Tokyo Report | Society | East Asia

What Tokyo’s Lockdown Debate Is Missing

Whether to lockdown is not a binary question. We need to ask, under what conditions should we do it?

By Kentaro Iwata, tr. Paul Kreitman for
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What Tokyo’s Lockdown Debate Is Missing

People wearing a protective face mask wait at a pedestrian crossing, April 2, 2020, in Tokyo.

Credit: AP Photo/Eugene Hoshiko

I’ve already stated that Tokyo should be locked down. But some people have retorted that the economic cost of such a lockdown would be too great.

It is true that a lockdown will have profound adverse side effects. There will be a sharp contraction in economic activity, and this presents a risk not only to the economy but also to human health. Put simply, without money people can’t buy food, and without food people can’t live.

Nevertheless, it is my position that the Tokyo area should be locked down. Politicians and bureaucrats should do what they can to make sure that people do not starve under such conditions, but when it comes to controlling the epidemic they should leave the decisions to the professionals.

To reiterate, I am not an expert on managing a lockdown or making political decisions, and so I cannot claim to know what kind of lockdown is realistically possible or appropriate. As I’ve written before, a lockdown in principle means stopping people from leaving or entering the target area, and ensuring that people within the target area stay in their homes. That said, no city and no country has managed to achieve a complete lockdown. There are countries in which grocery stores and pharmacies remain open (e.g. the United States), where healthcare workers and police officers continue to go to work (most countries), where people are permitted to go jogging as long as they don’t interact with others (e.g. Britain), and where people are allowed to take their children for a stroll (e.g. Italy). Which is to say that a “lockdown” is always a matter of degree.

Neither do I do know whether a lockdown of “Tokyo” should include the city’s 23 wards, the metropolitan area, or also commuter suburbs in neighboring prefectures such as Chiba, Saitama, and Kanagawa. I don’t know if just the bullet trains should be stopped, or if designated professions such as healthcare workers and police officers should be allowed to commute to work, or if all the trains and buses should be stopped completely. I cannot judge whether it is okay for delivery services and couriers to keep working. The lockdown in Sierra Leone during the Ebola epidemic was comparatively relaxed, and simply consisted of forbidding people to leave town or go out at night. But this too is one kind of lockdown.

Which is to say that “lockdown” is a matter of degree. No model lockdown exists that we can point to and say, “This is the correct type of lockdown.”

However, we need to make the jump from maintaining the status quo to at least some kind of lockdown, in whatever shape or form that may be. The reasons for this are as follows.

To start with, a lockdown is a means to an end, not an end in itself. It is a means to block the routes of infection. Contagious diseases need routes of infection in order to spread. If you block those routes, then you stop the spread of infection. This principle has been universally held to be true since the time of Louis Pasteur. A “lockdown” is just one among many ways to block infection routes. The current request by the governor of Tokyo for citizens to refrain from going outside unless absolutely necessary is aimed at blocking infection routes. So a lockdown is a logical extension of what the governor is now saying; the difference between the two is merely a matter of degree.

This is often misunderstood, so I want to restate my position once more. I am not a member of the “lockdown faction.” In any debate over how to respond to an epidemic, such factions should not even exist. I am generalist who believes one simple thing: if we control the spread of the epidemic the problem will disappear, and all binary debates about how to control the epidemic — “masks or no masks?”, “vaccine or anti-vaccine?”, “use antibiotics or not?”, “test or not test?” — are a nonsensical waste of time. If you ask a professional epidemiologist, “Are you in the faction that advocates using antibiotics?” they will cock their head and look at you oddly, thinking, “What does this person actually want to ask?” No such binary answer exists one way or the other. To frame questions in such a way is not science but ideology.

A two-sided debate over whether to lockdown or not is also nonsense. The only debate is over the timing.

So, when is the correct time to order a lockdown? Those who argue we should wait until COVID-19 has overshot are wrong. By that point it will be too late.

On the other hand, it would be a mistake to order a lockdown when the scale of infections is still small, because the adverse side-effects would be so huge. This, everyone understands.

The light from the stars in the sky was actually emitted many years ago. In the same way, the number of COVID-19 cases currently detected using PCR tests only captures the number of infections that occurred 10 to 14 days ago.

When an explosive, exponential increase is observed, that is actually capturing a phenomenon that occurred 10 days ago, or even before that. So measures implemented at that point will already be too late. This is why it does not make sense to argue that “for the moment we are still managing to hold out” or “there hasn’t been any explosive increase yet.”

We can see that every day the number of infected people in Tokyo is increasing. Apart from Sunday, when not many tests were carried out, this has been the case since about March 23. This cannot interpreted as the result of a series of accidental clusters; it is a trend that will continue to increase.

At present the containment strategy in Japan consists of detecting clusters, pursuing them, and isolating them. Which is to say, it consists of chasing and catching the epidemic from behind. To catch an opponent who is in front of you is difficult, but not necessarily impossible. In Japan we have been doing this ever since the start of the epidemic.

But in Tokyo we are now failing to keep pace with the virus. And by the time we start detecting several thousand new cases each day, the opponent we are chasing will have developed an insurmountable lead.

Therefore, we need a Plan B, so that we can shift our strategy radically — either before the overshoot begins, or when the first signs of one begin to show. By ordering a lockdown we can stop chasing after infected people, and instead optimize the environment so that people don’t get infected in the first place. We can run ahead of the contagion.

I’ve spent a long time fighting epidemic disease outbreaks, but I’ve never encountered a case where, as the situation has gradually worsened, simply maintaining the same strategy has resulted in things eventually improving. Usually we re-evaluate our hypotheses, look at the data again, study the existing situation critically, revise our strategy, and try doing something different. Sticking to the status quo is never a feasible option.

Some people say they oppose a lockdown because it will come with economic losses, but if we avoid a lockdown on that basis, what awaits us ahead? Probably an even more severe lockdown. A lockdown in which the contagion has spread so widely that it cannot be controlled. A more widespread, stricter, longer lockdown. The alternative plan to a lockdown is an even larger lockdown, with even more crippling economic losses. It is obvious which plan is the better. If you refuse to have a cancer removed because you don’t want the surgery to cut your skin, then all that awaits you is a more aggressive surgery that will require an even larger cut.

Of course, it is possible that I am mistaken. One could imagine a scenario in which the number of infections miraculously decreases immediately after a lockdown is imposed, and gradually dwindles to nothing. An immediate decrease of this kind would necessarily result from a phenomenon that began before the lockdown, so would not be the product of it. I am not inclined to be super optimistic, but in the real world inconceivable things do happen sometimes. In that case, what should we do? It is simple. We cancel the lockdown. Losses will be minimized, and everyone will be able to laugh at Iwata for his mistake. Smiles will return to people’s faces and everybody will win. Indeed, in my heart of hearts I hope for such a scenario.

I am not a specialist in forecasting, so I make no forecast. All I am doing is laying out all the possible scenarios in order of likelihood, and calling for the most appropriate response depending on the scenario we find ourselves in. This is what I do every day when treating my patients. This is game theory. In clinical medicine we are accustomed to making decisions in order to handle any scenario that occurs if a patient’s health changes unpredictably. In this sense we doctors are as a profession well-versed in game theory.

If we apply game theory we see that, no matter what scenario might unfold in the future, the best solution is to order a lockdown. Not only that, but to order a lockdown now. To repeat myself, there are various ways of executing a lockdown. But it is useless just to order something that looks like a lockdown but is actually ineffective. I’m not interested in the superficialities. What we need is to get results.

Needless to say, if there are better solutions, I would love to hear them. As I’ve said before I am not part of any “lockdown faction,” and if a better solution is offered then I very much hope a lockdown can be averted. However, nothing good will come of simply listing all the problems with a lockdown, or the reasons why it cannot be done. Quite the opposite in fact. Right now we simply haven’t the time to listen to these kind of opinions.

Kentaro Iwata is Professor at Kobe University’s Graduate School of Medicine Division of Infection Diseases Therapeutics. He attracted global attention when he publicly criticized the Japanese government’s handling of the COVID-19 outbreak aboard the Diamond Princess cruise ship in February 2020. Since then he has been a regular commentator on the coronavirus epidemic in Japan, tweeting as @georgebest1969 and blogging at https://georgebest1969.typepad.jp/blog/

This piece has been translated from the original Japanese, with Professor Iwata’s permission, by Paul Kreitman, Assistant Professor in 20th Century Japanese History at the Department of East Asian Languages and Cultures, Columbia University.