Heidi Przybyla, NBC News’ correspondent for this week, is featured tweetedA Michigan report on COVID-19 in public schools students. She said that her gloss meant that she had just received the data and that it revealed some important information about the advantages of having students wear masks. “NEW: Virus spread in schools without mask rules was 62% lower.”
Przybyla didn’t actually quote “NEW” when she cited the story. The story was actually published by WJRT on October 15, Flint’s ABC station. It is based on August and September data from the University of Michigan School of Public Health. The finding was not as significant as WJRT or Przybyla had hoped, as it didn’t take into consideration potentially important confounding variables like vaccination rates and precautions districts may have taken. Furthermore, the association between mask mandates and lower infection rates had faded by December.
David Folkenflik, NPR’s media correspondent pointed outPrzybyla is correct to point out that Przybyla did not find a new finding and it had not held up over time. acknowledgedIt was her error. This episode revealed how eager those who support school mask mandates to promote any evidence to back their policies, however ambiguous, is. This tendency is also evident in public health officials such as the Director of the Centers for Disease Control and Prevention, who claim they are following science but here desperately seek validation for a policy without solid empirical support.
The following is an AtlanticMargery, an infectious diseases scientist at the National Institutes of Health and author of this week’s article, argues in favor of school-mask mandates despite the absence of any evidence. Her co-authors note that two years on from the outbreak, unproven methods are no longer justified. “We reviewed a variety of studies—some conducted by the CDC itself, some cited by the CDC as evidence of masking effectiveness in a school setting, and others touted by media to the same end—to try to find evidence that would justify the CDC’s no-end-in-sight mask guidance for the very-low-risk pediatric population, particularly post-vaccination. Our findings were disappointing.”
Vinayprasad (an epidemiologist at University of California San Francisco) makes the point emphatically in a recently published article Tablet article. According to him, forcing students not only to wear masks, but also their teachers and grandparents isn’t an issue of safety. This is dangerous, delusional, and cult-like behavior.
Bobby Mukkamala is the American Medical Association chairman, and Przybyla was part of that cult. WJRT was told by him that “this is an exact study about this situation.” “It’s not possible to get more detailed than this research, which is about students in school without and with masks.”
Mukkamala presented a scientific argument for school mask requirements as being solid. “It’s one thing if it’s just sort of a gut feeling—well, you know, we think masks work, so why don’t we just go ahead and ask kids to wear them in school?” He said. “But this is way beyond that….This is data—one more study that shows the effectiveness, and not just masks in general, but particular to this situation.” He complained that there was a “deep division” in school over masks, but that it wasn’t always data-driven.
Mukkamala has a point, but not as he intends. To validate their gut feeling, mask enthusiasts such as Rochelle Walensky (CDC Director) and Mukkamala (CDC Director) are misleading the science.
Mukkamala believed that the University of Michigan’s October 12 report confirmed his earlier beliefs. It noted that districts with mask regulations may also be equipped with other preventive measures, which could help lower transmission rates. This means we cannot draw a definitive conclusion on the effects of mask regulations. The association that impressed Mukkamala may have been due to “other preventive measures”, such as increased ventilation, physical distance, testing, and other programs.
Another factor that could be confusing is the vaccination rates. It’s possible that they are higher in schools that require masks. According to data from Washington, D.C., California, New York City, and Washington, D.C., areas that follow strict COVID-19 policies have high vaccine rates. The Michigan data do not reflect the transmission of disease in schools but only cases from school-aged children.
Case rates for Michigan school districts that have mask requirements had been about the same in December as those in schools without them. A December 14 update stated that school-aged cases rates had become closer together due to increased community transmission. This suggested that masking-related differences could have been “potentially washed out” by transmissions in other settings. Nevertheless, “It is important that you keep your indoor environment clean Schools and other places can prevent transmission.”
This was interpreted as proof that mask requirements are effective when mask requirements were associated lower with case rates. However, when lower rates were not associated with mask requirements, this finding did nothing to change the belief that mask requirements are important. This belief is not necessarily data driven.
The CDC followed the same path. The CDC recommends indoor masking for children aged 2 and older. This includes toddlers at daycare, high school seniors, and even those in their teens. International standards consider this extreme advice.
“Many countries—the U.K., Sweden, Norway, Denmark, and others—have not taken the U.S.’s approach,” Smelkinson and her co-authors note, “and instead follow World Health Organization guidelines, which recommend against masking children ages 5 and younger, because this age group is at low risk of illness, because masks are not ‘in the overall interest of the child,’ and because many children are unable to wear masks properly. The WHO doesn’t routinely apply masks to children aged 6-11 years. Masks are not recommended due to the “potential effect of wearing a facemask on learning and psychosocial developmental.” To ensure that breathing is protected, the WHO explicitly advises not to mask children when they engage in any physical activity, such as jumping and running at the playground.
Although the CDC doesn’t require outdoor masking, certain school districts insist. “Many deep-blue areas such as Portland, Oregon; Los Angeles; and New York City have gone beyond CDC guidance and are masking students outdoors at recess,” Smelkinson et al. Note that “in part due to byzantine rules that force an unmasked, ‘exposed student’ to miss multiple school days, even though the exposure was outside,”
The CDC started recommending universal masking for schools and daycare centers in 2005, but there wasn’t any solid evidence supporting that recommendation. The majority of studies cited in the CDC didn’t even compare mask-mandated schools to those without. The exception to this rule was the study that was done in Georgia on elementary school students. It found that while masking of teachers had statistically significant effects on COVID-19 transmissions, it was not associated with masking of students.
The second study looked at “school-associated COVID-19 epidemics” in Arizona (rather that infection rates). The study found that school that required masks had a lower incidence of outbreaks. But as Smelkinson et al. Smelkinson et al. note that “more than 90% of the schools in this ‘no-mask mandate’ group were located in Maricopa County which has significantly lower vaccine rates than Pima County.” Critics have also pointed out other flaws in the study, including that it did not account for COVID-19 mitigation strategies.
A second study examined COVID-19 trends for approximately 3,000 counties that had different school masking policies. The study found that counties without school masking requirements saw greater increases in the number of pediatric COVID-19 cases after starting school than those with school masking requirements. However, this study was not able to control for vaccine rates and other mitigation strategies. The researchers also stated that the study was ecological and therefore “causation can’t be inferred”.
This is the most common way to deal with these issues. But no such studies of masking in schools have been conducted—a pretty striking omission for an intervention that affects millions of children across the country. Evidence is lacking for masking, even in general. While laboratory studies provide compelling evidence that masks—especially N95 respirators—can reduce virus transmission, it remains unclear what impact they have in real-world settings, where masks may not be clean, may not fit properly, and may not be worn correctly.
Mask requirements for children under 2 are added to the uncertainty. This may explain why it has been difficult to confirm school mask mandates having any positive effects. A preprint study based on data from Florida for the 2020–21 school year, for example, found no association between mask policies and case rates. Smelkinson et al. Cite other data from Tennessee and Florida North Dakota, and the U.K. that likewise are not consistent with the assumption that school mask mandates reduce virus transmission. Prasad points out that similar data are not available from Spain.
Prasad has long been skeptical that cloth masks—the kind most commonly used in schools—are effective in preventing COVID-19 transmission. With the introduction of the highly transmissible variant omicron, this view has been strengthened. CNN’s Leana Wen (a CNN medical analyst) stated last month that cloth masks were little more than cosmetic items in light of the omicron variant. The CDC finally admitted that N95s offer the best protection, while loosely woven cloth products offer the lowest protection.
Some schools responded by mandating the use of N95s or other masks. They are less effective, more painful, and much more comfortable for children than traditional ones. Given several facts, this escalation seems difficult to justify.
First, COVID-19-related symptoms that could lead to death have never been seen in children. Omicron infections are a less common variant of the disease. “A (pre-vaccine!) analysis from Germany shows that if a child is infected with COVID—with or without preexisting conditions—there is an 8 in 100,000 chance of going to the intensive care unit,” Prasad writes. According to that same study, there is a 3 in 1,000,000 chance of dying. There have been no reported deaths in children over 5 years old. These risks are astoundingly low.”
Second, the vaccine, available for anyone aged five or over, further decreases this already low risk. Teachers and adults may also be protected by the vaccine, which helps to reduce COVID-19 transmission from children.
The third is that immunocompromised adults and children who aren’t immune-compromised can prevent infection from wearing N95s, even though they don’t have to wear masks. Shira Doron, Tufts Medical Center’s epidemiologist and coauthors noted in The Washington PostThe “respirators” and the other quality masks provide protection that is highly effective, regardless what their surroundings are doing. Doron et al. Doron et al. argue that schools can now make high-quality masks available to students and staff.
The benefits of school-imposed mask regulations are unclear at best. However, it is clear that they are burdensome. They can also cause discomfort and interfere with social interaction, communication, learning, or learning.
“Recent prospective studies from Greece and Italy found evidence that masking is a barrier to speech recognition, hearing, and communication, and that masks impede children’s ability to decode facial expressions, dampening children’s perceived trustworthiness of faces,” Smelkinson et al. note. “Research has also suggested that hearing-impaired children have difficulty discerning individual sounds; opaque masks, of course, prevent lip-reading. Some teachers, parents, and speech pathologists have reported that masks can make learning difficult for some of America’s most vulnerable children, including those with cognitive delays, speech and hearing issues, and autism. Masks may also hinder language and speech development—especially important for students who do not speak English at home. Masks may impede emotion recognition, even in adults, but particularly in children.”
These serious concerns make it a grave failure for the CDC to show the positive effects of its recommendations or to openly discuss relevant research. Prasad says, “When the history books come out, we won’t look kind or wise for insisting that children and toddlers wear helmets for hours every year,” Prasad adds. Prasad concludes, “We’ll look stupid, fearful and cowardly.” We might even look worse than our primitive ancestors who, when faced with great plagues, engaged in all sorts of bizarre, superstitious behavior—but which rarely included making kids suffer most.”