Do infected people get what they deserve? Covid stigma in Japan

Diseases as deserts

Do you believe that people who get infected with Covid get what they deserve? If you’re Japanese, you’re much more likely to say “Yes” than a Briton or American.

Percentage of people who think people infected with Covid get what they deserve.

Obviously, people who think this way don’t constitute a majority of the population, but they are a loud and influential minority. So what kind of people hold this belief in just deserts (BJD) regarding people infected with Covid? A recently published study looked at results of a survey of about 1200 Japanese done in 2020. Respondents were asked for their level of agreement with the statement “I think anyone who gets infected with the Coronavirus (COVID-19) got what they deserved.” The authors found the following.

the BJD was significantly lower among women than among men. Further, it was lower among married individuals than among unmarried individuals and among those with children than among those without children. It also decreased with increasing age. However, no significant association existed between the region of residence, population density, educational background, or occupation and the BJD.

The authors also investigated the association with BJD and support for Covid restrictions. The seven question items included the following gems.

“In emergencies, anyone who goes out against government lockdown policy should be punished by law,”

“In emergencies, every citizen can autonomously take action to ensure that government policies are respected,”

“In emergencies, every citizen should watch over to ensure that government policies are respected.”

I’m sure you won’t be surprised to learn that “the BJD was…positively associated with human rights restrictions.” Put simply, people who hold prejudiced views toward the infected also hold punitive views toward people who don’t follow Covid rules.

Partial correlation for the belief in just deserts (BJD). Control variables: gender and age. CI: confidence interval. Areas of circles are proportional to the number of respondents (N).

The authors avoid drawing conclusions about causality, but I’ll have a go. Most BJD holders probably think that if you ignore the government’s instructions and leave your house unmasked to meet your friends for drinks during states of emergency, then you’ll deserve it if you catch Covid. And even if you don’t catch Covid, you deserve to be punished for your irresponsible behaviour anyway.

Stigma is infectious

Fortunately for the likes of me, the Japanese government is constitutionally prohibited from committing the wide-ranging human-rights abuses seen elsewhere during the pandemic. So instead, it relied on hysterical media reporting to exploit this prejudiced characteristic of Japanese society in order to make a PRC+ test be treated as a serious crime. And in collectivist Japan, your sins reflect upon those around you.

This example from April 2020 should give you some idea of the stigma associated with Covid early in the Pandemic.

On Thursday, Osamu Sekiguchi, chairman of Koriyama Kaisei Gakuen, an operator of private school Koriyama Women’s University and College in Fukushima Prefecture, and an affiliated high school, said in a recent news conference that some of his students and staff have been ridiculed after a female professor tested positive for the virus.

After one of its high school students, who was wearing a school uniform, was called disparaging names, all students were advised not to wear their uniform when coming to campus during the school closure for club activities.

According to the school, there have been about a dozen confirmed reports of such discriminatory treatment, including cases in which young children of school staff and younger siblings of its students were being denied entry in day care centers even though they did not have any close contact with the infected professor.

You’ll notice that even people several degrees of separation from the positive case were discriminated against. Now that’s what I call stigma!

It’s for this reason that organisations usually held press conferences to apologise after outbreaks of PCR+ had occurred.

42 members of baseball clubs test positive at the East Japan Tournament. Officials apologise for their response

It’s hard work living in such a society. Another survey of Japanese people also done in 2020 found the following.

“social pressure,” not “infection risk,” was one of the major concerns of our respondents. Social pressure refers to criticism and discrimination that they anticipate receiving from others should they contract COVID-19. It is possible that the collectivist nature of Japanese culture coupled with the government’s policy of relying on personal responsibility to combat COVID-19 explains some of the above findings, as the latter has led to the emergence of vigilantes. The presence of mutual surveillance can contribute to growing skepticism toward others as well as fear of ostracism, which may have negative consequences at both the societal and individual levels.

There’s evidence to suggest this social pressure and paranoia pushed some people over the edge. Okada et al. found that rises in female suicides in 2020/2021 positively correlated with the number of reported Covid cases (but not deaths) among Japan’s prefectures, which suggests watching nightly news reports about PCR+ numbers isn’t good for your mental health. This helps to contextualise why so many people surveyed in early 2021 thought that getting the vaccine would ease their anxiety.

The fact that many people fear social sanction more than the virus partly explains why Japan achieved such a high vax rate among the working-age population in 2021 without restrictions and mandates, as I’ve already written about before. But a real-world example always helps to clarify things.

An article in business magazine Toyo Keizai describes the experience of a woman who didn’t get the jab due to health reasons and caught Covid in early 2022. Because her coworkers, who all knew her vaccine status, had to cover her work for 10 days and take time off themselves to get tested, her relationship with them turned 180, and she was the subject of harsh looks and backbiting when she returned to work.

Whether or not the jabs stop infections is irrelevant here; it’s perception that matters. Wearing your mask and getting your jabs is how you show your coworkers that “I’m doing my best to stop the spread and not cause any bother” so that they’re more likely to forgive you if you test positive.

Dare you show your face?

As more and more Covid waves have come and gone, the public has become less concerned about Covid. But the above-mentioned “mutual surveillance” and “fear of ostracism” are still present, which explains why most people still wear masks outdoors when it’s raining. This is despite the vast majority of people below retirement age now ignoring the government and media’s desperate pleading that they help to reduce the stock of Omicron boosters.

Omicron booster rate by age group up to 19th December

The Japanese concepts of tatemae (建前, public front) and honne (本音, true feeling) explain the current situation for many people now: masks are for tatemae (“I’m a responsible person who follows the rules to stop the spread of Covid”) and vaccine decline is honne (“I’m not getting another jab with nasty side effects to slightly lower my chances of catching a cold”). Of course, this still means Japanese people who want to unmask daren’t for fear of social disapproval, and the government and media have no interest in helping them.

The western media have claimed peer-pressure and fear of social disapproval are reasons for Japan having fewer Covid deaths than the west and lauded Japan as worthy of emulation. There are certainly various positive things the west can copy from Japan. But stigmatising the infected and unmasked definitely isn’t one of them.

Copying the Japanese: Masks, microbes, and meals (Updated 23rd July)