Face Masks?

Face Masks?


When Covid 19 first appeared, my first reaction was that it would hit Japan (my area of expertise), particularly badly. We knew at an early stage that Covid 19 has a much higher rate of mortality for the elderly and Japan has the worst demographics in the World. For every person who is aged 65 or more there are only 2 people aged 15-64. The next worst country in the OECD is Italy where the ratio is roughly 1:3. It might strike some as not a particularly meaningful difference between the first and second most demographically challenged countries in the OECD but it is the equivalent of Japan having 50% more people aged over 65 relative to those aged 15-64. It is significant.

The Greater Tokyo Area is also the most populous metropolitan area in the World at 37 million and also the largest urban agglomeration economy. Next is Delhi on 25 million and then Shanghai on 23 million. The average daily commute in Tokyo is 80 minutes on  overwhelmingly cramped trains. 6 of the 10 busiest train stations in the World are in Japan with the busiest Shinjuku receiving 3.6 million travellers/day. We know Coronavirus is spread by close contact: jammed commutes don’t help. Last, Japan is close to China geographically and received last year 10 million tourists from China whilst many Japanese companies have production and distribution offices in China. China is Japan’s largest bilateral trading partner. If the Coronavirus originated in China, Japan looked to be, unfortunately, the country that would suffer the most. 

Whilst Japan was fertile ground for spreading the virus, government responses can also have a significant effect helping to mitigate its spread. Six months on from its recognition, it is very plain that government responses do have a significant effect.  However, unlike some of its Asian neighbours, Japan was slow to introduce contact and trace as in Singapore, Korea or Taiwan. Testing has also been poor. Central to other Asian countries success has been the testing of potential cases and the tracking down of people they have come into contact with as well as self-isolation and quarantining. Hong Kong, Taiwan, China and South Korea have had some the highest number of tests/million in the World. Unfortunately, this has not been the case in Japan which has the lowest ratio in the G7 and one of the lowest in the G20 despite its wealth. Nor has Japan had any quarantining of any significance: bars, restaurants, clubs, and offices, all remained open until early April. Schools, some sporting events and large entertainment venues were shut in March and a national lockdown only started in April and before the end of May had completely ceased apart from in venues with more than 1000 people. The lockdown in Japan was short as in some US states that are now possibly regretting their decision. Not only was Japan a prime candidate that would suffer from Covid-19 but government policy was not as aggressively geared to stopping its spread in testing, contact/tracing and in the shortness of its lockdown compared to many European countries and the UK. 

Below are two charts from the Oxford Martin School at the University of Oxford that have been tracking the Coronavirus globally and how governments have reacted. Taken together, no other rich, industrialised country has had a lower level of testing and contact and tracing. How has Japan fared given this backdrop? One would assume it was a disaster. 

The UK has had 671 deaths from Covid 19 per million of population versus 7.8 deaths per million in Japan as of the 12th July. Adjusted for differences in size of population, the UK has had 86x as many deaths. That is a staggering difference. If it were the other way around, it could perhaps be explained: by demography, the geographic/economic interconnectiveness  of the Chinese and Japanese economies, by the differences in government responses. Unfortunately, it can’t and instead it highlights (this is putting it politely), the myopia of the UK government and the West in general.

Why is it Japan has done so much better? Some Japanese politicians, proud of their resilience in the face of the pandemic like to invoke a uniqueness to Japan and its people, others suggest that spoken Japanese is softer than other languages causing much less spittle whilst many suggest not shaking hands and/or hugging as a form of greeting has lessened the spread of the daily virus. However, a much more likely explanation is the overwhelming use of masks in public places. In Japan wearing a mask when one has a cold is commonplace and as anyone who has commuted to work on a Japanese train knows, blowing your nose in public is generally not the done thing. When Covid 19 hit, mask use became widespread overnight as families retrieved their winter masks.

The Royal Society has recently published two reports on masks. Paul Edelstein, author of one of the studies (Emeritus Professor of Pathology and Laboratory Medicine, University of Pennsylvania) says: “The evidence for the benefit of wearing face coverings in protecting others from infection is becoming clearer all the time. In fact, we have now identified convincing decades-old and apparently forgotten evidence, from the time when surgical masks were made of cloth and were reusable, showing that they help to prevent transmission of airborne infectious agents. There is now even some evidence that masks might directly benefit the wearer.  The basics are simple to understand. There are people without symptoms going about their daily business who are unknowingly breathing out droplets that are carrying the virus. If they had their faces covered the majority of those droplets would be caught before they can infect other people. Wearing face coverings can help save lives and prevent disabling illnesses.” 

I don’t think wearing a face mask just helps, I think it can transform the spread of the virus allowing the economy and people’s lives to return to a semblance of normality. Wearing a mask should be made mandatory in all public spaces. Why? Look at Japan. 

By Chris Rigg

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