School-age kids are now eligible for the COVID vaccine. When can they stop wearing masks?

Noel Scott's 7-year-old son, Jabril, has missed roughly three months of school since his district, Los Angeles Unified, reopened classrooms for in-person learning in April. That's largely because Jabril, who has Down syndrome and autism, can't wear a mask – he breathes through his mouth and has sensory sensitivity.

Initially, Scott said, she was told Jabril couldn't attend school maskless without a medical waiver. But even with a waiver, he wasn't allowed to learn in a classroom alongside his peers. "I was like, 'That's not happening – ever,' " Scott said, a special education teacher who works with incarcerated young people and adults. "My kid is not going to be segregated more than he already is."

Eventually, she said, the district agreed to bring Jabril into the classroom as long as he sat behind a plexiglass barrier while at his desk. Now the mother of three plans on transferring to a nearby district whose COVID mitigation practices are, she has heard, less strict and more accommodating of students with special needs. With COVID-19 shots now available for kids ages 5 to 11, she plans to get her two eligible children, including Jabril, vaccinated as soon as she can secure an appointment.

"I'm definitely not anti-masks," she said. "But every child has their own set of circumstances, and we have to figure out how we can offer these students the educational opportunity that every other kiddo has." When districts are taking every other health precaution – from air filtration to vaccination outreach – they should be able to free at least certain students from wearing masks, she said.

As doctors' offices and pharmacies fill appointments fill to immunize children, parents across the country are looking forward to the freedoms their kids can enjoy after getting their shot. But the question of masking – especially in schools – still remains.

Some argue mask-wearing takes a toll on learning – and for children like Scott's son, who struggled with online learning, the toll has been clear.

Other parents say the value of school mask requirements has come and gone. Masks are “a mitigation that should’ve been used sparingly – a precision tool for a short period of time,” said Natalya Murakhver, a mother of two in New York City who started a campaign to eschew school mask requirements. "Now, we're done. Anybody who wants a vaccine for their kid can get one. ... I think (removing the mask requirement) is a really critical step to resuming normalcy, to seeing each other, relating to each other."

Vaccine mandates in schools: Pfizer's COVID-19 vaccine is available for kids. Will schools require it?

How does COVID-19 affect me? Don’t miss an update with the Coronavirus Watch newsletter.

It's hard to judge whether masks have any direct, widespread influence on children’s ability to learn because too many factors are at play.

And the evidence in favor of masking is clear, health experts say, and they stress it's too soon for most children to take off masks in schools. COVID-19 vaccination among younger children has just started. Masks also protect against other seasonal respiratory viruses expected this year as the flu season takes off, travel increases and families gather for the holidays.

“We know that masks work,” said Dr. Josh Schaffzin, director of Infection Prevention and Control at Cincinnati Children’s Hospital Medical Center. “What we’ve learned from the beginning of the pandemic is that masks are effective, and it’s good for us to get used to wearing them in many situations.”

Why health experts say kids still need to wear masks

The federal Centers for Disease Control and Prevention recommends universal indoor masking at schools serving kindergarten through 12th grade, regardless of vaccination status.

In an October study comparing schools, the CDC found the odds of a school-associated COVID-19 outbreak were 3½ times higher in schools with no mask requirement than in those that had them.

Did America’s schools open safely? We crunched the latest data on COVID-19 and kids.

The agency tried rolling back mask recommendations when vaccines became widely available to adults in the spring, but it quickly reinstated them when COVID-19 cases began to rise.

Health experts learned a hard lesson, Schaffzin said, and even as more Americans get vaccinated, they're going to be more careful updating mask recommendations and probably won't begin reassessing the mask guidelines until 2022.

As the holiday season nears, health experts urge parents to keep masks on kids to avoid transmitting asymptomatic illness to vulnerable family members and friends.

Family gatherings and increased travel during the 2020 holidays triggered a coronavirus surge in January 2021 that caused more than 1 million COVID-19 cases and 20,000 deaths a week, according to Johns Hopkins data.

In addition to fighting the spread of COVID-19, wearing masks helps prevent other seasonal respiratory viruses from spreading in schools, health experts say.

The CDC reported 199 children died of the flu in the 2019-2020 season. The CDC received only one report of a flu death in a child last season, when masks and other pandemic mitigation measures were in place.

“No virus is a good virus," said Dr. Xiaoyan Song, chief infection control officer at Children's National Hospital in Washington, D.C. "All viruses are harmful for children.”

Masks in schools are an impairment, 'not a breakdown'

Murakhver, whose children, ages 7 and 11, attend New York City public schools, laments that students these days are subjected to mask requirements far more often than adults – especially frustrating, she says, given how unlikely kids are to get seriously ill from COVID-19.

In New York City, students are required to wear a mask at all times, indoors and outdoors, except during lunch and designated, socially distanced breaks. The city's mayor-elect, Eric Adams, has indicated he aims to phase out the requirement by the end of this school year, "but it must be done with the science," he told CNN's Dana Bash last week.

But New York doesn't have a blanket mask mandate for vaccinated adults. It's hypocritical, Murakhver said. Adults have enjoyed some degree of “liberty and ease with which they can remove (masks) when they need to. It’s exactly the opposite of what we are doing with the youngest children, especially, who have no agency. ... The only place they have to wear a mask is in school."

Murakhver's older daughter has come home with stories of her middle-school peers lashing out at adults on campus as they try to enforce the mask requirement. "It's creating a real adversarial relationship where teachers are losing their credibility," she said.

Her younger daughter has begun to mumble a lot and complain about school being boring. Murakhver attributes those changes in large part to the mask requirement. "We're primed to react to people's facial cues," Murakhver said. "We've taken all the joy out of school."

Some research suggests mask-wearing can make it more difficult to engage in certain activities essential to classroom learning.

A few laboratory-based studies indicate it’s harder for kids to read the emotions of people wearing masks. But in general, the effects of mask-wearing on emotional skills are nuanced, and other research suggests the effect on children is milder than on adults. In that sense, experts say, schools shouldn’t be in a rush to offramp mask requirements.

Confused about kids and COVID? How the American Academy of Pediatrics' guidelines became the standard for kids + COVID

One research article was co-written by Claus Christian Carbon, a psychology professor at Germany’s University of Bamberg, and Martin Serrano, a 10-year-old who attends school in Sarasota County, Florida.

When he was 9, Martin did his science fair project on the effect of mask-wearing on his peers' abilities to read emotions. In his own interactions, he noticed his friends sometimes couldn’t tell when he was making a joke, Martin said. So he reached out to Carbon, who earlier in the pandemic had researched how mask-wearing affected adults’ emotion-reading skills.

Carbon was eager to team up with Martin, and their research found children are slightly better than adults at reading emotions through a mask.

“In some respects, children are coping even better with the masks than adults,” Carbon said.

Masks are “an impairment,” Carbon said, but “it’s not a breakdown in performance; it’s a decrease in performance.” With that in mind, schools should be deliberate about the activities for which they make masking optional, focusing on those where the effect is substantial, such as sports, playtime and phonetics lessons.

Given the relatively limited influence of mask-wearing on kids’ social-emotional skills, Carbon said, there’s no good reason to ban mask requirements.

"We are still in a very awful situation with the whole pandemic and are facing a lot of variants,” he said. “We are not at the end of the tunnel.”

Experts say equity is key: Will children of color get vaccinated at the rates of other kids?

Parents of 11-year-olds: Here's what experts say you should do about the COVID-19 vaccine

Could masks have some developmental benefits?

Judith Danovitch, a cognitive and developmental psychologist at the University of Louisville in Kentucky, acknowledged that masks aren’t ideal for any child and can be problematic for students with special needs. But she cited research suggesting masks can have cognitive and social benefits for children who are able to wear them.

People rely on others’ mouths to interpret language, she said, but they also rely on other cues.

“You can actually tell a lot about a person’s emotional status just from looking at their eyes,” she said.

Hand gestures and body language also play a role. By shifting kids’ focus to other forms of communication, masks might help to strengthen their self-control and attention.

As long as mask-wearing is found to be necessary, according to Danovitch, educators and parents can use it to hone those kinds of social-emotional skills. It can also “be an opportunity during a time of uncertainty for kids to feel like they’re doing something to help others,” she said.

Experts stressed children’s resilience and adaptability when weighing how schools should approach easing mask rules.

“Once the public health experts say we don’t need the masks, it’s not like there’s going to be a big kind of adjustment,” Danovitch said. “We don’t give (children) enough credit for how flexible they tend to be.”

Desi Aleman, a father of four in Corpus Cristi, Texas, said he got a mask exemption for his 15-year-old son, who has autism and is nonverbal. He can't wear a mask properly, and the covering was keeping his caregivers from monitoring his well-being.

Aleman’s son is vaccinated and learns in a building separated from the general student population, but Aleman hopes the school continues requiring masks for others. Case counts have subsided in his area, Aleman said, but he doesn't feel in the clear.

“I don’t think they should roll it back just yet,” he said.

Despite the findings of his science fair project, Martin no longer wears a mask now that they’re optional at his school. That’s largely because most of his peers don't wear one. Plus, it was hard for his teachers to hear him when he wore a mask, he said, and it got uncomfortable when he was wearing headphones while using the computer.

But he wouldn’t mind if masks were required. He and his friends adapted pretty well. Wearing masks became normal, he said.

“I didn’t think that much about it after a while.”

Follow Adrianna Rodriguez and Alia Wong on Twitter: @AdriannaUSAT and @aliaemily

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

This article originally appeared on USA TODAY: Will school mask mandates end with Pfizer COVID vaccine for kids?