As COVID-19 fears subside, Japan debates the future of masks

Disposable face masks were indispensable for Keiko Kataoka even before the pandemic hit Japan.

They were a staple accessory during the hay fever season in spring, and she often continued to wear them after pollen levels subsided. She also used them when she worked out at the gym without makeup.

“People around me would ask me if I had caught a cold,” the Tokyo office worker and mother of two says.

Following the onset of COVID-19, Kataoka wore face masks to and from work as well as during meetings, only removing them to eat a meal.

Masks ultimately became something akin to a safety blanket, and she says that she feels more comfortable wearing them “because I’m not too fond of the shape of my mouth.”

But Kataoka believes the widely adopted medical accessory is impacting her social interactions, and she finds it difficult to recognize individuals in crowds of half-covered faces. She also worries about the toll it is taking on her children’s interpersonal development.

Now, with case numbers stabilizing and the government slowly easing its mask guidelines as the country braces for a particularly hot and humid summer, Kataoka and the vast majority of the population that have voluntarily complied with mask-wearing guidelines for more than two years are questioning when, if ever, is the right time to dispense with them.

“I’ve gotten used to them,” says Kataoka when asked whether she plans to continue wearing masks post-pandemic. “I may not when I’m outside, but I’ll probably keep them on when I’m at the office or in crowded settings.”

Mass acceptance

Masks became omnipresent in Japan as the global health crisis unfolded, a well-documented phenomenon rooted in a culture of social conformity that experts say helped prevent the nation from suffering the substantial number of deaths seen in some other nations, including the United States, where mask-wearing has become a politically charged issue.

Japan’s affinity for face masks goes back centuries, and outbreaks such as the Spanish flu (1918-20), the Hong Kong flu (1968-69) and subsequent viral epidemics have widely ingrained the efficacy of the item in preventing the transmission of viruses. They’ve become a common sight over the past decades during hay fever and influenza seasons, while some people — often women — wear them for purely aesthetic reasons.

But with many nations now lifting mask mandates to various degrees, debate is heating up on when Japan will loosen — and perhaps eventually abolish — its own advisory.

In May, the government released a set of guidelines regarding mask use, saying it’s OK to remove them outside — even when standing near another person — provided people refrain from engaging in conversation.

Preschoolers age 2 and older are also not expected to wear masks, it said, backpedaling on a previous recommendation it had made in February when case numbers soared.

“It really comes down to the risks and merits involved in wearing masks,” says Intetsu Kobayashi, a professor at Toho University’s Faculty of Nursing and an expert on epidemiology.

“We know symptoms are getting less severe, and many have had two or even three vaccines,” he says. “We’re also heading into a hot and humid summer that raises the risk of heatstroke. So it’s time for the government to issue clear, strong guidelines on how to behave in different situations, or else people could succumb to peer pressure and continue wearing masks.”

According to a survey conducted by research firm Nippon Information in February, 54.5% of 972 respondents between the ages of 16 and 69 said they would always, or as frequently as possible, wear masks even after the pandemic subsides. That ratio rose among women in their 20s and 30s, with more than half pointing to the fact that it allows them to go out without makeup.

‘Face pants’

As the pandemic dragged on, a peculiar neologism emerged: kao pantsu, or, literally, “face pants.”

A satirical take on how some people have developed a strong resistance to removing their masks in public, the phrase essentially compares masks with underwear — you can’t leave home without them.

“Sensitive, introverted people who have trouble communicating with others, and those who are not confident with their facial appearance are often the ones who become dependent on masks,” says Yuzo Kikumoto, CEO of counseling service Kikiwell and author of “Date Masuku Izonsho” (roughly “Ornamental Mask Addiction").

In the late 2000s, Kikumoto noticed a spike in the number of clients who sought counseling regarding their obsessive mask use.

“They said they felt safe wearing masks, and that it protected them from unnecessary interactions with bosses and colleagues in the workplace,” he says.

While these cases appeared to decline gradually over the past decade as work-related stress and mental health issues gained broader recognition and understanding, Kikumoto sees the pandemic triggering similar symptoms.

“I’m sure there are, and will be, people dependent on masks for non-sanitary reasons,” he says. “But it will be difficult to find out as long as at least some level of mask advisory remains in place, which will give people an excuse to wear them.”

In a 2020 survey conducted by MedPeer, a doctors-only community platform, 416 of the 1,058 respondents pointed to mask dependence as a modern-day illness that needed to be watched, second only to the mask-induced dermatitis that was flagged by 490.

Kikumoto warns that the phenomenon is not only affecting adults, but school children as well.

“Kids who have entered elementary school since the pandemic began have been spending their entire school life wearing masks,” he says. “There’s bound to be various issues arising from that.”

Cognitive impact

Nobuyuki Kawai, a professor at Nagoya University and an expert on cognitive science, has seen the effects routine mask-wearing can have on children firsthand. When Kawai’s son was playing at a park recently without wearing a mask and his glasses, his friends from elementary school didn’t recognize him.

“Recognizing the face of individuals is a process that takes a surprisingly long time,” he says.

Kawai says adults are adept at picking up individual details such as hair style and makeup, but facial perception is not as fully developed among schoolchildren.

“There are negative effects on communication development when children do not see the faces of their peers for extended periods of time,” he says.

In a study published in "Cognitive Research: Principles and Implications" in February, children between the ages of 6 and 14 years old were asked to take a memory test showing upright and inverted faces with and without masks. The results indicated that children’s facial perception is more negatively impacted by the inclusion of masks compared to adults.

“Changes in face recognition performance and alteration in the processing of partially occluded faces could have significant effects on children’s social interactions with their peers and their ability to form relationships with educators,” the researchers said.

Meanwhile, lunchtime at school, which used to be an essential part of socialization, has been drastically altered during the pandemic. Instead of grouping their desks together and chatting while eating, students are asked to face the same direction and finish their lunch in silence under a policy of mokushoku (silent eating).

“Such practices must be detrimental for children trying to form relationships,” Kawai says. “Hopefully these losses in developing human skills is something that can be recovered once these rules are abolished.”

But, again, when is that going to be?

In May, the education ministry decided to inform boards of education and other organizations nationwide that it is not necessary for students to wear masks during physical education classes, both indoors and outdoors. Children are also encouraged to remove their masks on the way to and from school, provided they refrain from talking.

“When will people start taking their masks off? The Japanese have obliged to mask advisories on a voluntary basis, a phenomenon often linked to the nation’s culture of conformity,” Kawai says. “That may also mean that we may see a tipping point — perhaps not this year, but maybe next summer when the heat makes wearing masks unbearable — when people think ‘enough is enough’ and begin taking their masks off en masse.”

Old habits die hard

If and when Japan will bid farewell to masks is up for debate. For some people, though, COVID-19-induced sanitary practices will be hard to shake off.

“Since the pandemic began, we’ve been offering group customers individual portions of sashimi rather than serving them on one large plate to minimize contact,” says Takao Saito, the third-generation owner and head chef of a Japanese-style restaurant in Tokyo’s Taito Ward. “It’s something we will continue since I’ve realized that it saves customers the hassle of competing for slices of fish with others in the party.”

Saito also notes that he’ll likely wear a mask regardless of the state of the pandemic while preparing and serving food, saying “it’s simply more hygienic and clean.”

Mitsutoshi Horii, a sociologist and professor at Shumei University’s overseas campus in Canterbury, England, says the fact that there aren’t any legally enforceable mask mandates in Japan could make it more difficult for the nation to transition to a maskless society.

“In England where I live, for example, face coverings are no longer required by law,” he says. “Once the mask mandate was lifted, almost everyone took them off.

“But in Japan, it could be more complicated since mask-wearing has been largely voluntary to begin with. Unless there are clear rules applied to workplaces and schools, for example, people may feel compelled to keep them on to avoid being an outlier.”

To date, more than 30,800 people have died from COVID-19 in Japan, with new cases hovering at around 15,000 to 20,000 a day. The number of severe cases each day continues to decrease, having now fallen below 80.

While historical events and cultural characteristics have been cited as being behind Japan’s affinity for face masks, with case counts falling and death tolls shrinking, surely people won’t be wearing them forever?

“We shall see,” Horii says. “The mask has evolved into an item people seek to alleviate anxiety during uncertain times.”

That means social norms — much more than government guidelines and science — may ultimately decide when people will say goodbye to face coverings.

“And even then,” Horii says, “I’m sure the custom will remain in some form.”