Factors Explaining Japan’s Low COVID-19 Mortality: Comparison with Rich and Democratic Countries

The novel coronavirus (SARS-CoV-2) caused a large number of deaths during the COVID-19 pandemic. The pandemic had a greater impact on wealthy and developed countries. Considering the per capita deaths and fatality-to-case ratio, also known as the case fatality ratio (CFR), Japan was among the least affected countries. The CFR of Japan was compared with nine other democratic and wealthy countries: the US, Italy, Spain, France, Austria, Germany, Canada, Australia, and South Korea. Japan’s CFR was the second lowest at 0.2%, only behind South Korea with 0.1%. The highest rates were recorded by the US and Canada, each at 1.1%. The per capita (per 100,000 people) fatality rate of Japan was 57.72 deaths, whereas the US had six times more deaths compared to Japan. We calculated the mortality (fatality) rates based on the cumulative deaths as of March 16, 2023, when the pandemic was mostly over. The amount of GDP spent on healthcare in Japan, mask awareness, the stringency index (SI), vaccinations, urbanization, life expectancy (LE), and the age cohorts of the population were examined to determine the factors that resulted in a low mortality rate in Japan during the pandemic.