COVID expert: Without mask mandates, schools will be a riskier environment for kids this fall

Fifth-grade students
Fifth-grade students in Riviera Beach, Fla., wearing masks to help prevent the spread of COVID-19. (Wilfredo Lee/AP) (AP)
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In a matter of weeks, more than 50 million American children — the vast majority of them unvaccinated against COVID-19 — will return to indoor classrooms for the start of the school year. Meanwhile, the hypercontagious Delta variant of the virus has been ripping through undervaccinated parts of the U.S. and shattering hospitalization records in hot spots such as Florida and Louisiana.

In short, kids and COVID look like they’re on a collision course — and that's been causing a lot of consternation among parents and policymakers.

On one side, pediatricians in hard-hit areas have been reporting that their wards are overflowing with more sick children than ever — and warning that school could make matters worse.

On the other side, Republican governors like Florida’s Ron DeSantis have actually prohibited local school districts from requiring masks in classrooms, going so far as to threaten to withhold the salaries of superintendents and school board members who implement such requirements.

“I think the fairest thing to do is [to] just say, ‘Let parents make the decisions,’” DeSantis argued.

Yet parents have been caught in the middle, confused about whether Delta actually poses a bigger risk to their kids than previous versions of the virus — and eager to know what steps actually need to be taken to keep children and communities as safe as possible once school gets underway.

To cut through the noise, Yahoo News spoke to Dr. Caitlin Rivers, an infectious disease epidemiologist at the Johns Hopkins Center for Health Security who has authored or contributed to several influential reports that have guided the U.S. pandemic response — including last year’s report on school reopening by the National Academies of Sciences, Engineering, and Medicine.

Rivers’s message is clear: “We have seen that it is possible to have safe in-person learning,” she said. “We have not tried since Delta became established. But I think it’s possible too. We do need to use these mitigation measures, though. We cannot just open schools like it’s 2019 and expect that it will be as safe as it was last year.”

Here’s more from Rivers on mask mandates, breakthrough infections among vaccinated people, why the Delta variant is sending more kids to the hospital — and what to expect in the weeks ahead.

YAHOO NEWS: Before we get to kids, do you think it’s accurate to keep describing breakthrough infections from Delta as rare?

DR. CAITLIN RIVERS: I probably would not choose "rare." I would say breakthrough infections are uncommon or unlikely.

The reason I ask is because these words inform people’s sense of risk — especially parents’. If you and all the adults at school are vaccinated, and if you think breakthroughs basically never happen, you’re probably going to be less concerned about your kids getting COVID at school and spreading it throughout the community. But I personally know a dozen fully vaccinated people who have tested positive and transmitted the virus to other vaccinated people in the last month, and new studies are showing less protection against infection as well. Suddenly, that near-perfect backstop against community transmission we were hoping the vaccines could provide no longer seems so perfect.

Current data show that the vaccines are holding up very well against severe illness. So they will keep you out of the hospital, particularly if you're not in a vulnerable category. But for breakthrough infections, like, can you get infected at all? Can you develop symptoms? I’ve seen in the range of 70 to 85 percent protective.

An "Unmask Our Children" protest in Suwanee, Ga., in July. (Elijah Nouvelage/Bloomberg via Getty Images) (Bloomberg via Getty Images)

Which isn’t the original 95 percent. So when you’re looking at a big shift in behavior, like going back to school in the midst of a Delta surge, the vaccines are still great, but they’re not keeping vaccinated parents and family members and teachers entirely out of the chain of transmission, right?

Right. And then I would also say that even in highly vaccinated communities, schools should be considered a different category because they are where unvaccinated children come together. Ninety percent of the adults in your community could be vaccinated — but that’s not going to be true for the kids in your school.

So let's talk about Delta and kids. What do we know about Delta’s impact on children and how it may or may not be different than previous variants? Is it more dangerous?

Children are still at low risk of severe illness. But unlike what you sometimes hear, they do get infected and they can transmit to others. There’s a rumor going around that COVID leaves children untouched, and that’s just not true.

There are reports right now, for instance, of children's hospitals being overwhelmed. And even though that does not seem to be because Delta makes kids sicker, it’s still not good news. There’s a lot of virus circulating out there, and more kids are getting sick as a result.

I’ve heard a lot of people say that everything in life involves risk and that the risk to kids is quite low, so it’s not worth altering your life over. That argument seems to be at the root of a lot of the opposition to kids wearing masks, for example. But you’re saying that’s not how parents and policymakers should be thinking about it.

It’s not how we should be thinking about it. It’s true that we face all sorts of risks as humans. But we do a lot to buy down those risks, particularly for our children, because we want them to be safe and healthy. “Wear your seatbelt.” “Wear your helmet.” We make them eat their vegetables. And that’s all because we want to reduce those risks.

Now, again, children have a low risk of severe illness. I don't want to overstate the risk that something bad will happen to them. But even knowing that the risk that my child will end up in the hospital is less than 1 percent, I still don't want that 1 percent. And so when we’re thinking about doing things like gathering outside or wearing a mask, they’re such simple steps to take that can protect not just kids, but also the people around them.

That’s a really key point. On one side of the equation there’s the size of the risk. It might be fairly small. But then you have to balance that risk against what’s on the other side of the equation — that is, how easy or hard it is to minimize that risk.

For instance, mask critics often say driving is more dangerous for kids than COVID. For most families, it's way too hard to keep their kids safe by never driving anywhere, so you have to do it. But it’s very easy to buckle their seatbelts.

And the same goes for schools: It would be excessive to keep your kids safe by never sending them to school. But making sure they wear a mask to minimize their risk of getting sick or spreading the virus? That’s as easy as buckling a seatbelt.

Right. Everyone wants children back in school, in person, full time. I think that is a shared national priority. But we do need to do it safely. Schools didn't close because we lost interest in them. They closed because of the threat of COVID — and that threat is still with us.

Is the threat to kids actually higher in some ways than it was during the last school year? You mentioned that some children’s hospitals are now overwhelmed because kids are simply being exposed to more COVID than before. Between less masking and distancing in the community and some states taking a more relaxed approach to similar measures in schools, it strikes me that Delta’s increased transmissibility isn’t the only problem here. It’s clear that Delta is worse than other variants — but beyond vaccination, we’re actually doing less to shield kids from it than we were doing before.

At least seven states have now moved to limit the ability of local officials to implement mitigation measures. In Texas and Florida, for example, the governors have prevented requiring use of masks in schools. Individuals can still choose to wear masks, but they really work best if everyone wears them. And so rolling back masks and other mitigation measures makes schools a riskier environment.

As far as the wider community, it depends on the intersection with vaccine coverage. In many places, people went back to normal activities because they’re vaccinated and are able to do so relatively safely. But in places where vaccination rates are low and there's a lot of virus circulating — like the South right now — the level of community transmission has a great deal of bearing on the risk that the virus will be introduced into the school building.

Students arrive to school
Students in Boca Raton, Fla., on Aug. 10, the first day of school. (Joe Cavaretta/South Florida Sun-Sentinel via AP) (AP)

And that risk isn’t limited to kids, is it? On the one hand, kids can help spread the virus back into undervaccinated communities and get other people sick. On the other hand, the more kids and staff test positive in schools, the more they’ll have to quarantine, and that can totally upend life for working parents — even if they’re vaccinated and don’t end up getting sick themselves. Are you worried about these social and economic ripple effects?

Yes, absolutely. I wrote a tweet about this recently that got a huge response, which I think reflects the concerns of parents thinking about back to school and how disruptive it may be.

There are currently three options for quarantine. The least risky is 14 days. The middle one is 10 days. And the more risky one — and the CDC publishes what the residual risk of each of these options is — is seven days with the test on day five or afterwards. Those are still the recommended courses of action.

That’s a lot of time at home if the kid at the next desk tests positive.

Exactly. Employers have put a lot of effort into encouraging their workforce to get vaccinated, and that’s the right thing to do. I’m glad that they did it. But if kids are constantly having to quarantine for a week or more, and someone’s got to stay home with them, it’s not the case that having a highly vaccinated workforce will take that problem off the table.

For people who can work at home, for instance, it’s very difficult to work at home with children there. And then, of course, there are a lot of jobs where it might not be possible to work from home. Those families may face lost wages or endangered employment. And so there can be serious consequences of not minimizing the need to quarantine by minimizing the spread of COVID in schools.

In terms of just how much Delta might spread in schools, can we get any clues from overseas? The U.K., for instance, just had a huge Delta surge while kids were in school. Was there a lot of spread? Was there a lot of illness? What happened?

It’s nuanced. Many places in the U.S. and abroad have been able to reopen schools safely — with mitigation measures. And that part is key, right? There is a myth that schools are inherently safe. That’s not true. We make them safe.

But even then, when we’re talking about Delta and how it’s different, we did see in the U.K. toward the late spring and summer months that children under the age of 18 had the highest burden of illness. Across all age groups, they were the most likely to test positive.

So what do we need to do to make schools safe? As you mentioned, one of the big debates right now is masks. Should kids wear masks? Do we know they work? What does the science say?

Kids should definitely wear masks. They reduce risk. They do not eliminate risk, which is why it’s better if everyone wears them.

Some masks are better than others. The one that your kid will wear should be your first priority, because it’s the one you can control. Surgical masks are more protective than cloth masks, and I think those are better for younger kids. If you have an older kid who can tell you how they’re feeling about it, KN95 masks are both comfortable and protective.

There’s a difference, of course, between your kid wearing a mask and every kid in the school being required to wear a mask. What do we know about mask mandates in schools and how well they work?

Well, because the masks are not completely protective, it’s better if everyone wears them. Then there's more opportunity for source control — i.e., making sure someone who is infected is less likely to breathe out the virus. And then there’s some degree of protection for the wearer as well. So it’s really something that works better if everyone wears one.

What else needs to happen in schools to keep them as safe as possible now that kids are heading back?

Routine testing is a really important tool. In places that have implemented once- or twice-weekly testing, it’s been very successful at minimizing outbreaks. It’s better if a school is able to provide that as a service, and there was a lot of money in the American Rescue Plan to make that possible. But for districts where that has not been implemented, parents can now get over-the-counter antigen tests at most pharmacies.

What about vaccination for kids under 12? When can we expect them to be eligible now that the trials have been expanded to better detect rare side effects?

Recently I’ve been hearing winter. Hopefully by the end of the year.

But that’s not really fast enough to make much difference in terms of returning to school, is it? And even among kids over 12, vaccine uptake has been frustratingly low.

It's not great: about 30 percent for kids 12 to 15, and a little over 40 percent for 16- and 17-year-olds.

Given all of this — and given how Delta is surging right now — are you confident that sending kids back to school in person is the right decision, particularly in places where Delta is surging?

We have seen that it is possible to have safe in-person learning. We have not tried since Delta became established, but I think it’s possible. We do need to use these mitigation measures, though. We cannot just open schools like it’s 2019 and expect that it will be as safe as it was last year. Back then, places that opened were really throwing the book at making sure everything was safe and secure. We have to do that again.


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