Masking Down? Think Again!

Summer is fast approaching, bringing along with it new guidelines for mask-wearing from the Japanese government.

While masks are still regarded as vital to preventing COVID-19 from spreading, the use in outdoor spaces, in places where there is no close conversation happening, is now deemed unnecessary.

Despite the relaxation, many people in Japan seem to want to keep wearing masks ー even outdoors. Opinion polls show strong support for this measure, with even higher approval rates among young people.

“Mask and ventilate” has been Japan’s mantra to fight the pandemic since early 2020. Backed by extensive simulations of COVID-19 droplets and aerosols that were run on Fugaku, the fastest supercomputer in the world until June 2022, aerosol transmission and the importance of masks and distancing had been on the agenda since early on. The guidance seems to have worked out well so far.

Twindemic in the Southern Hemisphere

In the week of June 13, 2022, New Zealand surpassed Japan in terms of COVID-19 deaths per capita, making Japan the country with the lowest COVID mortality rate of all the wealthy OECD nations.

It is quite a surprising twist. New Zealand had long been a shining example of a well executed COVID fight, with an early and harsh lockdown that kept death rates low. But while Japan has had 245.21 deaths per million inhabitants, the toll in the Southern Hemisphere Pacific Ocean country now stands at 250.86.

In addition, as New Zealand is heading into winter, things seem to be getting worse. Ashley Bloomfield, the doctor who led New Zealand’s COVID-19 response until recently, warned in a media briefing: "There's no doubt the next few months are going to be tough."

Even for Bloomfield, the surge in cases had come as a surprise, with “about twice the number of hospitalizations that we had modeled a couple of months ago for this period”.

Not only COVID-19 is to blame for this rise. Well over half of the people hospitalized with severe acute respiratory infections have got other virus infections. After a hiatus of two years, influenza is back with vengeance.

MOFA sponsored — *Fugaku's simulation of the spread of droplets from talking across a table (by Riken)*

A Surge Down Under

Similarly, Australia’s winter season is also off to a rough start. Like in New Zealand, Down Under is hit by a “twindemic,” a double wave of COVID-19 and influenza. A surge in flu, cold and COVID-19 cases during the first two weeks of May has led to an almost 50 percent increase in workplace sick leave compared to previous years. Influenza cases in Australia have become the highest in five years.

Thanks to closed borders, quarantines, lockdowns and other COVID measures, Australia and New Zealand both have had two years of almost zero flu activity. But now that COVID-19 rules have been relaxed, people have also become more complacent about wearing masks and holding big events ー in general, less cautious.

This obviously matters most during the winter season, when people spend more time in indoor spaces with inadequate ventilation. Up to 15,000 Australians are expected to die of COVID-19 this year, according to Margaret Hellard, an infectious disease expert from the Burnet Institute in Melbourne. She warns that more should be done to encourage mask use and improve air quality.

Rising Cases in Europe and the United States

Traditionally, scientists have been looking at influenza patterns in the Southern Hemisphere for clues on how the next winter flu season will pan out in the Northern Hemisphere. This year, however, the first signs in the Northern Hemisphere do not bode well for next winter.

Europe is already experiencing unusual influenza activity for the warmer spring season. At the same time, COVID-19 cases are on the rise again, driven mainly by new Omicron sub variants like BA.4 and BA.5. Both are more infectious than the previous Omicron subtypes BA.1 and BA.2.

Summer Wave

At the start of summer in Europe, most COVID-19 measures have ended. With almost no mask mandates or travel restrictions in place, and less testing, Europe is now experiencing its first summer COVID wave. The holiday season with packed trains, long lines at airports, and the resumption of big festivals that draw thousands of visitors, will be pouring more fuel onto the fire.

The political messaging in Europe has been strongly focused on the need to vaccinate in order to regain freedom from mitigating measures. In addition, politicians have often conveyed the message that masks are uncomfortable, weird and only suited for health professionals.

This collides with the fact that scientists unanimously agree that masks are the most effective countermeasure we have. In study after study, data has shown they work in the real world as well, reducing the virus spread by almost 20 percent, according to one PNAS study.

People who wear masks most of the time have a 50 percent less chance to report a COVID infection.

*Commuters coming out of Tokyo Station on June 3 were wearing masks to protect themselves (and others) against the spread of COVID-19. (Photo by Kanata Iwasaki)*

Japan and Masks

In contrast, mask wearing in Japan has been a well established part of the culture for decades – especially during flu and hay fever seasons. Thus, mask wearing, like vaccinations, has not been a contested issue.

A high vaccination rate alone does not guarantee a carefree post-pandemic life. It doesn’t even guarantee a carefree summer, as Portugal has recently learned. Despite boasting one of the highest vaccination rates worldwide with 90 percent of the population having received COVID-19 shots, Portugal has seen a huge wave since May 2022 that has translated into a rise in COVID-19 deaths.

Recently, Israel is seeing the same pattern. COVID cases in the US are also on the rise again.

Makoto Tsubokura, who leads the Fugaku supercomputer research team on COVID, stressed in February that letting go of restrictions is a bad idea with the highly contagious Omicron virus variant. “It is important to go back to the basics and to make sure that people take measures against infection, such as keeping a distance from other people,” he said.

“Also, in order to reduce the risk of infection to the level of that of the original novel coronavirus,” he added, “we need more measures.”

Relaxing in Japan

In Japan, infection rates have been decreasing since the peak in February 2022. As a response, it has been relaxing mask guidance and quarantine measures for inbound travelers.

Pressure is mounting to do more, to drop masks and open up borders for tourism. However, in view of the twindemic in New Zealand and Australia, and rising covid numbers in Europe and the US, pre pandemic carelessness seems misplaced.

Most likely, Japan will not be spared a new wave fueled by new Omicron subtypes. However, with measures still in place and most people keeping up their mask wearing and ventilation, things might not get out of control.

Focus on ventilation and universal masks got Japan through the first omicron wave. It will also work the next time around. Letting the virus rip through a highly vaccinated population is not going to win the fight.

Author: Agnes Tandler

Since the start of the pandemic in 2020, Agnes Tandler has been based in Japan, where her reporting covers COVID-19 for a daily healthcare newsletter in Germany. Find other essays and reports for JAPAN Forward here.