The swine flu has finally managed to make its way to Japan, which was just about inevitable despite the high level of precaution taken by the Japanese health ministry, and ground zero is the Kansai area — especially the cities of Kobe, and Toyonaka-shi in Osaka, which is where I live. It’s suspected that the majority of the initial cases in this area were spread via close contact among high school students at a volleyball tournament. At last count there were some 292 confirmed cases of infection by the H1N1 virus in Japan, the majority of them in Hyogo and Osaka prefectures. Virtually all the schools in this area — around 4,000 in total — have been closed for the week and people living in the area have been advised to avoid densely populated public spaces, stay home as much as possible, wash their hands more often and more thoroughly than usual, and wear a facemask in public when spending time in crowded, close quarters (such as train cars).
Writing about what he calls Japan’s “surgical mask culture,” Danny Choo describes his surprise at first encountering ordinary citizens walking around in public wearing surgical-style facemasks. While most of the masks you see in Japan are not actual surgical masks, many of them have been designed with specific medical uses in mind; especially common are the masks that are used to block ceder pollen during Japan’s early spring allergy season. Most people, however, wear facemasks not to keep from getting sick (a popular misconception), but rather to keep from spreading their own germs to other people when they themselves are sick. The practice of wearing facemasks is so normative in Japan these days that many of my Japanese friends — even though they’re fully aware that masks aren’t commonly worn outside of Southeast Asia — are surprised to learn that the act of wearing a surgical facemask in public in the U.S. is generally seen as abnormal and can even provoke discomfort in those who are in close proximity to the wearer of the mask. Needless to say, when the Japanese government advised the wearing of facemasks as a measure to help stave off swine flu transmission the facemasks came out in force. According to one friend of mine who commutes right through downtown Osaka during the height of the morning rush (when people are packed into trains like sardines) the percentage of people wearing facemasks stood at around 98% on the first day of the outbreak. In Toyonaka-shi the rate seems to be much lower — about 50% on the street and in the trains — but the population in this area is much more dispersed so there isn’t nearly so much proximal contact.
Of course, there’s been a plenty of debate about whether or not wearing surgical-style masks will help to stem the spread of swine flu. The consensus in the English-language media seems to be that only proper surgical respirators of the N95 classification are likely to help prevent infection. In a short article at scientificblogging.com a similar claim is made:
There has been much debate about the benefits of wearing a mask to prevent infection with swine flu. Ordinary surgical masks provide some protection from airborne particles, but the UK Department of Health has stated that ‘basic face masks don’t protect people from becoming infected’.
This makes perfect sense to me as viruses are incredibly small and unlikely to be blocked in significant numbers by the non-N95 masks that everyone is walking around wearing. However, the assumption in the quote above is that people are wearing the masks as “protection from” rather than as a protection for others. But if it’s true that swine flu virus is primarily “spread when minuscule droplets emitted by coughing and sneezing or deposited on hands and surfaces reach the nose or mouth” (scientificblogging.com), then it makes sense that wearing a mask in public to capture your own moist droplets might in fact reduce the amount of transmission in tightly packed public areas where a sneeze could otherwise cover those in the immediate vicinity with spray.
My own feelings about wearing the mask are ambivalent. On the one hand, I’m not too worried about the flu myself (it only has something like a 0.4% mortality rate) and I think that taking other measures, such as avoiding places associated with the flu, not going out as much as usual, keeping your hands away from your face until you’ve washed them thoroughly, and getting enough sleep to keep your immune system up will ultimately prove just as, or more effective than masking up. One of the main reasons for this is that people are clearly not using their masks properly — I’ve seen people rubbing their hands all over the front of their masks while adjusting them (thus potentially contaminating their hands), people pulling their masks down to smoke, and even someone who was driving a car while picking their nose from underneath their mask. And I’m sure that most people are not using each mask just one time, as is recommended.
Another reason I’m not so keen on the mask is purely personal — I used to work for a small, custom bicycle manufacturer and we had to wear masks to keep metallic dust out of our noses. The masks were hot, sweat-producing, and had the amazing ability to amplify your bad coffee breath, which you then had to breathe all day. Later we received fitted respirators so we could avoid breathing chemical fumes when we used solvents, epoxies, etc. Getting the respirators fitted was an instructive process in just how much can get through a regular mask, or even an improperly fitted respirator. In order to fit the respirators we had to put our head into a clear, air-tight, plastic ‘bucket’ (for want of a better word). A tiny bit of saccharine powder, invisible to the eye, was shot into the bucket. Saccharine, it turns out, is incredibly diluted in those Sweet-and-Low sweetener packs and raw saccharine is incredibly strong in even minuscule amounts; even though you couldn’t see it, you could easily smell it. Basically our respirators were properly fitted when we could no longer detect the saccharine molecules and the difference between a properly and improperly fitted respirator was like night and day: improperly fitted and it was as if you’d just done a line of sweet and low, while with a properly fitted mask you would smell absolutely nothing. So if the tiny H1N1 virus does get airborne then there’s absolutely no way that any conventional mask is going to keep it out.
However, there’s another side to this equation, and that’s the idea that the mask functions in Japan as part of a wider cultural logic, a cultural logic that perhaps helps to explain why trains in downtown Osaka can have a 98% ‘mask rate,’ while Americans and Europeans can hardly be bothered. Two factors come into play here. The first is that Japanese children are raised to value and understand the interdependent nature of society, a cultural background that often results in the impression of an overly conformist society (think of school uniforms, etc.). In this sense Japanese society is far more communalist than many other societies and this is reflected in the widespread adoption of the wearing of the mask in the Kansai area. Most of the Japanese people I talk to don’t really think that the mask is any kind of serious barrier to the spreading of the swine flu, and it’s quite common to hear people saying things like, “Well, I suppose it’s possible that the mask might help a little bit.” Perhaps one way to view the mass adoption of the mask, then, is not as a personal psychological talisman that people wear in order to feel safer, but rather as a social symbol that acknowledges the need for interdependent action and care in combating the spread of communicable disease.
The second factor involved here is the Japanese idea of ritual purity. I’m often loath to bring in historical or religious precedent when discussing contemporary Japanese culture because it’s something that’s done so often and so poorly by so many people (i.e. ahistorical hogwash such as “Business success? A result of samurai values, of course!”). However, I do think in this case that the long history of Shinto-related practices surrounding the notion of ritual purity probably comes into play here, at least somewhat. The classic example of ritual purification is the washing of the hands and mouth before entering a shrine area. The idea here is, of course, not sterilization (no germs were hurt in the making of this movie) but purification. At this level the mask acts as a talisman, or symbol, or charm of purification; not in the sense that it will somehow ‘magically’ repulse attacking germs, but rather in the sense that the feelings of impurity associated with the spread of sickness can be partially warded off by the sense of ritual purification afforded by the mask.
Ultimately I’ve decided to wear the mask in those situations in which the clear majority of people are wearing masks. It’s a bit uncomfortable, and it probably won’t help stop the spread of swine flu, but I don’t see the sense of being a curmudgeonly refusenik about it. There are far, far more important things to be up in arms about.
(8 June, 2009)
A couple of addenda:
1) Apparently, the first popular use of medical masks in Japan followed the outbreak of Spanish flu in 1918.
2) I’m not quite sure, but there may be some kind of relationship between certain types of ceremonial masking related to Shingon Buddhism and the Japanese tea ceremony, and the use of medical masks in Japan. Before the swine flu broke out in Japan I visited an annual Buddhist ceremony at Dainenbutsuji temple in Osaka’s Hirano district. The ceremony itself consisted of an extensive procession that included gold-masked Buddha figures, various ranks of monks in traditional costume, and representatives of traditional Japanese arts, including the tea ceremony. During the procession, the masters of the tea ceremony all wore square paper masks that covered their mouths. These masks were definitely traditional and it seems pretty clear that they were objects of ritual purity.
3) On a more sinister note, it turns out that some of the Japanese students who went to Canada and returned with the swine flu recieved threatening phone calls at home because they decided not to wear masks while they were attending school in Canada. The students, understandably, didn’t want to feel out of place by being the only students at school wearing medical masks. This type of extremely aggressive and misplaced social blame is one of the major downsides that can appear when the notion of communal interdependence slides into the demand for absolute group conformity.
Filed under: culture, Japan, Kansai, Osaka, personal, religion, science, society | 2 Comments
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