Commentary / Japan

You don't have to be Asian to wear a face mask in an epidemic

by Shaun O'dwyer

In late February I first saw signs of growing consumer anxiety over the spread of the new coronavirus to Japan. During a convenience store stop I noticed that masks had sold out, but immediately beneath them condoms were in full stock. “People will over-prepare for a crisis” I thought to myself as I snapped a photograph of this melancholy scene, “but they won’t prepare for a happy ending.”

This face mask sell-out coincided with panic buying of toilet paper and tissues, sparked by false online rumors that these products were running short because they were manufactured in China and their export to Japan would cease. At first I thought such toilet paper panics were a Japanese cultural trait, based on my memories of the panic buying following the March 2011 Tohoku tsunami disaster, and my reading about the first toilet paper panic during the “Oil Shock” in Japan in 1973.

Subsequent toilet paper panics in other countries this month soon proved me wrong, of course. Still clinging to those assumptions about cultural difference, I imagined that at least Japanese shoppers are more stoic, or at worst passive-aggressive, while they are stripping supermarket shelves of toilet paper. In Australia, for instance, there have been incidents of enraged shoppers assaulting each other, supermarket staff and police. However, photographs of angry, scrumming shoppers from the 1973 panic in Japan made me rethink those assumptions too.

But talk about cultural differences brings me back to the topic of face mask wearing: To the wonderment of foreigners at Japanese people wearing them years before the coronavirus pandemic, and to the recent attacks on East Asians wearing face masks in the United States and Britain. It’s important to understand the many reasons why East Asians have increasingly been wearing face masks over the past two decades — but there are some good reasons not to exoticize, or stigmatize face mask wearing as a culturally “Asian” practice.

In this instance, assumptions about cultural difference are easy enough to confirm. Face mask-wearing has become ubiquitous in East Asian societies. When I first began teaching in Japan in the spring of 2000, I noticed that some students were wearing them, which they explained were for pollen allergies. Use of face masks has grown dramatically in the past decade, however. According to Nippon.com, production of face masks for personal use rose from 500 million in 2011 to 4.4 billion in 2018.

There are a number of explanations for this rapid rise in usage. Those explanations refer to government influenza advisories and mass media influencing trends to wear masks as a protection for the healthy and as an etiquette for the unwell, to the subtle social pressures to conform which accelerate such trends, and to clever marketing strategies which further normalize those trends, including the promotion of masks as fashion accessories to young women.

In some ways Japan’s growing mask-wearing habits overlap with similar trends in the rest of East Asia. The 2002-2003 SARS epidemic boosted mask usage in China, Hong Kong, Taiwan, Japan and South Korea, to the extent that outside East Asia the masked “Asian face” came to symbolize this epidemic — and also, Asian “otherness.”

Throughout East Asia masks are also increasingly used to ward off colds and viruses or to protect others from them, as protection from air pollution, and as fashion accessories, much like they are in Japan. As medical anthropologist Christos Lynteris pointed out in The New York Times, their use is also a social ritual, a means for expressing and performing solidarity and a common sense of belonging in a crisis. And not only in epidemic crises, as was strikingly illustrated by the defiant crowds of masked protesters in Hong Kong’s pro-democracy movement.

Such anthropological explanations provide valuable insights. However, when combined with what sociologist Rogers Brubaker describes as our inevitable habit of “essentialist reasoning”, they can reinforce inclinations to “other” East Asians as personifications of civilizationally distinct cultures. Such reasoning can also reinforce inclinations to self-exoticize, in nationalistic assertions of cultural difference from the West.

Under the influence of essentialist reasoning, we may come to see mask wearing, and the (diverse!) prevention, containment and mitigation measures being implemented in the present pandemic by Taiwan, China, South Korea, Japan or Singapore as culturally programmed manifestations of a deep, historically rooted Asian “collectivism” or “Confucianism.”

Even when such exoticizing is phrased in progressive terms as respect for cultural diversity, it can mislead. It can induce us to overlook past experiences when such practices, and measures, were adopted and indigenized across seemingly deep cultural divides. And it can get in the way of us asking ourselves whether, and how, they should be adopted today across those same presumed boundaries.

Christos Lynteris himself provides a useful corrective to such essentialist thinking. He observes that widespread use of face masks during epidemics originated in China. During a 1910 pneumonic plague in Manchuria, a Cambridge-educated Malayan doctor, Wu Lien-teh, recognized the infection was transmitted by airborne particles from infected people. He promoted the use of specially manufactured gauze masks among Chinese and foreign medical staff during the epidemic, and also among patients and “suspect cases.” The masks proved effective and were also photogenic for international news media, becoming “a marker of (China’s) medical modernity”.

Soon face mask wearing was adopted globally as part of a suite of variably implemented containment and mitigation measures during the 1918-1919 influenza pandemic. In cities as far-flung as Seattle, Tokyo and Sydney, people were required to wear them whenever they took public transport or visited public places. Photographs from the time hint at mask wearing as a form of social ritual not unlike that being observed today in East Asian countries.

But, the inevitable question arises: outside of standard clinical or emergency medicine settings, do face masks assist in slowing virus transmission? Here, the jury is still out. Following the SARS epidemic, researchers pointed to a lack of multivariate, case-control research demonstrating the efficacy of widespread mask usage by healthy people in epidemic conditions — and there are ethical problems inherent in conducting such research. In the face of inconclusive research results, and with growing global mask shortages, the governments of Japan, Taiwan and many other governments outside East Asia are advising only members of the public with illness symptoms to wear face masks. This is in order to prioritize the needs of medical staff and patients.

However, defenders of more widespread public use of face masks during epidemics invoke some evidence that such a measure provides moderate self- and community protection against virus transmission. They also highlight evidence of pre- and asymptomatic transmission of coronavirus as support for recommendations that even healthy people wear face masks when going out in public.

Let’s forget the culturalist nonsense that there are distinctively “Asian” approaches to mitigating and containing epidemics, including public face mask usage. Should everyone be wearing them? Thinking of the health and even lives of millions that are now at stake, I consider it smart as a layperson to follow expert and government advice concerning measures like social distancing, personal hygiene maintenance and face mask wearing, and to obey more drastic containment directives, should they come into effect.

The current Japanese government advice to citizens and residents is that only those with cold or other illness symptoms need wear face masks in public, and that advice makes sense in the current shortage. It also makes sense for healthy people to curb habitual mask usage and not to panic-buy and hoard masks, in order to give priority at least to those who are ill.

Supposing face mask production finally catches up with demand, I think it also makes sense for face mask-skeptical foreigners or Japanese to wear them on public transport or in crowded public spaces, and not only because of the modest evidence for the community protection that practice confers during epidemics.

Research has shown how epidemic crises can elicit atavistic anti-outsider and xenophobic reactions latent in our disease-avoidance psychology. The social ritual of wearing face masks may play a role in sustaining humane sentiments of solidarity, decency and cooperativeness in such crises, while keeping that atavism at bay. Perhaps this sounds like a rather Confucian argument: but after all, you don’t have to be a Confucian, or even East Asian, to believe it.

Shaun O’Dwyer is an associate professor in the Faculty of Languages and Cultures and author of the recently published book Confucianism’s Prospects.

Coronavirus banner