Tuesday, May 19, 2009

Flu Closings Not Working As Expected

The number of infected is up to 191 people, and a lot of schools are closed for a week. Most infected people are high-school students so I guess it makes some kind of sense. Not all schools are closed, however; as the link above hints, jurisdiction over things like schools is an unholy mess of overlapping and conflicting responsibilities here. The Osaka prefecture, for instance, can order all schools in Osaka prefecture to close - except for those in Osaka city and Sakai city. They're the biggest cities and their schools are not under prefectural control. And private schools are private and can't just be ordered to close.

Of course, the incubation period of the virus seems to range from a day up to nine days, so a week-long break might really be too short to break the chain of transmission. Besides, it's high-school students we're talking about here; compulsive socializers, with a primal urge to see each other at any cost. The kind of people that would meet up during a hurricane just to show each other how cool and unimpressed they are. What are the chances that they simply meet each other out on the town instead, rendering the school closings ineffective? And true enough, the Osaka evening news featured a broadcast from Amerikamura where large numbers of middle- and high-school students have gathered today to celebrate a few days off school.


Street corner in Amerikamura, just a few minutes from Namba in Osaka:1. The whole area is full of fashion shops of the more embarrassingly juvenile kind - faux-reggae clothes, belt buckles with skulls, t-shirts with pot leaf patterns, that kind of stuff. Teens are drawn to the place like moths to a flame.

Day care centers are also closing. Which impacts young mothers that work part- or full-time. They can no longer go to work since they need to stay home with their kid. According to a television report this morning, many such young parents gather at each others home. That way the kids have friends to play with, and the parents can help each other out so some can go grocery shopping (or even go to work part time) while the others watch the children.

Great idea - except that it defeats the whole purpose of closing the day care centers in the first place. And instead of having the kids watched by trained nursery staff that knows to look for early signs of infection and knows what to do if they see it, you have parents that of course really have little clue about what to do.

To their credit, a number of people have begun speaking up about this current hysteria, and some of the media is giving them a voice. Some doctors have rightly pointed out that many of the current measures don't really work. All they do is disrupt people's lives and incite panic. Our Fearless Leader, Osaka Governor Hashimoto (who seems to be putting on some weight; might want to go easy on the takoyaki there) has called for a step-down on the pandemic response and start treating it more like a normal flu outbreak. The radical measures are out of proportion to the current severity and spread of the disease. This is already happening to some extent. For instance, Osaka city now disregards the guidelines for a pandemic that requires infected people to be treated at hospitals. As most current cases are very mild, people are allowed to recuperate at home if they wish. This alleviates the pressure on the health care system and it's more comfortable for the patient.

So cooler heads may indeed prevail. But this is a country that will panic over the most trivial health issue, so I fully expect the whole nation to have a field day with this over the next month or so.


#1 If this blog were an actual news outlet I'd have to point out that this is archive footage, not taken today. But it isn't so I won't.


  1. While I agree there is no need to panic there is also very little information on the situation except in Japanese or on some news sites that have their own reasons for spreading panic.

    I made a post today on my blog with some advice and hotline numbers. I sort of disagreed on your advice on masks though.

    As to Hashimoto-san, I am generally a supporter, but he was a little uninformed (advised?) in this case. He went into a meeting with the top govt. official not knowing the reasoning behind the school closures and having to embarrassingly backtrack shortly afterwards.

    I'm sure things will return to normal soon, and we can help by taking some common sense precautions.

  2. The advice on masks is not mine, but that of people who've actually researched the matter. But as I pointed out in my previous post, preventing infection is not the only reason to wear a mask, so I'm not saying not to wear it, but be careful that you don't think you're actually protected.

    School closings is one area where experts really disagree wildly. Theoretically it helps. The problem is reality, where it turns out that the effect is pretty small, at the cost of a lot of disruption at both an individual and societal level. This disruption is not free; it has human, economic and medical costs too, and the question right now is if not some of these actions do not actually cost more than they help.

    It is worth noting that the health departments in most other countries generally recommend against wearing masks in public (it doesn't help, and the sight will increase a sense of panic). In Japan wearing a mask is quite normal so in this case it may be a good idea simply as a security blanket; it may lessen the sense of panic instead of increasing it.

    School closings have also varied wildly from place to place, with entire school district closings at the very first case, down to only the same home room being sent home and tested if one person fall ill. This is one area where the optimal response is hard to find. But closing all schools everywhere the way Osaka is doing is almost certainly an overreaction.

  3. Hi, Janne. Thanks for your article, which has provided me with an update (in English!) of the flu situation in Osaka. The mask issue is not quite as simple as you'd put it. Studies that'd shown masks to be ineffective against influenza are mainly conducted in:

    a) experimental settings where they got a nebulizer (highly efficient aerosol generator) to be the source -- but the human lung is not a nebulizer and generates a very different aerosol profile (e.g. http://www.ncbi.nlm.nih.gov/pubmed/17096360)

    b) real world settings where the adherence to mask usage is low and the results are not adjusted to reflect it (e.g. http://www.ncbi.nlm.nih.gov/pubmed/18461182)

    In other studies where adherence is taken into consideration, there is usually a beneficial effect observed with adherent use of face masks (e.g. http://www.ncbi.nlm.nih.gov/pubmed/19193267). Also, while there is disagreement over the practical values of face mask protection, there is little doubt on the utility to reduce virus spread if the infected persons wear it. Unfortunately, even this effect is not readily demonstrated in real life probably because of the low adherence. Finally, bad practice like touching or removing the masks without washing your hands afterwards increases the risk of infection and is considered to be worse than not wearing a mask at all.

    My take on the issue is that masks can protect people from flu, but they can't protect people from themselves.

  4. LQ,

    Thanks for the comment.

    I saw that paper too. Note that it tested mask use for people nursing an infected individual. That greatly increases the amount of and type of exposure over time and changes both mask effectiveness and adherence. It's not readily transferable to the situation of diffuse exposure outside.

    There was a test of mask effectiveness on television just last week. They did not test the permeability of masks, but simply how well they actually filtered air through the mask rather than around it. They had 8 volunteers don a mask, then move their heads and talk. As it turned out, an N95 mask, fitted properly by a medical professional, only protected three of the eight subjects; the other five had facial features that were irregular enough or too small (the women, especially) for the mask to fit tightly. For surgical masks, they did not catch the airflow for any single volunteer. So even adherent use is very difficult to achieve even if everybody sincerely would try.

    And that's why real-world testing is important. People do have wildly different features, and they will move about and talk wearing a mask. The real-world impact of mask wearing is minimal from a protection point of view, though worthwhile for people already infected.

    In Japan, wearing a mask doesn't hurt, especially if it calms people down. In some other societies the added sense of fear and panic that seeing medical masks can engender may well more than offset any benefit. Anyway, I'm writing a second post on this right now.


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