When schools reopened this fall and the discussion surrounding mask policies was being hotly debated, it felt obvious to many, including physicians like us, that masks should be mandatory. At the time, the Pfizer Covid-19 vaccine had only been approved for children 12 and older, so there was a significant portion of the K-12 population that was unvaccinated and otherwise unprotected.
The good news is that recently the Pfizer vaccine was authorized for emergency use by the US Food and Drug Administration for children 5-11 years old, and the US Centers for Disease Control and Prevention has recommended that all eligible individuals get inoculated. Major medical organizations including the American Academy of Pediatrics and the American Academy of Family Physicians have voiced their support of this guidance. But along with this vaccine approval has come the rehashing of the old question: Should masks still be required in schools? We believe that, at this stage in the pandemic, mask mandates should exist and still play an important role in protecting children and preventing the spread of the virus for four main reasons.
First, children are still being heavily affected by this pandemic. According to the American Academy of Pediatrics, over 6.6 million children have tested positive for Covid-19 in the US, making up about 16.8% of all cases. Last week, 122,229 childhood Covid-19 cases were diagnosed, which made up 27% of the new cases. This number of weekly new childhood cases has been greater than 100,000 per week for the past 14 weeks. While it is true that severe Covid-19 illness is not statistically common in children, we do not yet know the long-term developmental, cognitive, behavior or physical effects of the virus on this population. We should also consider that children with Covid-19 — whether symptomatic or not — have the ability to spread the virus to their households and surrounding community.
Second, we do not yet know what the childhood vaccination trends are going to look like. Currently, about 59% of the general population is fully vaccinated, including just over 50% of adolescent children ages 12-17, according to CDC data. As of Wednesday night, about 1.9 million children under the age of 12 have received their first dose of the vaccine.
Most importantly, the reality is that while vaccinations for children 5 and older represents a major step forward in protecting our kids, it does not guarantee that they will no longer pick up or pass to other children the SARS-CoV-2 virus that causes Covid-19. Since breakthrough cases can occur, having a second layer of protection regardless of vaccination status can be valuable in preventing viral spread. This is why the CDC still recommends that masks universally be worn in indoor school setting by those aged 2 and up.
Third, masks are simple, inexpensive, non-invasive, and a valuable viral prevention strategy in educational settings. The CDC rigorously evaluated the benefits and disadvantages of mask-wearing, before recommending it as a layered approach to infection prevention – along with physical distancing and frequent handwashing. Many studies have also shown the benefits of masks in the educational setting.
A study recently published in the CDC Morbidity and Mortality Weekly Report (MMWR) evaluating 520 US counties between July 1 and September 4, showed that those without mask mandates in schools had greater increases in rates of childhood Covid-19 infections once the school year began than counties with mask mandates in schools. Another study observing two counties in Arizona between July and August revealed that the chance of a school-associated Covid-19 outbreak was almost four times higher in schools without mask requirements than in those with early mask requirements.
Finally, by mandating that children, teachers, and school staff wear masks to reduce the number of Covid-19 outbreaks, school shutdowns can be prevented. According to the CDC, between August and mid-September, an estimated 1,800 schools had closures attributable to Covid-19 outbreaks, affecting the education and well-being of over 900,000 students. This is not only difficult for students who experience a disruption in their educational routine, but also for teachers who need to keep pivoting between in-person and virtual teaching models.
The time for loosening school mask policies will eventually come, but right now it is too early in the pandemic to take this action. Children have been some of our most vulnerable patients during the pandemic. Part of our job as physicians is to advocate for their long-term health and safety. Therefore, for as long as masks are beneficial in reducing the spread of the virus among children, we will continue to support them. We have the resources to protect ourselves and others. Now is the time for us to use everything at our disposal to keep the light at the end of the tunnel in our sights.