An article in the May 4 issue of The New Yorker outlined the differences between Seattle and New York in their initial responses to the new coronavirus. Washington was the first state in the United States to identify a resident who had contracted the virus, and Seattle, its biggest city, quickly acted to contain a serious outbreak. New York was relatively slow to address the pandemic and has since seen more than 15,000 people die from the infection. Although the article is careful to point out the demographic and cultural differences at play, the general theme is that Seattle's success in bringing the virus under control was because scientists were in charge of the message from the start, while politicians were directing traffic in New York.

Something similar could be said about the difference in response between South Korea and Japan. South Korea managed to suppress its own outbreak early on thanks to a concerted effort to test and trace based on expert guidelines. Japan's methods have been more improvisational. The results seem encouraging in terms of reported deaths, which are below those in many other countries, but anecdotal news reports point to a troubling aspect in that people with serious symptoms have had to wait for medical care. Several have died. These stories reinforce others that explain how the main concern of the authorities is to prevent existing medical systems from being overwhelmed, which brings up two questions: How prepared was Japan for the pandemic, and how well can it medically adapt to the emergency going forward?

A recent article in Tokyo Shimbun says that the people in Japan who have shaped the response are neither experts nor politicians, but rather bureaucrats. Starting in the 1980s, one of the government's ongoing aims has been to reduce medical costs covered by the state through various national health insurance plans. According to Hidenori Sato, an associate professor at Tohoku Fukushi University, the health ministry began limiting the number of medical students in order to prevent an excess of doctors in 1982. This policy accelerated with Prime Minister Junichiro Koizumi's restructuring plan, which increased out-of-pocket payments for treatments from 20 to 30 percent and decreased compensation paid to medical institutions. More significantly, since 1994 the number of public health centers (hokenjo), which are managed by local governments but funded by the central government, have been reduced by almost half. Public health centers are the interface between the public and medical institutions during an infectious disease outbreak.