Why so little flu in Japan?

Most of the countries in East Asia have very low rates of Covid relative to the West. (BTW, That’s also true of Australia and NZ.) Some people have suggested that there is some sort of natural immunity in East Asia, and that the low Covid rates do not reflect differences in behavior.

I wouldn’t entirely rule out that hypothesis, but unless I’m missing something this seems to suggest that behavior is a factor, especially mask wearing:

Japan has suffered just 18 deaths per million people, a higher rate than in China, but by far the lowest in the g7, a club of big, industrialised democracies. (Germany comes in second, at 239.) Most strikingly, Japan has achieved this success without strict lockdowns or mass testing—the main weapons in the battle against covid-19 elsewhere. . . .

As early as March, Japanese officials began warning citizens to avoid the san-mitsu or “3cs”: closed spaces, crowded places and close-contact settings. The phrase was blasted across traditional and social media. Surveys conducted in the spring found that a big majority were avoiding 3c settings. . . .

While Americans argued over whether face coverings were an assault on personal freedom, Japanese lined up outside Uniqlo for the release of its new line of masks. During the first ten weeks of flu season this autumn, Japan saw just 148 cases of common influenza, or less than 1% of the five-year average for the same period (17,000).

Japan does have much less obesity, but it’s also a society with more elderly people than the West. Thus demographics alone cannot explain such an enormous difference in fatality rates.

But it’s the flu data that really caught my eye. Suppose there were some sort of natural immunity to Covid in Japan, how would that explain the extremely low levels of flu? Doesn’t it seem more likely that behavioral changes in Japan have reduced the flu season to only 1% of the usual level?

On the other hand, the flu is less contagious than Covid and flu rates are down sharply even in countries with high Covid rates. Thus it seems like a level of social distancing that is insufficient to stop Covid often is sufficient to stop a flu outbreak.

Another piece of evidence that behavior is important comes from the fact that Wuhan was hammered by Covid and the rest of China got off quite lightly.

To conclude, we know that social distancing stops the flu. The question remains as to whether it can stop Covid.

PS. Don’t miss the Christmas star (Jupiter/Saturn conjunction) tonight—the best in 800 years—even last night it looked very impressive. SW sky—an hour after sunset.

Update: This caught my eye:

True to form, on Friday a pro-Trump lawyer named L. Lin Wood, who spearheaded attempts to overturn Georgia’s president election results, lodged a new suit on similar lines, signing off his complaint that it he made his claims under “plenty of perjury,” rather penalty of perjury.

“I declare and verify under plenty of perjury that the facts contained in the foregoing Verified Complaint for Declaratory and Injunctive Relief are true and correct,” Mr Wood, an accomplished libel attorney with a large conservative following online, wrote in his complaint.

For once I agree; Mr. Wood engaged in plenty of perjury.

Update: On second thought, perhaps I better make it clear that I’m just joking here.



50 Responses to “Why so little flu in Japan?”

  1. Gravatar of Todd Kreider Todd Kreider
    21. December 2020 at 17:18

    Japan averages 3,200 deaths per year but last year was unusually high, thereby when Covid-19 struck, there were fewer vulnerable elderly. This year instead of flu deaths, the dominant coronavirus will have claimed 3,000 lives, those with an average age of around 82.

    Japan is counting Covid-19 deaths the same as it has counted flu deaths, unlike the U.S. where the CDC gave doctors far greater latitude to declare a death Covid-19 if that appeared anywhere on the death certificate. Up until this March, doctors were required to list a main cause on the Part 1 line, and the CDC changed that to “causes” (plural) in March.

  2. Gravatar of Jonathan Miller Jonathan Miller
    21. December 2020 at 18:05

    According to this paper, at least, there wasn’t much excess mortality in Japan this year. They only discuss data from the early part of the year.

    The nice national comparisons of excess mortality which shows how high the US is, and how Sweden has also increased recently, do not include Japan.


  3. Gravatar of ssumner ssumner
    21. December 2020 at 18:54

    Jonathan, Thanks for that info.

  4. Gravatar of dtoh dtoh
    21. December 2020 at 23:36

    As I’ve said before the most convincing hypothesis is BCG vaccinations. If you read the actual studies, I think you will find them convincing.

    As for masks, no that is not the reason.

    In the first Covid wave where Japan was one of the first countries to be hit, mask wearing was limited….. approximately 15 million unmasked riders on Tokyo subways and commuter trains everyday.

    Now mask wearing is much more prevalent, but if you go into restaurants and bars at night, everywhere is packed, no one wears masks, and people are inches away from each other. If you spent 5 minutes walking around Tokyo in the evenings you would really how ludicrous this theory is.

    Also most Japanese are wearing cloth masks which probably provide almost no protection and generally they lower their masks whenever they are talking.

    FWIW – I’ve stopped going to indoor bars and restaurants, and I wear a N95 respirator whenever I have to be in an indoor space.

    As for flu, 1) everyone is scared to go to the medical facilities so flu simply isn’t getting reported. 2) Unlike Covid, fomite transmission is probably a more common vector, so all the handwashing and alcohol dispensers probably help.

  5. Gravatar of Cartesian Theatics Cartesian Theatics
    22. December 2020 at 01:33

    Latest data on countries where bats are regularly eaten (Deaths/1M):

    philippines: 81
    indonesia: 70
    china: 3.4
    Nigeria: 5.97
    Madagascar: 9.6
    Malaysia: 13.21
    Guinea: 62.69
    Thailand: 0.86
    tanzania: 0.36
    Papua New Guinea: 0.91
    Vietnam: 0.36
    Liberia: 16.81

    Average: 22

    Other countries:

    USA: 921
    Europe: 364.07
    Germany: 283.21

  6. Gravatar of Cartesian Theatics Cartesian Theatics
    22. December 2020 at 01:35

    Oops, “Europe” is actually Canada.

  7. Gravatar of JMCSF JMCSF
    22. December 2020 at 04:57

    Anecdotal, but according to my friend who lives in Japan Covid is definitely being underreported and while there may not be official lockdowns people are staying in.

    Who knows, still interesting though.

  8. Gravatar of Todd Kreider Todd Kreider
    22. December 2020 at 05:03


    Did your friend in Japan explain where the Covid-19 deaths are being hidden?

  9. Gravatar of Alan Goldhammer Alan Goldhammer
    22. December 2020 at 06:24

    @dtoh – there is no convincing evidence that BCG vaccinations confer any kind of immunity for SARS-CoV-2 infection. There are a small number of trials going on with healthcare workers to see if the vaccine might be protective but no results have been published yet. All the papers that I have read on BCG being protective are based on very weak correlations and as we know ‘correlation is not causation.’ I’ve read an equal number that point to it having no effect at all.

  10. Gravatar of steve steve
    22. December 2020 at 07:30

    Criticizing spelling is elitist. Remember when Obama said he “visited 57 states and had two more to go” or when Quayle put an “e” at the end of potato? Oh, the horror. Everyone is sloppy sometimes.

  11. Gravatar of Michael Rulle Michael Rulle
    22. December 2020 at 07:40

    Have you not noticed we have the lowest number of deaths —-at least by attribution—to flu than we have ever had? CDC says 6900. But I do not know what that really means—-as flu has always been modeled, not counted—-although you need some counting to model. But 6900 includes “with or without Covid and with or without Pneumonia”. That is amazingly low. If it is with Covid, it most likely is also a Covid death—-it is okay to double count in these category differences—-as long as it it is well defined—-which Covid deaths are not.

    I think most observers agree with your premise regarding behavior in Japan——much more careful with the common sense rules. But your deduction that it is that behavior which is the dominant cause of lower deaths with Covid is pure speculation. Does not make it wrong, but I think it is unlikely. I am sure it helps of course. But there is something more fundamental going on—that’s my speculation. And many studies are in process to try and determine what it could be——genetics per se is one of many ideas being studied—-and is not high on the list.

  12. Gravatar of Jim B Jim B
    22. December 2020 at 08:29

    Do you suppose there is any impact of other customary differences aside from mask wearing? I’m just thinking that a pre-COVID greeeting in the West was often a handshake, hug, or a kiss on the cheek. Clearly much more exposure prone than a bow, but I haven’t been to Asia or studied the relative prevalence of touch vs. non-touch greetings in various countries. I would think that even a modest difference in touch vs. non-touch could drive a lot of difference in transmission rates of flu.

  13. Gravatar of Michael Rulle Michael Rulle
    22. December 2020 at 08:46

    Speaking of Covid——while Scott keeps obsessing over masks, Israel make an interesting point. An article by David Wallace-Wells using data from Israel notices that if we can persuade people over 75 to take vaccine, which represents 7.5% of people in Israel, deaths with Covid would decline by 75%. I know we have a “compromise’ in place in US with front liners and over 75 being the first.

    I think if we just did all over 65 you would not need front liners vaccinated——because their would be no patients—-virtually.

    I think we will be surprised when a large minority will not take the vaccine. Are they dumb? Maybe. I think we just don’t trust anything the government says—-more so now than in previous decades.

  14. Gravatar of Todd Kreider Todd Kreider
    22. December 2020 at 09:19

    Micheal wrote: “-as flu has always been modeled, not counted—-although you need some counting to model.”

    The flu had been counted but I think often lumped with pneumonia as the CDC does now. Modeling started in 2003.

    Michael also wrote: “But your deduction that it is that behavior which is the dominant cause of lower deaths with Covid is pure speculation. Does not make it wrong, but I think it is unlikely.”

    No, Scott is way off.

  15. Gravatar of H_WASSHOI (Maekawa Miku-nyan lover) H_WASSHOI (Maekawa Miku-nyan lover)
    22. December 2020 at 09:26


  16. Gravatar of xu xu
    22. December 2020 at 10:01

    To recap Scott “CCP” Sumner’s beliefs & values:

    1. Loves to see Uighers killed.
    2. Wants to “control” your behavior
    3. Thinks CCP totalitarian rule should be copied & implemented
    4. Thinks that typos — not the evidence – determine viability.
    5. Supports Pedophiles Hunter & Joe Biden.
    6. Supports crooked politicians
    7. Gets a boner when Hunter is banging a 13 year old Chinese with a crack pipe.
    8. Wants to legalize all drugs, because as we all know that worked in China during the century of shame.
    9. Thinks everyone should “do what they are told” and “shut up and deal with it”.
    10. Believes in relative morality over universality. In other words, he wants to remove the inalienable.
    11. Promoted BLM Marxists and Radical Antifa’s in an incompetent, unintelligible, July rant.
    12. Ignores Medical studies (over 90% of them) showing cloth masks are no more effective than covering your mouth with your hand, yet somehow claims he supports “science”
    13. Ignores 10,000 experts condemning economic shutdowns, but, remember, he supports “science”.
    14. Wants to devalue our currency and cripple future generations
    15. Refuses to acknowledge that 5000 allegations, and expert witness testimony might be worth investigating.
    16 Refuses to acknowledge that the forensic audit showed substantial irregularities – including manually removed logs, which is highly highly suspicious.
    17. Believes Maricopa county refusing to comply with a court order is “nothing to worry about”.
    18. Downplays threat of CCP, and suggests Russian Hacking is equivalent to exterminating Uighurs.
    19. Thinks Bolton – a war monger and military industrial complex puppet is a “viable source of information”.
    20. Refuses to publicly support Hong Kong, Taiwan, and the great legend Jimmy Lai.

    To summarize, he supports a lawless society, the very degradation of American culture, and the sick policies that we see implemented from both sides of the aisle – but predominantly from the totalitarian left.

    In short, he is a mouthpiece for the CCP.

  17. Gravatar of harry harry
    22. December 2020 at 10:15

    Lin Wood is an American Legend & Patriot who loves his country!
    Sumner is a fool.

    And no typo suggests otherwise.

    If you cannot attack the message, then you attack the messenger.

  18. Gravatar of harry harry
    22. December 2020 at 10:15

    Lin Wood is an American Legend & Patriot who loves his country!
    Sumner is a fool.

    And no typo suggests otherwise.

    If you cannot attack the message, then you attack the messenger.

  19. Gravatar of bob bob
    22. December 2020 at 10:29

    Humans around the world are being misled by the greedy globalist Scott Sumner, who is vying for a position on the globalist take over of the Federal Reserve.
    People are dying.
    Vaccines are designed for population control.
    Robots will replace us.
    Few remaining humans will either be forced to turn into cyborgs, or turned into gays like the frogs.

    Jan 6th is our last hope for human survival.

    Stop the CCP.
    Stop Sumner’s globalist agenda.

  20. Gravatar of Cove77 Cove77
    22. December 2020 at 11:22

    L Lin wood is a legend in his own mind. His legal deficiencies go well beyond typos tho that shouldn’t prevent him from making an ass of himself and his client


  21. Gravatar of Michael Rulle Michael Rulle
    22. December 2020 at 12:07


    Yah, way off is not much different than unlikely but I am with you. I like to use normal polite language. Not all the time. I’m not exactly St Francis of Assisi. In reality I think his flu argument makes no sense

    My point on flu is this. All flu numbers this year are 1) stand alone, 2) with pneumonia, 3) with Covid. In other words, if a person dies with flu with either pneumonia, Covid, both , or nether it adds up to 6900. That is record low by some large factor. It cannot be “true” or historical flu deaths are not true.

    The only death numbers that indicate a Covid problem is excess deaths. Yet excess deaths, as CDC keep repeating, is 1/3rd of deaths with no Covid. To claim that those deaths are indirectly caused by Covid is a bizarre way to frame it. It was caused by policy.

    So, we have excess deaths off 300 or so. . It’s a 12-13% death increase. That is a lot. If true. So if you had a .5 % chance of dying you now a .56% chance.

    But that assumes we know the baseline. It assumes we really know deaths in 2019-2020. I have to assume that Covid has caused many deaths.

    But don’t we have a vaccine too ? Maybe that’s make believe. Scott talks about masks in Japan —/I would rather talk about how to maximize vaccine usage for over age 65. All who want it by March 30th. When that happens great. If it doesn’t, who will be blamed?

  22. Gravatar of Carl Carl
    22. December 2020 at 12:46

    Someone less appreciative of your genius might consider it ironic that you posted your comment about Scott’s efforts to further CCP world domination on an article about how Japan has controlled the coronavirus in a laissez-faire way.

  23. Gravatar of Todd Kreider Todd Kreider
    22. December 2020 at 13:41

    “…an article about how Japan has controlled the coronavirus in a laissez-faire way.”

    Japan has not controlled the virus just as Denmark has not controlled the virus. The heading: “The Japanese authorities understood covid-19 better than most” is a joke.

    By the way, anyone notice that when the Western media quotes a Japanese expert it is almost always Hitoshi Oshitani?

  24. Gravatar of Carl Carl
    22. December 2020 at 13:45

    @Todd Kreider
    Okay. “Addressed” the virus in a laissez-faire way.

  25. Gravatar of jayne jayne
    22. December 2020 at 14:10

    Lin Wood grew up an orphan.
    Graduated top of his class.
    Has won a suit against CNN for defamation.
    Tough guy.
    Nice guy.
    And without question one of the nations preeminent defamation attorneys. He’s handled a wide variety of cases, but when it comes to defamation he as the top of the hierarchy. If you are Tom Cruise, and you need one Attorney to defend your name: Lin Wood is that guy! Nobody would turn him down. If he took your case, you ought to get on one knee and kiss his toes. That’s how amazing he is.

  26. Gravatar of janice janice
    22. December 2020 at 14:14

    That is why CNN never attacks him!
    They don’t want to lose another 330M.
    I cannot blame them

  27. Gravatar of Anonymous Anonymous
    22. December 2020 at 14:16

    Does anyone understand what the deal with accounts like jayne and bob is?

    They both have similar formatting and an extremely strange way of writing and their posts are generally a bunch of nonsensical assertions.

    But I’m curious: Are they bots, trolls, etc? Genuinely curious.

  28. Gravatar of dtoh dtoh
    22. December 2020 at 15:27

    @alan goldhammer

    You obviously haven’t read the studies.

  29. Gravatar of Anonymous Anonymous
    22. December 2020 at 16:33

    dtoh, could you post some of the studies? I know this was something that was debated earlier this year and I also thought it turned out not to be the case but it would be interesting to discuss.

  30. Gravatar of dtoh dtoh
    22. December 2020 at 18:15


    I commented before at

    Recent studies

    In addition there are many large scale random clinical trials underway.

  31. Gravatar of dtoh dtoh
    22. December 2020 at 18:49

    There some links and comments in early moneyillusion posts.

    More recently data from Cedars Sinai and study from St. Petersburg University.

    Also many large scale randomized trial are currently underway which given the funding and effort required suggests that it’s a reasonably probably hypothesis.

  32. Gravatar of ssumner ssumner
    22. December 2020 at 22:14

    dtoh, I’ve always thought the BCG vaccines mattered, just not as much as you do. But I have an open mind on the issue.

    steve, I never criticized his spelling, I praised it.

    (I never trust anyone who doesn’t have a sense of humor.)

    Jim B. Yes, I think other cultural differences in Japan also make a difference. (Less hugging, handshakes, yelling, etc., and more handwashing, etc.)

  33. Gravatar of Anonymous Anonymous
    22. December 2020 at 22:35

    dtoh, fantastic, will read over the next few days. Thanks!

  34. Gravatar of Todd Kreider Todd Kreider
    23. December 2020 at 01:07

    Scott wrote: “Yes, I think other cultural differences in Japan also make a difference. (Less hugging, handshakes, yelling, etc., and more handwashing, etc.)”

    That probably has some effect. Now try out that hypothesis in much louder South Korea where they have 40% fewer deaths than Japan then try it in Vietnam where they have had 35 Covid-19 deaths or 1% that of Japan. Cambodia and Mongolia have recorded zero COvid-19 deaths.

  35. Gravatar of rinat rinat
    23. December 2020 at 02:22

    Assad owns the libs in new video.
    Everything he says is true.


  36. Gravatar of sarah sarah
    23. December 2020 at 02:39

    That is an interesting video. I don’t agree with Assad about religion & marriage, but about gender, drugs, and cancel culture he’s certainly right.

    Obama should be prison for what he did to those people.

    The leftists cannot handle any type of dissent, nor can they accept different opinions. They want a globalist govt, so the uncooperative are being removed. It started with Saddam, then Gadhafi, and thank fully Russia stopped them from overthrowing Assad.

  37. Gravatar of Steve Steve
    23. December 2020 at 04:02

    I think there is little flu in Japan because of all the radiation.

  38. Gravatar of Michael Rulle Michael Rulle
    23. December 2020 at 07:27

    I like to hunt down odd numbers on Covid—-it’s an obsession of sorts. Not OCD—but obsessive. With that as a intro, here is my latest observation.

    As of 12/19 “excess deaths” are 12% since 02/01—about where it has been all year—-although it hit 13% a week or 2 ago. Even as Covid deaths are 4 times what they were in September. I assume this is a seasonal adjustment——more deaths occur in cold weather—-but that is a guess. So I find that interesting.

    What I find most interesting is the following. First, the term they use regarding Covid deaths——is “involving Covid” NOT caused by Covid. Second, they still are saying 1/3 of excess deaths do not involve Covid —-meaning the dead never had Covid. Using their 12% number excess deaths are, 300,000. (they know that later months are delayed, but in footnotes they appear to say they adjust for that ——in other words—-they compare the same time frames —-i.e comparing years using same methods—-when numbers were known —-so apples to apples.)

    Alright here it comes. Pretend there is some number—-let’s call it 20%—-it’s just a number—-use another if you like——-of the 288k “deaths involving Covid” were really 80% CAUSED by COVID. This would subtract 57K out of the Covid death column. Then, since there are 300k excess deaths, 100k did not have Covid.That means 200k had Covid. The numbers get confusing because excess deaths are only coincidently the same as “deaths involving Covid”.

    I subtracted the 57k from 288 to 221k deaths “caused” by Covid. Then added that to 100k for 157k —-for excess non Covid deaths. 378k deaths—-of which 300 are excess.

    This is obviously an approximation ——so 221 Covid and 157 not Covid. These are obviously meaningful and big numbers. And only 300 k are excess. What is my point?

    Why do we have so many excess not Covid? The answer seems to be by most, that we have under treated by policy and by over panic or fear the people.

    What politician tried to lesson fear? If there were less fear would there have been less non Covid excess deaths? I think it is yes. But we would not have known it——because it never would have happened. But it is reasonable that the media’s hatred of Trump caused deaths. And the Dems total war against him.

  39. Gravatar of Goldie Goldie
    23. December 2020 at 10:53

    Flu hospitalizations in CO are down 97% so far this season.


  40. Gravatar of ssumner ssumner
    23. December 2020 at 13:37

    Steve, That’s more like it. A little humor.

  41. Gravatar of dtoh dtoh
    23. December 2020 at 15:08

    @michael rulle

    To your point, after Fukushima, not a single person died or became ill from radiation, but 1500 older people died from being moved out of their homes and being forced to sleep on gymnasium floors.

  42. Gravatar of bob bob
    23. December 2020 at 22:11

    We know your plans sumner.
    And we’re coming!
    Its’ 1776 times.

    Sumner is starting to get nervous. He was hoping for a reset, and he got the AWAKENING. Now patriots everywhere will fight – against all enemies, foreign and DOMESTIC.

    We are human. And we are coming.

    All lies will be revealed.

  43. Gravatar of Benjamin Cole Benjamin Cole
    24. December 2020 at 03:18

    On the economic news front:

    Personal income decreased $221.8 billion (1.1 percent) in November according to estimates released today by the Bureau of Economic Analysis (tables 3 and 5). Disposable personal income (DPI) decreased $218.0 billion (1.2 percent) and personal consumption expenditures (PCE) decreased $63.3 billion (0.4 percent).

    Real DPI decreased 1.3 percent in November and Real PCE decreased 0.4 percent (tables 5 and 7). The PCE price index had no change. Excluding food and energy, the PCE price index had no change (table 9).”

    PCE core up 1.4% YOY.


    OK, so personal income and spending going down, and inflation still below target.

    How can the Fed answer this?

    How could stimulus checks answer this?

  44. Gravatar of Todd Kreider Todd Kreider
    24. December 2020 at 08:57

    Flu cases by week in Japan from 2015 to 2020:


  45. Gravatar of ssumner ssumner
    24. December 2020 at 09:24

    dtoh, That’s similar to our overreaction to 9/11.

  46. Gravatar of Todd Kreider Todd Kreider
    24. December 2020 at 11:04

    I don’t remember the American government forcing tens of thousands of people out of their homes of which 1,500 died from that.

  47. Gravatar of ssumner ssumner
    25. December 2020 at 08:56

    Todd, How many died in Iraq?

  48. Gravatar of Todd Kreider Todd Kreider
    25. December 2020 at 18:23


    You are seriously equating 500.000+ Iraqis killed by Americans as “similar” to the Japanese government accidently killing 1,500 their own people?

    OK, whatever.

  49. Gravatar of Todd Kreider Todd Kreider
    26. December 2020 at 05:00

    And 4,500 Americans.

  50. Gravatar of ssumner ssumner
    26. December 2020 at 09:24

    Todd, You seem to have a problem with reading comprehension. Maybe you should read things twice before commenting.

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