(Updated below)
DEAR JAPAN – YOU DO NOT NEED TO WEAR MASKS IF YOU ARE NOT SICK OR PARTICULARLY AT RISK FOR SWINE FLU!!!!!
In Japanese for clarity:
日本の皆様へ：豚インフルエンザを予防するには、マスク着用の効果は低いのである。これはＷＨＯの発表でも明らかであり、日本の各メディアでマスクの推薦は、十分な裏づけがあるとは言えないだろう。
世界保健機関（ＷＨＯ）及び米当局の米疾病対策センター（ＣＤＣ）は、マスク着用に関するガイドラインを発表しており、いずれも「どちらかというとマスク着用を推薦しない」との立場だ。主な理由は、マスクを正しく使用しないと逆に危険だからである。ＣＤＣによると、インフルエンザの症状が出ている者に対して、一人じゃない時や公共の場にいる時などはマスクの着用を推薦しているが、それ以外のケースについてはあえて「マスクの着用や呼吸装置の使用を推薦しない」としている。オバマ大統領なども言うように、よく手を洗ったり、うがいをしたり、セキをするときは袖で口を防いだりすることで十分らしい。
一方、ＷＨＯのサイトをそのまま引用すると「気分が悪くなければマスクを着用する必要はない。患者の面倒を見ている方は、その患者に近くなるときのみマスクを着用し、接触した後にすぐマスクを廃棄し、手を良く洗ってください。気分が悪いときでも出かけないといけないときは、口と鼻をふさいでください。マスクは、いつも正しく使用することが大事。もし誤った使い方をしてしまうと、かえって感染のリスクを高めるのである。」
要するに、日本でみるような、一日中同じマスクを着用し続ける習慣は逆効果ということだ。花粉症対策などでは、マスクの効果はあるようだが、周りの人の顔が見えないなど、社会的デメリットも多いと思う。豚インフルエンザの問題はともかく、日本のマスク文化のメリットがそのコストに見合うのか、疑問を抱かざるを得ない。
English translation:
People of Japan: Sanitary masks have little effect in preventing swine flu. This is clear from WHO reports and indicates that the Japanese media’s recommendations to wear masks do not have sufficient basis in fact.
Both the WHO and American CDC have released guidelines for the use of masks, and they have both taken the position that on balance masks are not recommended. The main reason is that they could actually be dangerous if not used correctly. According to the CDC, masks are recommended for people who have flu symptoms if they are not alone or if they go in public, but for all other cases they specifically state “masks and respirators are not recommended.” As President Obama and others have stated, it is likely enough to gargle, wash your hands often, and be sure to cough into your sleeve.
To quote from the WHO website, meanwhile, “If you are not sick you do not have to wear a mask. If you are caring for a sick person, you can wear a mask when you are in close contact with the ill person and dispose of it immediately after contact, and cleanse your hands thoroughly afterwards. If you are sick and must travel or be around others, cover your mouth and nose. Using a mask correctly in all situations is essential. Incorrect use actually increases the chance of spreading infection.”
In other words, the practice of wearing the same mask all day long as seen in Japan is actually counterproductive. They may have some effect in fighting hay fever, but there are social costs such as not being able to see people’s faces around you. Setting aside the swine flu issue, I cannot help but be doubtful as to whether the benefits of Japan’s mask culture justify the costs.
Even as concern over swine flu appears to be subsiding, Japan remains on high alert. The conspiracy theorist inside me wonders if the hysteria has to do with PM Aso’s fight for political survival, as the economic turmoil has apparently whetted his appetite for building public support through fanning crisis. My case in point was a dead-tree op-ed in the Nikkei last week by a member of the editorial board (I think) who openly wondered if the swine flu would open the door to a glorious LDP-DPJ grand coalition (this was before Ozawa stepped down).
Even without a potential pandemic, many people in Japan wear masks when they are sick or stricken with allergies during hay fever season (starting at the end of winter and lasting off and on through May or so), backed by common recommendations by doctors. In fact, a recent Nikkei article noted that while masks used to be limited to hay fever season and when some people were worried about spreading colds to others, the practice has increased in recent years as people have become more used to them and earlier flu epidemics resulted in official campaigns to encourage people to wear masks. Today, they have become so widespread that people now use masks for non-health related reasons, such as to hide their faces. Some even report prefering to use masks in public to guard from germs in general or just as a kind of coping mechanism. It has gotten to the point that masks are a big business, and various innovations have come out to meet the needs of regular users. A recent article in magazine Hansoku Kaigi (Promotional Meeting) featured the success of campaigns to promote more advanced masks that are designed not to fog glasses (glasses-wearers make up a disproportionate share of mask wearers).
While railing against mask use is probably one of the most tired gaijin complaints, my gripe is not categorical – I am willing to accept actual, justified uses for the masks. For instance, on the topic of hay fever, the US-based Mayo Clinic website (itself sponsored by drug companies) only recommends them “when doing outdoor activities such as gardening.” I will accept that for some people the pollen season in Tokyo can feel like you are constantly working in the garden. Hay fever in Japan is all too common due to the widespread cedar forests planted in the 50s in a failed attempt to develop a homegrown lumber industry. I too have felt as if I might develop hay fever just sitting at my desk. But even still, their widespread use outdoes even this justifiable concern.
Still, my chief gripe with them is only tangentially related to their effectiveness. I simply feel like a society where a third of the people is constantly hiding their faces is kind of depressing and unfriendly. If the masks were saving hundreds of lives a year it would be one thing, but the WHO actually warns against their widespread use!
This revelation really hit home on my way back from the US on a JAL flight direct from New York earlier this week. All the flight attendants wore masks to prevent infection during the height of the alert. While I will not fault them for protecting themselves, the usually sunny customer service came up a little lacking when I couldn’t be sure whether they were even smiling or not.
Worst of all is the uncritical recommendation of masks by the Japanese media (as can be currently seen on the Asahi.com front page), flying in the face of WHO recommendations. Considering that the pharmaceutical companies (who make the masks) are ubiquitous advertisers in the media conglomerates (this blogger caught a documentary with one drug company executive laughing his ass off at how easy it is to sell masks), it is probably difficult to push back if it’s suggested that masks are the answer.
I realize that this post may in fact trigger a backlash among Japanese readers as I am a foreigner. I have heard it said from both Japanese and foreign commentators that using a mask to prevent the spread of germs is a uniquely Japanese form of politeness and selflessness that is hard for foreigners to understand (this phenomenon is also mentioned in the Wikipedia page on masks as a “decisively different” aspect of mask culture as opposed to other countries).
But I feel like this kind of misses the point. According to that same Wikipedia article, other countries, including the US, have seen widespread use of sanitary masks at various times in the past, such as the 1918 Spanish flu epidemic. But that is no reason to support the situation in Japan today.
Supposed folk beliefs and customs in all modern societies are often manufactured or encouraged by marketers with something to peddle (diamond wedding rings, it’s unlucky to light three cigarettes with one match, etc.), and I feel like this is a case in point. In this case, the marketers are preying on perceived danger as a ploy to develop regular customers of an ultimately unnecessary product with side effects that are, as I mentioned, generally depressing and antisocial.
UPDATE: Reuters points out that masks are far from the only official recommendation to prevent swine flu.
Our office health department rates them as “better than nothing”. Is the reason they are worse is because they convey a false sense of security?
As for three ciggies from one match – I thought that was from WWI as the three lights attracted a sniper’s attention.
If you do not immediately dispose of a mask after using it then it becomes a haven for germs. If you then touch the mouth area of the mask, the germs can move onto your hands and from there to whatever your hands touch. Transitive property, BAM – it’s actually worse than nothing. In fairness, the health authorities claim there is not enough info to make a conclusive rejection of their effectiveness, but the evidence points in favor of NOT recommending them except in the most sensitive circumstances, especially since people can’t be trusted to use them correctly.
In that case, Adam, I think your Japanese post title is misleading — it isn’t that there is a “low” effectiveness of the masks, but a counterintuitive threat from them.
Yet another great post following on your post on Indonesian nurses. My concern is — what will happen to the anti-English teacher racket rants now that you’re doing this?
“I realize that this post may in fact trigger a backlash among Japanese readers as I am a foreigner. ”
First!
Number one.
Wearing mask is a vital sign in the office meaning “I care 4 U”.
It helps us maintain our uniquely harmonious office environment.
Number two.
It helps to make others to acknowledge on your symptom without yourself walk all the way up to your superior’s desk and report that.
Right, I wrote that before I finished the post and altered my conclusion a little. Changed.
The rants will continue if I find something to set me off.
BTW, the Nikkei is only now reporting that enrollment in language schools is off 39% from last year, something I noted and graphed back in March (maybe revised figures were released?)
https://www.mutantfrog.com/2009/03/04/more-eikaiwa-data-mostly-bad-news/
https://www.mutantfrog.com/wp-content/uploads/2009/03/image001.gif
http://www.nni.nikkei.co.jp/e/ac/TNKS/Nni20090511D11JFA11.htm
Ken:
I just heard the thing about matches from a recent Planet Money podcast. Apparently a famous business fraudster from around that time may have either originated or helped popularize the concept. Unfortunately I have not verified this info (and the reporter admits it isn’t for certain a marketing invention), but the idea at least helps make my point. Here is the link:
http://www.npr.org/blogs/money/2009/05/hear_forget_me_not.html
“…it is likely enough to gargle, wash your hands often, and be sure to cough into your sleeve.”
“If you are sick and must travel or be around others, cover your mouth and nose.”
Forget the rant about the masks, Adamu. I don’t think it’s the masks per se, but rather the use of the masks.
For me, the correct use of masks is necessary, precisely because people are in close proximity to one another, and also because the vast majority of Japanese that I have witnessed in 9 years of living in the Tokyo+3 metropolitan area do *not* cover their mouths when they sneeze or cough. Maybe it’s just the people I’m seeing, but I think Japanese skew their preventative measures towards gargling and masks. When you don’t have your hands free to grab your handkerchief on a train, coughing into a mask is the best you can do for everyone around you. The key is learning how to properly dispose of it, and washing hands etc. afterwards.
I feel that the danger you present here centers around those who decide to use masks for the first time. (Heck, even I got a sinus infection when using a mask for the first time.) It wasn’t until later when the correct use and disposal of a mask was explained to me by a colleague who frequently uses masks herself.
The NYTimes had a non-ranting spot reporting on how there is some thought out there that blowing one’s nose can actually end up hurting the sinuses. While I found it informative, I don’t believe it will change people’s practices anytime soon. I have a similar feeling about your polemic to the nation of Japan.
Peter, I read somewhere that blowing your nose fools the sinuses into thinking you sneezed, which sets off the snot glands. Soft blowing is best, but sniffing is actually better than a standard blow – air/snot travelling inwards doesn’t trigger the same reaction.
Also, I wonder about cough etiquette – perhaps because there is reluctance to blow noses on trains, getting a tissue out for a sneeze would fall under the same manner rule, so therefore masks allow you to sneeze politely?
(My pet hate in trains is the constant sniff-sniff, and I never understand why tissues are bad but pulling a face and sniffing is perfectly natural even for women)
Is the increased population density really that much of an issue? Do people actually catch cold more easily here? It feels like even if it were an issue the general cleanliness would be enough to keep people healthy even without masks.
If I have one arm above me on a crowded train, that’s enough for me to cover my mouth if necessary. And I would say public service announcements about covering your mouth would be a better value (and would please my Western sense of etiquette).
Like I said, if people used them correctly maybe that would work out and save us all from the terrible swine flu. But why shell out money for masks when coughing into your sleeve or even a reusable handkerchief would suffice? In fact, you could tie a bandana around your face for the duration of the train ride if the ride is really that insane. That I’d like to see.
Ken:
I once offered a sniffling woman tissues because she was sitting next to me and doing it right in my ear, which is always annoying as shit. She gave me a surprised look, DECLINED, and then kept on sniffling to her heart’s content, since obviously I was trying to give her anthrax powder.
“Is the increased population density really that much of an issue?”
There was an interesting study done by the University of Rochester years ago that observed how viruses are transmitted (the study used something called the respiratory syncytial virus, which can hospitalize an infant, but will only cause a cold in older children and adults). In the sample of hospitalized babies, they introduced a population of visitors in three categories: Sitters, touchers, and cuddlers. Sitters just sat in the room at a distance from the infant, touchers touched the area around the crib when the baby was not present, and cuddlers cuddled with the baby.
The results found that more touchers got sick than sitters. This evidence, applied to Japanese trains, would imply that proximity to the fomites (read: manky surfaces) of other passengers increases the chance of catching their mankiness.
So if you have one arm above you, you’re probably grabbing one of the straps, making you a “toucher”. Now let’s say that you yourself are knowingly or unknowingly infected, and you then use that hand to cover your mouth, and put it back in the strap. You’ve now created a fomite. If you cough into your sleeve, it may not be much better. And covering your face with a bandanna in Japan will probably get you detained by the cops.
I understand your point that masks are not a vaccine, and could end up being harmful to both the people wearing them as well as those with whom they come in contact, but “ENOUGH of the masks already” is probably not the most effective public service announcement either.
My point is that masks serve an reasonable purpose on the trains of Tokyo, as long as they are used in addition to clean hands and general courtesy. Counting on everyone to wash their hands is not enough, as many adults (18% of surveyed Americans, according to a 2005 study) don’t even wash their hands after going to the bathroom…
Clean hands, spicy food, and sleep are my weapons for staving off infection. Anyone else got a working formula?
“As for three ciggies from one match – I thought that was from WWI as the three lights attracted a sniper’s attention.”
As Adam mentioned, I just heard today in an interview with Frank Partnoy on NPR’s Planet Money that this was popularized by Ivar Kreuger (http://en.wikipedia.org/wiki/Ivar_Kreuger) AKA The Match King through advertising to help increase match usage, and hence his profits. It did however exist as a minor sort of superstition before that, but wasn’t widely followed.
Regardless, I agree that most people have no idea WHEN to use a mask. If you are not yourself sick or a hospital worker, there is usually little reason to wear one. However, if you are sick then wearing a mask is an excellent way to lower the chance of spreading infection. In fact, it would be good for everyone if this particular aspect of Japanese mask use were common in other countries as well.
As a sidenote, in Taiwan masks are commonly worn by women riding motor bikes/scooter, as the exhaust of cars ahead of them sticks to the oils in makeup and makes your face all grubby. However, these are not medical masks at all but mere cloth face-coverings, and only worn while on the road. People there also wear medical masks much as the Japanese do, although in lower numbers.
Roy brings up a good point – masks can be effective if you’re already sick during cold/flu season. HOWEVER! This again brings up the issue of filthy masks left on the face all day PLUS the fact that sick people use masks to ostensibly protect those around them at the workplace when they should really just stay home.
Problem about NOT wearing a mask is, it can’t be your chosen gesture of being “Gaijin With Attitude™” because no one notice what you are doing.
The answer to that problem is to wear my convictions on my sleeve instead and be a dick about it to everyone!
You won.Adamu! since you make this statement by putting at least something on your risk unlike many allegation coming from gaijin regarding stupid Japanese practices.
And this post can be an excuse for not wearing one for myself that my wife so insists everyday…..
A girl told me today that she had just bought a mask because of swine flu, and I tried to explain this to her but she just said “well, in Japan people wear masks at times like this” so whattaya gonna do?
Take my advice young man.Wear a mask.Please.
Adamu and I can still make a joke on this,but you are in hot zone now…..
Hm yeah pandemic time is no time to ignore official advice. Keep an eye on things and hopefully they wont cut off all of Kansai
I haven’t actually seen anyone wearing a mask recently, so it can’t be as bad as Adam is saying. Of course, I also haven’t ridden any trains in a while.
“in Taiwan masks are commonly worn by women riding motor bikes/scooter,” that brings back memories of when I was living in Taipei. In the morning at work, as I was usually the first in, seeing all the scooter riders with a stripe of soot across their face after they removed their helmets and masks. Whereupon they’d do a quick cleanup job to be ready for the rest of the day.
I think the Japanese’s reluctance to blow their nose in public (and therefore a preference for interminable sniffling) might be illuminated by considering the Japanese word for snot–“hana kuso”–which quite literally means “nose shit.”
I think the key sentence in the Japanese paragraph is
「主な理由は、マスクを正しく使用しないと逆に危険だからである。」
“The main reason [for not recommending masks] is that, if improperly used, masks have the opposite effect by being a hazard.”
So the REAL question is: are Japanese using masks correctly? I see most people use the masks only during commuting (not used all day), and changing their masks (as they are sold in big packs of at least 7 or more and are disposable) every day.
The WHO/CDC seems to take their position on masks because not because masks don’t help per se, but rather because they believe the world population, on average, is stupid, and they should governments should refrain from dispensing advice that a moron can’t handle.
Which is a little ironic, because WHO/CDC also recommend condoms even though a condom, in the hands of a moron, is only 86% effective (for preventing pregnancy). In the hands of a someone that uses them correctly, they’re 98% effective.
My take is this – maybe most people use them effectively. But the flu outbreak means that even people who don’t usually wear masks will start. Therefore it’s near-certain that a lot of people will use them incorrectly. It’s hard to tell what kind of impact that would have, but given the typical use of masks in Japan as a way for sick people to continue working since it would be disharmonious to take a day off, I am not ready to place my faith in their safety.
Contrast that with the WHO recommendation, which is that only sick people and those immediately around them wear masks. In that situation almost no one on the street will be wearing them, and that makes no difference in terms of preventing or spreading the infection. So in this situation which would you choose – a) questionably useful masks everywhere; b) very few masks, which is definitely not dangerous? To me the choice is clear, especially since seeing so many sick-looking ninjas everywhere is kind of depressing.
Also note that the government is finally coming to its senses and reminding everyone that this outbreak is no worse than seasonal flu, so in other words there is not that much to worry about. And just to be clear, I think that on balance the government’s done a pretty good job of dealing with the disease. I just don’t see the need for an outlay of a billion masks under such dubious circumstances.
I have a lot more faith in Japanese knowing how to properly use (that is, dispose of after one use) a mask than I do for most other countries in the world. Even if Japanese do use masks as a way to avoid taking a day off from work, they don’t wear a used mask to work. Just like you don’t wear a dirty socks to work.
As for the WHO recommendation, I not sure how much relevant it is towards Japan. The recommending that only sick people should wear masks is a PREDICATED on the belief that people are too poor or stupid to use masks correctly.
If I lived in a developing country where people buy one paper mask and try to make it last 24/7 for a week, then yeah, thumbs up to the WHO advice.
But this is Japan, the land of disposable chopstick and disposable お絞り {oshibori; wet hand towel} waste. Just as Adamu has faith in the workaholic Japanese public to go to work when sick, I have faith in the Japanese public to dispose of their masks the minute they can’t see the sharp crisp paper folds in it or the second its color is not equal to RGB(255,255,255) {brilliant white} — whatever comes first.
Considering how many people the SEASONAL flu kills on average per year (250K‥500K; 36K in USA; 10K in JPN ※), yes, I think a billion masks in Japan are worth it if H1N1 is anything near as bad as the seasonal flu.
※ to put those numbers in perspective, 230K were killed by the 2004 Indian Ocean tsunami
In almost every single article written about the swine flu risks it is mentioned over and over again to wash your hands with soap. One doctor recommends singing Happy Birthday while doing it as an appropriate amount of time necessary to kill the virus. The apparent reason for doing this is that the main source of contamination is via nasal passages. You touch a door handle or escalator rail and then inadvertently rub your nose. Apparently influenza viruses can live for even days in hand oils on surfaces that haven’t been sterilized. For many hours in the air as well. Well, you can’t rub your nose even if you are wearing a mask incorrectly. Although, I have seen quite a few Japanese children that only use masks to cover their mouths.
If you watch people talking at the right angle in the right light you can actually see their personal splutter cloud. This splutter is an actual visible cloud that can be seen clearly for about 50cm from the speakers mouth. Wearing a mask does not eliminate this splutter but it does catch a certain amount of it and clearly reduces it’s visible impact.
Ah, silence truly is golden.
One of the main reasons for the CDC and the WHO being conservative in their approach and attitude to wearing masks probabaly has more to do with there just not being enough to meet this sudden world demand. Imagine what would happen if just these to agencies suddenly started recommending that everyone wear an anti viral mask and for them to be effective they should be changed 3-4 times a day at least to be effective. I seriously doubt that anyone from the CDC or WHO would ride a packed Japanese train without wearing a mask and more likely they’d freak everyone out buy having on their full body space suit like condoms with air tanks.
In any case it looks like at this point wearing a mask is only delaying the inevitable because sooner or later the big bad boogey man swine flu is gonna get ya no matter what you do. In the case of the Swine Flu most of us will probably survive. However, if it meets up with deadly virulent cousin the bird flu were in real trouble. Tamiflu and other like viral drugs are no longer effective for the bird flu as many Chinese chicken farmers put it in their chicken feed as a preventative. Now the bird flu has mutated and resists these life saving anti-virals. I read that the only reason it isn’t infected us and spreading like the swine flu is that it doesn’t replicate well in the lower temperature of human nasal passages. However if infected there is about a %60 fatality rate. The mutant hybrid bird flu is still rampant throughout all of Asia although much less in Japan. If the Swine flu with it’s transmission ability meets up with bird flu and mutate together we are all in deep shit with or without masks. These days I not only sing Happy Birthday but I even wash out my nasal passages with iodine gargling solution as well. This is also suppose to be a great preventative. As often flu viruses hang out for a while on our nasal hairs until they start migrating inwards for their miraculous cellular cloning hi-jack.
i totally agree wirh you!!! インフルだからって結構多くの人がマスクをしているけど
ちょうびみょ～～だと思います。一日同じマスクしてる人やマスクが売れ切れで手に入らないからずっと同じの使ってる人もいるよ～。
一日同じマスクしてる人やマスクが売れ切れで手に入らないからずっと同じの使ってる人もいるよ～。
Wow, that’s scary. That actually *increases* the risk of transmission, right?
“Considering how many people the SEASONAL flu kills on average per year (250K‥500K; 36K in USA; 10K in JPN ※), yes, I think a billion masks in Japan are worth it if H1N1 is anything near as bad as the seasonal flu.”
Er, if I follow your logic correctly, aren’t you suggesting that Japanese people should purchase a billion masks *every* flu season?
“Er, if I follow your logic correctly, aren’t you suggesting that Japanese people should purchase a billion masks every flu season?”
That is less than 8 masks per person, average. Hardly an unreasonable number, actually.
What is more interesting to me is the first part of that quote: Japan has more than 10 times the population density of the US, but only 1/3 of the seasonal deaths (I think population density has more of an impact on rate of transmission/number of cases than actual raw population numbers, or in any case would certainly cancel out the fact the US is starting from twice the population). They must be doing something right, so when I see WHO or CDC advice that “the efficacy of masks is not proven”, I tend to think “perhaps technically so, but what about the huge difference in mortality rates between the US and Japan?”
“That is less than 8 masks per person, average. Hardly an unreasonable number, actually.”
Sure, but I don’t think he meant the “billion” literally. I read it as “you may think that Japanese people are overreacting with masks right now, but considering that normal flu kills people, this scarier strand of flu certainly justifies the reaction it’s getting.” If that’s the case, then it would also justify a media panic *every year.* Of course, maybe I’m just putting words in Adrian’s mouth, in which case I apologize.
“apan has more than 10 times the population density of the US, but only 1/3 of the seasonal deaths”
Considering also that the population here is more top-heavy, yes that is very interesting. But surely better medical care overall has a lot to do with it too.
@Ben – aha, I see where you are coming from. Perhaps so, but then again, the annual flu is not an unknown quantity. H1N1 is all-new, and it seems to be improving itself as well (according to the latest reports I saw on it). Sure, there is a flu season every year, but the strains are known quantities, vaccines exist, now there is Tamiflu. Sure, every year people die of it but every year people also die from suzumebachi stings. And they pretty much always have. Now, if a “new and improved” suzumebachi of unknown origin, behavior and lethality suddenly appeared and started to spread, with a few hundred casualties in the first couple of weeks, then I would expect a media panic. Same thing. Given time, the panic seems to be dying down as people realize that H1N1 is not one of the Four Horsemen.
At least not yet.