Masks forever?
A dramatic drop in common viruses raises the question
NASHVILLE, Tenn. — Masks and physical distancing are proving to have major fringe benefits, keeping people from getting all kinds of illnesses — not just COVID-19. But it’s unclear whether the protocols will be worth the pain in the long run.
The teachers at New Hope Academy in Franklin, Tennessee, were chatting the other day. The private Christian school has met in person throughout much of the pandemic — requiring masks and trying to keep kids apart, to the degree it is possible with young children. And Nicole Grayson, who teaches fourth grade, said they realized something peculiar.
“We don’t know anybody that has gotten the flu,” she said. “I don’t know of a student that has gotten strep throat.”
Important trade-offs
It’s not just an anecdote.
A study released in March in the Journal of Hospital Medicine, led by researchers from Vanderbilt University Medical Center, found that across 44 children’s hospitals the number of pediatric patients hospitalized for respiratory illnesses is down 62%. The number of kids in the U.S. who have died of the flu this season remains in the single digits. Deaths have dropped dramatically, too, compared with the past 10 years: The number of flu deaths among children is usually between 100 and 200 per year, but so far only one child has died from the disease in the U.S. during the 2020-21 flu season.
Adults aren’t getting sick either. U.S. flu deaths this season will be measured in the hundreds instead of thousands. In 2018-19, a moderate flu season, an estimated 34,200 Americans died.
It’s not just the masks and physical distancing that are tamping down communicable disease, said Dr. Amy Vehec, a pediatrician at Mercy Community Healthcare, a Tennessee clinic that gets federal funding. It’s become a serious societal faux pas to go anywhere with a fever — so parents don’t send their ailing kids to school, she said.
“They are doing a better job of staying home when they’re sick,” Vehec said. That includes adults who may feel ill.
Isolating when feeling bad could be kept up after the pandemic. But the isolation, the distance and the masks are not working for many kids, Vehec said.
Children with speech trouble aren’t seeing their teacher’s mouth to learn how to speak correctly, for instance.
“I think it has been a necessary evil because of the pandemic, and I have completely supported it, but it has had prices. It’s had consequences,” she said. “Kids’ education is suffering, among other things.”
And with COVID-19 vaccines unavailable to children for a while yet, it may be another year of masks in schools.
Some experts, like researchers trying to improve masks, argue that more societies should embrace masking — as some Asian countries have. But even infectious disease experts like Dr. Ricardo Franco of the University of Alabama at Birmingham doubt that’s practical.
“I’m a little skeptical that this crisis will be enough for a widespread culture change, given how difficult it’s been to achieve a reasonable culture shift in the previous months,” Franco said.
Changing the system
The most realistic setting for lasting change may be within health care itself.
Doctors and nurses didn’t usually wear masks before COVID-19. Dr. Duane Harrison, who directs an emergency department for an HCA Healthcare hospital outside Nashville, mentioned a physician colleague who has worn a mask since he got out of medical school.
“We used to joke and clown with him about this,” Harrison said. “Until this.”
Now that everyone wears masks, Harrison’s department has found the same thing many other workplaces have: Employees aren’t calling out sick, unless it’s COVID-19.
“When COVID’s done, this is a practice that most of us will probably continue,” Harrison said. “Because we won’t be worried about runny-nose kids and elderly people who don’t know they’re sneezing in your face.”
Some hospital systems, including Nebraska Medicine, have started to relax universal masking requirements for their staffs. But even vaccinated staffers still have to wear a mask when seeing patients. Intermountain Healthcare in Utah has signaled masks will continue to be required when a statewide mandate lifts in April.
But even believers in the effectiveness of masks have their doubts about the medical community keeping it up.
“The larger question is: Is everyone going to need a break?” asked Dr. Joshua Barocas, who studies infectious diseases at Boston University.
Whatever the future holds, public health officials say, the time has not yet come to drop mask requirements as the U.S. waits for more people to get a COVID-19 vaccine. But eventually, even doctors and nurses are ready to see smiling faces again.
“I know I’m going to need to retire my masks at some point in the future,” Barocas said, “for a little bit.”
“When COVID’s done, this is a practice that most of us will probably continue. Because we won’t be worried about runny-nose kids and elderly people who don’t know they’re sneezing in your face.”
DR. DUANE HARRISON, EMERGENCY DEPARTMENT DIRECTOR AT AN HCA HEALTHCARE HOSPITAL