Unmasking of children could be our undoing

In March, masks were considered a scarce commodity for health-care workers. There was little debate around their effectiveness; it was primarily a hunt to secure them. The generous outpouring and combined dedication of Canadians, however, supplied the missing personal protective equipment (PPE), facilitated containment measures and flattened the ominously rising curve.

Now, with five weeks before schools reopen, the once unified approach to conquering COVID-19 has deteriorated into a cacophony of mixed messages. From East to West, Canadian public health officials and politicians have adopted a patchwork of policies and practices on mask-wearing. You will need a mask to get a haircut, but not if you are standing in a classroom in September, for eight hours a day, teaching twenty potentially infectious children. Given that the CDC and WHO recommend masks, it is astounding (and unconscionable) that some Canadian school boards have opted to negate the evidence of the importance of masks. Only Nova Scotia has mandated masks in schools. What is even more bizarre is how divided opinions have become about the topic.

The reasons touted for why children can’t wear masks have ranged from fear that “there is no added benefit” (then why would medical professionals wear them?) to “my child won’t be able to stand them” (how then does one wear a ski mask for hours?) to “my child won’t know how to wear a mask” (but developmental milestones state that a fiveyear-old can be taught to use utensils and toilets, so why not masks?) to “it’s not what Canadians do” (so culture trumps safety?).

Even after seven months of deliberation, Canadians have no national mask policy. Children will be sent back to public schools in regular size classrooms totally unmasked. In the absence of moral leadership and political will, desperate parents are now considering sending their children out of town to avoid the inevitable community spread. The idea sends shivers down my spine, and is reminiscent of the Second World War, when families shipped their children off to the countryside to spare them from the devastating effects of war. It is well known that adverse childhood experiences, such as separation from family, can lead to significant emotional and physical sequelae. These desperate solutions to avoid infection will only compound the anxiety and fear children have already experienced through this pandemic.

Masks are a cost-effective solution to the dilemma of reopening schools full time, particularly when they are used as part of a larger containment strategy. For working families, full-day, in-person schooling is the only viable option. However, children are excellent vectors for this virus, with asymptomatic rates as high as 40 per cent. Based on a South Korean study of nearly 65,000 kids, even slightly older children (over 10 years of age) can transmit this virus as much as adults.

Among various changes needed for safe school return, cloth masks prevent droplet transmission and would be a warranted approach to reduce community spread. In Singapore, the government has distributed reusable, comfortable antimicrobial cloth masks for every citizen. The expectation is that everyone, barring the very young, can learn how to use masks safely and effectively.

Canadian school boards should follow suit and mandate masks for all children ages five and up (except for those with medical exemptions). Fastidious symptom screening, physical distancing and hand hygiene are also crucial. Denmark reduced classroom sizes and allowed for outdoor learning to reduce transmission risks. Their infection rates have not skyrocketed, and schools continue to remain open.

In the ideal world, Canadian public schools would have the same resourceful plans as our Danish and Singaporean counterparts: happy children sitting two metres apart, learning and socializing in outdoor or well-ventilated classrooms, in small groups, with reduced school hours and government-provided masks. Canadian children deserve a safe start in September. It is time to act now — or the unmasking of our children will be the start of our own undoing.