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The only contact Yuumi Matsuno has had with her mother since the coronavirus reached Japan was on the phone, separated by a glass panel.
For 10 months, the nursing home Hisako lives in has restricted all visitors from 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] he doesn’t speak as much as he used to, “Ms. Matsuno said.
“When you talk on the phone, it is sometimes hard to hear and maybe you feel it is annoying, so you talk less.
“He also doesn’t have many topics to talk about because he does the same things inside.”
Holding her 91-year-old mother’s hand is what Ms. Matsuno misses most.
But with a third wave of infections gripping Japan, any chance of reunification will likely be delayed until next year at the earliest.
Because Japan has a lower death rate
Japan, which has the oldest population in the world, is once again experiencing a wave of COVID-19. More than 2,500 cases were detected there earlier this month.
But what was surprising was that the COVID-19 death rate in the country remained relatively low at just 1.53 deaths per 100,000 people, according to Johns Hopkins University.
It is significantly lower than the United States, at 78.2 per 100,000 people, and even lower than Australia, with a death rate of 3.63 per 100,000.
Part of the reason the rate has remained so low has been the swift and rapid relocation of some aged care facilities to block them.
Many aged care homes had already put rigorous measures in place to control seasonal flu when the virus hit Japan around February, according to aged care expert Toshihisa Hayasaka.
“So limiting visits isn’t a special measure and was done during normal times when the flu was ongoing,” said the associate professor at Toyo University.
“But it has no precedent to completely prohibit visits like this time.”
Since February, most aged care facilities have been locked down and have so far managed to safely protect residents.
Each nursing home has its own individual rules, and many even have staff restrictions in place.
For example, in a nursing home in Sendai, northern Japan, staff are prohibited from interacting with friends and family from Tokyo and surrounding regions.
Staff were also urged to “avoid going to drinking parties”, as well as shopping malls, live events and cinemas.
“Japan’s unique culture is, for example, that we don’t have to do something, but everyone feels like they have to follow it and it works, in a good way,” said Ryoichi Yanaginuma, who runs the nursing home where Hisako lives.
“We feel a responsibility to provide a safe environment and I think it’s because everyone is good at wearing masks and washing their hands in Japanese society.”
However, it wasn’t all perfect; a nursing home on the northern island of Hokkaido saw around 70 percent of residents become infected with the coronavirus, and at least 15 people died.
“Many people have died in the Hokkaido case, but not many people have died as a result of clusters,” said associate professor Hayasaka.
“After the Hokkaido case, they separated people with severe and mild conditions from the initial stage and prevented infection – I think it was effective.”
The third wave isn’t over yet
The challenge now will be to continue keeping a third wave of infections out of homes and aged care facilities.
The Japanese Ministry of Health said there were 263 groups in aged care facilities in Japan as of November 16 and 2,147 in the country in total.
It did not provide information on how many people within those 263 clusters had died.
But Japanese scientists learned a lot from the Diamond Princess fiasco earlier this year, when 712 people on board contracted the infection, including 14 dying.
During the unprecedented crisis on board, just as the little-known virus was emerging globally, the outbreak proved to be an extraordinarily valuable source of data on the spread of the virus.
It helped formulate the country’s “3C” approach, avoiding enclosed spaces with poor ventilation, crowded and tightly-knit environments.
It has now evolved into the “5 reserves”: keeping groups small, meals short, voices low, portions separate and rooms ventilated.
And while the country has been severely criticized for a lack of testing – with rates still low to date – teams of “cluster busters” have competed to track down super speakers.
Japan’s national network of public health centers, known as hokenjo, has existed since the 1930s.
Experts say their abilities to find close contacts in the fight against tuberculosis have helped in the effort to track down the coronavirus.
They helped the country get through the first and second waves, but this time around they may have a hard time dealing with COVID-19 cases.
The problem is when the numbers of infections start to rise, reaching the kind of levels that are now observed, the cluster tracking teams start to get overwhelmed.
In the second wave of July-August, many infections were people in their 20s and 30s getting them in bars, but now the number of cases from 40 and over is on the rise.
Only 8.2% of infections in July involved people over 60.
As of November 17, it is 17.1%.
It is infections among the elderly that will begin to strain and potentially collapse the country’s medical system.
During the third wave, the government suspended parts of an internal travel campaign aimed at stimulating the economy, but some health experts criticized the lack of urgency.
Residents may lose willpower and quality of life
There are also concerns that while the coronavirus may have been largely kept out, a new insidious threat is emerging from within: dementia.
Ms. Matsuno said she was concerned that her mother Hisako may show the first signs of the disease.
“Sometimes my mother asks ‘why can’t you come here?’, ‘Why do we talk through the glass?'” She said.
“He also asks ‘when can I go out?'”
Mr. Hayasaka said that in such settings, dementia would get worse.
“[Residents] lose their willpower and quality of life within the facilities, “he said.
“And if older people can’t – or are afraid to use home care services – their bodily functions may not be able to be maintained and dementia will get worse too.”
It prompted Hisako’s nursing home staff to try to create new ways to bring the outside world to the residents.
Once a week a student will live stream a walk in a park or a stroll through the shops. Residents can also place their orders for snacks, sweets and fruit.
“Many people in the nursing home stay inside the facility every day and cannot breathe fresh air,” said volunteer Kazuomi Hanaoka.
“So I show them the sky and the weather today and I say things like ‘it’s sunny today, it’s a hot day’ and then I try to share that feeling.
“I try to do it so that older people feel like they bought things themselves.”
As the cases continue to grow, the hope is that this will be enough to keep going until the day when the families are able to reunite again.
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