As states loosen COVID-19 restrictions across the country, masking, particularly in schools, remains a controversial—and confusing—issue.
While it is true that COVID-19 case rates are dropping after the Omicron surge, the pandemic is not over, and as recently as mid-February, the Biden administration and CDC said it was premature to lift mask mandates in schools. Then in late February, the CDC relaxed its masking recommendations in public spaces and in schools, based on a new county-level assessment of risk.
Those in favor of unmasking in schools say transmission among schoolchildren has never been well-studied and point to the social and emotional burden of masking, particularly in young children who benefit from seeing their teachers’ facial expressions.
Given these various points of view, it’s no wonder that many parents are torn—and frustrated—as an increasing number of governors, including Connecticut’s, have set a date to lift mask mandates in schools, leaving the decision up to local authorities.
If your child’s school makes masks optional and you aren’t ready for them to be removed, should you make your child continue to mask up? What do we know about how masks prevent COVID-19 transmission in schools?
We talked with Jaimie Meyer, MD, MS, a Yale Medicine infectious diseases expert, and Eugene Shapiro, MD, a Yale Medicine pediatric infectious diseases specialist, to help make sense of this latest stage of the pandemic—and how best to navigate it—as sanely and as safely as possible.
Why are mask mandates in schools an issue?
The move to unmask started in early February when several states announced plans to ease many pandemic restrictions as the Omicron surge began to recede. It was a loosely coordinated effort that came on the heels of public health discussions and focuses groups that began after the November election.
In Connecticut, the impending expiration of the governor’s pandemic-related executive orders, including a mask mandate in schools, brought the topic to the forefront. The state legislature voted to extend the mask mandate in schools until Feb. 28, after which the decision will fall to individual schools, towns, and cities.
Dr. Meyer notes that there is nothing from a health metrics perspective that is “magical” about this date.
“Why now? Why this moment? That’s pure politics. It is just executive orders expiring,” she says. “But I also think people don’t like mandates. They are tired of being told what to do. I think that really frustrates people.”
Ending mask mandates: a science- or political-based decision?
As Connecticut ends its mask mandate, Dr. Shapiro says that mask mandates in general—not just for schools—are a thorny topic.
“We are getting into politics when we talk about mask mandates in public spaces as opposed to recommending them. I will be wearing a mask for a long time—for as long as the virus is with us,” he says. “It’s not unreasonable to wear a mask, but a mandate is something different, with all the legalese involved.”
Rather, Dr. Shapiro says he would separate the mandate from information about the benefits and downsides of wearing a mask. “To me, it’s not that onerous to wear one, and there’s a reason we wear them when we go into rooms in the hospital where someone has a respiratory illness,” he says. “What are the adverse side effects of masks? In that, you get into a lot of sociology and politics.”
While it’s clear that masks reduce both the risk of spreading and the likelihood of contracting COVID-19, the question remains of how much, Dr. Shapiro adds. “Right now, the incidence of the disease is going down, but in a month and a half, it might go back up,” he says. “There could be a new variant. There is just so much uncertainty, and what is right this week might not be right next week.”
Messaging on masking should be clearer
A persistent problem throughout the pandemic has been messaging, Dr. Meyer says. “Communication needs to be clear and consistent if you want people to follow it,” she says. Specifically, the messaging problem is the “all-or-nothing” approach to COVID-19 precautions, she adds. “Masks are being pitched as a switch. We turn on the switch and we have mask mandates. Everyone masks all the time in public places and in schools,” she says. “Then, the executive privileges end and we turn off the switch, and no one will be wearing masks.”
The recent CDC masking guidance—which classifies counties as high-, medium-, or low-risk, and advises mask-wearing for those in the “high” zones—does take this gradation into account, Dr. Meyer says. “It is much more objective and based on case rates, hospitalizations related to COVID, and hospital capacity,” she says. “It also acknowledges that while you might be in a country that is ‘low-risk’ right now, it could be ‘high-risk’ in a month, and other precautions are needed.” In other words, instead of a switch, precautions should be thought of as more like a dial, Dr. Meyer adds. “Mandates are the extreme version of the dial. We had to crank it up to 10 when we were in the midst of a surge, especially if we wanted our kids to be able to stay in school,” she says. “Masks are effective in schools. They’re the reason why outbreaks in schools that have mask mandates are so rare, especially when paired with vaccination for staff.”
So, it’s appropriate, as the Omicron surge ends and more people become vaccinated, that the dial gets turned down, Dr. Meyer says.
“We give people back some autonomy and give them the right to wear a mask or not wear one. But we are turning the dial to a seven—not a zero,” she says. “Plus, some people still need to mask up. If you have high ongoing community transmission or if you have underlying health conditions that make you more at risk for severe disease, you’re still going to need to wear a mask. It’s not all or nothing.”
Does masking in schools affect transmission?
Several CDC studies released in September 2021 highlight the importance of universal masking, layered with other prevention strategies, to stop the spread of COVID-19 transmission in schools. The studies show that school districts that did not have a universal masking policy were more likely to have COVID-19 outbreaks.
But it’s important to note that masks were one of many mitigation measures, including vaccination and social distancing, which makes it difficult to assess effectiveness. “When you’re trying to say whether or not an intervention of any kind is effective, you want to look at that intervention in isolation. And there’s no way to do that,” Dr. Meyer says. “Places that have mask mandates in place were also places that have higher vaccination coverage. In Connecticut, we often have vaccination requirements for educators. It was a part of a ‘package of interventions.’ It’s therefore hard to disentangle what works best.”
Instead, it’s a matter of association, not causation, Dr. Meyer explains. “We can at least see that in the places that had high masking participation or mask mandates in school, there were much lower infection rates among school-aged kids. There were fewer outbreaks,” she says. “But whether it was the masks, the vaccinations, or the cleaning and the distancing, we just don’t know. It was probably all those things.”
On the other hand, Dr. Meyer says she hasn’t seen any data saying that masks do not work in schools. “From just purely public health, infectious disease mindset, removing masks makes absolutely no sense to me. It’s a droplet-borne infection,” she says. “If you prevent it from leaving someone’s nose and mouth, and entering the nose and mouth of another person, then it will prevent infection. That’s why we see such low rates of flu this year and last year because everyone was masked.”
What should parents do when mask mandates in schools end?
As states and schools iron out their masking policies in public places and in schools, it remains to be seen if the CDC updates any of its guidelines. In Connecticut, the Departments of Public Health and Education have the right until June 30 to put a mask mandate back in schools, if deemed necessary.
In the meantime, parents of children in schools where mask mandates are taken away face a personal decision.
“As if parenting through a pandemic wasn’t hard enough, what’s really stressful for parents is the whole individualized risk assessment,” Dr. Meyer says. “There are some instances that are clear. If your child—or other people in your immediate household or family—has an underlying health condition that puts them at risk for severe disease—you’re going to have to take extra precautions.”
But other factors should also be at play, including vaccination status. “Maybe if case rates and hospitalizations were low enough, vaccination would be sufficient,” Dr. Meyer says. “Otherwise, I would err on the side of caution. I’m going to have my kids wear masks for now, for example, even though they are vaccinated.”
Vaccination rates are low in the youngest group (ages 5 to 11) now eligible, with the CDC reporting that only about a quarter of this population is fully vaccinated. But vaccination can also be enough of a protective factor for some families, she adds. “I think vaccinating yourself and your family is an empowering thing to make you feel ready to unmask,” she says. “I also think that if your comfort level isn’t there yet, it’s okay for your kids to mask.” At the end of the day, now is not the time to completely ditch masks, Dr. Meyer says.
“As more and more people are vaccinated and immune, and as we head into warmer weather, we can open windows and be outside,” she says. “I think when all of this happens, those extra precaution measures with masks will become less and less important. ”But if virus circulation increases again and hospitalization rates increase, then the dial needs to go back up, she cautions. “That’s the problem when it’s considered a switch—people don’t want to turn the switch back on,” Dr. Meyer says. “But when there’s a deal, we can be flexible. We have lived through a pandemic now. We have to be flexible enough to add measures back, when necessary.” Masking, Dr. Meyer adds, is just another protective layer, and one that families can still choose to use.