Japan's Coronavirus Numbers Are Low. Are Masks the Reason?

Japan’s Coronavirus Numbers Are Low. Are Masks the Reason?

Japan’s Coronavirus Numbers Are Low. Are Masks the Reason?

Japan’s Coronavirus Numbers Are Low. Are Masks the Reason?

TOKYO — When the coronavirus arrived in Japan, people did what they normally do: They put on masks.

Face coverings are nothing new here. During flu and hay fever seasons, trains are crowded with commuters half-hidden behind white surgical masks. Employees with colds, worried about the stigma of missing work, throw one on and soldier into the office. Masks are even used, my hairdresser once told me, by women who don’t want to bother putting on makeup.

In the United States, where masks only recently arrived on the scene, they have been a less comfortable fit — becoming an emblem in the culture wars. A vocal minority asserts that nobody can force anyone to put a mask on. Protesters have harassed mask-wearing reporters. The president himself has tried to avoid being seen in one.

As Japan has confounded the world by avoiding the sort of mass death from coronavirus seen in the United States, I began to wonder whether the cultural affinity for masks helped explain some of this success. It also got me thinking about the evolution in my own feelings about face coverings.

A decade ago, before we moved to Tokyo when I became The New York Times bureau chief, my husband, two children and I visited Japan to see family and friends. I had picked up a cough on the plane, and my Japanese godfather pointedly dropped into a convenience store to buy me a packet of masks.

Shame on me, but I declined to wear one — they seemed unsightly and uncomfortable.

Fast forward to early this year, when news of a strange virus started emerging from China, and Japan soon reported its first case.

Advice on masks that I was reading from international experts was mixed, if not outright skeptical. The surgeon general of the United States implored the public in a tweet to “STOP BUYING MASKS!” The Centers for Disease Control and Prevention initially said it was not necessary to wear one if I wasn’t sick.

Still, living in Tokyo, I had grown accustomed to seeing them everywhere. I decided it was better to buy some for me and my family. By then, masks were sold out in most Japanese drugstores, but the Tokyo bureau of The Times managed to procure a small supply that we had to ration.

I was sometimes confused about when to wear one, though I did so when reporting near the Diamond Princess, the cruise ship that was the site of a large coronavirus outbreak, or when I attended crowded news conferences in unventilated rooms.

It took some getting used to. The mask made my glasses fog. I didn’t like the feeling of my own breath on my face.

But I’m now a convert, especially since Tokyo was placed under a state of emergency in mid-April. I bought handmade cloth face coverings from a Facebook friend in Okinawa. We wash them daily and line them with coffee filters. Even though the emergency declaration was lifted in late May, I still won’t let anyone in my family leave our apartment without putting on a mask.

With paper masks sold out everywhere, the Japanese government sent cloth masks in the mail in April. The initiative, which cost about $400 million, became the butt of jokes, when people discovered the masks were too small to cover most adults’ mouths and noses.

The masks became a symbol of failings in the government’s coronavirus response. In the early months of the pandemic, Japan seemed not to follow much of the conventional epidemiological wisdom, deliberately restricting testing and not ordering a lockdown.

Yet a feared spike in cases and deaths has not materialized. Japan has reported more than 17,000 infections and just over 900 deaths, while the United States, with a population roughly two and a half times as large, is approaching 1.9 million cases and 110,000 deaths.

“Japan, I think a lot of people agree, kind of did everything wrong, with poor social distancing, karaoke bars still open and public transit packed near the zone where the worst outbreaks were happening,” Jeremy Howard, a researcher at the University of San Francisco who has studied the use of masks, said of the country’s early response. “But the one thing that Japan did right was masks.”

But one of Japan’s most visible responses has been near-universal mask wearing, seen here as a responsible thing to do to protect oneself and others, and as a small price to pay to be able to resume some semblance of normalcy.

Japan’s experience with masks goes back hundreds of years. Mining workers started using them during the Edo period, between the 17th and 19th centuries, to prevent inhalation of dust. The masks were often made from the pulp of plums, said Kazunari Onishi, author of “The Dignity of Masks” and an associate professor at St. Luke’s International University in Tokyo.

Dr. Onishi said that early in the 20th century, the Japanese viewed masks as unattractive, but were persuaded to wear them during the 1918 flu pandemic. More recently, the Japanese public has used masks during the SARS and MERS outbreaks — which also left Japan relatively unscathed — as well as to protect against pollution and pollen.

During the current pandemic, scientists have found a correlation between high levels of mask-wearing — whether as a matter of culture or policy — and success in containing the virus.

  • Updated June 5, 2020

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • Will protests set off a second viral wave of coronavirus?

      Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

    • How do we start exercising again without hurting ourselves after months of lockdown?

      Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

“I think there is definitely evidence coming out of Covid that Japan, as well as other countries which practice mask-wearing, tend to do much better in flattening the curve,” said Akiko Iwasaki, a professor of immunobiology at Yale.

The scientific evidence on whether a mask protects the wearer from infection is mixed. But experiments show that masks can be effective in blocking the emission of respiratory droplets that may contain the virus, even when someone has no symptoms of illness. And there is some evidence that infected people with no symptoms can still transmit the coronavirus.

A study published last month suggested that just talking can launch thousands of small droplets.

“Wearing a simple cloth mask could significantly block speech droplets from being released,” two of the study’s authors, Philip Anfinrud and Adriaan Bax of the National Institutes of Health, wrote in an email.

Dekai Wu, a professor of computer science and engineering at Hong Kong University of Science and Technology, has modeled the potential for mass mask-wearing to significantly reduce infections.

While it may be possible to establish only correlation, not causation, he said, “if the downside is nothing, and the upside is huge, then you take the bet.”

Still, most scientists say, masks alone are not enough; social distancing is also needed.

“Many people think that just covering their mouth and nose is enough,” Dr. Onishi said. “If they wear a mask, they think they can go to crowded areas, but that is still very dangerous.”

My family and I have seen that kind of thinking in action. On a recent weekend, we masked up and went for a bicycle ride in Tokyo. After miles of coasting down quiet residential streets and along a flower-lined path, we took a turn into a surprisingly crowded shopping arcade.

As we wove through the crowds, I spotted a long, tightly packed line for coffee at a cafe. Inside a grocery store, nobody was paying much attention to the distance between customers. At a food stand, a huddle formed around the server’s window.

But nearly everyone was wearing a mask.

Hikari Hida contributed reporting.

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