infected with the virus.

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