Should children be required to wear masks at school?
A review of the costs and benefits, including some of the latest science, does not add much to the case for mandating school masks.
First, some basics... The risk of death from COVID-19 among schoolchildren is very, very low.
A Nature study estimating the COVID-19 infection fatality rate (IFR), or proportion of those infected who die, found IFRs of just 0.001 percent in children aged 5–9, and IFRs well below 0.01 percent in all those aged 19 and under.
That’s less than one in 10,000 among teenagers and less than one in 100,000 in 5- to 9-year-old children.
The American Academy of Pediatrics (AAP), which has advocated masking children aged 2 and up, found that only 460 children had died of COVID-19 between late May 2020 and Sept. 9, 2021 across 45 states, New York City, Guam, and Puerto Rico—0.08 percent of the total number of deaths they counted.
Looking again across multiple states, the AAP found that COVID-19 cases among children have surged in recent weeks, growing by 10 percent from 4,797,683 to 5,292,837 between Aug. 26 and Sept. 9—a trend that could be related to the start of in-person schooling.
Yet the AAP’s own data shows children are just 0.9 percent of COVID-19 hospitalizations, a rate on par with previous weeks, and down from reported hospitalization rates of 3.8 percent in mid-2020.
With all that in mind, what are the benefits of masking children?
According to the AAP, those benefits include the “protection of unvaccinated students from COVID-19,” as well as “reduc[ed] transmission.”
Yet as described above, COVID-19’s risks for schoolchildren have been, and remain, extremely low.
What’s more, vaccines have been made widely available or are even mandated among teachers, who belong to age groups more vulnerable to COVID-19 than children—and despite efforts to restrict access to ivermectin, individuals may still be able to obtain the drug, identified as an “essential medicine” by the World Health Organization, as well as other potential therapeutics.
Like the AAP, the Centers for Disease Control and Prevention (CDC) now recommends universal masking in schools, a change from its previous stance that vaccinated students and teachers do not have to wear masks. (Neither the AAP nor the CDC mention natural immunity in their school masking guidance).
They, too, point to transmission as a justification for universal indoor masking, citing the highly transmissible Delta variant.
Concerns about transmission come down to two questions:
First, how much is widespread COVID-19 transmission driven by children in school, and
Second, how well do masks and mask mandates limit transmission?
While some scientists have provided evidence that children might play a significant role in community spread, researchers generally agree that children, and especially young children, are not the primary drivers of it.
An observational study in the Journal of the American Medical Association suggested that children up to the age of 9 attending school were not major contributors to COVID-19 spread, though the study’s findings on teenagers were more equivocal.
A 2020 meta-analysis, or analysis of multiple studies, on COVID-19 susceptibility among young children and adolescents concluded susceptibility was lower in those groups than in adults and offered “weak evidence” that they play a lesser role in population-level transmission.
More recently, a 2021 meta-analysis on COVID-19 transmission clusters concluded that children infected in school “are unlikely to spread SARS-CoV-2 to their cohabiting family members.”
While the Delta variant appears to be more contagious, driving a rise in CCP (Chinese Communist Party) virus-related cases and deaths, many have argued that it is less deadly than the original Alpha strain.
This would be in line with the hypothesized trade-off between transmission and virulence, which suggests that pathogens evolve in the direction of spreading farther while also becoming less damaging to their hosts.
The effectiveness of masks, and mask mandates, in schools is also a matter of dispute, with mask mandates for students apparently lacking clear support.
In his July 30 executive order against mask mandates in Florida schools, Gov. Ron DeSantis argued that “forcing students to wear masks lacks a well-grounded scientific justification,” citing a 2021 preprint that found no correlation between mask mandates and COVID-19 case rates among students and faculty across schools in Florida, New York, and Massachusetts.
Yet the authors of that study stressed that their research was limited to just three states, meaning their conclusions may not apply elsewhere. They also emphasized that the masking variation they identified in Florida schools could make their findings “even less generalizable to all U.S. students.”
A 2020 report by the CDC itself on elementary schools in Georgia noted that “COVID-19 incidence was 37% lower in schools that required teachers and staff members to use masks.”
Crucially, however, the CDC found that mask mandates for students did not have a statistically significant impact on COVID-19 incidence.
Here too, the study’s authors noted some limitations to their work; notably, their findings were based on self-reporting, and investigators did not directly examine whether people were using masks.
What About Masks More Generally?
An early randomized controlled trial of 4,862 adult participants from Denmark did not find that surgical masks reduced COVID-19 infection, although the authors noted that some results were “inconclusive.”
On Sept. 1, however, researchers released a working paper detailing a cluster-randomized trial of mask promotion across communities in rural Bangladesh, which involved 600 villages and more than 300,000 individuals, that appeared to support masking.
After surveying “all reachable participants” and testing blood from symptomatic individuals, the researchers linked mask promotion to a slight reduction in symptomatic COVID-19 infections.
Yet similar to the Danish study, the Bangladesh study was explicitly intended to examine mask-wearing among those “who appear to be 18 years or older”—not the young children or adolescents to whom school mask mandates apply.
What, then, are the potential costs of requiring children to be masked at school?
An obvious one is cleanliness.
“We were almost all taught as children that disposable tissues are good because handkerchiefs are unhygienic and disgusting,” wrote Michael Brendan Dougherty in an article for National Review Online. “But for young children, toddlers in particular, the cotton-jersey masks that they most often wear in schools are just that, a handkerchief pulled over their mouth and nose constantly. They often are disgusting at the end of a day of use.”
Unsurprisingly, children’s masks may be a breeding ground for bacteria and other microorganisms, some of them potentially dangerous.
One recent analysis from the University of Florida revealed that most masks worn by children in 90-degree-Fahrenheit heat were contaminated with parasites, fungi, and bacteria, including a virus known to cause a fatal systemic disease in deer and cattle.
Masks, particularly disposable masks, are also harmful to the environment. With billions of single-use masks being thrown out every day, researchers believe that discarded masks and respirators are adding to plastic pollution—a problem to which school mask mandates can only contribute.
Masking and other interventions may also have knock-on effects related to the frequency of other respiratory diseases.
The recent, out-of-season spike in pediatric hospitalizations for respiratory syncytial virus (RSV) has been tied to the COVID-19 response, with infants and young children who would have otherwise been exposed to RSV at an earlier age now falling ill from it.
Masking may also have significant psychological and developmental effects on children.
A 2004 article on masking in a pediatric hospital, authored long before the COVID-19 pandemic shifted the scientific debate on masking, expanded on some of the psychological hazards for children.
“Imagine the impact of a hospital filled with “faceless” people on a young child. Who is smiling? Who is frowning? How do I recognize my doctor? How does my nurse recognize me? Why is everyone so scared of me and my germs?…”
“When wearing masks, goggles and/or face shields, non-verbal communication is impaired. Subtle facial cues are absent or can be misread and lip-reading is impossible.”
More recently, in a roundtable with Governor DeSantis and other scientists, Stanford professor Dr. Jay Battacharya argued that masking children is both medically unnecessary and “developmentally inappropriate.”
“I mean, how do you teach a child to read with a face mask on Zoom? I think children develop by watching other people,” Battacharya said.
The controversy over the developmental impact of masking children has even impacted the AAP.
In August, Internet users unearthed an AAP webpage emphasizing the developmental importance of face time between parents and babies that had apparently been removed from the organization’s website, along with other AAP webpages describing how babies and young children learn through looking at faces.
The AAP responded by explaining that the web pages disappeared as a result of website migration, telling Just the News that “some content areas, including Early Brain and Child Development, are still being organized before they go live on the new platform.”
Finally, the practice of mandating masks could be argued to compromise individual and parental autonomy.
Advocacy groups such as Utah Parents United have spoken out against school mask mandates, saying that they undermine parental rights and are unnecessary for such a low-risk group, particularly given the availability of vaccines to adult teachers and staff.
With all that we know so far, how can we answer these parents?
If the benefits of mask mandates do not outweigh the costs, it’s hard to find fault with opposition, or at least skepticism—especially for young schoolchildren, who are at the lowest risk of serious illness and death, and who may be most vulnerable to the uncertain and understudied costs of universal masking and other stringent measures.
Britain investigating Delta subvariant as possibly more transmissible
The UK Health Security Agency designated a Delta coronavirus subvariant called AY.4.2 as a "Variant Under Investigation," saying there was some evidence that it could be more transmissible than Delta.
Britain says investigating Delta subvariant as possibly more transmissible
October 22, 2021; 9:17 AM EDT
LONDON, Oct 22 (Reuters) – The UK Health Security Agency on Friday said it designated a Delta coronavirus subvariant called AY.4.2 as a “Variant Under Investigation”, saying there was some evidence that it could be more transmissible than Delta.
“The designation was made on the basis that this sub-lineage has become increasingly common in the UK in recent months, and there is some early evidence that it may have an increased growth rate in the UK compared to Delta,” UKHSA said.
“While evidence is still emerging, so far it does not appear this variant causes more severe disease or renders the vaccines currently deployed any less effective.”
Our Standards: The Thomson Reuters Trust Principles.
uk coronavirus covid-19
‘Build Back… You Know, The Thing’: Americans Have No Idea What’s In Biden’s Economic Plan
‘Build Back… You Know, The Thing’: Americans Have No Idea What’s In Biden’s Economic Plan
While Congressional Democrats spar over the ultimate size of President Biden’s "Build Back Better" economic plan, Bloomberg astutely points out that..
While Congressional Democrats spar over the ultimate size of President Biden's "Build Back Better" economic plan, Bloomberg astutely points out that Americans have no clue what they're signing up for with their tax dollars. In fact, according to a CBS News poll published Oct. 10, just 10% of Americans say they know the specifics of the bill, while only 1/3 think it would benefit them directly.
What's more, "Not even Congress knows what the bill would accomplish, with the contents of the plan changing day-by-day as Democrats squabble over how much it should spend, who it should benefit and who should pay for it."
For example, on Tuesday, the White House suggested it would jettison free community college. The next day, Democrats were focused on proposed tax hikes after moderate Sen. Kyrsten Sinema (D-AZ) put her foot down over corporate and personal tax rates.
In an attempt to provide some clarity (don't hold your breath), Biden on Thursday night held a CNN town hall-style event (on the same night as Dune's US release).
In short, their messaging sucks.
"I will state the obvious, but they need to shift the focus away from process to policy. So far, the coverage around their proposal is all around Democratic divisions, which inevitably makes it impossible to sell," said former Marco Rubio communications director, Alex Conant. "Frankly, they need to talk about what their goals are," he added. "Why is this necessary?"
Republicans, on the other hand, are clear on their messaging; "Massive government spending leads to massive tax hikes," according to GOP strategist Ron Bonjean. "When you have a shifting number and shifting programs, it becomes confusing to follow."
Instead of focusing on the legislation’s new investments in child care, the elderly, education, healthcare and climate change, Democratic lawmakers have openly haggled over the price tag. A standoff between the party’s progressive and centrist factions has created cable news-ready drama.
“Given how much is wrapped up in this package, it was always going to be a long and intense negotiation,” said Ben LaBolt, a former spokesperson for President Barack Obama. “One way to start is to build the case for the way this will help middle class families and focus the public on those conversations, while at the same time preserving room for the closed-door negotiations to bring all of the elements of the party together for the biggest, most comprehensive approach possible.” -Bloomberg
In a Wednesday speech in Scranton, PA, Biden tried - and failed - to convey how his economic agenda would help working class families - by intermingling stories about growing up in the area and programs contained in the legislation.
"Frankly, they’re about more than giving working families a break; they’re about positioning our country to compete in the long haul," said Biden, doing his usual poor job of reading a teleprompter. "Economists left, right, and center agree."
Meanwhile, Biden - let's face it, Biden's 'advisers' have failed to ink a final compromise between warring factions of Democrats. For the Build Back Better plan to pass, every single Senate Democrat must be on board. As moderates Sinema and Joe Manchin (D-WV) balk on the price tag and demanding deep cuts, progressive House Democrats are sure to similarly balk at passing the smaller, $1.2 trillion infrastructure package that's already passed the Senate.
While advocacy groups have started to spend heavily to promote policies in the plan, most of the discussion remains centered on its cost.
Biden’s advisers are banking on the presumption that ordinary Americans don’t pay much attention to the machinations of everyday Washington. Much as they were during the presidential campaign, the president’s aides are largely dismissive of what they call horse-race stories.
But Biden’s team had a much easier time selling his pandemic relief legislation, the American Rescue Plan, in March, with its convenient focus on three clear issues -- money for vaccines, money to re-open schools and checks sent directly to American households. -Bloomberg
"They haven’t laid out why we need this, other than Democrats are in power now and aren’t going to have it again for a long time," said Conant.
Good luck with that.
Parents were fine with sweeping school vaccination mandates five decades ago – but COVID-19 may be a different story
Public health experts know that schools are likely sites for the spread of disease, and laws tying school attendance to vaccination go back to the 1800s.
The ongoing battles over COVID-19 vaccination in the U.S. are likely to get more heated when the Food and Drug Administration authorizes emergency use of a vaccine for children ages 5 to 11, expected later this fall.
California has announced it will require the vaccine for elementary school attendance once it receives full FDA approval after emergency use authorization, and other states may follow suit. COVID-19 vaccination mandates in workplaces and colleges have sparked controversy, and the possibility that a mandate might extend to younger children is even more contentious.
Kids are already required to get a host of other vaccines to attend school. School vaccination mandates have been around since the 19th century, and they became a fixture in all 50 states in the 1970s. Vaccine requirements are among the most effective means of controlling infectious diseases, but they’re currently under attack by small but vocal minorities of parents who consider them unacceptable intrusions on parental rights.
As a public health historian who studies the evolution of vaccination policies, I see stark differences between the current debates over COVID-19 vaccination and the public response to previous mandates.
Compulsory vaccination in the past
The first legal requirements for vaccination date to the early 1800s, when gruesome and deadly diseases routinely terrorized communities. A loose patchwork of local and state laws were enacted to stop epidemics of smallpox, the era’s only vaccine-preventable disease.
Vaccine mandates initially applied to the general population. But in the 1850s, as universal public education became more common, people recognized that schoolhouses were likely sites for the spread of disease. Some states and localities began enacting laws tying school attendance to vaccination. The smallpox vaccine was crude by today’s standards, and concerns about its safety led to numerous lawsuits over mandates.
The U.S. Supreme Court upheld compulsory vaccination in two decisions. The first, in 1905, affirmed that mandates are constitutional. The second, in 1922, specifically upheld school-based requirements. In spite of these rulings, many states lacked a smallpox vaccination law, and some states that did have one failed to enforce it consistently. Few states updated their laws as new vaccines became available.
School vaccination laws underwent a major overhaul beginning in the 1960s, when health officials grew frustrated that outbreaks of measles were continuing to occur in schools even though a safe and effective vaccine had recently been licensed.
Many parents mistakenly believed that measles was an annoying but mild disease from which most kids quickly recovered. In fact, it often caused serious complications, including potentially fatal pneumonia and swelling of the brain.
With encouragement from the Centers for Disease Control and Prevention, all states updated old laws or enacted new ones, which generally covered all seven childhood vaccines that had been developed by that time: diphtheria, pertussis, tetanus, polio, measles, mumps and rubella. In 1968, just half the states had school vaccination requirements; by 1981, all states did.
Expanding requirements, mid-20th century
What is most surprising about this major expansion of vaccination mandates is how little controversy it provoked.
The laws did draw scattered court challenges, usually over the question of exemptions – which children, if any, should be allowed to opt out. These lawsuits were often brought by chiropractors and other adherents of alternative medicine. In most instances, courts turned away these challenges.
There was scant public protest. In contrast to today’s vocal and well-networked anti-vaccination activists, organized resistance to vaccination remained on the fringes in the 1970s, the period when these school vaccine mandates were largely passed. Unlike today, when fraudulent theories of vaccine-related harm – such as the discredited notion that vaccines cause autism – circulate endlessly on social media, public discussion of the alleged or actual risks of vaccines was largely absent.
Through most of the 20th century, parents were less likely to question pediatricians’ recommendations than they are today. In contrast to the empowered “patient/consumer” of today, an attitude of “doctor knows best” prevailed. All these factors contributed to overwhelmingly positive views of vaccination, with more than 90% of parents in a 1978 poll reporting that they would vaccinate their children even if there were no law requiring them to do so.
Widespread public support for vaccination enabled the laws to be passed easily – but it took more than placing a law on the books to control disease. Vaccination rates continued to lag in the 1970s, not because of opposition, but because of complacency.
Thanks to the success of earlier vaccination programs, most parents of young children lacked firsthand experience with the suffering and death that diseases like polio or whooping cough had caused in previous eras. But public health officials recognized that those diseases were far from eradicated and would continue to threaten children unless higher rates of vaccination were reached. Vaccines were already becoming a victim of their success. The better they worked, the more people thought they were no longer needed.
In response to this lack of urgency, the CDC launched a nationwide push in 1977 to help states enforce the laws they had recently enacted. Around the country, health officials partnered with school districts to audit student records and provide on-site vaccination programs. When push came to shove, they would exclude unvaccinated children from school until they completed the necessary shots.
The lesson learned was that making a law successful requires ongoing effort and commitment – and continually reminding parents about the value of vaccines in keeping schools and entire communities healthy.
Add COVID-19 to vaccine list for school?
Five decades after school mandates became universal in the U.S., support for them remains strong overall. But misinformation spread over the internet and social media has weakened the public consensus about the value of vaccination that allowed these laws to be enacted.
COVID-19 vaccination has become politicized in a way that is unprecedented, with sharp partisan divides over whether COVID-19 is really a threat, and whether the guidance of scientific experts can be trusted. The attention focused on COVID-19 vaccines has given new opportunities for anti-vaccination conspiracy theories to reach wide audiences.
[Over 115,000 readers rely on The Conversation’s newsletter to understand the world. Sign up today.]
Fierce opposition to COVID-19 vaccination, powered by anti-government sentiment and misguided notions of freedom, could undermine support for time-tested school requirements that have protected communities for decades. Although vaccinating school-aged children will be critical to controlling COVID-19, lawmakers will need to proceed with caution.
James Colgrove has received funding from the National Library of Medicine, the Greenwall Foundation, the Milbank Memorial Fund, and the William T. Grant Foundation.cdc disease control emergency use authorization covid-19 vaccine fda spread
Copper Price Update: Q3 2021 in Review
Jim Chanos: China’s “Leveraged Prosperity” Model Is Doomed…And That’s Not The Worst Of It
FDA Approves Moderna, J&J Boosters And Releases Guidelines For “Mix And Match”
Navigating the debt legacy of the pandemic
The FDA’s War Against The Truth On Ivermectin
What is COP26? Here’s how global climate negotiations work and what’s expected from the Glasgow summit
Zinc Prices Hit 14 Year High as Power Costs Rise
Seeking Solace in an Equal-Weight Cybersecurity ETF
Get set for a major public stoush over immigration
Do You Know About This Secret Government ‘Financial Crisis’ Situation Room In the White House?
Crypto15 hours ago
Walmart Rolls Out Bitcoin ATMs Across 200 Stores Nationwide
Stocks20 hours ago
Tesla share price forecast after Q3 results
Stocks10 hours ago
Zinc Prices Hit 14 Year High as Power Costs Rise
Stocks8 hours ago
PayPal Stock Forecast: Everything You Need to Know Before Investing
Stocks18 hours ago
Stocks That Miss Expectations Are Being Hammered By The Most On Record
Crypto16 hours ago
Shanghai Man: Blockchain Week with Vitalik still happening, ‘Bitcoin’ searches on WeChat hit 26M in a day
Stocks2 hours ago
Best Penny Stocks to Watch as The Market Turns Bullish
Economics11 hours ago
Guest Contribution: “How far to full employment? – An update”