THE 3 R’S & MASKS
All our kids have to wear face coverings in school as new year approaches
In-person school really matters. Children need their teachers, and they need their friends and classmates. As pediatricians, this is one lesson that we’ve learned over and over through this complicated and difficult pandemic year. There is real value to learning with children and teachers together in the classroom. Kids need us to keep schools open and safe this fall, and they need us to do it right, which is going to mean masks.
As a group, children have not been the most likely to get seriously ill or to die of COVID-19. Even so, we know that children and their parents have suffered a great deal over the past 16 months, and that these burdens continue to fall disproportionately on the most vulnerable — families with less money and less privilege, children with special needs, and those in the Black and Brown communities hit hardest by the pandemic.
And although it’s rare, children truly can become severely ill from COVID. Our combined experience in New York City hospitals has included being part of teams caring for children with COVID and their frightened families in our intensive care units. We see the other end of that spectrum in our clinic, where recently a child who had come for a checkup insisted that he had studied hard all year on Zoom, but his mother whispered that it made her sad to remember how much he had loved going to school, back when it was safe, and she didn’t think that he’d made much progress with the computer. In different ways, each of these kids has suffered from the pandemic.
Right now, as another school year approaches, our job as a society is to work together to apply our hard-won knowledge about the virus and its transmission to make learning as safe and as effective as possible for all children, not just the most privileged. Fortunately, science and hard work have given us the tools and the know-how to get this job done. But we have to think about children, science and safety, not about our adult political feuds and agendas.
Our most important weapon in this fight is vaccination against COVID-19. Every person who chooses to get vaccinated brings us a step closer to ending the pandemic, which is good for everyone — especially kids. Even though many schoolchildren are too young to be vaccinated under current guidelines, the development of safe and effective COVID vaccines gives us the ability to protect those around them: their teachers, their parents, their grandparents, even their adolescent siblings. So we must protect everyone we can protect with those safe, effective vaccines that we have available. That means all children age 12 and up, the teachers and school staff, and parents and other family members at home.
But though clinical trials are underway in younger children, and pediatricians are eagerly hoping to be able to offer those vaccines in the not-too-distant future, it seems clear that we will start the school year with a large population of unvaccinated children in elementary schools, and with an incompletely vaccinated population of older children — and adults.
The COVID-19 delta variant has been driving a rise in case numbers in recent weeks, causing a tremendous — and increasing by the day — amount of disease in unvaccinated adults, and also affecting a significant number of children. The delta variant is more easily transmitted, which also seems to mean a somewhat higher number of breakthrough infections in those who are vaccinated. Even though vaccinated people with COVID are extremely unlikely to develop serious illness, they may still be able to transmit the virus — especially to the unvaccinated. So COVID is still very much with us, with the virus taking advantage of vulnerable and unvaccinated populations, and while getting vaccinated is your best possible protection, none of us are home free yet. And to really get there, we need to bring everyone along.
That means that as we look towards the fall, we need to do everything possible to reduce transmission when kids are back in school. Vaccinating everyone who is eligible is the first step, but we also need to look to masks, social distancing and improved ventilation in the classroom. Experience and science have taught us that these additional strategies give us the ability to keep schools open safely — even if not everyone is vaccinated yet. The key is that we have to continue to use these tools. especially with rising cases in many areas of the country.
The American Academy of Pediatrics has said exactly what needs to be said: Children — all children — should start the school year wearing masks when they are indoors. And adults — all adults — who teach and work in schools should be masked indoors as well. In schools, everyone over the age of 2 should be wearing a mask.
What’s the logic behind asking even vaccinated adolescents and adults to mask? First, it recognizes that we’re still concerned that vaccinated people may occasionally be able to transmit the virus, and that any school that
includes children under 12 will have a large unvaccinated and therefore vulnerable population. Vaccinated people wear masks to help protect their community — and to grant themselves an addition layer of protection against breakthrough infections in the setting of the highly transmissible delta variant. Yes, they’re kept overwhelmingly safe by their vaccines, and they may choose to go without masks in other settings, but when you’re trying to open schools safely in a pandemic, you take every extra precaution, and you’re grateful for every additional degree of safety. Especially when the layer of protection is so cheap and easy, as masks are.
Second, having everyone wear masks takes away the burden of verifying who is actually vaccinated and enforcing mask mandates on some people but not others. Schools won’t have to single out particular students or teachers. No one will have to feel self-conscious about wearing a mask, because masks will be the norm. They won’t be a badge of your immune status; they’ll be a sign of your commitment to keeping everyone — including yourself — uninfected and safe.
A masked classroom will be a safer classroom, and children, who have been coping with anxiety and stress all through the pandemic, will be able to understand that. They will know that they are wearing their masks to keep from getting sick, and also to keep from bringing infections home. They will understand that their masks protect them, their teachers, their parents, and everyone they know and love.
Wearing masks in school comes with an additional benefit: much less spread of other respiratory diseases, like influenza. That is something else that we saw over the past year and a half. Keeping kids away from other viruses will be another key to making this school year work.
Keeping schools open and safe will be a much less agonizing process if there are not too many sick kids. And that’s going to be particularly vital this fall, when any fever, any cough, any runny nose in a child is going to raise the question of COVID-19, and put pediatricians like us in the position of testing kids and making decisions about who has to isolate, who has to stay out of school. If you can possibly help it, you don’t want to be in the pediatrician’s office or the emergency room with a feverish coughing child this fall.
We recognize that it is not trivial to ask schoolchildren to wear masks in school. There will be some hot days. It’s less comfortable than going without masks. All things being equal, it’s better for teachers to see children’s faces, and vice versa, to see smiles and frowns and other vital cues.
But all things are not equal. While we would all like to be back in a world in which schools can run without masking, without distancing, without taking the virus into account every day, we’re not there yet. Meanwhile, there are real children who are growing up and won’t get these years back. They aren’t the “COVID generation” or the “pandemic children”; they’re just kids, growing up in the times they were dealt. They need their childhoods, and they need schools. It would be a huge accomplishment to get schools open and keep them open. It’s what children deserve. Let’s acknowledge that a goal that grand is worth some effort and some sacrifice.
Opening schools safely will help children, families, communities and our country move forward out of this pandemic. An open school, with masked children learning together (ideally in well-ventilated classrooms, with vaccinated-and-also-masked teachers) would be a sign that our community is healing from this past year, and looking toward a future in which, we hope, these COVID restrictions will be memories.
If all of us — parents, teachers, politicians, pediatricians — work together, our children’s memories can include the joy of seeing friends and classmates every day this year, and the triumph of working together to protect education in an extraordinary time.
So let’s get everyone who is eligible vaccinated as soon as we possibly can. Let’s vaccinate everyone 12 and up, which will help get us all to safety sooner. And let’s get on board with having kids start the year with masks in school.
There are so many doctor jokes that start, I have some good news and some bad news. Wearing masks in school is not really bad news; as pediatricians, we wear our masks all day, and we often wore masks even before the pandemic. Still, for some children — and some parents — this can feel like “the bad news,” but the real bad news is that we’re not out of the pandemic yet, by any means. We’re facing rising case numbers in many parts of the country, and we’re dealing with a dangerous new variant. Working together — prioritizing what’s important and, yes, sacrificing so that we can keep schools open and safe — would be very powerful good news for kids, for parents and for a country trying to emerge from a dark chapter.