How culture has saved Japan from the ravages of the COVID-19?

Events that have transpired in the last three months have reminded mankind that every country, big or small, rich or poor is susceptible to mother nature. In a stark reminder of the 1918 Spanish flu that made the world poorer by 50 million humans, COViD 19 has set many industries on a path financial losses, while people struggle to come to terms with the disruption to their lives. Many states have descended into chaos and are imposing lockdowns.

Japan’s tryst with the virus

Japan has been relatively unaffected by the COVID 19 despite its geographical proximity to China. Japan, as of March 18, reported only 900 cases, while neighbor South Korea reported 8500. Buses, metro, restaurants, and cafes in Japan remain open and are bustling with visitors as usual. Preparations for the 2020 Olympics is also proceeding seamlessly. Why then, a country with a vast majority of its population over 80 years of age see mortality rate and infections less than a third of Italy?

Figure 1: Number of COVID-19 cases

Figure 2: Deaths from COVID-19

Japan has reported fewer than 10 deaths since its first case was reported on 14 Feb 2020. By comparison, South Korea reported 66 while Italy saw 3000 deaths. The USA and the UK which have fared slightly better up until mid-March have started to exhibit an unfavorable trend. Europe is the worst hit, with Spain and France reporting 18000 and 10000 cases respectively.

The Japanese culture plays a role in the prevention of community spread of COVID-19

According to the World Health Organisation (WHO), in order to prevent the spread of COVID-19, it is essential to follow social distancing and maintain sanitation and hygiene. The unique culture of Japan instills etiquette wherein people value personal space which fulfills the prevention criteria recommended by the WHO. Japanese customs like bowing instead of shaking hands and low levels of interaction with people contribute to minimizing physical contact. Bowing here is a symbol of remorse, respect, greeting, and gratitude. Thus, every Japanese citizen follows this social convention instead of touch-based gestures like handshakes or hugging which are customary in Italy and Spain.

Furthermore, following the golden rule “Treat others as THEY would like to be treated”, Japanese prefer not to bother anyone and avoid proximity with others. In case of social events such as weddings and funerals, small gatherings with closest members of the family are preferred over big-scale events. Moreover, weddings are arranged in homes rather than in public places.  

These etiquettes extend to other aspects of their social lives too. For instance, the first rule of behavior is “Do not speak to other guests”. In bars like Hitori in Tokyo, entry only for singles is allowed. Hikikomori is another custom that is socially acceptable in Japan. In Hikikomori, people completely withdraw from all forms of social interactions. Bars and eateries maintain a certain aesthetic; guests that appear too friendly to strangers are not welcome. Maintaining distance while interacting socially is a norm (exhibiting “high-context” communication); standing too close is considered inappropriate. More than 2 million people in Japan follow this culture as of 2019. By contrast, in Italy, physical touch is a part of socializing (exhibiting “low-context” communication), much like other parts of Southern Europe. Needless to say, this has helped contain the spread of transmission in Japan to a great extent.

Consider the country’s nursing culture. Studies have shown nursing to play an important role in infectious disease prevention (Arkansas State University, 2017; Stirling, Littlejohn and Willbond, 2004; World Health Organisation, 2001). Close attention to the infected patients’ hygiene and clinical settings, regular disinfection, active participation in their diagnosis and undertaking preventive measures for the spread of the disease helps reduce the risk of transmission. In Japan, nursing is deeply influenced by its culture of responding to one’s needs without being asked for. Nurses in Japan are deeply involved with patients’ needs through verbal and non-verbal communication. It helps them sense patients’ emotions and empathise with them while working in complete harmony with doctors. They are thus proactive rather than reactive to the problem of transmission. In comparison, nursing in Italy is strongly influenced by its political culture; they are often overwhelmed with multiple shifts, workplace conflicts, high patient workload and lack of autonomy, resulting in a lack of motivation and emotional turmoil. This begets a state of nursing care that is flawed, imperfectly executed and lacking in depth in relationships with doctors and patients.

All these Japanese customary norms indirectly support social distancing, due to which community-based spread of Covid-19 is not taking place in Japan.

Sanitation and hygiene follow social distancing

Sanitation and hygiene also take precedence in Japanese culture. For instance, footwear is left outside entering homes, traditional Japanese style inns, temples, some restaurants and historic buildings. This practice of hygiene is not only applied in private spaces but also in the public. School children in Japan see classrooms and bathrooms as a part of their education. Roaming in public sans a face mask when sick is seen as irresponsible and frowned upon. Furthermore, the Japanese consider eating while walking sloppy, while blowing a nose in the public is considered rude. Such practices reduce the risk of transmission of viruses and bacteria among people.

Lessons that can be learnt from Japan

Even without a nationwide lockdown and favourable demographic composition, Japan has been virtually safe. Japan has set an example for the rest of the world in the rules of socialising by preventing clusters of outbreaks even in a densely populated city like Tokyo. Will the 21st century human, a slave to technology and unempathetic to sustainability, adopt the Japanese cultural traditions for survival? Only time will tell.

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