Masks, Protection, Courtesy, and the Virus

I learned the custom of masks here in Japan about 40 years ago, back when it was definitely an unfamiliar sight outside Japan, and when many fellow 外人 (gaijin)  here made fun of the practice.

The first guy who explained it to me was my trainer as a missionary. As most missionaries are, he was not perfect, but his explanation was later confirmed by Japanese people I trust. This was not one of the things he misunderstood.

The mask is a custom of courtesy, less to protect the wearer than to provide partial protection for the people around him or her.

(I mention the fact of his misunderstandings because it is a fact of life, as a stranger in a strange land, that one must assume that information is, at best, incomplete, and often wrong. I guess it's even more of a fact of life when you think you are not a stranger.)

I am not an expert. I know what I'm talking about, but there are many things I don't know. Nonetheless, I think many people are operating without even this much knowledge about masks.

One, they are not, by any means, perfect protection.

Even the best masks, the ones used in surgery when the patient is immuno-compromised, are not much use long-term. Just as needles should never be re-used, the masks worn in surgery should be disposed of after finishing the surgery (and sometimes replaced periodically even during a single surgery).

[JMR202005261910 added:
I had a surgical nurse tell me I'm wrong about the above. I guess she wasn't in the operating room where I was operated on. Not every operation requires the same level of protection. But she does acknowledge washing her mask daily.
]

Why? Spattered blood or other body fluids quickly soak through the mask. Likewise, moisture, spit, phlegm, etc. from the breath of the person wearing the mask soaks through the other direction.

Faces itch under the mask, and the mask slips, so the mask tends to be touched by either the wearer's hands or an assistant's hands. This offers opportunity for transferring biologically active matter both ways across the barrier.

(Biologically active matter -- virus particles, bacteria, infected body cells, etc.)

Ordinary masks are much more porous than surgical masks, and the wearers tend not to replace them every fifteen minutes to half-an-hour. (That would be rather difficult, really, both economically and logistically -- and ecologically, come to think of it.)

[JMR202005261925 added:
I know I'm speaking in extremes in the above. The point I'm trying to make is that masks are not magic shields that block all the bad stuff and let the good stuff through no matter how long you wear them. Don't go to a rave wearing a mask and expect the mask to protect you.
]

Using terminology from information security, masks are a low wall or a speed bump.

Like the low wall and the speed bump, they can actually make problems worse when we refuse to use sense when we use them.

So why wear them at all, other than wearing true surgical masks in surgery?

[JMR202005262020 added:
Someone might bring Japan's infection and fatality rates up as empirical evidence. Yes, it is evidence, but you should understand that Japan has a long tradition with masks and other habits than help to limit the spread of aerosol spread diseases.

You do know about bowing instead of shaking hands, right? Well, even that is not that simple, but it's there. You aren't getting the whole story about Japan in the news.

Japanese people have been effectively voluntarily limiting a lot of the more dangerous activities.

Yes, there was an order, but it had, in the western mode of expression, no teeth -- other than social pressure, which is pretty powerful in Japan. Many of the less necessary businesses have been shuttered for the last couple of months, and, while there were a couple of the "live events" that Japanese entertainers, artists, comedians, etc., sometimes hold in the days after the order, people came away infected, and that fact was heavily reported and made the topic of talk shows and comedians' acts. Serious social pressure not to hold any more.

Sumo and professional baseball put on hold. The national high school baseball tournament, which is as big as the Japan Series in the fall, canceled for this year. (Probably. It might get revived if things go well now the order has been lifted.)
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Japan is a country of mixed-mid-to-high population density.  Masks tend to be used more commonly in population centers.

Close quarters requires building walls that don't make sense in less densely populated places.

Many of Japan's differences in customs have to do with common-sense differences between low-density environments and high-density environments.

Many of the common-sense customs have been altered against reason and sense over the last three-quarters of a century, and here is one. Wearing a mask and going to work is actually a self-contradictory behavior. If you need to wear a mask, you shouldn't be going to work, whether you are trying to protect yourself or your co-workers.

Well, unless your job is important.

(Ahem.) Unless your job is especially important, because every job is important. And unless your job is not so important that passing a common cold among your co-workers would be a bad thing.

Hmm. Maybe I'm getting sidetracked, doing a bit of hand-waving at topics this post doesn't have room to tackle. Back to the point.

Okay, so the traditional use of the mask was for cases where you were a wee-bit sick, but your need to be at work or to go to the market outweighed your need for rest and isolation. (And outweighed their need for you to be getting rest and isolation.)

Wearing a mask every day, long term, was neurotic behavior, but your friends would put up with it because they had their times of paranoia and neurosis, as well.

And, here's the kicker: Even though the mask can be counter-effective if you misuse it, for such things as the common cold, the speed-bump has regularly helped slow the spread until everybody developed resistance. This is repeating in the current case.

What kinds of behavior are counter-effective?

Counter-effective mask behaviors include such things as when you fail to wash your washable mask at least once a day, or dispose of your disposable mask in an appropriate garbage pail. Or regularly take it off and set it down where it can aid in the spread of germs.

Or such as wearing a mask so you can go out when you're coughing up so much that it gets soaked by your phlegm before you get home. Or decide that, because you are wearing the mask you don't need to wash your hands or stay home from work or stay away from public places like the market.

[JMR202005262040 added:
And there is also the recent news from China about a couple of students who were made to wear masks while they were given exercise tests, who died from respiratory/circulatory failure which was likely induced by the high-filtration masks. Wearing a mask with excessive filtration is another mistake.
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(Masks can be good while you're sleeping, to keep the throat and sinuses moist -- until the mask slips down, anyway, and if they aren't too tight to let you sleep. And if you aren't reacting to the inevitable lint. In this particular use, it's good to get the mask wet before you go to bed.)

For the individual, wearing a mask probably does not stop you from getting infected. It does slow the infection process down enough that your body can often fight it off, or you can get by with just catching a mild case.

(In surgery, if a doctor has symptoms, he or she is going to postpone the surgery or get someone else to do it, instead of depending on even surgical masks, etc.)
[JMR202005262045 added:
Related information, one medical study estimates that the rate of asymptomatic infection of SARS-CoV-2 in Kobe is probably 3%.
]

In groups (in the calculus of social behavior), having many speed-bumps and low walls helps slow the rate of spread down enough to prevent an epidemic. (Or slow down an epidemic to prevent it becoming a pandemic.)

If people behave sensibly.

If and only if people behave sensibly in the aggregate.

Aside from such things as cancelling raves and other high-attendance, close-encounter activities, what kinds of behavior are the common-sense behaviors I'm talking about?
Well, I've posted twice on this, if you want some more light reading:

• talking about learning from the virus that competition is not a good excuse to forget to live, 
• and discussing some specific measures to take.

[JMR2020052055 added:
For what it's worth, I wear a mask when I'm out working. (I'm currently working as a long-term temporary postal delivery person for Japan Post.) It is required for the job, but I do not wear it because of the requirement, and I do not wear it because of social pressure.

I wear it for courtesy.

I recommend wearing masks for the duration, in general. I do not recommend trying to force everyone to wear them. Too many people have problems with masks that they are unable to express or explain.

If masks cause you problems, I recommend restricting your close-quarters contacts as much as you can.
]

In summary, masks are an example of the fact that individual behavior does matter, and that being courteous does come back to you.