Messaging matters.

I’ve been thinking about that with regards to the success Japan has had with the coronavirus. You see, Japan just ended its state of emergency. That’s despite being dealt a bad early hand: that country has the world’s most densely populated city in Tokyo and the world’s oldest population, (Japan’s elderly population is nearly double that in the U.S.). It is relatively close to the site of the first outbreak in Wuhan, and one of the first major outbreaks — the Diamond Princess cruise ship — was full of nearly 2,000 Japanese citizens.

And yet, Japan currently has fewer than 900 deaths, including just one in its most recent report. On a daily basis, Japan gets about one case for every three million residents, the approximate equivalent of Utah having just one new case per day — we are above 200 per day. Japan has beaten the coronavirus to an insane degree.

But what’s interesting is just how mild the coronavirus prevention measures were there. Officials didn’t impose restrictive lockdowns either at the national or local level. Japan has better contact tracing than the United States, but it’s not as good as South Korea’s. Among big nations, its testing rate is relatively low: countries with about the same number of cases per capita generally have tested between two and 20 times as many people.

Here’s what Japan does have going for it: public communication that worked, and a population that listened to good advice.

To stop the virus from spreading, Japan figured it had to know how the virus spread. So its public health leaders studied the places where coronavirus clusters happened. “We try to identify the clusters and [determine] their common characteristics,” Hitoshi Oshitani, a virologist and public health expert at Tohoku University, told Science magazine. “This has been the most important component of the strategy.”

These researchers found that most of the clusters had things in common: they “originated in gyms, pubs, live music venues, karaoke rooms, and similar establishments where people gather, eat and drink, chat, sing, and work out or dance, rubbing shoulders for relatively extended periods of time,” as Science explains. That’s similar to our own compilation of the research here at The Salt Lake Tribune. I could only compile studies from around the world, but they had the weight of the government behind their efforts.

That led them to create what they called the Three Cs of avoiding the coronavirus, where they instructed people to avoid closed spaces, crowded places, and close contact.

Japan's "Avoid the Three C's!" poster in English. (https://www.pref.tottori.lg.jp/item/1195022.htm)

Over the course of several weeks, they hammered this messaging. When cases reached their peak, they added a goal, asking people to reduce their number of contacts by 80%. And even though they weren’t being forced to, the Japanese people listened. The virus’ spread stopped.

Interestingly, there are significant studies that point to Americans’ capacity to listen, too. One study looked at Fox News viewership — not necessarily a group known for taking advice from experts. In particular, they compared viewers of Tucker Carlson’s and Sean Hannity’s programs.

Carlson actually focused on the dangers of the coronavirus relatively early, including three separate major segments on the show from Jan. 28 to Feb. 25. Meanwhile, Hannity underplayed the virus in multiple segments. He compared coronavirus deaths to car accident deaths, or violence in Chicago. Once, he called it a “hoax” Democrats were using to discredit President Donald Trump. (Fox News, by the way, defended Hannity’s reporting by pointing to his interview with Dr. Anthony Fauci in late January. That did happen, but in my opinion there was a clear difference in the way Hannity and Carlson approached the virus in its early days.)

Interestingly, both sets of viewers responded to the shows they were watching. Carlson’s viewers took social distancing measures three days earlier than the average Fox News viewer, while Hannity’s audience was slow — they started social distancing five days later than the average Fox News viewer. Getting it right also had an effect on the ratings for both shows: in April, for the first time, Carlson’s show surpassed Hannity’s.

But there is a degree to which over-the-top messaging can scare people too much. One study told two groups of people about the contagion rate of the disease: one was told the lower-bound scientific estimate that every sick person on average infects two other people, while the other was told the upper-bound estimate was a contagion rate of five. Despite thinking the disease was worse, the upper-bound group took fewer social distancing measures than the other group — figuring since everyone was going to get it so rapidly, their actions didn’t have an effect.

Another study was even more direct: researchers just showed two groups different messages about the pandemic. The over-the-top group got a message that contained the phrase “Some are beginning to wonder if physical distancing even works, or whether it is worth the cost to our economy and well-being.” The optimistic group got a message that emphasized the success of nations that did implement early.

The fatalistic group actually didn’t lose any support for social distancing measures, they just didn’t gain any. Meanwhile, the optimistic group showed more support for social distancing.

How different study groups supported COVID-19 mitigation efforts differently depending on the message they received. (https://www.researchgate.net/publication/340979910_Fatalism_in_the_Fight_against_COVID-19_Implications_for_Mitigation_and_Mental_Health)

Essentially, we have a lot of evidence that people respond relatively rationally to the messaging that they’re given. If they’re told that the coronavirus is a big deal and that they can help, they’ll do something about it. If the virus is minimized, or people are given data or messaging that indicates the virus is too contagious to control, they won’t change behavior at all.

Had these studies been conducted in Japan, I bet they’d be even more effective. For example, Japan has a holiday, the third Monday of September, called Respect for the Aged Day. On many public desks or counters, Japanese people have a variety of reading glasses ready for seniors to use. People frequently bow more deeply when speaking to Japanese elderly, or use a more formal mode of speech. With such a percentage of Japan’s population being so high-risk, their people may have been more willing to listen to the dangers.

Japanese citizens are also taught at an early age about the dangers of infections diseases and what everyday people can do to mitigate their spread. At the earliest sign of a sniffle or allergies, most Japanese folks will put on a mask. Sometimes, people wear them for fashionable reasons, or just to avoid putting on makeup. That cultural familiarity with masks probably helped reduce the barrier to getting more people to wear them.

In other words, with regards to COVID-19, Japan’s advantages in education and communication — as well as some differences in culture — outweighed their demographic disadvantages. And that gives us real lessons to be learned locally: ones we can use to minimize a second wave, or even get a better handle on the next virus that comes around.

Andy Larsen is a Tribune sports reporter who covers the Utah Jazz. During this crisis, he has been assigned to dig into the numbers surrounding the coronavirus. You can reach Andy at alarsen@sltrib.com or on Twitter at @andyblarsen.