2. Masks are a no-brainer

And they don't cause covid.

Across the United States, children are back to school.  Some of these kids are equipped with face masks, but many are not. And as one could reasonably predict, this is a recipe for disaster.

Photo credit: https://www.michigan.gov/coronavirus/0,9753,7-406-100997_100998---,00.html

As an exposure scientist, and a parent, I am deeply concerned about the thousands of school districts across the United States who are reluctant to implement universal masking requirements to protect children. Strong recommendations by state and district leaders are one-tenth of a step in the right direction, but it is a kid-glove approach to an extraordinarily huge global burden.

The Case of Texas

In Texas, where schools are not required to notify parents of covid cases, about 172,000 cases have been reported in kids in the first month or so of school. If you stood those kids in a straight line, 18 inches apart, it would stretch about fifty miles. Imagine a line of children standing along I-35 from San Antonio to Austin. That’s what 172,000 cases looks like.

There is no scientific controversy over the usefulness of wearing facemasks to reduce risk. Their use throughout 2020, even occasional or reluctant use, probably saved lives and bought us some time until the vaccines arrived. They reduce potential exposures whenever people are together.

But they do have one serious flaw that makes them a ripe political target: when strapped across your face, they are a highly visible public health protection measure. As a result, masks are sometimes described derisively by the very people who are elected to serve the public. It is perplexing why someone would use derogatory language for something that saves lives. Imagine if someone made a similar comment about polio vaccines or wearing seatbelts. 

Many school districts are delaying their opening, hoping to somehow outlast the virus. Texas has already declared defeat to the virus by allowing up to 20 school days – that’s an entire month – of remote learning for those kids who test positive. This approach is defensive and is not in the best interest of the child.

In recent metro Atlanta school reporting, a little more than half of the school districts require masks at the beginning of the school year, with the other districts remaining as mask-optional. Districts that require masks have an average COVID incidence rate of about 3.9 cases per 100,000 students.  For those districts where masks are optional, the COVID incidence rate is 8.1 cases per 100,000 students, or more than double that of mask-required districts. 

The conclusion: Masks work, but only if they are required.

Just a handful of states have implemented universal masking policies for schools in the United States. My home state of Massachusetts employed a stopgap mask requirement measure for the first four weeks of school, now extended for a few more, which is a step in the right direction, but one that is temporary and fleeting.  We will be faced with the same risks a month from now when these strategies expire. Across the United States, there is a hodge-podge of different approaches, some that are more robust than others. This has to change, and leaders can not be derelict in their duty to protect public health. Mask mandates have to be a central part of this conversation.

Why is a mandate important? Let’s look at the data.

Public health, when it is working well, is largely invisible. When it is not working, it leads headlines in newspapers and fills hospitals to capacity. Sound familiar?

The challenge for public health is that it is a political end of two products: evidence and argument. You need both to make rational and effective public health decisions, but they are often in conflict with one another. The evidence on COVID transmission, and effective strategies like masks, have become much more vivid in the past year and a half. But political hesitancy remains because there might be a political downside to such a mandate. While this may be true, there is a more serious risk, and one that is far more certain, in millions of children who return home each day carrying a preventable infection. 

It certainly doesn’t help when we are faced with a whipsaw of mixed messages, with the CDC making an abrupt reversal to now recommend masks in places where community disease transmission is high.   Nor does it help when some clinicians make outrageous statements on the supposed hazards of wearing masks, when there simply is no evidence to support these statements. But it is now crystal clear, from both the Centers for Disease Control and the American Academy of Pediatrics that masks work.

Whether its hubris or arrogance or blind political rejection, it is amazing that so many state and local school boards simply ignore scientific consensus that places families in danger. Sure, children are at a lower risk for disease severity. But they bring these infections home to their siblings, their parents and grandparents, and their playmates. I’d much prefer kids to bring home their spelling bee assignments or art projects - the usual loot of a school-aged child, and leave infectious variants in the classroom.

But there is a real political risk that we seem to be ignoring.  If school outbreaks become out of control, as the data suggest they might, we can expect a return to remote learning for many of the 56 million schoolkids. And with that comes more parenting responsibility to again guide children through their school, and leading to decreased business and worker productivity, and a continuation of the same difficult working conditions many faced.  Closed schools also mean closed businesses.

This pandemic is not yet finished with us, and masks are an inexpensive, equitable, and effective strategy to reduce disease transmission. Failing to act broadly to protect children will only worsen our position. Public health is not a zero-sum competition; no one loses when we take preventative measures.

But everyone can lose if we don’t.