I May Have COVID19．Now What?

Edo Naito                                                                                                    March 1, 2020

At the end of December, we visited a shop where we have been going for many years. We heard that the owner who had been going to Wuhan weekly for business had the flu and his entire family later had the flu. At that time, of course, no one even knew of COVID19 much less test for it. But his “flu” symptoms had been modest and he was fine by then. Two weeks or so later my wife had slight “flu” symptoms but nothing that warranted going to the doctor. Toward the end of January, I started with “flu” symptoms and they continue even now.

After a couple of weeks, I went to the doctor. He did a classic flu test. Swab up your nose for 8 seconds and then 3-4 minutes later they come back with the results. My results for both A and B flu were negative. Any doctor's office in Japan can do that. Have you ever counted how many kits must be available throughout Japan for every hospital, clinic and simple doctor's office to be able to this simple test AND give you the results in under 4 minutes?

Many Japanese expect COVID19 should be handled in the same way as seasonal flu. But not really. To test for COVD19, you need to do a deep throat swab, something called a PCR test, then send the specimen to one of about two dozen labs around the country with special safety sets up to process the test. It takes up to 6 HOURS to process and it is expensive. Following this, the results need to come back to the patient - 3-4 days from test to results depending upon where you live and the lab backup. No country in the world can yet do a flu nose swab test for COVID19 because at this point "no one has the serology" of this bug. THAT is a quote from Professor David Heymann, former UK public health head, former WHO leader during SARs (I wish we had him in WHO today) and he is considered by his peers to be the #1 infectious disease public health control expert in the world.

https://www.chathamhouse.org/file/how-concerning-new-coronavirus-outbreak?CMP=share_btn_fb&fbclid=IwAR05UHRZYqTLrUzN-Kb7Mb0bNg0jgbtRfu0Lmp5XIwhXIxpG4SZbZjppCv0#

On Feb. 3, Japan could only do a maximum of 300 tests per day (and Japan had the 3711 souls on the Diamond Princess and the 800 Japanese Wuhan evacuees to consider) and there were only two labs in Japan that could process them. Today, testing capacity has increased to 3800 tests per day and two dozen labs have now been authorized. But there may be 3800 flu tests conducted in Tokyo's Setagaya-Ku alone on any given day. That gives us something to consider when we reflect on what that means for coronavirus testing capacity for the entire country.

Is it not entirely sensible that the national testing capacity is fully reserved for the most vulnerable portions of our population? And so the testing criteria in Japan is as follows: Japan currently limits COVID19 testing to those in direct personal contact with Hubei/Wuhan, elderly with existing medical conditions with quite slight symptoms (fever 37.5C) over 24 hours, elderly who show slight symptoms (fever over 37.5C. coughing, etc) over 36 hours, patients that show symptoms suggesting they MAY be trending toward the 10% of all COVID10 patients whose conditions MAY eventually require hospitalization. Prime Minister Abe announced last night that major coordinated effort is underway to try to get a test as accurate as the current PCR test but one the can be processed in 15 minutes. The costs for the tests will all be covered under Japan’s national health insurance system.

Without understanding the facts, some were quick to charge that the Japanese government must have been unprepared, uniquely incompetent, or simply uncaring. That is what some self-serving mass media, their academic supporters and certain politicians want you to believe. Now when we observe what is going on in the US with the CDC in charge, the premiere infectious disease control center in the world, grave questions inevitably emerge. The New Year Times which recently printed two of the most overtly politically motivated slam pieces on Japan’s handling of the virus to date had the hutzpah to publish what is a kid glove, by comparison, review of the US situation. Imagine – almost 4 weeks since the Diamond Princess arrived in Yokohama, there is still only one lab in all of the US, CDC’s own lab in Atlanta that can process the PCR type test kits and they are simply not available. The State of California with a population of 35.4M people had a grand total of 300 kits on hand, not per day but in total. The State of New York decided after receiving defective test kits to try and develop its own and is seeking authorization to test them in a NY based lab. 

https://www.nytimes.com/2020/02/27/health/coronavirus-testing-california.html?action=click&module=Top%20Stories&pgtype=Homepage&fbclid=IwAR20EDCdNXKA45dd_96GJH0F33nVsZ3uQbJ6ouYfbNkSfZ46LT0YDbw9mBM

https://www.reuters.com/article/us-china-health-usa-testing/new-york-scrambles-to-replace-u-s-governments-faulty-coronavirus-test-kits-idUSKCN20N00J

So where are we? Well, I do not fit the current testing criteria as I have not been to Wuhan, a bit under the Japanese definition of “elderly” and have no medical conditions. (I would not meet the testing criteria in the US either as it is even more strict.) So there is no way to confirm I have the coronavirus. The question is what would really change in what I am doing if they did take one of the valuable test kits and confirm I had it? I am self-quarantining, resting, drinking a lot of fluids and started taking antibiotics for the infection that a blood test confirmed – just the origin of the infection is “unknown”. Given my age and overall robust health, I am not worried in the least. I am instead worried about there being adequate test capacity for all of the elderly and anyone who is showing possible signs the virus for them might be one of the 10% that require hospitalization. I am delighted that instead of taking a test to satisfy my curiosity that those tests are deployed where they can protect more vulnerable people. For the 85-90% of those who catch COVD19 but who show no or slight symptoms confirming you have it does not change anything at all in how you will be instructed to treat yourself.

Japan has been handling this situation from the beginning in a calm, measured, pragmatic and scientifically supported manner with the original focus on "containment" (trying to keep it as much as possible out of Japan) and then shifting to "mitigation", reducing the peak number of community infection cases and at all costs saving lives, by deploying all critical resources to protect and treat the most vulnerable.

Another thing the good Professor Heymann said is that countries need to understand that it is up to each of them to be responsible for our health and each country needs to make its own risk assessments based on the specific conditions in each country. In the end, all of us in Japan are in this together. 

Being a cup half full kind of guy, I am not going to end on some grim note so here is my forecast. Next year for the flu season they will have a new vaccination soup to administer that also covers COVID19. By the way, flu vaccinations in Japan are FREE for those over 65.  And the 4-minute flu test will cover A, B, as it does now, and C. From everything I have read, COVID19 will simply meld into the global community disease portfolio that we each carry. 

At times like these, remaining calm and keeping one’s perspective is critical. And using our basic Japanese common sense. You really do not need a personal 3-4 months stockpile of tissue and toilet paper. Common sense and a rational focus on the real health priorities will defeat this virus but panic, fear, and media/political hype will not.