Japan Sees a Drastic Drop in Coronavirus Cases

In mid-August, Japan was recording over 20,000 daily coronavirus cases, its highest levels during the pandemic. On Wednesday, it reported just 310 nationwide.

About 70 percent of the eligible population has been fully vaccinated, the government announced Wednesday, and life in the country has returned to a state of cautious optimism and near normalcy from one of acute concern. Tokyo has lifted nearly all restrictions on daily life, and the subways, streets and shopping arcades are once again filled with people. The city has reported fewer than 50 daily cases for over a week.

Experts in Japan are unclear about what caused the precipitous drop in cases, although they agree that high vaccination levels and ubiquitous masking are probably the most important factors keeping the virus at bay.

In remarks to reporters on Wednesday, government experts said other factors, such as cooler weather, an effective testing regime and heightened caution during the recent surge in cases, may have also contributed to the sudden drop in cases.

They also noted that asymptomatic cases of the virus also seemed to be on the wane.

Testing levels in the country, however, are significantly lower than in its peer countries, which could mean an underreporting of cases. At the peak, Japan was performing only around 270,000 tests a day.

Unlike other countries, Japan had never gone into lockdown or put compulsory restrictions on people’s behavior. Instead, the government placed the country under a succession of national emergencies in which the authorities called businesses to voluntarily shorten their hours and urged citizens to reduce the amount of time they spent outside.

Nevertheless, infection levels in the country have remained relatively low through the pandemic, peaking at around 23,000 in late August before rapidly dropping. Total deaths in Japan stand at just over 18,200.

Despite the current low infection levels, government experts warn that the country could experience a new surge in cases in the winter as more activities move indoors. In preparation, officials say they will ease access to testing and increase the number of hospital beds available for coronavirus patients.

Hisako Ueno contributed reporting.

An experiment in Ukraine that pursued an aggressive campaign to vaccinate most inhabitants of one small town has yielded the expected results: very low infection rates and no hospitalizations for Covid-19.

In April, when Ukraine was still short on vaccines, only certain categories of the population, like teachers and doctors, were allowed to get vaccinations. But the Health Ministry made an exception for the town of Morshyn, in western Ukraine, allowing local health authorities to try to vaccinate all 6,000 residents.

Morshyn was chosen partly because its economy, which depends on tourism to resorts and spas, had essentially shut down because of the pandemic, and because it was thought people would be receptive to vaccination so they could resume working.

The plan was to give 70 percent of the town a first dose of vaccine in one month. But despite the economic incentive, distrust in vaccines was an obstacle. Nationwide, 56 percent of Ukrainians still say they will not be vaccinated.

Morshyn’s authorities went on the offensive.

“We realized that we need to call each person individually,” Dr. Henadiy Yukshynsky, the town’s chief doctor, said in an interview with local news media. “We created five special teams that called people and explained to everyone the need for vaccination.”

The local authorities posted billboards, set up tents with information tables inside, made videos for social networks and the news media, and created handouts advocating vaccination.

In the end, it took two months to vaccinate 72 percent of the town’s residents, far more than Ukraine’s nationwide rate of 16 percent, which is the lowest in Europe.

Across the country, infections and hospitalizations are soaring, with an average of 21,364 new cases a day over the past week. The death rate in Ukraine is higher now than during the first wave of Covid, with an average of 538 deaths per day. Panic is beginning to take hold, and more areas of the country have been designated “red zones” and placed under partial lockdown.

But life in Morshyn goes on as usual. It has no patients hospitalized with Covid and only 19 cases of the virus, 15 of them in people who were not vaccinated.

— Maria Varenikova

A large clinical trial has found that a common and inexpensive antidepressant lowered the odds that high-risk Covid-19 patients would be hospitalized. The results, published on Wednesday, could open the door to new guidelines for the drug’s use both in the United States and globally.

The drug, fluvoxamine, has been safely prescribed for nearly 30 years as a treatment for obsessive-compulsive disorder. But when the coronavirus started spreading, researchers were drawn to the medication because of its ability to reduce inflammation, potentially allowing it to quell the body’s overwhelming response to a coronavirus infection.

Several smaller studies of fluvoxamine earlier in the pandemic showed promising results, but none was as large or persuasive as the one published on Wednesday by a group of researchers in Canada, the United States and Brazil, outside scientists said. Among nearly 1,500 Covid patients in Brazil given either fluvoxamine or a placebo, the drug reduced the need for hospitalization or prolonged medical observation by one-third, the study found. It was published in The Lancet Global Health.

Some patients struggled to tolerate the drug and stopped taking it, the study said, raising a question among outside scientists about whether they had yet identified the ideal dose. But among those who had largely followed doctors’ orders, the benefits were even more striking. In those patients, the drug reduced the need for hospitalization by two-thirds and slashed the risk of dying: One Covid patient given fluvoxamine died, compared with 12 given a placebo.

“That’s really good,” said Dr. David Boulware, an infectious disease scientist at the University of Minnesota who worked on a smaller, real-world study of the drug in Covid patients in California. Plus, he added, “it’s not a shiny new, expensive drug. The nice thing about this is it has a known safety profile.”

Beyond proper dosing, the study left other questions unresolved, scientists said. Penny Ward, a visiting professor in pharmaceutical medicine at King’s College London, noted that part of the drug’s benefit appeared to come from reducing the need for extended medical observation, which the study tracked alongside hospital admissions. And most patients in the study were unvaccinated, Professor Ward said, so it’s unclear how well the drug would work in the vaccinated.

The new study, coming nearly a year after smaller trials of the drug, was a reminder of the difficulty that many researchers have had running large tests of Covid treatments. The Biden administration has made more funding available for such trials, scientists said, but enrolling enough patients has only gotten more difficult: Most high-risk Americans are vaccinated, and vaccine-averse people may be less likely to participate in trials.

Because fluvoxamine is already approved for treating O.C.D., doctors can already prescribe it “off label” for Covid. But Dr. Boulware said that prescriptions of the drug had increased only slightly during the pandemic, unlike other repurposed drugs with far less scientific support, like hydroxychloroquine and ivermectin.

“It hasn’t really gotten any cult following,” he said.

Federal treatment guidelines say that larger trials are necessary to evaluate the use of fluvoxamine for Covid, and scientists said they expected those recommendations to change on the basis of the new study.

The new findings are also expected to boost the popularity of the drug in less wealthy countries: A 10-day course of the drug costs about $4.

Gov. Kay Ivey of Alabama issued an executive order this week directing state agencies to not cooperate, whenever possible, with federal vaccine mandates, describing the Biden administration’s actions as an “overreach.”

The governor’s directive comes as some Republican governors across the country, playing to their conservative bases, have taken actions aimed at countering President Biden’s attempt to raise the country’s overall vaccination rate through expansive mandates.

The White House has issued an order requiring all federal employees, workers for federal contractors, and people who work for health care companies receiving Medicare and Medicaid to be vaccinated. The administration also has plans to ask companies with more than 100 workers to adopt vaccine mandates or weekly testing.

The federal mandates, along with masks in schools, are unpopular among conservatives, many of whom see them as an infringement on personal freedoms, and Republican elected officials in some states have sought to capitalize on that sentiment.

“Alabamians are overwhelmingly opposed to these outrageous Biden mandates, and I stand with them,” Ms. Ivey said in a statement.

In Texas, the Republican governor, Greg Abbott, issued a broad executive order that bars virtually any coronavirus vaccine mandate in the state. And in Florida, Gov. Ron DeSantis, who is seen as a possible G.O.P. presidential contender, has adamantly opposed any measures that would require vaccines or masks, saying they infringe on personal liberties.

Ms. Ivey’s order says state agencies should prepare to assist with a lawsuit that the Alabama attorney general is expected to file challenging the federal mandate.

Legal experts say the federal government has broad authority to address the public health crisis created by the pandemic, and Mr. Biden has predicted that his health orders will survive legal challenges.

Beyond political symbolism, the impact of Ms. Ivey’s order is unclear. It directs state agencies not to punish businesses and people who do not comply with the federal vaccine mandate. It also states that if an agency is required to enforce the federal mandate, employees should inform those businesses or individuals that the state “does not approve, condone or otherwise endorse” such mandates.

“The federal government’s outrageous overreach has simply given us no other option but to begin taking action, which is why I am issuing this executive order to fight these egregious Covid-19 vaccine mandates,” Ms. Ivey said in a statement.

Ms. Ivey has walked a fine line on the issue of vaccinations. During the summer, she expressed frustration over unvaccinated people’s refusal to get a shot, saying that it was “time to start blaming the unvaccinated folks, not the regular folks.”

“It’s the unvaccinated folks that are letting us down,” she told reporters in July.

Still, Ms. Ivey said that she is “adamantly” opposed to issuing her own vaccine mandate in the state, adding that she believed the way to increase vaccination rates was through “persuasion.”

Athletes traveling to Beijing for the Winter Olympics will be able to skip quarantine if they are fully vaccinated, a signal that China is willing to ease some restrictions to ensure that teams make it to the Games in February.

But athletes will still face strict rules, and punishment for violating them, including expulsion, the Beijing Olympics’ organizing committee said on Wednesday. The committee members did not specify what offenses would merit expulsion. But the Beijing Olympics are already shaping up to be the most extraordinarily regulated, large-scale sporting event since the start of the pandemic.

Organizers have outlined a “closed-loop management system” that will restrict athletes, officials, journalists and staff members to a bubblelike environment for the duration of their stay in China. Those in the bubble must be fully vaccinated or spend 21 days in quarantine, and they will also be tested for the virus daily. Currently, all overseas arrivals to China must undergo quarantine.

Other potential penalties for violating the rules include warnings, temporary suspension of credentials or other “relatively serious consequences,” Zhang Jiandong, a senior official on the committee, said at a news conference.

Tickets for the Winter Olympics will be sold exclusively to domestic spectators. Beijing’s Covid protocols so far appear more strict than those of the Tokyo Olympics in July and August.

At the Tokyo Games, athletes were not required to be vaccinated, and they were allowed limited contact with people outside the bubble. Some athletes violated the rules, including not wearing masks. And other people went on unauthorized sightseeing excursions. No participants, however, were actually removed from competition unless they tested positive for the virus, and the organizers allowed almost no spectators.

China enforces a strict “zero Covid” policy, carrying out widespread lockdowns and testing to eliminate even small-scale outbreaks. On Tuesday, it locked down Lanzhou — a northwestern city of about four million people — as officials tried to quash a small Covid outbreak.