The first case of coronavirus disease 2019 (COVID-19) in Japan was confirmed on 16 January 2020. The first wave of cases peaked on 10 April 2020 (n = 710) and the second on 7 August 2020 (n = 1595). Iwate Prefecture in north-eastern Japan was the last prefecture to confirm a case of COVID-19, on 29 July 2020, 110 days after all other prefectures had confirmed cases. No cases were reported during the first wave.1 As of 21 September 2021, there had been 3469 cases (282.8/100 000 population) and 52 deaths (1.50% fatality rate) in Iwate and 1.7 million cases (1333.2/100 000 population) and 17 294 deaths (1.03% fatality rate) in Japan overall. This article discusses possible reasons for the low number of COVID-19 cases in Iwate.