(ABC.NET) – The only contact Yuumi Matsuno has had with her mother since coronavirus reached Japan has been over the phone, separated by a pane of glass.
For 10 months, the nursing home Hisako lives in has limited all visitors from the outside, except staff, in part to prevent any potential spread of COVID-19.
While it has largely been successful, it has come at a cost.
“She [my mum] doesn’t talk as much as before,” Ms Matsuno said.
“When you speak on the phone, sometimes it’s hard to hear and perhaps she feels it is troublesome, so she speaks less.
“Also she doesn’t have a lot of topics to talk about as she does the same things inside.”
Holding her 91-year-old mother’s hand is what Ms Matsuno misses the most.
But with a third wave of infections gripping Japan, any chance of reunion will likely be delayed until next year at the earliest.
Why Japan has a lower death rate
Japan, which has the world’s oldest population, is once again experiencing a surge in COVID-19. More than 2,500 cases were detected there earlier this month.
But what has been surprising is that the COVID-19 death rate in the country has remained comparatively low at just 1.53 deaths per 100,000 people, according to Johns Hopkins University.
It’s significantly less than the United States, at 78.2 per 100,000 people, and is even less than Australia, at a rate of 3.63 deaths per 100,000.
Part of the reason the rate has stayed so low have been the early and swift moves by some aged care facilities to lock down.
Many aged care homes had already put in place strict measures to control seasonal influenza when the virus hit Japan around February, according to elderly care expert Toshihisa Hayasaka.
“So limiting the visits is not a special measure and it’s been carried out during normal times when the flu was going around,” the associate professor at Toyo University said.
“But it’s unprecedented to completely prohibit visits like this time.”
Since February, most elderly care facilities have remained locked down, and have so far managed to safely protect residents.
Each nursing home has its own individual rules, with many even putting restrictions in place for staff.
For example, at a nursing home in Sendai, in northern Japan, staff are prohibited from interacting with friends and family who come from Tokyo and surrounding regions.
Staff have also been urged to “restrain from going to drinking parties”, as well as shopping malls, live events and movie theatres.
“The unique culture of Japan is, for example, we’re not being forced to do something, but everybody feels like they have to follow and it works, in a good way,” said Ryoichi Yanaginuma, who runs the nursing home where Hisako lives.
“We feel the responsibility that we must provide a safe environment and I think it’s because everyone is good at wearing masks and washing hands in Japanese society.”
However, it has not all been perfect; one nursing home on the northern island of Hokkaido saw around 70 per cent of residents become infected with coronavirus, and at least 15 people died.
“Many people died in the Hokkaido case, but not many people have died from clusters after that,” Associate Professor Hayasaka said.
“After the Hokkaido case, they separated people with serious conditions and mild conditions from an early stage and prevented the infection — I think that was effective.”
Third wave not over yet
The challenge now will be continuing to keep a third wave of infections out of aged care homes and facilities.
Japan’s Health Ministry said as of November 16, there had been 263 clusters in elderly care facilities in Japan and 2,147 in the country in total.
It did not provide information about how many people within those 263 clusters had died.
But Japanese scientists have learned a lot since the Diamond Princess fiasco earlier this year, when 712 people on board contracted the infection, with 14 of those dying.
During the unprecedented crisis onboard, just as the little-known virus was emerging globally, the outbreak proved to be an extraordinarily valuable source of data about how the virus spread.
It helped formulate the country’s “3Cs” approach — avoiding closed spaces with poor ventilation, crowded and close-contact settings.
That’s now evolved into the “5 keeps” — keep groups small, meals short, voices down, portions separate and rooms ventilated.
And while the country was severely criticised for a lack of testing — with rates still remaining low to this day — teams of ‘cluster busters’ raced to trace down superspreaders.
Japan’s nationwide network of public health centres — known as hokenjo — have been around since the 1930s.
Experts say their skills in finding close contacts in the fight against tuberculosis helped in the tracing effort with coronavirus.
They helped the country see off the first and second waves, but may struggle to tackle COVID-19 cases this time around.
The problem is when infection numbers start to escalate, reaching the kind of levels being observed now, cluster tracing teams begin to get overwhelmed.
In the July-August second wave, many infections were people in their 20s and 30s catching it at bars, but now the number of cases from people 40 and above is increasing.
Only 8.2 per cent of infections in July were among people over 60.
As of November 17, it’s 17.1 per cent.
It’s infections among the elderly that will start to strain and potentially collapse the country’s medical system.
Amid the third wave, the Government has suspended parts of a domestic travel campaign aimed at stimulating the economy — but some health experts have criticised the lack of urgency.
Residents could lose their willpower and quality of life
There are also concerns that while coronavirus might have been largely kept out, an insidious new threat is emerging from within — dementia.
Ms Matsuno said she was worried that her mum Hisako might be showing early signs of the disease.
“Sometimes my mum asks ‘why can’t you come over here?’, ‘why are we talking through the glass?'” she said.
“She also asks ‘when can I go outside?'”
Mr Hayasaka said that in such environments, dementia would get worse.
“[Residents] lose their willpower and quality of life within facilities,” he said.
“And if elderly people can’t — or are afraid to use at-home care services — their body functions may not be able to be maintained and the dementia will get worse as well.”
It has prompted staff at Hisako’s nursing home to try to create new ways to bring the outside world to residents.
Once a week a student will livestream a walk through a park or a stroll to the shops. Residents can even place their orders for snacks, sweets and fruits.
“Many people at the nursing home are staying inside the facility every day and unable to get any fresh air,” volunteer Kazuomi Hanaoka said.
“So I show them the sky and today’s weather and say things like ‘it’s sunny today, it’s a warm day’ and so I try to share that feeling.
“I try to do it in a way so the elderly people can get a feeling that they bought the things themselves.”
As cases continue to grow, the hope is that this will be enough to get by until the day families will be able to reunite again.