TOKYO — My Home Harumi, a nursing home in central Tokyo, is on lockdown.

Volunteers, service providers and even family members are turned away in hopes of keeping the center sealed against the spreading coronavirus. A sense of crisis pervades the home as employees wear masks, constantly wash their hands and disinfect every surface, said its deputy director, Kumi Iwasaki.

It’s a life-or-death mission: The virus kills older people at a far higher rate. The battle is being waged all across Japan, which has the highest proportion of elderly people in the world, as the number of reported cases in the country has steadily climbed to 230, with 11 deaths, mostly among people in their 80s. Globally, nearly 3,000 people have died, the vast majority in China.

Other countries with aging populations, like South Korea and Italy, which have both experienced recent surges in infections, are also facing acute challenges. Those two countries have done just what experts recommend: They have moved quickly to test large numbers of people so they can be treated and isolated from others.

But after weeks of caution, the Japanese government has only just begun to take more aggressive action, most notably by moving to close schools for a month. That step, though, was aimed at the young, who often show only mild symptoms or none at all when infected, not vulnerable older people, who sometimes develop severe pneumonia.

All the while, officials have maintained strict constraints on testing for the virus, which has only added to the fears about risks to the elderly.

South Korea is conducting more than 10,000 tests a day; Japan, by contrast, is performing only a tiny fraction of that. What’s more, the Japanese authorities recommend that elderly patients be tested for the coronavirus only after they have had a fever for at least two days (for most others, it is four days).

That may be too late for many older people, said Masahiro Kami, a physician and executive director of the Tokyo-based nonprofit Medical Governance Research Institute.

“What we know is that older patients are the most vulnerable, and once they get sick or ill, they quickly deteriorate,” Dr. Kami said. “They should definitely not wait two days.”

He speculated that the limitations might be driven by politics, as Prime Minister Shinzo Abe seeks to keep the spread of the virus from derailing the Tokyo Olympics. “It may be Abe or someone around him wants to downplay the number of infections or patients because of the upcoming Olympics,” Dr. Kami said.

Whatever the motivation, given Japan’s large aging population — about 29 percent of its 36 million people are 65 or older — experts said the country’s testing gap could leave the most vulnerable people exposed.

  • Updated Feb. 26, 2020

    • What is a coronavirus?
      It is a novel virus named for the crownlike spikes that protrude from its surface. The coronavirus can infect both animals and people and can cause a range of respiratory illnesses from the common cold to more dangerous conditions like Severe Acute Respiratory Syndrome, or SARS.
    • How do I keep myself and others safe?
      Washing your hands frequently is the most important thing you can do, along with staying at home when you’re sick.
    • What if I’m traveling?
      The C.D.C. has warned older and at-risk travelers to avoid Japan, Italy and Iran. The agency also has advised against all nonessential travel to South Korea and China.
    • Where has the virus spread?
      The virus, which originated in Wuhan, China, has sickened more than 80,000 people in at least 33 countries, including Italy, Iran and South Korea.
    • How contagious is the virus?
      According to preliminary research, it seems moderately infectious, similar to SARS, and is probably transmitted through sneezes, coughs and contaminated surfaces. Scientists have estimated that each infected person could spread it to somewhere between 1.5 and 3.5 people without effective containment measures.
    • Who is working to contain the virus?
      World Health Organization officials have been working with officials in China, where growth has slowed. But this week, as confirmed cases spiked on two continents, experts warned that the world was not ready for a major outbreak.

“What you’re telling me is that Japan is a senior living facility at a larger scale,” said Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center in Nashville. “That would motivate me, if I were the minister of health, to test more broadly and to open up testing.”

Mr. Abe promised on Saturday to make testing more widely available. Speaking during a hastily called news conference, he acknowledged that the screenings had been insufficient and said that the government would add the procedures to the national health insurance plan and expand the number of locations able to administer them.

Japan currently has the capacity to conduct about 4,000 tests a day, but it has carried out less than half that number on any given day since the crisis began, according to statistics provided by the health ministry.

That approach differs dramatically from those of other places in East Asia that have been hit by the virus.

South Korea, which reported on Saturday that cases in the country had risen to 3,150, has offered drive-through testing in Daegu, a hard-hit city, and other places, while in Hong Kong, clinics have begun to give residents kits that allow them to take the tests at home and send them to a lab.

“You wonder, if they were testing nearly as much as South Korea is testing, what would the actual number be? How many cases are lurking and just aren’t being caught?” said Tobias Harris, an expert on Japanese politics at Teneo Intelligence in Washington.

Making the problem worse, only a small number of public health centers in Japan have been authorized to provide the tests, which can be processed by just five companies selected by the government, creating a potential bottleneck.

That has forced clinics to turn patients away, even when they are presenting serious symptoms like high fever, according to news reports and statements from the Japan Medical Association, which said it had begun looking into the issue.

Erika Tamada, 33, a nursery school teacher from Hyogo Prefecture who lives with her 59-year-old parents, 83-year-old grandfather and younger sister, said both her mother and grandfather had had fevers and other symptoms, including runny noses and coughs.

But neither of them has been able to get tested for the virus, by local public health clinics or by the hospital they visited. Ms. Tamada said she was taken aback when a doctor at a health center told them to “wash hands, gargle and just work hard not to get infected.”

It is not clear why Japan lags behind other governments in the region in its ability to test for the virus.

Yasuyuki Kato, a professor of infectious diseases at the International University of Health and Welfare in Narita, Japan, said the country had been largely untouched by past outbreaks of coronaviruses, such as SARS and MERS, giving it a false sense of security.

Among the “neighboring countries of China, only Japan has no experience of managing any of the diseases,” he said, adding that there was “insufficient preparedness” for handling an emerging illness.

Policymakers in Japan first came under heavy criticism for their response when they instituted a quarantine of the cruise ship Diamond Princess, where the pathogen rapidly spread among passengers, crew members and the medical professionals tasked with providing care.

Despite the severity of the outbreak, the authorities were slow to test those on the ship, saying that resources were limited. Feverish passengers waited in their cabins for days without seeing a doctor, and once the two-week isolation period ended, the authorities allowed a number of people who had been exposed to the virus to slip away untested, without submitting to an additional quarantine.

Experts said the government needed to strike the right balance on screening for the virus. Some worry that if testing is increased too much, the nation’s health care system could be overwhelmed.

Hospitals in metropolitan areas are already filled with patients exhibiting mild symptoms, said Masaya Yamato, a doctor at the Rinku General Medical Center in Osaka. If the number of patients increases dramatically, that could hinder care for the most serious cases, he said.

“Most hospitals are not used to accepting such patients, so they can’t save patients who should be saved,” he said, adding that difficult cases leave medical workers “exhausted.”

“If they have many such patients,” he added, “it makes it more difficult for hospitals to treat older patients with serious conditions.”

Reporting was contributed by Hisako Ueno and Eimi Yamamitsu from Tokyo; Su-Hyun Lee from Seoul, South Korea; and Tiffany May from Hong Kong.



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