COVID-19 Pandemic Response in Japan: What Is behind the Initial Flattening of the Curve?
2. History of COVID-19 in Japan and Basic Policies and Measures Applied
3. Emergency Law in Japan and its Implications
4. Characteristics of Japanese Lifestyles and Their Possible Implications
4.2. Healthcare System
- Cold symptoms and/or a fever above 37.5 °C, which lasts for 4 days or more,
- Elderly or those with preexisting health problems,
- Heavy physical fatigue or trouble breathing.
4.4. Food Habits
4.5. Immune System
- Robust integrated health and emergency management policy, the basic healthcare system should be a core pillar of society. During the pandemic response, an integrated emergency response system is required, where decisions are made based on science and expert advice, and adaptive policy responses are ensured. Chan and Shaw (2020) provided several cases of incorporating public health in disaster risk reduction  and vice versa through the health emergency disaster risk management framework (WHO 2019) [47,48,49].
- A healthy lifestyle is key to promote a healthy immune system. An ecosystem-based lifestyle change is essential, as exemplified above in the case of Japan. Mukherjee et al. (2020) argued for an ecosystem-based business continuity plan to recover from COVID-19.
- Use of new and emerging technologies: online classes, meetings, telework, etc. Extensive use of 5G and other information-related developments is essential 
Conflicts of Interest
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|Aspect / Factors||Japan||Overseas|
|1. Government Response|
|Lockdown||No, but declared a state of emergency for seven prefectures that then evolved to a nationwide emergency state||Yes|
|Greeting||Bow, sometimes shake hands||Shake hands, hug, Cheek kissing|
|Wearing a mask||No emotional resistance||Emotional resistance|
|3. Health Care System|
|National Health Insurance Program||Universal (for all people)||Regional disparities|
|Medical system (guideline for COVID-19, CT scan, etc.)||Available with detailed guidelines||Available|
No. of CT 
|After CT scan|
|Basic handwashing with soap||Educated since childhood|
Washing hands after toilet :
Italy 57%, UK 75%
|Gargling throat||Educated since childhood||Not common|
|Hot water bathing||Japanese custom|
Almost all houses have a bathtub
|Shower instead of immersion bath|
|Ventilating a room||Open window||Air conditioner|
|Disinfection gel||At the entrance of a building or in a washroom||Regional disparities|
|Wet towel||Served when eating out||Served rarely|
|5. Food Habits|
|Eat seaweeds||Yes (marine algae, marine plants)||Rarely|
|Eat fermented food||Yes (miso, soy source, tsukemono)|
something that includes lactic acid bacteria)
|Few (e.g., yogurt, cheese, beer, wine) but a different type of Japanese foods|
|Cutlery||Chopsticks||Folk, knife, spoon, but sometimes use hands|
|6. Immune System|
|Spread type of COVID-19||S-type spread from China earlier than L-type, generating partial resistance||L-type spread|
|Intestinal environment||About 90% of Japanese have intestinal flora with genes for enzymes that disassemble dietary fiber in seaweed||Less than 15% have genes found in Japanese population|
|Response measure||Individuals take action to enhance their immune system||Depend on immunological mechanisms of vaccination|
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Tashiro, A.; Shaw, R. COVID-19 Pandemic Response in Japan: What Is behind the Initial Flattening of the Curve? Sustainability 2020, 12, 5250. https://doi.org/10.3390/su12135250
Tashiro A, Shaw R. COVID-19 Pandemic Response in Japan: What Is behind the Initial Flattening of the Curve? Sustainability. 2020; 12(13):5250. https://doi.org/10.3390/su12135250Chicago/Turabian Style
Tashiro, Ai, and Rajib Shaw. 2020. "COVID-19 Pandemic Response in Japan: What Is behind the Initial Flattening of the Curve?" Sustainability 12, no. 13: 5250. https://doi.org/10.3390/su12135250