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To mask or not to mask?

To mask or not to mask?

Perhaps this would be the question of a modern-day Hamlet.

Among the various effects of the pandemic, "masks" from simple devices such as a glove or a helmet have taken on symbolic values unthinkable till 2019.

Exactly, 2019. The headlines concerned PM10, the particulate matter of pollution, Europe's fines for our cities, and almost all cyclists, or those who travelled and moved around, covered their faces with … filtering masks.

Droplets, aerosols and how many other terms you have come to know since 2020 and erroneously attributed by many to CoVID alone, they’re part of the same thing we called "Particulate" in previous years, distinguishing it by numbers that were nothing more than the dimensions in microns: SARS -CoV-2 would be called PM 1, in a size range common to the influenza virus, but also to many other "fine particles" which I will discuss shortly.

Size matters? For our airways: yes.

PM 10 arrives and stops in the nose, mouth, pharynx, larynx… -remember the big drop of saliva and mucus in a thousand videos and studies in these two years?? - with local irritative effects such as dryness and inflammation; PM2.5 reaches the bronchi and bronchioles, and can cause an aggravation of chronic respiratory diseases, such as asthma, bronchitis and emphysema; but only PM 1 is "respirable", that is, it arrives in the pulmonary alveoli and can pass into the blood.

Good, or rather bad for us, the vast majority of PM1 or lower particulates… comes from human beings production: soot, combustion processes such as internal combustion in cars engines, wood combustion, industries, agricultural and zootechnical activities are all activities created by man, which generate those "fine particles" that we feared so much until 2019 and which still cost us hefty fines for the pollution of our cities. Of course, a small proportion of PM 2.5 and PM 1 are also bacteria or viruses, but which, again, are similar to a "human effect", because we are the ones who host and exchange most of the "respiratory pathogens", which then make many people ill, although fortunately not all.

Do you remember that, until 2019, only the Japanese wore masks, when they needed to protect or protect themselves from respiratory infections?? Were you wondering why??

The Spanish flu epidemic, yes that one, arrived in Japan in 1918 as well. The country had not been much affected by the First World War, contrary to the tragedy it would have had to endure with the Second. In fact, when the Spanish flu arrived and with that first toll of deaths, Japanese Health Authority learned that San Francisco and other cities reported a better control of the infections the higher the use of masks in the population. The Japanese authorities issued directives for the population to wear masks in Healthcare places, in transports, in places of entertainment or in crowded areas. The masks were distributed free to those who could not afford to buy them.

With all the difficulties of counting the population, the sick and the dead rates in a Japan still at the dawn of industrial development, difficulties no different from many other countries in the first post-war period, statistics demonstrated the effectiveness of the use of masks in controlling the flu, with an incidence comparable to virtuous countries, much lower than those of countries that were seriously affected by that pandemic.

This determined the Japanese to maintain the use of the mask by the individual on every occasion of infectious disease or symptoms that made it suspicious. Wearing the mask became a sign of civic sense, to protect not so much oneself, but as a signal of respect towards one's family, community, country.

Japan also showed advantageous results during pandemics in the Far East, from Hong Kong 1958 to 2003 SARS 1 to 2013 swine flu.

At the beginning of our century, the Japanese authorities reiterated health campaigns that encouraged the individual to use the mask spontaneously and autonomously. The employee who used the mask showed respect for his colleagues, allowing them to continue working in health. So the pupil for his classmates and teachers. In schools, to get the children used to them, days-with-the-mask were adopted once a week, so as to get acquainted to a gesture not different from using a raincoat and an umbrella or boots and a cap depending on whether it is raining or snowing.

So, returning to us, to the pollution, which unfortunately has returned to be very appreciable, and to the respiratory tract infections, which in any case characterize the winter and spring seasons in Italy, why not learn too, albeit a hundred years later, as the Japanese did , from a pandemic?

Why not use a mask to avoid coughing or sneezing in the face of someone who travels with me, is with me in a cinema or supermarket, and maybe could suffer more than me from a respiratory infection?

Why not wear a mask when pollution, or pollen, makes the air I breathe less friendly to me and my throat?

Choosing to do something, understanding its civic sense, is better than suffering it, puffing and not considering the overall benefits.

A recommendation that seems to me to be part of a necessary ABC for those who work with the voice, of any type of voice (and which all Japanese artists have adopted for a lifetime, without anyone ever being harmed by a mask…)

To mask if better to mask.

A poster promoting mask-wearing in Japan during the Spanish flu outbreak. Source: Asahi Shimbun https://


  • Barceló, J.; Sheen, G.C.-H. Voluntary adoption of social welfare-enhancing behavior: Mask-wearing in Spain during the COVID-19 outbreak. PLoS ONE 2020, 15, e0242764

  • Chandra S. Deaths associated with influenza pandemic of 1918-19, Japan. Emerg Infect Dis. 2013 Apr;19(4):616-22. doi: 10.3201/eid1904.120103. PMID: 23631838; PMCID: PMC3647405.

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