 Hello, everyone. Welcome to the Science Summit of the United Nations General Assembly COVID in Okinawa, how a remote island embraced science technology and pandemic preparedness. Thank you so much for your participation. We start the session. I'd like to explain that we will have simultaneous interpretation into English and Japanese. Please go to the globe mark at the bottom and choose your language, English or Japanese. Today's session is happening along the United Nations General Assembly in New York as part of the Science Summit aimed at supporting the use of science and technology for the achievement of the SDGs. From Japan, three sessions are taking part. Okinawa is being represented, like last year, by the Okinawa Institute of Science and Technology and Ryukyu Shimpou. I am Shimayoko, the Ryukyu Shimpou editor-in-chief and I will be your emcee for today. COVID-19 changed the world dramatically. It also gave a platform to the great work of many scientists and doctors. Okinawa had many cases, but was able to reduce the number of deaths relatively and the Okinawa model gained a lot of attention. We would like to look at COVID from a science perspective, reflecting on the past and thinking about the future. Again, we will have simultaneous interpretation for today's session. So please go to the bottom bar and select the language of your choice from the globe. And now, on behalf of OIST, the host, Heather Young, our VP for Communication and Public Relations, will give a few words. Thank you. Welcome. Konnichiwa and haitai, as we say in Okinawa. My name is Heather Young and I'm the very proud Vice President of Communications and Public Relations at OIST, the Okinawa Institute of Science and Technology. I'm also the summit's co-chair in Japan. Before I introduce this session, I would like to take a minute to thank everyone who has worked to make the summit and the session possible. I'd like to give special thanks to the Organizing Committee for their tireless work behind the scenes and for allowing us really the privilege to present at the Science Summit of the 78th UN General Assembly. And also, thank you so much to my team at OIST, our partners at the Ryukushinpo, and the awesome speakers today. Thank you all for your time and energy. And thanks to all of you for joining us. You are in for a real treat with speakers from the University of the Ryukus, the Okinawa Chubu Hospital, the Ryukushinpo, and OIST. Not only is the topic a meaningful one, but we are very fortunate to be with these speakers to meet. I have heard a couple of these passionate, brilliant individuals before and a couple I'm meeting for the first time. And let me tell you this lineup is incredible. The session will consider how science and technology, especially digital technology, are significantly changing society and our lives. And it will look ahead to a new future in which new science will be used to respond to new pandemics. And really to have this conversation at the Science Summit is a privilege. The primary objective of the summit is to understand the role and contribution of science in attaining the UN sustainable development goals. It builds on work from last year's summit, which was witnessed to 1600 speakers from every continent in more than 400 sessions. The summit brings together thought leaders, scientists, technologists, innovators, policymakers, decision makers, regulators, financiers, philanthropists, journalists, and community leaders from around the world. Thank you all for being part of this conversation and this community. Thank you for sharing Okinawa on the world stage. So, from Tomikusuku to Tokyo, from Toronto to Tunis, from whatever time zone you're joining us, I know you will enjoy this session as it informs and inspires you. Thank you. Thank you very much, Vice President Heather Young. For this year's session, we are inviting three speakers who were very involved in COVID anti-measures. We will, for the first half, ask for each presenter to present 15 minutes and then we will have a discussion to deepen our understanding in the second half. I would first like to introduce Professor Mahesh Bandy, he is a professor at OIST, specializing in non-linear and non-equilibrium physics. He put together an international medical team, suggested anti-COVID measures to governments around the world, and he also developed a machine to produce fiber when there was a shortage of masks. When India suffered from a shortage of medical oxygen, he developed an oxygen enrichment device using science and technology to develop what was needed. We'd like to understand the anti-COVID measures in Japan from his scientific perspective. Professor Bandy, please. Good evening. Good evening in Japan. Good morning in New York and good day from wherever you all might be joining. I'd like to first thank OIST and Ryukushin for this opportunity to share some of my thoughts and to meet some wonderful people, colleagues in the research community of mine, as well as all of you who are joining here. So let me start my screen share. So to give you a brief introduction of myself, I actually have very little to do with epidemics. I'm a professor of physics, I study experimental non-linear, non-equilibrium and soft matter physics, focusing specifically on fluid dynamics, disordered solids, life sciences and renewable energy. And as part of my work on renewable energy, I study with a loose-knit community of researchers on energy and infrastructure analysis, the resilience of electrical grids, networks. And network, the kind of tool kit we use is for network transmission electrical grid network. It's not really different from the pandemic network. And that is how I got involved in this with colleagues, like-minded colleagues from all over the world. But also at OIST, we worked on, used our experimental abilities to develop N9 to 5 quality masks in-house using a cotton candy machine, how to sanitize masks and electrocharge them using corona discharge treatment, and also DIY oxygen concentrators during the pandemic. But I will not be discussing that today. I would like to share my thoughts on how COVID ravaged communities and what lessons could we learn for future pandemics that are definitely going to strike us unfortunately. So, how nations responded to give you a very quick recap. 31st December 2019 is when WHO reported cases in Wuhan and 30th January 2020 is when WHO declared a public health emergency that's a technical term used to declare the pandemic. And incidentally, it's on May 2023 that the pandemic was called off finally. So, I'm going to compare two cases that of Singapore in Japan. On 31st December when WHO reported cases from Wuhan, Singapore activated a screening of passengers from Wuhan through order from the Ministry of Health. By 20th January passengers with pneumonia and 14-day travel history to China were being isolated and quarantined. By 22nd January, the disease outbreak response system Coordination of Dorscon was elevated to yellow, which basically activates interministerial civil service for quick emergency response. This was a system that was developed by Singapore in response to the first SARS pandemic. Singapore then went into lockout, prepared quarantine centers and isolation centers and then reopened a few weeks later and followed a calibrated system of circuit breakers, not lockdowns. And by 19th February 2020, they were in full-scale systematic testing program. In comparison, Japan reported its first case on 16th January and first fatality on 13th February. 30th January, the late Prime Minister Shinzo Abe established the National Pandemic Task Force and restrictions on passengers from schools were requested to close. The response of Japan was quite similar in timelines to most other countries. The question that is what asking between Singapore's response was the Japan's response is what was the thinking behind Singapore's response? And that has to with two lessons learned from the past. The first I've already mentioned, which was the Dorscon system that was set up by the Singapore government. And the second has to do with a civil servant who had been worrying about pandemics for several years and had studied the history of pandemics. So if we do go through a very quick brief and incomplete history of pandemics, the first we come across is a Justinianic plague that broke out in the Byzantine Empire in 541 of the Common Era. It took 200 years to spread across the world in multiple waves because there wasn't much people-to-people traffic across the inhabited world. Second big pandemic we are aware of is the Black Death that ravaged Europe. It started in 1346 in Kyrgyzstan and ended in 1353. It took four years to spread. So you notice that the timeline for spread is decreasing as people-to-people contacts are increasing. The Spanish flu of 1918 started in USA and ended in 1920 and took less than a year to spread. In comparison, COVID-19, which we have lived through, started in December 2019, ended in 2023 and took just weeks to spread. To give you an idea, let me just show you a graphic of how the spread occurred. So many of the first cases we know were clustered around the Huanan Seafood Market, which was next to the Hanko train station through which thousands of passengers passed every day. And this is in the city of 11 million people. Four cases grew to dozens by the end of December and doctors only knew that the patients had viral pneumonia that did not respond to the usual treatments. But in reality, there were nearly a thousand cases from estimates that we have obtained from various colleagues in the community. With each patient infecting two to three others on average, even a perfect response could not have contained this spread. The timing of the outbreak was rather unfortunate. What you're seeing here is a visualization of the major telecom transmission, that is the mobile users that were traveling across China. This is the passenger network. And this was the Lunar New Year, so a lot of people were moving. So Jan 1, this was the travel passenger network. And at least 175,000 people left Wuhan just on Jan 1 alone. The departure is accelerated and about 7 million people left by Jan 21st. But by then, thousands of travelers were infected. And by the time Chinese officials acknowledged the risk, and local outbreaks were already seeded in Beijing, Shanghai, and other major cities. And from between Jan 21st and Feb 4th, you see the travel network is almost extinguished. Wuhan is in lockdown. But local outbreaks were already growing very quickly. As the outbreak moved across China, international travel continued as normal. And thousands of people flew out of Wuhan to cities around the world. Over 900 people used to travel to New York, about 2,200 to Sydney. And over 15,000 people went to Bangkok, which is of significance, because the first case outside China was recorded from a 61-year-old woman who traveled from Wuhan to Bangkok, despite having a fever headache and a sore throat. Other early cases turned up in Tokyo, Singapore, Seoul, Hong Kong, Seattle, et cetera. And about 85% of the infected travelers were undetected, but they were still contagious. It was only at the end of Jan when Wuhan was placed in the lockdown that flights were cancelled. But it was too late. Outbreaks were already seeded in over 30 cities across 26 countries. The virus started spreading locally and infecting people. By March 1st, thousands of cases were reported in Italy, Iran, and South Korea. China was no longer the driver. In fact, China was systematically testing, tracing, and isolating patients. In fact, cases were declining dramatically. Similar thing happened in Singapore, Hong Kong, et cetera. But in the United States, where testing had lagged, President Trump suspended most travel from Europe. And these are the cases size of March 11th. By March 20th, they had grown to this size. So that is a pretty stark graphic of how the virus spread across the planet. The key lesson to learn is global connectivity and passenger traffic is what accelerated the pace. And there is a network science and complex systems and statistical physics which I am a student of. We know that beyond a certain point of connectivity and pace of traffic, there is something we call the transition to extinction in the pandemic setting. And this is a very scary scenario. We could not stop the pandemic from spreading because of the extremely high connectivity and very quick information and passenger traffic. The second lesson we learn is the importance of regular community testing for getting an accurate count as well as to control the asymptomatic people. Here is an example of a super spread event during spring break in Fort Lauderdale in United States in March 2020. Many students were actually enjoying spring break and all these people were enjoying the beach. I have taken this video from CBC News and this video here shows you an algorithm that is basically doing a contact tracing and it will show you how many people from that super spread event went on to infect how many more people across the United States. So within one week, the party, so it did not happen all at the same time but over a period of one week, 5,600 infections out of many thousands of people who congregated there. And from the 5,600 infections you will see just from this beach that I am highlighting now. If you look to your top right screen, you will see out of 52,000 people, 5,600 infections were recorded from this super spread event. And from there, if we zoom out and see how the infection, how they go on to infect others, the count is increasing all right, 370,000, 500,000, 870,000. So by the end of it, 5,600 people who were on that beach ended up infecting 870,000 people across the United States. It's pretty scary. Now the lesson 2 we learned is not lockdowns but calibrated measures. This is an old system that was actually figured out by civilization but we sort of forgot it. In the old days, Italian city-states like Venice and Genoa and the Ottoman Empire followed a calibrated system of border control, in fact the word quarantine is derived from the Venetian dialect Quaranta meaning 40 because ships had to remain for 40 days out at sea before they could enter the Venetian harbour. And this allowed them to maintain a normal life, commerce and economy was juggling along while dealing with the Black Death. In contrast, Marseille which had no such system, the port of Marseille did not have a Lasaretto. It saw 100,000 deaths in 1720 due to the great plague of Marseille. Now the third lesson we learned is testing is good but it has issues. So this applies specifically in Japan because Japan was fortunate to have low infection rates but even with low infection rates and particularly because of low infection rates, even if the test kit is of good quality, it does not guarantee an accurate test result. So let's consider where a test is taken by a patient. If the patient is positive and the test is positive, good. If the patient is negative and the test is negative, that's a good result. But if the patient is positive but the test is negative, we call it a false positive and if the patient is negative but test positive, that's a false positive. So a test with low rate of false positives has high specificity and with low false negatives has high sensitivity. So if a test has 95% specificity and 95% sensitivity and we applied to a population of 500 people with a low infection rate of 5%, then what you see is 500 dots. All the red dots are negative, are positives. Red dot with cross is a false negative, gray dots are negatives and gray dots with crosses are false positives. Now in this scenario, an individual who tests negative has 99.8% guarantee of getting the being negative, but an individual who tests positive only has a 50% chance of actually being positive because roughly 50 of the test results are false positives. On the other hand, if the same test is administered to a population of 500 people with 25% infection rate, then we see that in this scenario, 98.3% of a chance exists of actually the patient being actually negative, whereas an individual who tests positive has 86% chance of actually being positive. And there are ways to work around this because this is not a problem with the test, it is a problem with statistics. And this was actually worked out by two smart gentlemen, Daniel Kahneman and Amos Tversky, who coined base rate negligence or base rate fallacy and they won the Nobel Prize for this idea. And finally, the work around for this is doing something known as pool testing. This was worked out by Americans after the Vietnam war when the soldiers were returning, a lot of them had sexually transmitted infections. So the soldiers were pooled in groups of 10 or 15 or 20, and a single test was given to them. If we were to apply this to COVID, if you do a routine high throughput approach like anti-gen or PCR in a community with 1% infection, the result is what you see for the dashed green line. The routine high throughput for 5% infection rate, what you see is the solid green line. But if you apply the pool testing approach, as the number of samples in the pool grow, you look at the number of the reduction factor in the number of tests that are required grows. And that is given by the dashed black line, and it hits a maximum at around 20 people. So these were the kinds of strategies that are informed by statistics and statistical physics that we tried to bring to bear upon the COVID pandemic. So let me stop with that and take any questions. Thank you very much for your attention. Professor Bandy, I know you're very familiar with the situation in Okinawa. You talked about Singapore and overseas COVID-19 situations. So looking at the Okinawa COVID-19, what are the characteristic features of our infection cases? Initially, I personally was quite worried about Okinawa because Okinawa is a blue zone. It has Japan in general, but Okinawa in particular has a high percentage of senior citizens. And this was a very worrisome case. And I'm sure my colleagues will elaborate further on this. But we were fortunate because what I noticed from my daily work around or life around the island was people were extremely cautious about maintaining social distancing, about venturing out or rather not venturing out unnecessarily. So there were several simple common sense measures that were employed and staying masked. And Japan is legendary for pulling out its masks at the first sign of the flu every season. So I think Japan's in general and Okinawa's good public health policies have held us all in good stead. Thank you. Thank you very much. And we will continue our discussion later on. And now I would like to ask, I would like to introduce Dr. Takayama Yoshihiro. He's a doctor at the Okinawa Chubu Hospital in infectious diseases internal medicine. He was a prefectural government policy advisor until March 2022. He's currently a member of the prefectures expert task force. So we will ask Dr. Takayama to share with us what was very important in Okinawa's anti-COVID measures. Thank you very much for that introduction, Shima-san. I'm Takayama from the Okinawa Chubu Hospital. Thank you for the invitation to speak at this important session. To be able to share Okinawa's experience with the global audience is very much an honor for me. So I would like to go ahead and share my screen now. I work at a public hospital in internal medicine. I'm also a medical coordinator for Okinawa prefecture. I would like to talk about the outbreak of COVID and the counter-measures that were taken in Okinawa. So here's the hospital where I work. It has 550 beds. It's located in the center of the main island of Okinawa. During the epidemic, pandemic, we received about 50 inpatients with COVID. As of today, we have only nine people who are hospitalized, but that means that we still have COVID patients, so the pandemic continues. But what's different now is there are more people now with influenza. We continue to fight against infectious diseases. COVID has attracted a lot of attention, but actually, since the very old days, humankind has been fighting malaria and malaria, such as tropical infectious diseases. Here we're showing the transition of hospital patients from the early days of the pandemic. In Japan, epidemics are experienced in the winter, but Okinawa has them in the summer, and that puts a strain on our medical facilities. When infectious diseases become seasonal, then there's a period where there's almost no epidemic, but then the epidemic is actually still continuing. So it basically becomes endemic. And of course, we have to get our daily lives back, but we also need to maintain vigilance against infectious diseases. Okinawa prefecture is actually where the pandemic was the most intense in Japan. I've been asked this question repeatedly. Why was the pandemic so bad in Okinawa? There's a combination of reasons, though, and it cannot be explained by a single factor. Okinawa is at the southernmost part of Japan, so the hot summer arrives ahead of the rest of the country. Schools and offices turn on the ACs, and they become very enclosed. So outbreaks of aerosol infections can occur in Okinawa. This is a unique issue. I will go in clockwise order for the other points. Okinawa has the highest percentage of children in the nation. It's very difficult to restrict children's activities. We weren't able to do that in the past. Okinawan people truly value socializing with the elderly and their relatives. Okinawans like to enjoy eating and drinking out together. There are also many visitors who come from outside of the prefecture. This is also unique to Okinawa. All of these are good things when times are normal, but it became a weak point during COVID. We also had mass outbreaks in hospitals and elderly care facilities. These facilities are very crowded in Okinawa. I felt that the older the facility, then the larger the scale of the outbreaks. Also, Okinawa was the least vaccinated prefecture in Japan, which is unfortunate because that made it easy for infections to spread. On the horizontal axis, we're showing the number of vaccinations per capita and the number of infected people on the vertical axis. In 2022, Okinawa had less than one vaccination per capita, and it also had a major outbreak. This low vaccination rate is one of our communication issues. There are also many people who avoid vaccinations, but that's because they're not getting the right information. They're not getting the right support needed to be vaccinated. And this led to a large number of elderly people being prone to serious illness, also caused hospital beds to become overcrowded. There are many public health challenges, but we worked very hard to ensure that we continue to provide medical care to the Okinawa people. Okinawa is a remote island. It's 500 kilometers away from the Japanese main archipelago, so it has to work within the islands. Since 2020, when the pandemic started, Okinawa started this basic strategy in providing medical care. We focused our efforts on centralized functions to the prefectural headquarter. We also upped cooperation from medical care to nursing care, established control mechanisms based on health data, and clarified role assignments and human resource allocation. This is not just something important for COVID. I believe that this is the future blueprint for medical care in regional areas. This is an example of how we use data. The prefectural government and medical institutions shared this data. One row shows the medical institution, and this is all tracked by real time. We showed how many we were tracking hospitalized patients, as well as the severity of their illness. The medical institutions were very honest in reporting this information, so that allowed us to track how many new patients could be accepted. We also were able to understand how many employees were having to be off work. Many cases, even though beds were available, we were not able to welcome new patients in because of a labor shortage, but this data allowed us to overcome that issue. Medical care in Okinawa was reaching a critical point to begin with. This is the utilization rate of hospitals in 2019, and you can see that Okinawa was number one in the country by a wide margin. On average, the beds were 86% used, so we've always had bed shortages during the flu. This is the Ryukyu Shimpo from seven years ago. There were already reports that the Okinawa medical system was actually very fragile. We were not able to improve the situation before the pandemic hit, so I believe that that's an important lesson for us. Moreover, this situation is getting worse year after year. Nationwide, the population is aging. In Okinawa, the population aging rate is very severe. We have to rethink the coordination between medical and long-term care services to realize an efficient system. This pandemic was actually an attempt to overcome the increasing demand for medical care due to the aging of the population by rapidly accelerating the process. We could say that the regional healthcare system was exposed to a stress test so that we were able to identify the vulnerabilities. Why is Okinawa's population aging so rapidly? That's because Okinawa has a very unique population pyramid. This is from the national census three years ago. You see that in the 75 age group there's a huge drop. This is when World War II there was a fighting on the ground and this generation died because they were toddlers at the time. We know that Okinawa has a high birth rate, but there's actually a generation of population demographic where many died during the war and the baby boomers who require a lot of medical care, they are aging. This is an important background to note in terms of the COVID pandemic. As the pandemic raged, we needed to focus on reducing the death rate. Where were the fatalities occurring? We followed over the last year the age and the estimated infection pathway for the 457 deaths that were reported. It's clear that the risk of death increases with age. However, when we look at the transmission pathways, many people died after being infected in the elderly care facilities. Three quarters of all deaths, as you can see on the pie chart on the right, three quarters of all deaths were due to institutional infections. In order to reduce deaths, it's important to prevent mass outbreaks in elderly facilities and to maintain a support system in the event of an outbreak. Okinawa established a support system to quickly intervene within 24 hours after an infection is identified. Here we're indicating the process of when that happened. This is how our team worked. We had logistics, doctors, and nurses. So these three teams would work together. We needed all of them in order to be effective and sustainable. I would also like to share some photos of the work scene now. We conduct an analysis of the current situation with the team. We look at the chain of command, infection situation, infection control, healthcare, resource management, environmental maintenance, and mental healthcare. It's important for us to quickly ascertain the situation. The logistics is being handled by a prefectural government employee. The prefectural staff, DMAT admin members worked very quickly together. The doctors and nurses who were supporting the work were aided very much by the admin staff. This is a specialist nurse teaching infection control at the hospital. Professionals need to put the priority on contributing to society. The hospital workplace is just one area where you can contribute to society. If you're needed in the community, then experts need to go into the community. Okinawa prefecture really provided support for these experts. It's possible for us to culturally, as doctors, go out where the help was needed. And I think that was very meaningful. Doctors are conducting screening tests at facilities where outbreaks occurred. Okinawa had one of the highest number of tests and test centers. Thorough testing was conducted at facilities with high-risk individuals. OIST was very helpful as well. They actually handled a huge percentage of the tests in Okinawa, so I'd like to take this opportunity to thank OIST. We conducted clinical assessments of infected patients and transported to the hospital, those who needed to be transported. We were able to do this multidisciplinary and simultaneous approach, and that contributed to the lower number of deaths at these facilities. Here we're showing the infected patients per population on the horizontal axis and the number of deaths on the vertical axis. If you think about the number of deaths, it may seem small compared to the size of the pandemic, but we were not very successful. Our response to the pandemic was thorough, but we didn't make enough efforts to prevent the spread of the infection. The low vaccination rate is definitely a disappointment and something we need to focus on in the future. But if we compare this situation to other industrialized countries, I think that Okinawa did pretty well. We definitely need to make improvements for where there were failures, but we shouldn't be too harsh on ourselves. It's important to take advantage of the lessons learned and then make Okinawa more resilient to infectious diseases in the future. What are the areas that we need to improve? We need to improve the social issues that we have in Okinawa. Rune Dupos, the famous bacteriologist, said, all epidemics are conditioned by some social circumstance. I think this is something that we are all painfully aware of. In 2020, we'd first hit the U.S. military bases in Okinawa prefecture around the nightlife district. I helped the woman who had been infected. I was surprised at the number of single mothers who came to be quarantined with their children. I think it symbolized the instability of Okinawan society. There were repeated outbreaks in the foreign community as well. Many people didn't know that medical care was free or that PCR testing was free. We tried to share information proactively at churches for foreigners, but I think that this was still a very big issue in Okinawa. We also need to be attentive to smaller remote islands where the population is declining. Hundreds of emergency transports were performed for everyone from newborn babies to the elderly. We are grateful for the help from the self-defense forces, the Coast Guard, and the local fire departments. These infections target vulnerable areas of society. There are single mothers working in cabarets, essential workers in nursing homes, elderly people living alone, and foreign communities. COVID was spreading where society was weak. It was as if COVID was telling us where the vulnerabilities in our society were. We need to re-examine our social security framework, and that is the only way that we can truly overcome the pandemic. Just getting back to a normal society is not going to end the pandemic. We have to face up to our weaknesses and then improve upon them. Then we can look back and say the pandemic was tough, but our society became more compassionate. The rapid aging is continuing. It's a big mistake to think that after COVID, the issue will resolve itself. Time is too limited to talk about the changes in the health care for Okinawa, but it's clear that we're very vulnerable to these types of changes. These are issues that will confront not just Okinawa but also Japan and other Asian countries that face an aging population. Finally, I would like to conclude with a report on the Okinawa Prefectural Medical Task Force for COVID. We were able to get through the past three years thanks to the support of many people. I'd like to thank everyone who helped to protect the local health care. Thank you very much. Thank you very much, Dr. Takayama. It was a very easy way for us to understand the vulnerabilities in Okinawa society and how the pandemic struck those areas. Okinawa has remote islands. There's distance between the islands, the smaller the island, the more elderly people there are, and therefore more high risk with fewer medical facilities. And how did the remote islands affect the medical delivery system? We have 40 smaller remote islands. We actually have a medical network across these remote islands built on the local communities. We have emergency air freight transports, so we did have an established network of medical care. There was also an online meeting system even before Zoom became commonplace, so we were able to connect with medical clinics in remote areas. We had also conducted many drills assuming natural disasters in these remote areas, so I think that actually paid off during the pandemic. Local governments, residents, there was great coordination between the parties, and it's not something that actually started during COVID. We were doing this during normal times. You want to take advantage of these experiences and make sure that we support the medical system in the remote islands. Thank you very much, and we will come back to you later. So I'd like to move on now to introduce you to Ms. Emi Tamaki. Professor Tamaki is a research and developer of technology for sharing human sensations with others remotely via computer. She's a professor in the Faculty of Engineering at the University of the Ryukyu, as well as being a visiting professor of the University of Tokyo and has started her own business H2L, of which she is CEO. Professor Tamaki in this pandemic, leveraging technology is a big change where people couldn't meet in person. We've had video conferencing, so let's hear about technology and science and what we've been able to do in the pandemic. Thank you very much, Ms. Shima, for your introduction. So for this science summit, I'm very, very honored to have this opportunity to speak to all of you. So as per the introduction from the pandemic, I wanted to look at the lessons that have been learned, as well as what new technologies are emerging for the future that might be adopted to make Okinawa an even stronger place than we've seen so far. So allow me to talk to these topics. So from a moment ago, we've been talking about the features of Okinawa. So there is a large number of children in Okina and tourism has a very large share of industry in Okinawa, comparing Tokyo versus Okinaw Prefecture. The younger population in Tokyo represents 11.15%, but in Okinaw Prefecture, it's 16.58%. So it's a little higher than in metropolitan Tokyo. And looking at the industries, tertiary industries in Okinawa represent 84.2%. Other than tourism, there are, of course, commercial and information communication businesses, but the majority of tertiary injuries are tourism related industries. So hospitals and care facilities are, of course, important, but when you think about a pandemic, there has to be focused on educational facilities, making sure there's no spread of infection there, but also to make sure that we can maintain and sustain the tourism industry. So to talk about something slightly different, let's think about work. We don't want to stop industry. We don't want to stop work. Remote workers really take in a hold as a result of the pandemic. It spread once the pandemic took hold of the country. From 2004 through 2000, you can see the data here. There had been gradual increase in remote working, but in 2020, there was a more than doubling of remote work practices. So up to that point, videoconferencing was that unavailable? Up to that point, no, that's not the case. In the 2000s, anybody could use videoconferencing systems. Let's take a look at the history of videoconferencing back in 1984 in Japan, NTT. That's the name of the company now, of course. They had a TV telephone service called the Captain System, and from 1990 through 2003, PC-based videoconferencing services, multiple examples had been made available like Yahoo's Messenger Skype or MSN Messenger, which perhaps some of you are familiar with or feel a little nostalgic about these services. And then from 1999 onward, it was possible to have videoconferencing with your mobile phone. In other words, the TV conferencing systems needed for remote work were available to anyone in the 2000s. In other words, technology, had it been spread, maybe because this was available to everyone from day to day, had we been using these technologies before the pandemic had spread, we may have been able to switch over immediately. So let's get ready for the next pandemic. The first thing is to have digital technologies rapidly introduced into educational facilities which will help to prevent the spread of future pandemics. And at the same time, digital technology could be a way for exploring new forms of tourism. So this is an example of new technology. This is called body sharing. This is about sharing bodily sensations. It's a system to allow you to do that. For example, a remotely located robot can be manipulated and operated. Or you can get a human to experience movement or how much force is being applied. You can sense what somebody else is experiencing through perception and sensory inputs. So this is true for educational settings, but also in tourism, sports, exercise, and a variety of other scenes and settings. So this isn't something that is particularly well known amongst the general public, I don't think. The reason for that is that up to now, the digital technologies that we've been sharing has been focused on visual as well as sensory information, like the cameras and the monitors that we're using now here in this Zoom, microphone speakers. So apologies, I have a little bit of noise on my mic, so one moment while I reset. So everything was focused on visual and sound information, but this wasn't enough for digital information as digital technology. We wanted something that was more active and real. We wanted to have proprioception as we know it in English. It's deep sensations, sometimes it's called. By sharing proprioception through digital technology is what I'm working on develop. So getting a sense of weights, having gestures, knowing about motion and muscle displacement. So having inputs and outputs, both of those, we share those. So let's take a look at a particular example. So you can see your fingers, how much pressure you're applying there is that deep sense that you know. On the right hand side, you see on the graph, it's measuring the finger pressure you are making visible the pressure that's being applied by the fingers so that you can get a better sense of that in a digital context, whether you're cooking or in other scenes. So let's take a look at a specific example. So this is a remote sophisticated sports training. So this is feedback for your golf swing. You see the red balls and the yellow balls, this is in the augmented reality display. So the red are index and middle fingers, how much pressure is being applied. Yellow is how much pressure is being applied by the ring of little fingers. So by having a correct swing, a good swing, you want to put your pressure and force into the ring and little fingers of your right hand. So you shouldn't be putting too much strength and force into your index and middle fingers. Let's take a look at this in a video. The swing is exactly the same, but take a look at the red and yellow balls. You can see where the forces are being applied, the poor swing and the good swing. You can see the difference between the two, the good swing has more of the yellow ball being bigger, there's more force in those fingers, more strength. The poor swing is where you're putting too much force into the index and middle fingers, the red ball. This is something that's been tricky to teach in person, but remotely, we're now trying to teach these kind of skills. It's often hard to put this into words. You can't grab a hold of somebody's hand to show them how much strength to put in. So we're trying to use digital technologies to try and help that. We're also doing this remote agriculture robot as a service. This is a system that you can use remotely. There's a robot that's in a faraway remote location. You connect with a user that is city-based or perhaps somebody who finds it difficult to go outdoors. They can operate that remote robot to experience agriculture practices. This is in actually using that remote service. So this is actually a remote tourist farm and somebody's having to go picking strawberries. We have other remote tourism experiences. You use the upper body of a robot to be able to do remote tourism. We're working with Dogumo 5G and also Isco to have experiences of Okinawan tourist offerings. With the pandemic, despite a pandemic for Okinawa, perhaps you can't travel by boat or by plane, but even if you're remotely further away from Okinawa, it's possible to use these new devices. So you can kayak in the mangroves. You can canoe in the seas around Okinawa. So these are new forms of tourist industry that we're trying to explore so that we can create a more strong Okinawa. So just to summarize, Okinawa has relatively high number of children and has a large share of tourist industry in its industries. So being aware of prevention of spread and still wanting to maintain tourism for the next pandemic or the next crisis, we want to be able to proactively introduce digital technology in a rapid manner into educational settings. And we want to try and find new forms of tourism, leveraging digital technology so that we don't stop the Okinawa economy from running and moving so that we can all work together to grow that as one. So that was my presentation. Thank you. Ms. Tamaki, thank you so much. So using a robot's body to be able to do remote tourism is a really interesting thing that you're engaging with. So this technology, so for example in the COVID pandemic, as Dr. Takayama was talking earlier, there were medical personnel who became infected and that led to a labor shortage. Perhaps there are ways of leveraging this technology to overcome those kind of challenges by leveraging robots and using such solutions is that a possibility is that feasible. And if it is feasible, when do you think that might be possible? Maybe you could share your thoughts on that. Yes, at this moment in time, the visual and audio information, in addition to that kind of technology, it's possible to support care using robot or using medical or ways of leveraging digital technology in the medical field. That's something that my R&D team is working on as well. But in the medical field, there are international standards. There are no international standards right now associated with this kind of digital technology. So the establishment of international standards at the very earliest is going to be 2027 before those are introduced. So tied in with national projects, we are starting to explore what we can do in readiness for that. We're working with the Japanese government on that. So the first thing is about sharing prior perceptions, not just the deep sensations, but surface feelings. So touch or being able to differentiate hot and cold, there are ways to be able to communicate with the medical field. These will in turn have international standards set and I think from 2027 through 2030, if society can accept these methods, I think that would be the earliest timing for adoption. Thank you very much. So in four years time, I guess, but it sounds like there's a lot of new things that you're engaging with and exploring. So that was a very interesting presentation. Thank you very much. Thank you very much. Now we would like to invite back all three panelists so that we can have a discussion. Professor Bandy as well. Thank you. Thank you again. So we heard from three guests about their different areas of expertise. Do you have any thoughts you would like to share or maybe any questions for the other panelists? So can you keep it under three minutes? Please starting with Professor Bandy. Any question for the other two? Well, I have no questions. I'm just blown away by the kind of work my colleagues have been doing, both in the frontline of medicine as well as in robotics. I would never have imagined such things could be possible with the haptics and proprioception. So I'm actually speechless. Thank you. In terms of the Okinawa medical system, Professor Bandy, you said that you were worried because there are many elderly people. But wearing simple masks, not meeting people, you said that that kind of approach was very effective. So in the future, if there is something that Okinawa should be undertaking, then what would you recommend that Okinawa start doing? The Okinawan prefecture has several bases, US bases. One of the problems that happened that occurred was that the infections on the bases came under the United States count, even though the people were physically located in Okinawa. But when they went in and out of the base, those infections were not getting counted in the United States. They were getting counted in Okinawa. So I think a proper accounting of the infections on the base would actually be very useful for the OPG and the Okinawan medical community to have a better tracking system. I think Dr. Takayama would be able to shed better light on it. The second issue is, unfortunately, Japan had suffered from a shortage of testing case. I think it is important for the nation to develop its internal capabilities in testing case. And the third point would be, in specific context of Okinawa, would be about the hospitals. I think Dr. Takayama put it very succinctly and informatively. In Okinawa, in Japan in general and Okinawa in particular, you have specialized hospitals or clinics for different diseases. So there is a clinic for infectious diseases instead of having a department of infectious diseases in every major hospital. As a result, rather than spread the patients and reduce the burden on the medical staff, most of the patients had to end up at one designated hospital. I think that is something that the policy leaders could think about for the future. Thank you. Thank you very much. I'd also like to speak to Dr. Takayama some more about this. So first of all, Dr. Takayama, having heard the two presentations from Professor Bandy and Professor Tamaki, I'd love to hear your comments on those presentations and your response to what Professor Bandy was saying there. So I'd just like to add some more information to what Professor Bandy was saying and I'd like to ask a question to Professor Bandy too. So with regard to the US forces and the spread of the infection that they were counted outside of Okinawa, prefectures count. And yeah, there were some issues about our dealing with the spread of the COVID. So back on 2020, July 4th, Independence Day, there was as usual a very big party at the bases. And we can't say for certain that that was the source for the spread of the infection. We have to do some genetic testing, but it's also a case that epidemiologically we had a big spread of the infection in COVID from then. Now the US bases were proactively sharing information with us and we had quite a lot of meetings with them. So the US military, we did feel that they were working really hard to help us. But like Professor Bandy was saying, the spread of the infection inside of the bases themselves, all we know is how many cases were. We didn't know where the infections were happening, what the route was, how the infection was taking place. That information was not coming into us. So there's no national borders to infections and you cannot prevent that with fences or gates. So we have to overcome these political barriers when it comes to infectious diseases. We have to have more proactive information sharing. And this is particularly critical for Okinawa that has so many US bases. So that was the additional information I wanted to add. So I have a question for Professor Bandy. So Professor Bandy, the presentation you made wonderful technology and I think this ties in with Professor Tamaki's presentation as well, but these wonderful technologies, we want to leverage those in the medical field, in medical locations, but matching up medical fields and science and technology, it's quite difficult because accessing that kind of technology sometimes is really hard because you have to come through connections to get to technology. So I want to know about how we bring technology to medical fields. So Professor Bandy, I'd like to hear from your perspective on that. Well, I think the best way to do it in Okinawa is for Chubu Hospital and OIST to collaborate. We're always looking for collaborations and OIST was established for the sustainable development of Okinawa. So it sits very well with our mandate. And furthermore, we are an interdisciplinary institution by design. So we don't have departments. So we are always looking to think outside the box. And I can speak, I think for all my colleagues at the university, we don't worry about asking foolish questions or stupid questions because we're just looking to learn from each other. So I welcome you to come visit us and let's sit down and explore what we can do together. Thank you very much. So perhaps we're going to ask that question to Tamaki-san as well. So thank you very much, Professor Bandy. So our hospital and OIST, hopefully we can collaborate together. So I have a question for Professor Tamaki as well, if I may. So this time, listening to all these different systems that Professor Tamaki described, and I think there are many cases where we can leverage those in caregiving as well as medical, not just in tourism, like automated or autonomous driving systems. These are spreading overseas outside of Japan. But when we think about transporting patients, we want drivers to not be put to any kind of risk, but we want to quickly reach those patients and then to transport them to where we need them. And also trying to get samples for testing from our patients is probably many ways where we could leverage robotics to do that, to do that more simply. So Professor Tamaki, your various research fields, I'm sure there are many applications for that. Perhaps you could share on that. Thank you very much. So yes, as far as the medical field goes, I'm sure that there are various places, multiple places, where we could introduce this technology. So for example, not in our research and development, but automated or autonomous driving systems, it's really hard to do experiments or testing on public roads in Japan. Outside of Japan, for example, in San Francisco around 2012, experiments were already happening on the roads, but in Japan, domestically, using roads here, it's very challenging to do that. So Kyushu University, who's done a lot of advanced research on this, they ran vehicles, they had private sites. Kyushu University is a very large place, so they found spaces on their own property, also at Tsukuba University as well. And they carried out these experiments. And they were forced to do those experiments because of the restrictions that we face, because in Japan, to introduce new technologies, that ability for society to accept those new technologies were not necessarily as flexible as elsewhere. So bringing in new technologies to the medical front is particularly challenging to have those new technologies accepted. And we are working with a variety of companies to seek certification and accreditation for using medical fields. And that's a challenge that we, with two, three, a number of companies, there shouldn't be just a few companies working on this. There should be political drivers behind that, not just for Okinawa, but for Japan as a whole. I think that's a challenge that needs to be resolved. Thank you very much. I think Okinawa needs to be designated as a special zone for science and technology, for medical, for technology, experimental use. I hope we have some representatives from Okinawa Prefectural Office, so I hope that that can be achieved. Professor Tamaki, any questions for the other two? I do have a lot of questions, actually. I have two questions for each. So Professor Bandy, my question to you is, I truly enjoyed your wonderful presentation and your new discoveries based on statistics. I was really blown away. In Japan, there were many test kits that ended up with false negative results. I actually had test kits at home. I knew for sure that I had COVID, and that was validated later when I went to a hospital. But when I used the test kits, they all turned back a negative result. I used so many kits, and they were all negative results. So if we do a pull method, then up to what percentage of the negative test will still mean that it is effective? If we have another kind of COVID, Okinawan people do have test kits at home, but are they still going to work? So that's my one question, and then my second question is, you know, simple measures like wearing masks, which we do to not get the flu anyways, or maybe not go out that much or wash hands frequently. Two people know that it's important real time. If we could actually share your research, Professor Bandy, to the Okinawan residents, that would be more compelling. So in the future pandemic, do you think you can actually show that kind of data and evidence real time? Professor Bandy, could you answer please? Thank you very much, Tamaki Sensei. To answer your first question, the test kits have an expiry date, so they will not work indefinitely. You are quite right. The test kits in Japan, if they're antigen test kits, then there is a problem, because there is a certain sensitivity and a certain specificity, due to which there is, you have a certain probability of getting false negatives or false positives. Unfortunately, in the early days of the, maybe until half, until 2021, early 2021 or so, the test kits were not reliable in terms of their sensitivity and specificity. And this tended to give a lot of false positives and false negatives. The second reason is, because Japan has a low infection rate, as I pointed out, this concept of base rate negligence, it really doesn't help us. So PCR testing is the goal standard by which to go. So I think if your antigen test kit gives you a negative when you think you are positive, I think it makes sense to go for a PCR, because it has a very sensitive detection. As to the second question, well, we all hope there won't be a future pandemic. We have lived through a horrible one, but unfortunately for us all, reality is there will be pandemics again in the future. And as I pointed out, the rate of spread is increasing because the world is hyper connected. It's not even super connected. It's hyper connected. And that actually increases the fragility of societies. And it is extremely important to educate population as both of you have pointed out. And if I, if I and OIST can be of service in any way, we would gladly do so. Thank you. Thank you very much. So see our testing, getting that and Professor Bandy that you'll be sharing lots of evidence going forward. That's great for those comments. Thank you. So next, if I may go on to ask my questions of Dr. Takayama, of course, go ahead. So I have two questions for Dr. Takayama. With regard to Okinawa Prefecture, the vulnerabilities of our medical system. So this is something that came up in the pre discussions. I think one of the most vulnerable things is the lack of ICUs or the lack of hospital beds, or is it the lack of medical worker labor resource? That's my first question. What is it that's lacking? My second question is if the issue is labor shortage in medical workers, if that's one vulnerability of Okinawa Prefecture, then is that something that can be overcome with operational efficiencies or using technologies? Thank you very much for the questions. Let me answer. So first of all, specifically with regard to COVID, ICU shortage was actually very rarely the case. However, at certain times, limited times, there were shortages of ICU. So we can't say that we had enough. So there were some times when there were some great pressures and it was really hard to deal with COVID. But that was more to do with regular hospital beds rather than ICUs. But because we had the pressure on hospital beds, that actually had an impact on elderly care facilities, for example, because it was really difficult to accept patients being transported because we had those shortages and that had an impact on care facilities. So there was a lot of burden placed on medical facilities as a result. I think this is partly because COVID treatment in Japan was offered for free and also in Japan, the environment that there was easy to have longer term hospitalization, patients could be brought to hospitals. When you were in hospital, your safety was very much guaranteed. So I think there was a very great, very high level of medical care that was applied. So I think it's about efficiencies and role definitions. If you had less severe symptoms, let's get the situation in place where you can remain at home as you recover. We can also look at possibly increasing overseas workers in our care facilities to try and support there. So let's clarify what the role is for medicine for high level sophisticated medicine versus regular recovery hospitals. So being able to cover a wide range of COVID situations, open up the wings so that we can accept a broader range of activities. I think that's the thing we need to do. So the operation being really important, I certainly get that. And yeah, I agree. I think big hospitals were very full, but like your neighborhood clinic seemed to be kind of quiet, not so busy was a situation I certainly felt during the pandemic. So I think it's about having all of that connected up and making sure that all those resources are allocated and assigned. Thank you for answering. Thank you very much. And then I think the other point was can technology help to supplement labor shortage? Well, with the declining birth rate and depopulation, I think there's probably a limit to what we can do with our workers. As I said earlier, we really need to establish a multicultural society in Okinawa where we have foreign workers in the medical field. We might be able to make it work in the elderly care facilities, but we haven't been proactively doing that in the medical field yet. Right now, we're focused on better efficiencies. Tamaki-san, you introduced us to a lot of robotics and also I think the option of using AI that will allow us to use the labor resources more effectively. Thank you very much. Actually, one follow-up from me, please. There was talk about the antigen tests. You had a lot of negative results. And yes, PCRs are much better. But as of now in many clinics, they're using medical kits. PCR tests are reliable. If you want only the PCR tests, then people will stop going to these check-up clinics. The medical antigen tests, they're actually becoming much more accurate. They're much better. So don't automatically think only PCRs are reliable. Please go to a clinic, use the kit. If you get a negative result, but then you still have pretty heavy symptoms, then maybe you can go to a bigger hospital. I think for our citizens, it's important to have the breadth of options. The technology of the kits is also improving. Yes, when the first test came out, I think Professor Tamaki, many people shared the same kinds of results. But nowadays, these simple tests, the rapid tests actually have a pretty good precision rate. Thank you very much. I think hearing our three panelists, there was a lot of interesting information being shared. But as we've been hearing, pandemics will be repeated again in the future. I think this is a historical fact, a historical lesson. So the next one will not be COVID perhaps, but if it's a different disease, what kind of mindset should we take? There's medical, there's physics, there's science, your researchers in these fields. When the next pandemic comes, is there something that you would like to propose doing? Could we start with you, Professor Bandi, if there's a new pandemic that is to come upon us, what would you want to try? What would you want to do? Thank you. So in the philosophy of science, we teach students a subjective principle called cautionary principle. This principle, when applied to the pandemic setting, asks the following question. What is the price of inaction? So in the early days of the pandemic, in the first few days, Singapore decided to close its borders and prepare its medical facilities immediately, whereas US, Japan followed few weeks later because their approach was we don't have enough information, let us take stock of the new data as it is arriving. And it was during those crucial weeks that closing the borders was absolutely crucial. The virus got through as a result. So there is a risk involved if you do not act, but there is also a risk involved if you do act. And that has to be, as I said, a calibrated response. Complete lockdowns don't work. So some of the lessons we learned is actually lockdowns have led to a very high price. So for example, in India, where I come from the first lockdown led to severe hardship, both economic and societal. Japan did not go for it. We should also recognize, as Takayama Sensei showed in the last slide, we have to take into account the specific aspects of every society, every culture. Japan's needs and its cultural settings are different from say the United States or from Singapore or from India. So for example, Japan did not even have a law to pass an emergency, to declare an emergency. The government could only request, the federal government could only request people to shelter at home. So and that exists for a good reason, a good historical reason, whereas Singapore has laws that could order citizens to behave in a particular way. So these are specific aspects of each society. I'm not questioning the wisdom of one legal system or national constitution over the other. What I'm saying is whatever policies we take up, it is not a one size fits all. I think the first common sense response would be lockout, that is close the borders, prepare yourself and then reopen in a calibrated manner. And take your constitutional or legal framework and cultural particularities into account in reopening and testing and formulating the public health policy. Thank you. Thank you very much. So Dr. Takayama, same question for you. For the next pandemic, what would be your recommendation for preparedness? So for the next pandemic, I don't think it's about what we should do. I think it's about, it's too late if we started at the next pandemic. So disaster medical care is all about preparation and pandemic medical treatment is about preparation for the pandemic. That will decide whether we are succeed or fail. This time, because there was a lot of panic action is because we didn't have enough preparedness as Professor Bandy was mentioning, making sure that we have a system where you can expand the testing mechanisms is really important. And Professor Tamaki was mentioning using digital technology in education, technology spreading into medical and care fields as well. Then that will help society. And it's again too late to do that once the pandemic and spread has started. And just as Professor Bandy was mentioning, when there are interventions into a confused society, it's important to have a consensus beforehand, whether it's to do with lockouts. Once it started and you have a debate is too late. So you have to have the legal framework in place first and also closing schools, behavioral restrictions like eating out or going out. How much are you going to do? How long are you going to do? These should be talked about in normal time so that we're prepared. And also there should be some good communications with social welfare, like I mentioned single mothers in my presentation. At the end, all we did was isolate them. And that was it. It's really disappointing. We should have heard what they had to tell us more. We should have thought about providing more societal support so that we can overcome the kind of biases that people have. This is something we should have learned backward the AIDS crisis. So there are possible challenges with this in the Okinawa society on this. Well, me as a member of the medical community, I'd like to deal with that as of tomorrow. Thank you. And if we think about lessons from COVID that we have to learn from and leverage, I think those are really important points. So I'd like to ask the same question to Professor Tamaki. So for the next pandemic, what is it that you would like to do? Yes, I think as much as possible in terms of preparedness, being new technologies, not just around myself personally, but looking across the whole of Okinawa prefecture, thinking not just about the forefront of business, but thinking about tourism, entertainment, educational settings. We covered it in the discussion earlier, but thinking about care and medical facilities too. But there's a whole variety of other facilities out there too. So taking all of that into account, making sure that nothing is missed, trying to make sure that we cover as much as possible, make sure that we have new technologies available as options to as many as possible. Not just for companies and businesses, but for the general consumer to have it as an option that they can choose creating that digital environment that enables that is something I'd like to be engaged in doing. For example, in the case of our company, my company, and certainly with the companies that we partner with, the metaverse office, it's often called a virtual office, but the metaverse office or the virtual office, this is just perfectly normal for us. And in that context, the pandemic happens. So we're able to switch over to remote working pretty much immediately. So spreading the infection at the workplace in my company, with the companies we work with, there's virtually no infection spread in the workplace. But if you are a business who doesn't have a metaverse office, doesn't have a virtual office, it was really hard to switch over to remote working and virtual working. And there was spread of infection in the physical workplace or during the commute. I think there are many cases of that. So I think being able to immediately or very quickly being able to accept and switch over to new technology, that gives you strengths for overcoming pandemics, but also other aspects, helping minorities, helping people with disabilities. You create a kinder society by having all of these in place. Thank you very much. Almost out of time. But we've been getting a lot of questions actually. So Professor Bandy, how did you, why did you come up with the idea about making masks using the cotton candy machine? This is from a student. Because I couldn't find a mask. It's usually not the case in Japan. You can find a mask in any convenient center store. But we couldn't find masks. And so I asked myself, I am an experimental physicist who works in a lab. How can I make a mask for myself with the tools that I have been taught over nearly two and a half decades? If I cannot do that, then all my learning is useless. So my thoughts went back to a passing remark by my postdoctoral advisor at Harvard in 2010, who talked about the cotton candy machine. And so I brought together bottle caps from garbage and crushed them in my home blender and did it in my garage. So yeah, that's how I got the idea. That's really amusing and very impressive just to make something out of your own hands when you can't find it. Next question is Professor Tamaki. As a researcher and also as an entrepreneur, what was something that you felt was important to you when you were a college student, when you were a high school student? I see. When I was a student, I think I really put value on my imagination because pandemic or in other areas, what's going to happen in the future? What kind of society do we want to create? To actually imagine, not to create, but to imagine what kind of world we want to create. And actually, in Japanese, creativity and imagination are the same word in Japan, in Japanese, but when I was a student, I really tried to think about how could I do these two? How do I create the world that I'm imagining? And not to sound rude, but when I was a student, I didn't really feel that I needed to do something that would be useful for society. So trying to avoid or prevent a pandemic, trying to reduce the effects of a pandemic or maybe just trying to minimize the effects on society or maybe try to enjoy time during a pandemic, I think it would be great if students could really imagine to their fullest and that would help them acquire good skills. So I wish you a lot of luck. Great. That's a new way of thinking about things. And then Dr. Takayama, there are a lot of students who are not very healthy, vulnerable. As a teacher, what is something that I can do to care for them? I'm sure that the teacher already has a lot of experience in protecting the students. So it's important to just continue doing those things. But I think one important lesson from COVID is if somebody is suspected of being infected, if they have mild symptoms, then we need to make sure that they can take time off of school. That's really the most important anti-pandemic measure, wearing masks, etc. This pandemic taught us about the importance of these things. But really, if children or students have symptoms, then they need to take time off of school and they're able to switch over to remote learning or remote work. That will allow even children who have illnesses to be able to enjoy their school life. Thank you very much. Thank you very much. We have had a lot of questions, but unfortunately we are pretty much out of time. So I'm afraid we're going to have to leave it there. But I would like to communicate the question separately to all of our panelists. So one and a half hours just spared by, I would like to say thank you to our three panelists. Oh, it's class five now for COVID. We're talking about post-COVID here in Japan. But listening to our three panelists, there is a battle for our next pandemic. Before we get to the pandemic, we've already got to start preparing for it. Japanese people often say that, you know, we do have to learn from difficult and painful experiences. We have to leverage those experiences. That is what important for Okinawa prefecture, but for Japanese society at large and more broadly for the world. I think we all really feel that. So thank you so much for today's discussion. With that, I would like to close out today's session. Thank you so much for those of you who have joined and watched. Today's video will be available at a later date on the OIST YouTube channel at the end of October. This will also be reported in detail on the Ryukyu Shippo newspaper. So I hope you'll take a look at that article when it's available. Thank you very much today for everybody who's been watching. I really appreciate your participation and for our three panelists. Thank you so much. A applause to our three panelists. Thank you very much. Thank you.