"Whenever you cough or sneeze, do it behind your handkerchief, please."

–Louise J. Lundberg, 1st grade teacher; Silverhill, Alabama, 1939

I am a physician. I took the traditional Hippocratic Oath at the time of graduating from medical school. Part of it reads, "I will abstain from doing harm," often paraphrased as the Latin primum non nocere. Thus, I should not knowingly place another human at risk for any disease.

I hate wearing a mask unless it is in the fun of a costume party, Halloween, Mardi Gras, or perhaps the Carnival of Venice (I have done all of those). But I also hate being sick or causing illness in others.

Pre-pandemic Masking

I was last in Tokyo about 3 years ago and noticed that a mix of people were wearing (non-Halloween) face masks at Narita Airport and even in the Ginza shopping district. I asked a family member who has lived in Japan what was up. Here is what she told me:

"Many Japanese citizens wear masks in public. They usually wear a mask when they are in a shared space such as trains, buses, or shops. They wear them when they aren't feeling well and want to prevent others from catching their sickness...I think it is very positive and thoughtful to wear a mask. I personally feel safer knowing that they are taking certain measures and don't mind sharing their space. This is in comparison to taking [Bay Area Rapid Transit] here in California, or even at work, and you see how others are sneezing and/or blowing their noses. One difference between Japan and California is that in Japan, it is more of a 'group' mentality. You are always aware of what you are doing and how it impacts others."

I asked another family member from Japan about her experiences and any references she could provide. She suggested a website from the Japanese government that refers to the 1918 influenza pandemic and how lessons from that experience were applied to SARS-CoV-2. (The website is in Japanese, but the Google translation is credible.)

She noted that it was quite common and accepted for people in Japan to wear masks when they visit doctors or hospitals, or if they are coughing for any reason, to protect others as well as themselves. Maybe this fastidious and very health-conscious culture is a reason why the average expected life span of a Japanese man or woman is the longest on earth.

It is not only the Japanese who've adopted this practice. Many people in Singapore, Hong Kong, and Taiwan wore masks after the SARS-CoV-1 epidemic emerged. But face mask use in Asia extends as far back as the 1950s, when they were used for many different reasons: to ward off air pollution, bacteria, or viruses; to hide facial blemishes or a lack of cosmetics; to obscure any visual display of emotions; or even to discourage unwelcome social interactions.

Beat COVID, but Keep the Masks

What is so difficult about applying my mother's schoolroom dictum to normal polite (and safe) societal living? If you believe yourself ill, socially distance by staying home. If you must go out and mix with other people, don't shake hands, do wash your hands frequently, maintain 6-feet distancing, and wear a mask to protect others from your infection. You may also be protecting yourself.

Be careful and caring, as individuals and as members of a civil society. Let that be a long-term lesson from our experiences with that voracious beast SARS-CoV-2.

Our young America still has much to learn from the wisdom of older cultures.

It is common sense that a cloth barrier to forcefully exhaled, yelled, sung, coughed, or sneezed breath would impede transfer of various-sized infectious agents. This has surely contributed to Japan's having lower rates of SARS-CoV-2 infections and deaths relative to most of the world.

So, in global regions where community COVID lurks and during upper respiratory infection season, I intend to "mask up."

I believe in: medical science, individual clinical care, and the health of the public; driver's ed and driver's licenses; obeying traffic lights and stop signs; fastening my automobile seat belt; driving a car with air bags; not driving after drinking; and not speeding.

I hereby declare my (and your) "right to mask" without receiving backlash, and suggest that others think about this as reasonable behavior.

Mother was right. Let's make her proud.

That's my opinion. I'm Dr George Lundberg, at large at Medscape.

George Lundberg, MD, is sheltering in place without access to his usual video studio. He is contributing editor at Cancer Commons and a clinical professor of pathology at Northwestern University. Previously, he served as editor-in-chief of JAMA (including 10 specialty journals), American Medical News, and Medscape.

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