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How Japan's mask culture may have saved lives during coronavirus

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How Japan's mask culture may have saved lives during coronavirus

While citizens of other countries around the world struggling with the coronavirus pandemic have railed against face masks as unnecessary, ineffective or an infringement of their civil liberties, Japanese people have in virtual unison done as many experts have suggested and covered up.

And while wearing a mask may not be the only reason why Japan has such a relatively low infection and death rate from the disease, epidemiologists say it is almost certainly a positive contributing factor.

As of Saturday, Japanese health authorities had reported 92,063 confirmed coronavirus cases and 1,661 fatalities in a nation of 126.5 million people. In comparison, the United states has reported 7.9 million cases and more than 219,000 deaths among its 328 million citizens and the UK, with a population of 66.7 million, has just over 689,000 cases and nearly 44,000 deaths.

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The Japanese figures are relatively low, it has been suggested, because the country has a culture of cleanliness, including washing hands frequently, while people bow in formal situations instead of shaking hands and people here do not kiss cheeks to greet friends or family.

Similarly, wearing a mask in public is a habit that has been widely practiced for more than a century and appears to have its roots in religious festivals.

Ancient customs

There are suggestions that in ancient times, people hung the leaves from the sacred "sakai” tree in front of their mouths to prevent their "unclean breath" from defiling religious rituals and festivals.

By the time the Meiji Period dawned in 1868, people were already being depicted in works of art with their mouths covered. And in the latter decades of the 1800s, as Japan hurried to modernize and catch up with its Western counterparts, concerns about infections meant that more and more people were purchasing cloth masks to protect themselves.

The production and wearing of masks soared in 1918, when Japan was affected by the Spanish flu outbreak that caused as many as 50 million deaths globally.

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It is believed that the illness was brought into Japan in the spring of 1918 by three sumo wrestlers who were returning from a tournament in Taiwan. A second outbreak was reported that May, with a sailor on a warship anchored off the port of Yokosuka diagnosed with what was initially called the "epidemic cold."

Records are incomplete, but academics estimated that between 257,000 and 481,000 Japanese died from the Spanish flu, although a study by US academics published in the journal "Emerging Infectious Diseases" suggested the real figure may actually be around 2.02 million deaths.

That figure would account for 3.71 percent of the population at the time of 56 million, and put Japan's experience on a par with other parts of Asia.

Acceptance of face masks has remained ever since, particularly in the winter flu season and the spring months, when many Japanese suffer from pollen allergies brought on by the swathes of evergreen trees that were planted in the years immediately after World War II to provide timber to rebuild cities.

Read more: Coronavirus: What we can learn from the Spanish flu

Masks are part of Japan's culture

As a consequence, Japanese did not bat an eyelid when medical experts stated in the early weeks of the pandemic that wearing a mask would at least reduce the risk of contracting the coronavirus.

"The Spanish flu pandemic of 1918 was when people really realized the importance of wearing a mask and ever since then we have just accepted it as a sensible precaution to take," said Yoko Tsukamoto, a professor of infection control at the Health Sciences University of Hokkaido.

"Face masks have now reached the point where covering one's face is part of our culture and not something that anyone questions," she told DW.

"Many foreigners who visited Japan before the pandemic believed that people were wearing masks to protect themselves from the people around them," she said.

"That is true to a certain extent, but it was far more out of consideration of the people around them on the train or bus, especially if they had a cold or something similar. We see it as the considerate, polite thing to do."

Social pressure

Makoto Watanabe, a professor of communications at Hokkaido Bunkyo University, agrees - but adds that there is also a high degree of social pressure in play.

"Japanese people are completely used to wearing masks to protect themselves and others, but there is also social convention in effect," he told DW.

"People know that they should wear a mask and be considerate towards others, so they wear a mask to show the people around them that they are following the rules — even if those rules are unwritten — and that no-one can blame them if they get ill."

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Watanabe points out that there were a limited number of angry confrontations between passengers on trains and in shops when some people failed to wear a mask in the early days of the pandemic, but such incidents are virtually unheard of now.

"The science on wearing masks fluctuates quite dramatically and some experts put it as low as reducing the likelihood of catching the virus by just 30%, but Japanese people are protecting themselves socially as much as medically," he said.

"As a society, we expect those around us to have the same standards, and right now that means wearing a mask."