A Tokyo shopping district last month. But face masks were a common sight in the city long before the coronavirus arrived. Photo / Noriko Hayashi, The New York Times
In America, masks have become a weapon in the culture wars. In Japan, wearing one is no big deal, and deaths have stayed low.
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.
READ MORE:
• Covid 19 coronavirus: The 8 other countries that beat the virus
• Kate Hawkesby: Covid 19 coronavirus alert level 1 is 'out of whack'
• Covid 19 coronavirus: Zero! Bring on level 1 - NZ now Covid-free
• In awe of NZ: How world media reacted to New Zealand eliminating Covid-19
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 US$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 materialised. Japan has reported more than 17,000 infections and just over 900 deaths, while the United States, with a population roughly 2 1/2 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."
Japanese leaders eventually urged karaoke bars and other businesses to close and cajoled employees into teleworking. Schools were closed at the beginning of March — far earlier than most countries — and large cultural and sports events were canceled. None of these restrictions were mandatory.
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.
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.
"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 modelled 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," 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.
Written by: Motoko Rich and Noriko Hayashi
Photographs by: Noriko Hayashi
© 2020 THE NEW YORK TIMES
The trio have been charged with premeditated murder and multiple other offences.