I am a physician and mother of four children, two of whom attend public elementary school in northern Virginia. Our state’s newly inaugurated governor recently issued an executive order giving parents the choice of whether or not their children wear masks to school. But instead of complying, several districts including mine are suing the state to keep mask mandates in place. I believe it is time to follow the science and give parents the choice when it comes to masking in schools.
This isn’t necessarily a popular opinion to express around here. After the governor issued his order, multiple members of a local mothers’ group I belong to passionately equated his action to large scale homicide in a frenzy of emotional emails. Despite the peril of going against the grain, I took a leap and hit “reply all,” calmly expressing my belief, supported by scientific evidence, that schools abide by the new executive order and transition to optional masking. I was fully prepared to have an inbox overflowing with hate mail. Instead, I received a multitude of private messages of support thanking me for being brave, presenting an alternative view and bringing scientific evidence to counter the usual echo chamber of fear mongering. Based on this response, I conclude that many parents agree with me but are afraid to speak up. Indeed, frustration with COVID-19 restrictions and school closures was cited as a major reason Gov. Glenn Youngkin, a Republican, won his election in our blue state.
Many parts of the U.S. issued mask mandates in 2020 when COVID-19 was new and poorly understood. It was sensible to take maximum precautions in a chaotic and frightening situation; many thought it a small sacrifice to make while scientists toiled to gain a greater understanding of the virus and to develop vaccines. But two years later we know much more about the virus and how to stop it, including abundant evidence showing the lack of efficacy of some of these measures (cleaning surfaces, masking in schools). Lifesaving vaccines are now also widely available. As a physician, I’m well aware that medical knowledge is constantly changing. As our understanding grows, our practice changes. This should be a time to peel back layers of mitigation that we now know to be ineffective, yet many school districts are doubling down.
There is no significant evidence that the kind of masking (i.e. non-medical) that is common in schools is worth it. An Arizona study frequently cited by CDC director Rochelle Walensky as evidence for continued masking in schools has been thoroughly dismantled. More and more experts have concluded that the evidence for masks in schools doesn’t hold up to scrutiny. There are several studies that show a minimal reduction in COVID-19 transmission with masks in schools, but the results were not statistically significant. Moreover, most of these studies do not account for Covid-19 vaccinations in adults and none of them take into account vaccinated children. According to data from the Kaiser Family Foundation, 18.8% of children in the 5-11 age group are fully vaccinated, and 28.1% have received one dose. In vaccinated children, the flu poses more danger than COVID-19.
It is important to acknowledge that the risk of severe disease from COVID-19 to healthy children has always been low. As of this writing, CDC data shows 863 total pediatric deaths related to COVID-19 since the beginning of the pandemic, which is less than 0.001% of the COVID-19 deaths in the U.S, and this number does not specify “from COVID-19” vs “with COVID-19.” While any death is a tragedy, many if not most of these children had underlying medical conditions which made them exponentially more vulnerable to severe COVID-19 than the average child. Those in favor of mask mandates have assumed that asymptomatic children are a major source of spread but evidence does not exist to support this claim.
U.S. policy is an outlier: the World Health Organization advises against masks for kids under 5 and only selectively for kids under 11, and many European nations have kept schools open without requiring masks. U.S. schools that remained open with or without masks have not seen major outbreaks over the past two years. Many students wear cloth masks that provide little to no protection; public health expert Dr. Leana Wen says they are “little more than facial decorations.” Yet we have had low spread in schools with facial decorations only. Isn’t it possible that kids don’t need masks at all, and we can start getting them back to a normal life?
Many people argue that masking is a small inconvenience for the greater good. However, masking kids is not a damage free intervention. It negatively affects learning and causes significant social and emotional harm. Masking impairs verbal and non-verbal communication between teachers and students, limits facial identification and has occasional physical side effects. Visualization of the entire face is of crucial importance to social, emotional, and speech development. My first grader has had to learn to read and make friends without ever seeing his teacher’s mouth or other students’ faces. Our children long for their former lives back, and they need to see the expressions and reactions on the faces of their peers and teachers. This nonverbal feedback is how they often weigh their actions and behavior against those around them, developing social and emotional intelligence and interrelatedness that is crucial to their educational development. If masks were clearly proven to work to prevent transmission, perhaps it would be worth this detriment, but they aren’t.
Masking in schools was intended to be temporary, and there needs to be an exit ramp from these policies. Children have been suffering from mask effects for two years, and enough is enough. At this point, teachers and other adults have all had the opportunity to be vaccinated, and if they feel uncomfortable or are at higher risk, they can wear a mask. Likewise, if parents do not yet feel comfortable with their children going maskless, or their child is at higher risk medically, they are free to continue masking.
As with any medical intervention, risks must be weighed versus benefits, and there is no proof that universal masking in schools is beneficial. We need to take into account the lack of evidence for mask efficacy and re-evaluate our policies and procedures. We know much more now than two years ago. The virus is likely shifting from a pandemic to endemic, and we need to shift with it. Parents should be able to follow the science, properly evaluate risk, and have the choice to unmask their children.
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