In 2020, Deaths In Japan Declined. NewsWire

NEWSWIRE: 3/9/21

• Last year, the number of deaths in Japan declined for the first time in more than a decade. The decrease appears to have been driven by a large decline in respiratory illnesses and stands in stark contrast to the steeply rising mortality experienced by other countries during the pandemic. (The New York Times)
• NH: In 2020, Japan recorded 1.4M deaths, which is 9,300 fewer than the year before. In other words, Japan has experienced negative excess mortality. This is remarkable since Japan has such a large elderly population and its winter season is relatively long, cold, and dry. Nonetheless, Japan has seen very few deaths from Covid-19.
• To be exact, Japan has thus far recorded only 65 Covid-19 deaths per 1M people. Let’s compare that to deaths per 1M in Europe and North America: UK, 1,828; Italy, 1,657; US, 1,619; Spain, 1,521; and France, 1,360. Clearly, Japan has fared much better than most western countries. On the other hand, it actually stands at the high end of mortality rates among high-income East Asian countries. In South Korea, for example, Covid-19 deaths per 1M is 32; Hong Kong, 27; Singapore, 5; and Taiwan, 0.4. (That's right: Taiwan, hit earlier than any other country outside China, has suffered only 10 total Covid-19 deaths.)
• This leads us to a broader question: Why have so many Asian countries controlled the disease so much more effectively than the West? It boils down to three basic reasons:
• Strict public health measures. Many of these countries wasted no time in their government response to the pandemic. China, Vietnam, and Hong Kong quickly enacted draconian lockdowns. South Korea and Taiwan poured money into testing and contact tracing. Having already dealt with SARS in 2002, these countries were already prepared for a swift and organized response.
• High acceptance of face masks. Since SARS, face masks have been a staple in many Asian countries. People wear them during flu seasons, and it is customary to wear one when you are personally ill. They are also seen as fashion accessories. I'll be highlighting new data on the importance of mask-wearing in my Covid-19 update this Thursday. 
• Cultural differences. National cultures can be arrayed on a spectrum of formality and informality--from huggy-kissy countries Italy, Spain, and Brazil at one extreme to most of Confucian East Asia at the other. East Asian people tend to be more distant in their personal interactions. Japanese will often bow when greeting each other. This gesture naturally eliminates touching and close contact. (Interestingly, the biggest super-spreader event in South Korea was a vast and atypical group-hugging event conducted by an evangelical Christian congregation in the southern city of Daegu.)
• In Japan’s case, IMO, culture and masks were most important in mitigating the pandemic’s impact. Unlike most of its neighbors, Japan actually did not do a lot in the way of public health measures. Nevertheless, with voluntary social distancing and near-100% face mask compliance, Japan was able to avoid a massive death toll.
• While this explains why Japan did not experience positive excess mortality during the pandemic, why did it experience an actual decline? Given Japan's gradual aging, the general trend has been year-over-year mortality growth.
• The preliminary death data don’t specify mortality by cause. But we're free to speculate. We have seen around the world that other contagious viruses like the flu have largely disappeared due to lockdowns and overall social distancing measures. This is true in Japan as it is everywhere else. From September through December 2020, there were only 383 reported influenza cases. The average number of flu cases over those same months in the previous five years was 90,000.
• When Japan officially publishes mortality statistics for 2020, look for a decline in non-Covid respiratory mortality as a significant driver of the overall fall in deaths.