Early on when I was living in Japan, my Australian housemate came home from work and started ranting. “Japanese people are so paranoid!”, she exclaimed in disgust. “They wear masks on the train because they’re afraid of getting sick!” I explained that she had it all wrong; though some Japanese people wear masks in order to keep out pollen during allergy season, mostly it’s something that sick people do, in order to keep their own germs from spreading to other people. It’s not germophobia; it’s social responsibility.
As the COVID-19 pandemic slumps toward its end here in the U.S., people are looking forward to taking off their masks. And that’s good! I no longer wear a mask outside (I was fully vaccinated long ago), and I only wear one inside because it’s still mandated. Community transmission in San Francisco is down to a small trickle, and most people here have gotten at least one shot of the vaccine. Soon, as low case counts and high vax rates become the norm in all parts of America, mask mandates can disappear, and we can all breathe easy again — literally.
But now that we Americans have all learned how to wear masks, my question is: Why not adopt the Japanese custom? Mask mandates are unnecessary outside of a pandemic, but Americans who are sick with the flu or a cold can still voluntarily choose to mask up on public transportation or in crowded places, to keep from spreading their germs around. It would be a nice thing to do.
Unfortunately, some Americans are not big fans of doing nice things. When I suggested on Twitter that mask-wearing by sick people could become a normal part of American culture, most people were highly supportive, but there was ferocious pushback from an outspoken few.
For whatever reason, some people are in a mood to inveigh against masks. For some people, fighting against the last remnants of the social norm of mask-wearing probably feels like a way of reasserting control over their lives. Yascha Mounk, for example, wrote a recent blog post urging people to take off their masks in order to “resume normal life.”
For these people, the notion that the pandemic could permanently change something in our society might feel like a defeat or surrender. So I expect some of them to vigorously resist the idea that Americans should now start wearing masks when we’re sick. A few will probably even harass and ridicule those who choose to altruistically protect others from their germs.
But this is a misguided impulse Sometimes crises have a silver lining; they force us to learn better ways of doing things. COVID-19 taught us the value of mRNA vaccines, for example, which may now be used to vanquish a large number of other diseases. It also taught us the importance of keeping supply chains for crucial medical equipment in the United States.
And hopefully, it has taught us the usefulness of masks.
By now, there is a vast preponderance of evidence showing that masks help to reduce the spread of COVID-19. If you still don’t believe that evidence, then no amount of studies I could quote you will change your mind; you’re on your own personal journey that has little to do with science. The fact, is, masks work.
But what’s less known is that masks also work to some degree against other respiratory viruses like the flu. A 2020 meta-analysis of 21 studies showed that while masks don’t stop the flu as much as they stop COVID-19, they do significantly reduce transmission. Dummy simulations and physical measurement of flu particle exhalation from infected patients also find a protective effect. Studies of schoolchildren find that masks reduce flu transmission in Japan, etc. etc.
In a normal year, somewhere between 12,000 and 60,000 Americans die of the flu. That’s no COVID-19, but if the practice of wearing masks when you’re sick could prevent even just a thousand deaths a year, it seems like it would be worth it. And what’s the cost, really? Masking up is mildly annoying, but for someone already sick with the flu it’s not much additional pain. And we already wash our hands and avoid sneezing or coughing in other people’s faces; how different is this?
Of course, people can theoretically just stay home when sick, as many people suggested in their responses to my tweet. Then there’s no need to mask up. But realistically, lots of people can’t take time off, and our nation also simply can’t afford to keep every worker home who’s feeling under the weather.
We should copy good ideas from other countries
One common (and angry) response to my suggestion of adopting the Japanese practice of mask-wearing was “We’re Americans; we don’t do that.” But a chavinistic attachment to local tradition is a terrible reason to resist adopting practices from other countries.
To a large degree, countries’ economic development depends on absorbing and adopting technologies from other countries; figuring out how to do what foreigners already know how to do is a lot easier than reinventing the wheel yourself. Countries’ institutional and cultural ability to import foreign innovations can determine their success or failure.
In 1793, when Britain sent a diplomatic mission to China that displayed examples of new industrial technologies, China’s emperor haughtily sniffed that “I set no value on objects strange or ingenious, and have no use for your country's manufactures.” Almost two centuries of national decline followed. But in 1853, when Japanese leaders beheld the sight of American steamships, they knew their country could no longer afford to resist foreign ideas; the most rapid technological and social modernization the world had ever seen followed shortly thereafter.
Masks are nowhere near as big a deal as steam ships. But they’re just one of a bunch of small Japanese ideas that Americans have refused to adopt, like washing toilets or buttons to call wait staff (fortunately we do seem to be slowly learning to take off our shoes inside the house). And there are many institutional practices that we could also stand to adapt, like effective train systems. I’m sure there are other ideas from many other countries besides Japan that would also benefit America, if only we could dispense with the notion that “that’s not how we do things around here.”
This is not to say that America a uniquely closed-minded or parochial society; there are plenty of American things Japan could stand to import, like walk signals that give you enough time to cross the street. Nor is it to say that we should copy everything Japan does differently; for example, scrapping and rebuilding all of our buildings every few decades seems like it would be a waste of resources.
Instead, the point here is that nations succeed when they pay attention to other nations and copy best practice. Often this involves a lot of adaptation of foreign practices to local cultural particularities; when Japan imported American and European innovations in the 1800s, they strove to maintain a native feel to the things they imported (an idea known as “wakon yosai”, meaning “Japanese spirit, Western things”). So if Americans do adopt mask-wearing, expect the practice to be a bit different from the way they do it over there.
I believe that America has gotten too insular and complacent. Other countries have been passing us up in a lot of areas, from health insurance systems to construction costs to infrastructure, and we should start paying more attention to alternative ways of doing things. Masks are just one tiny tiny piece of this, but we need to get into the habit of not instinctively resisting foreign ideas.
America needs a dose of social responsibility
Finally, I think adopting a practice of wearing a mask when you’re sick, to protect other people, would be a good way for Americans to practice pro-social behavior.
Many of the people who responded negatively to my tweet declared that they weren’t scared of the risk of cold or flu. This is an inherently selfish perspective; infectious diseases are infectious, and masks are for reducing your chances of making someone else sick. That some people didn’t seem to grasp this speak to the toxic selfishness that has pervaded parts of American culture.
Thinking only of yourself is not a healthy form of individualism; instead, it is a toxic abdication of your personal responsibility to protect other people. Healthy individualism should emphasize not just freedom to do whatever you feel like, but also the individual’s duty to others.
Sociologist Robert Putnam has written about how America experienced an upswing in pro-social behavior in the mid 20th century that then began to erode in the 70s and 80s. It’s not clear what caused this swing toward selfishness. It probably had something to do with the divisive politics and culture wars that began in the late 60s. The proliferation of car culture and the internet might have isolated us from our surrounding communities as well. Those on the political Right will undoubtedly blame immigration and diversity for the change, but given that it seems to be a faction of people on the Right who despise the idea of masks, I’d say some introspection is required there.
In any case, I think wearing masks to protect others from your germs would be one small step in the direction of becoming a more pro-social, considerate society. And becoming a more pro-social, considerate society seems like an important step toward healing the toxic, crippling divisions that are holding our nation back from achieving its full potential.
In the end, masks are not a huge deal, but I think the idea of looking out for the people next to you has important symbolic value.
Countries with customary masking have very high rates of respiratory deaths (https://www.worldlifeexpectancy.com/cause-of-death/influenza-pneumonia/by-country/), including Japan.
As a crazy alternative, how about normalizing that sick people stay home?
Wearing a mask could be the perfect compromise when you wake up feeling "meh" and don't know whether you should waste a sick day on it.