CDC and doctors call for masks in school. Will states, schools follow guidelines?

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Amid mounting COVID-19 transmission before children return to classrooms, the Centers for Disease Control and Prevention called Tuesday for mask-wearing in schools among students, staff and teachers to protect children who aren't eligible for vaccines.

The more aggressive transmission of the delta variant is worrisome and prompted the tougher masking guidelines, said Rochelle Walensky, director of the CDC. The guidance is a major change from the CDC's recommendations this month that vaccinated students and staff need not mask up in schools.

The CDC recommended everyone in communities with substantial virus transmission wear masks indoors.

"Vaccinating more Americans now is more urgent than ever," Walensky said in a conference call. "This moment – and most importantly, the associated illness, suffering and death – could have been avoided with higher vaccination coverage in this country."

Doctors support the prospect of more widespread vaccine mandates while acknowledging the political difficulty. As long as vaccination rates stall, health experts recommend a return to many of the indoor virus mitigation protocols of the past school year, including masking and social distancing.

Many schools, particularly in Southern and Republican-led states, have dropped those requirements while planning to return thousands of unvaccinated children to classrooms.

“The CDC is doing the responsible thing by altering their recommendations as we’ve seen rising infection rates across the country,” said Lewis Nelson, chair of emergency medicine at Rutgers University Medical School in New Jersey.

Although young children rarely get very sick from COVID-19, infections have climbed this summer as the delta variant spread. About 4.1 million children have had a diagnosed case, resulting in about 18,000 hospitalizations and more than 350 deaths.

High school and many middle school students are eligible to be vaccinated, but younger students in elementary schools are not. A vaccine for children under 12 probably won't be available until the end of this year at the earliest.

Tina Tan, a pediatrics professor at Northwestern University, said, "Only 30% of kids ages 12 to 17 have been vaccinated."

Increased vaccinations for eligible children and adults are the best way to control outbreaks in school settings, Tan said Tuesday in a conference call hosted by the Infectious Diseases Society of America.

“It’s pretty clear that the cases that are occurring all around the country are not being driven by the fully vaccinated,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “It’s not a coincidence where cases are high, vaccination rates are also low.”

Conflicting national guidance on masks

Conflicting advice on masks from the CDC and American Academy of Pediatrics added to the confusion as schools prepare to welcome children and staff back for full-time instruction.

Both medical organizations want schools to reopen because of the academic and social benefits for students. But the pediatrics group recommended anyone over the age of 2 be required to wear a mask in school – directly contradicting the CDC's earlier advice that vaccinated students and staff don’t need them.

Tuesday, Walensky cited rare cases of vaccinated people who became infected with the delta variant. “This new science is worrisome and unfortunately warrants an update to our recommendations,” she said.

Before Tuesday's update from the CDC, school leaders made their own decisions.

Public schools in Springfield, Missouri – where infections exploded this summer, largely because of low vaccination rates – reinstated a mask mandate for July summer school. Masks were optional in June.

The first districts to start in California and Arizona in July featured dramatically different protocols. Arizona’s governor has forbidden districts from mandating vaccines for teachers or students and from requiring face coverings. In California, the state health department requires masks indoors in K-12 schools when children are present, regardless of vaccination status.

California will require that masks be worn at schools when classrooms open this fall.
California will require that masks be worn at schools when classrooms open this fall.

Los Angeles, where schools will reopen Aug. 16, is under a countywide face mask mandate for all indoor public spaces – a measure reinstated July 17 because of a rise in infections.

In Mississippi, most districts planned to make masks optional when students and staff return, because there's no state guidance requiring them.

"The era of statewide mask mandates is over," said State Health Officer Thomas Dobbs.

In Tennessee, only Memphis schools require masks – a "local decision," state Education Commissioner Penny Schwinn reiterated Monday.

Other districts are in limbo. In Florida, which again leads the nation in COVID-19 infections, the Alachua County School District in Gainesville made masks optional in April but is reconsidering that move. The school board plans to make a final call on Aug. 3.

Florida's governor threatened to call the Legislature back in session to ban school systems from requiring masks.

“There’s been talk about potentially people advocating at the federal level, imposing compulsory masks on kids,” Gov. Ron DeSantis said. “We’re not doing that in Florida, OK? We need our kids to breathe.”

Vaccine mandates get mixed response

Even health experts are split to some degree on mask mandates. Though Tan recommended masking in schools, Adalja said face-covering requirements could be relaxed for vaccinated students and staff in communities where virus transmission is low.

However, he said, it’s time to make vaccines mandatory for teachers and other staffers who don’t have a medical exemption.

“The teachers unions are saying, ‘We want to have access to the vaccines, but, no, we don’t want to be forced to take them,’” Adalja said. “That doesn’t make sense to me. Either the vaccines are of value to the teachers or they’re not.”

Public school teachers in New York City and California will be some of the first educators subject to vaccine mandates, unless they submit to regular coronavirus screening.

Vaccine or testing: California, NYC unveil plans; VA makes shots mandatory for medical workers

A spokeswoman for New York's United Federation of Teachers union stopped short of fully endorsing the vaccine requirement in a conversation with a USA TODAY reporter Monday. In a statement, the United Federation of Teachersrs union said the new approach "puts the emphasis on vaccination but still allows for personal choice."

About 60% of New York City's Department of Education employees have had at least one dose of the vaccine, according to Chalkbeat, an education news site. The figure does not include education workers who were vaccinated outside the city.

A family enters a pop-up COVID-19 vaccine site on June 5, 2021, in the Jackson Heights neighborhood in the Queens borough in New York City.
A family enters a pop-up COVID-19 vaccine site on June 5, 2021, in the Jackson Heights neighborhood in the Queens borough in New York City.

New York City has required masks for summer school but hasn't made a final ruling for fall, according to the UFT.

Preeti Malani, a professor and chief health officer at the University of Michigan, cited a "big contrast" between schools and college campuses, where most students are eligible to be vaccinated.

Last week, a federal judge upheld the University of Indiana's mandate that students, faculty and staff must be vaccinated against COVID-19 by mid-August.

Tuesday, citing the spread of the delta variant, the California State University system announced it would mandate vaccines for students, faculty and staff who come to campus. The university system had already planned to require COVID-19 shots, but the mandate was contingent on the Food and Drug Administration fully approving one of the available vaccines.

Members of the Cal State community have until Sept. 30 to prove their vaccination status. The California State University system is one of the largest in the country, with 23 campuses and 486,000 students.

Most colleges encourage their students to get vaccinated, and 600 campuses have mandated vaccines, according to the Chronicle of Higher Education.

"The campuses that are highly vaccinated are going to be in the best position to avoid major disruptions this fall," Malani said. "Even with some unknowns, getting vaccinated is far safer than getting COVID."

Contributing: Chris Quintana, USA TODAY; Keisha Rowe, Mississippi Clarion-Ledger; Meghan Mangrum, Nashville Tennessean; Gershon Harrell, Gainesville Sun; Laura Testino, Memphis Commercial Appeal

This article originally appeared on USA TODAY: CDC recommends masks for back to school: Guidelines for delta variant