All public health interventions have a public health cost, and masking our children –especially very young ones – against COVID is no exception. That's why the new school reopening guidelines announced Friday by the Centers for Disease Control and Prevention are a big step in the right direction.
The agency says masks are unnecessary for fully vaccinated students, teachers and staff, as long as they can maintain 3 feet of distancing, and recommends continued indoor masking and distancing for those who are unvaccinated. I agree with this as long as it doesn't lead to mask mandates for young children, who are not yet eligible for vaccines.
Dr. Daniel Benjamin, Duke Professor of Pediatrics and principal investigator of multiple studies on the risk of COVID transmission in schools, told me that that risk of spread has been shown to be less than 1% in school studies in North Carolina, Utah and Nebraska, and that mask wearing plays a significant role in decreasing this transmission. This is important in areas of increasing community spread, especially due to the delta variant.
Masks have down sides for kids
On the other hand, regular mask use in children is far from risk-free, especially in circumstances when the masks are not frequently changed or worn properly. With 67% of American adults having received a shot of a COVID-19 vaccine and close to 50% being fully vaccinated, now is not the time for a pervasive across the board mask mandate for our children.
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Consider that a survey in Germany of over 25,000 children determined that 68% had trouble managing nose and mouth coverings. And a Polish/German study just published in the prominent journal JAMA Pediatrics examining 45 children determined that the carbon dioxide level was at least three times greater than the upper limit determined as safe (2000 ppm) by the German Federal Environmental office. The study concluded that “most of the complaints reported by children can by understood as consequences of elevated carbon dioxide levels in inhaled air.”
Some critics have said the study design was flawed. Still, a study from Singapore back in April also showed that carbon dioxide content increases with face mask use. And last year, a study of 343 health professionals on the front lines in New York City determined that prolonged mask use led to headaches, rashes, skin breakdown, impaired cognition, or other adverse affects in a majority of those studied.
Beyond that, young children have trouble reading faces and learning unspoken behavior with masks on, especially following more than a year of remote learning and diminished socialization experiences.
The country is deeply divided on mask mandates, which is reflected in a patchwork of rules and options. There has been disturbing inconsistency from state to state and little correlation between vaccine compliance, case numbers, the emergence of the delta variant, or whether there is a resistance to mask mandates.
The CDC guidance should cut down on state and local school mask policies that are driven by politics rather than by science. For example, masks for schoolchildren are optional in New York State, but have been mandatory in New York City, despite extremely low case rates. On Friday, officials said they were reviewing the new CDC guidance.
Test and screen young children
There is simply no overriding public health reason for mask mandates in all schools, despite the delta variant, especially at a time when hospitalizations and deaths from COVID-19 have dropped dramatically in the U.S. Though some estimates show that the percentage of COVID-19 cases among children is increasing, almost all cases remain mild or asymptomatic. Certainly, rapid testing and screening can remain in place for young children next year.
All three vaccines currently available are effective against the delta variant. Any teacher or school staff who feels concerned about COVID-19 risk can simply be vaccinated, and that goes for every child from the age of 12 and up.
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Children under 12 are still much less likely to get sick from COVID-19 and are less likely to spread it. They also benefit from a community immunity developed by those around them who have taken the vaccine, recovered from COVID-19, or both. Schools have also been shown, throughout the pandemic, not to be the superspreader sites predicted by government and media fearmongers.
The CDC guidance leaves the door open to mask mandates for students too young to be vaccinated, but I hope state and local leaders do not take this path. Our children have suffered enough.
Based on current science, I vote yes on CDC guidance and no on mandatory masks in schools. Masks for kids may be recommended, but not forced. If your young child is immunocompromised or has a chronic medical condition that puts them at greater risk of a COVID complication, or simply wants to wear a mask, then they should. Public health decisions need to be flexible and consistent with the latest science.
Dr. Marc Siegel, a member of USA TODAY's Board of Contributors and a Fox News medical correspondent, is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. His latest book, "COVID: the Politics of Fear and the Power of Science," was published last fall. Follow him on Twitter: @DrMarcSiegel
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This article originally appeared on USA TODAY: CDC COVID guidance shouldn't prolong school mask mandates for young kids