Japan’s lessons on COVID-19 and wearing face masks can show California the way forward

The U.S. has become a natural laboratory for how COVID-19 spreads when health advisories are ignored or carelessly implemented. We know from several Asian countries that when social distancing is combined with widespread masking, testing and contact tracing, viral transmissions and mortality are nearly eliminated.

As of July 2, Hong Kong and Singapore still are reporting very low death totals —7 and 26 respectively, while South Korea, which has 12 million more residents than California, has just 282 deaths. In contrast, California, which has so far tried only social distancing, often observed in the breach, has suffered more than 6,100 deaths.

Hong Kong, Singapore and South Korea are also well past peak infection rates. Meanwhile California, and especially Fresno County, continue to set records for new infections per day, after re-opening of businesses with no mask requirements. It’s safe to be in public in Japan, but not so in Fresno County.

One might credit the more advanced health care systems in some Asian countries, where COVID-19 test kits are abundant and apparently accurate. But Japan serves an especially intriguing comparison. Dr. Jeremy Howard, a medical data expert at San Francisco State, says that Japan “kind of did everything wrong” in terms of social distancing (The New York Times, 6/6/20). And yet, with three times California’s population, only 969 people have died — just 16% of California’s total. Japan also has a mere 18,900 cases (compared to more than 230,000 in California) and are well past their peak infection rate.

Why the difference? According to Dr. Howard “the one thing that Japan did do right was masks.” Health scientists have long known that masks are effective — and they tried to tell public officials. On April 12, Dr. Howard and 18 scientists from all over the world published a study titled “Face Masks Against COVID-19: an Evidence Review,” citing decades of published research. To ensure wide dissemination, the paper was published in an open-access pre-print journal (so it’s is free).

This is what scientists should do, and it’s why tax dollars support research: having information that can help the public, that information must be shared when it can aid public policy. As Dr. Howard explained to me: “I was surprised to find how strong the evidence was (for mask wearing). So I figured I should work to communicate that evidence. The team I put together for the paper are top epidemiologists, biostatisticians, aerosol chemists, and other relevant experts.”

Countries that listened to those experts, like Singapore, South Korea, Hong Kong and Japan, are reaping the health, social and economic benefits.

But in the U.S., by dint of public policy, we are trying a different experiment: what happens when we take effective health measures but apply them haphazardly? Then remove them? Then re-institute them again? What if we require masks, but advertise nonenforcement, so as to encourage noncompliance?

A research group at Texas A&M (Zhang et al. 2020) has some preliminary results. They found that early social distancing and sanitization measures “minimized short-range contact transmission, but did not prevent long-range airborne transmission…”. But once masking was implemented, more than 60,000 lives were saved in New York and more than 70,000 in Italy (and counting). Their work again emphasizes “airborne transmission as the dominant route for the spread of COVID-19” and mask use “the most effective means to prevent interhuman transmission.”

Meanwhile, in California, policies and public messaging seem almost designed to inhibit key protective measures. A week after Gov. Newsome’s masking order, highway message boards and public signage still say: “wash your hands”, “don’t touch your face” and “practice social distancing” — with no mention of masks. And for their part, Fresno-area law-enforcement agencies seem uninterested.

Elections occur on a timescale much longer than the timescales of viral spread, infection and death. It seems that we must rely on public empathy, rather than codified public policy — as appears to be common in Hong Kong, Japan, South Korea and Singapore, where masks are worn without public orders. From prior epidemics, they know that nonsymptomatic people can be contagious, and they appear loathe to harm others by not wearing masks. We can do the same. And perhaps at some point, elected public officials will join us; we may even see highway signs reading: “Open your heart; wear a mask.”

This is an update of an earlier version posted on July 2, 2020.