According to the Centers of Disease Control and Prevention, most Americans can take off their masks. Based on new metrics that take into account Covid hospitalizations, hospital capacity and new Covid cases, more than 70 percent of the country lives in an area where indoor masks are no longer recommended. For schools located in these parts of the U.S., this represents a seismic shift. Up until now, the agency had recommended universal indoor mask use in K-12 schools to reduce Covid transmission.
The safest way to navigate the new unmasked world is to stick with a self-imposed mask mandate; high-quality, one-way mask use remains crucial.
As with previous CDC decisions, the political considerations may be holding more sway than medical ones. After all, the move comes as school mask mandates have become the latest battleground in America's never-ending pandemic wars. Though some polls continue to show support for mask use in the classroom, states are scrapping their mandates while charged-up parents are demanding a pandemic “off-ramp” for their children. Even liberal areas that were once bastions for mask use are now heatedly discussing the required need for face coverings in schools.
As it happens though, the Covid trends in many parts of the nation support the CDC’s decision. Infections are dropping quickly in America. As of Feb. 16, the seven-day moving average of new daily cases had declined 43 percent compared to the previous week. And from Feb. 9 to Feb. 15, Covid hospital admissions were down 28.8 percent from the prior week. As community Covid case incidence declines across the country, so does the risk of transmission at school.
But that doesn’t mean I want the mask mandates to go away. Science still doesn’t have a magic number for “what level of Covid-19 transmission is acceptable in schools before and after masks are removed,” as Dr. Jay K. Varma, a physician and epidemiologist, wrote in The New York Times.
As the parent of an unvaccinated 3-year-old boy in day care, a Covid infection is a palpable, daily consideration for me. Despite multiple positive cases and resulting exposures in his class over the span of the recent and supercontagious omicron surge, he fortunately remained unscathed. Throughout this spate of infections around him, there was only one constant: a mask requirement.
For parents who remain concerned about their children younger than 5 who cannot yet be vaccinated or their immunocompromised family members, the safest way to navigate the new unmasked world is to stick with a self-imposed mask mandate; high-quality, one-way mask use remains crucial, as does employing other mitigation measures that continue to minimize infection risk.
The proclamations by the CDC are merely guidance. Local governments and districts must decide for themselves if their Covid metrics, vaccination rates and overall population risk level will permit mask removal now or in the coming few months. But in the wake of the plummeting numbers and the soaring pandemic fatigue throughout the country, 49 states have announced plans to end their indoor mask mandates. And with the flurry of national and local regulations coming down, some private companies have also relaxed their own mask policies.
For sure, mask mandates must be reflective of the pandemic moment and not indefinite. Given the unpredictability of new variants and surges, which may mean masks become necessary again in the future, metrics and criteria should be identified now to guide the start and end dates for when mask mandates can be removed. As Dr. Ashish Jha, dean of the Brown University School of Public Health, told the Times, “If not now, when?”
The CDC’s call for “universal indoor masking by all students (ages 2 and older), staff, teachers, and visitors to K-12 schools, regardless of vaccination status” was out of step with the surrounding world. The World Health Organization’s guidance, which multiple European countries follow, recommends against masks for children ages 5 and younger “based on the safety and overall interest of the child and the capacity to appropriately use a mask with minimal assistance.” For the WHO, masks provide little protection or benefit in kids, who are at low risk for disease and unable to wear them correctly.
Indeed, the studies performed by the CDC on Covid spread in schools either failed to find a statistically significant benefit from mask use by students or were confounded by vaccination rates of the staff and the surrounding community. Another study from Brown University did not find a correlation between mask mandates and student infections.
These findings are consistent with recent CDC data showing that cloth masks, which are the primary face covering of choice in kids, did not demonstrate a statistically significant benefit in reducing the wearer’s risk of a Covid infection. “The data is becoming increasingly clear that cloth masks do not seem to work in congregate settings to reduce transmission or exposure,” said Dr. Monica Gandhi, a professor of medicine at the University of California, San Francisco
In addition to preventing routine social and academic normalcy, early data suggests that mask use can hinder learning and development in young children, especially for those with speech and hearing impairments or autism.
The bottom line in all this is that children continue to be at lesser risk for severe Covid outcomes than adults. In the latest CDC data, Covid hospitalization rates for children younger than 4 and 5-17 are 3.8 per 100,000 and 1.2 per 100,000, respectively. For context, the rates in the 18-49, 50-64 and 65 and older groups are 3.7, 8.5 and 22, respectively.
Yet, lower risk is not an absence of risk. During the omicron surge beginning in late December, Covid hospitalization rates among those younger than 17, with the largest increase in the 0-4 group, which remains ineligible for vaccination. And the BA.2 variant, a more transmissible omicron strain, is gaining traction in America, which could lead to the reimplementation of mask mandates.
Of course for many families across the country, mine included, the threat of a classroom infection does not end at an unvaccinated child. The concern extends to household members, especially those who are immunocompromised or high-risk, such as my pregnant wife.
So even as school mask mandates come down, we must find ways to protect the vulnerable. One-way masking with fit and filtered masks like N95, KN95 or KF94 (particularly in kids) protects the wearer regardless of the mask habits of those surrounding them. This was confirmed in a recent CDC study that showed “a respirator offers the highest level of personal protection against acquiring infection.”
The issue, then, is not mandating masks, but making sure kids wear the highest-quality face coverings. “What are our weakest links? It is actually about the quality of masking and how it’s done. That is more important than anything else,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
Beyond an effort to upgrade masks in young kids, particularly those still unvaccinated, improved ventilation and filtration systems, combined with continued testing of symptomatic students and their contacts, are important. Further safety is provided through higher vaccination rates in the greater community, along with the vaccination and mask use of teachers.
The potential end of mask mandates in schools is an opportunity to re-evaluate the choices we are making to protect our children from Covid, and a chance to choose public health practices supported by science, rather than parental anxieties. Until vaccines become available for my 3-year-old, I can still choose extra precautions to hopefully bring him through the pandemic safely.