Wearing masks for medical reasons is a long-established tradition in Japan
by Leroy W. Demery, Jr. Special to California Rail News
The 1918 “Spanish flu”
pandemic of 1918-1919 resulted in an estimated 257,000 – 481,000 deaths in Japan. (A recent study based on
prefectural-level records concluded that the death toll was much higher, 1.97 –
2.02 million.) The pandemic gave rise to a singular response in Japan: the
wearing of masks to control the spread of airborne disease. (Face masks would
probably have been introduced to Japan’s former external possessions, e.g.
Taiwan and Korea, at the same time.)
In time, masks became part of
Japanese social etiquette. Forty years ago, it was not uncommon to see people,
suffering from colds, wearing reusable gauze masks to avoid spreading viruses
to others. Today, “sickness mask culture” has expanded greatly – both
in volume (annual sales) and uses – for health-related and non-health reasons.
Masks as protection became common
during flu season, in particular during the H1N1 (“swine flu”)
pandemic of 2009-10. Another occasion for wearing a mask for protection: taking
children to the doctor. People who suffer from hay fever or other allergies
often use masks during springtime to help reduce exposure to allergens.
Masks are popular for aesthetic
reasons and as fashion statements. Some people believe that masks make their
faces appear “smaller” (“small face” is considered a
desirable feature in Japan) – and emphasize their eyes. Scented masks,
odor-absorbing masks, colored masks (black masks are popular), form-fitting
masks, masks marketed to women (e.g. with lotion), or men . . . and so forth.
Masks are said to provide a
“privacy shield,” as sunglasses do. Some celebrities wear masks in
public to avoid recognition. According to stereotype, criminals often wear
masks and sunglasses to hide their identities. Some retail outlets post signs
forbidding entry to persons wearing both masks and sunglasses, and police
training exercises feature “robbers” who wear masks and sunglasses.
The Japanese word for
“mask” is just that – “mask,” borrowed from English. This
is spelled out in katakana
phonetic characters as マスク. This, at slow speed, would be pronounced ma-su-ku but at normal
conversational speed sounds much closer to the English pronunciation than
implied by the katakana.
The popularity of masks increased
dramatically from the early 2000s, when surgical-style disposable masks were
first sold as consumer products. The initial marketing targeted people who
suffer from pollen allergies, but the new masks quickly became the
“standard,” displacing the reusable gauze masks used previously. The
new masks are made from lightweight non-woven material, and are known for low
cost, ease of use and disposability. (Littering of discarded masks has become a
problem in Japan – at restaurants in particular.)
The sale of masks in Japan has soared
over the past decade. According to the Japan Hygiene Products Industry
Association, fewer than one billion masks were sold during 2010. By 2018, sales
exceeded 5.5 billion at 2018. The great majority of these – 4.3 billion – were
for personal use. About one billion were for medical use, and a small fraction
– about 0.2 billion – for industrial use. The great majority of all masks (more
than 4 billion) were imported from suppliers overseas.
The coronavirus pandemic has led to
soaring demand for medical masks. This has generated concerns about the
stability of the mask supply. Last month, a major domestic producer announced
that it would sharply increase production of antibacterial masks. Another
apparent result: price gouging. Masks have been offered online at greatly
inflated prices, by unregulated outlets described as “online flea market
sites.” This led to allegations that some individuals purchase masks at
pharmacies and other retail outlets for resale online at large markups (e.g. 10
times retail price). In March, the government banned the resale of masks
“at prices higher than acquisition prices.” This was described as
part of government efforts to eliminate shortages of face masks as the COVID-19
virus spreads. The ban covers masks purchased at retail outlets and online, and
does not apply to “business transactions” among suppliers,
wholesalers and retailers.
Local governments, responding to
concerns and complaints about mask shortages, have begun posting instructions
on websites for residents to make their own face masks and disinfectants. In
addition to Japanese, such instructions have been posted in English, Chinese
and Korean, for the benefit of foreign visitors.
Demand for masks is likely to climb
even higher: a government panel of experts warned at mid-March that, in spite
of Japan’s success in “flattening the curve” of COVID-19 virus
proliferation to some extent, the continued spread of the virus in some regions
could lead to a “massive epidemic.”
Near the end of February, the
government of Prime Minister Shinzō Abe requested emergency closures of all
primary and secondary schools – elementary, junior high, high school and
special needs – until the start of the scheduled spring break. This was part of
the government’s measures to contain the virus. Implementation was left to municipalities
and prefectures. Compliance was very high but not total (e.g. 98.8 percent of
all municipal elementary schools started “extraordinary breaks”
During March, Abe directed the education ministry to draft guidelines for
school reopening.
As of 2020 March 18, Japan had 873
confirmed COVID-19 cases and 31 fatalities. The number of infections reported
by local governments ranged from 1 (several prefectures) to 154 (Hokkaidō). On
February 28, Governor Naomichi Suzuki declared a three-week state of emergency
in Hokkaidō, the prefecture with the largest number of COVID-19 cases,
including a weekend “stay at home” request and school closures. This
ended as scheduled on March 19. An important aspect of the government response
to regional outbreaks of COVID-19 in Japan is masks.
The reaction of foreign visitors to
Japan’s mask culture has been stereotyped by various Japanese media outlets as
steeped in skepticism and lack of comprehension. It is true that some foreign
visitors say they do not understand the popularity of face masks, or describe
mask culture as “strange,” “weird,” or other pejorative
terms. However, it is also true that a small number of people, in countries far
from Asia, could be seen wearing face masks well before 2020. In the US, the
popularity of face masks among college students, during “flu season”
in particular, grew significantly from 2000, and this growth accelerated
rapidly following the “swine flu” pandemic of 2009-2010. Some of the
people who wore face masks prior to 2020 were obviously not of Asian ancestry.
The effectiveness of masks in
preventing the transmission of airborne viral disease has been questioned – or flatly denied, as by the US Surgeon General, Jerome M. Adams, MD, MPH, at the end of February. Outside the U.S., this was widely understood as an attempt to downplay the shortage of masks, a key part of the federal government’s fumbled response to the novel coronavirus. A recent study indicated there are 7
asymptomatic viral carriers for every identified case. To seriously reduce the rate of viral transmission, that makes it essential that the entire population wear masks when out in public. Americans should pay careful attention to the Japanese experience with face masks – attention which has been sorely lacking to date.
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