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When can kids take off their masks in school? Here's what some experts say

Nov 12, 2021
Originally published on November 12, 2021 9:45 am

When can kids safely take off their masks in school? About three-fourths of the nation's largest districts required masks at the start of the school year. Recently, the calls by some parents to unmask children have grown louder, especially now that there is a COVID-19 vaccine available with emergency authorization for children as young as 5 years old.

The country is still in a pandemic that's killing more than 1,000 Americans every day. And a body of evidence shows masking, in combination with other safety measures, effectively cuts COVID-19 transmission in K-12 schools. Masks are cheaper than renovating school buildings to improve ventilation or create outdoor learning spaces, and they're (still) easier to get ahold of than COVID-19 tests, which can also be used to preempt transmission.

On the other hand, masking has continued, in many cases, into a third school semester. Several months after most adults have been eligible for vaccines, tens of millions of children are spending school days with the bottom half of their faces swathed in either fabric or, in the case of surgical masks, a substance called "melt-blown polypropylene." If they have a long commute, they could be masking for 10 or more hours a day; in some districts, masks are required even outside. Parents are concerned about social development, language learning, skin irritation and mental health.

NPR posed the question of when kids can safely take their masks off in school to scientists and policy leaders in different parts of the country and found a range of nuanced positions and timelines.

Centers for Disease Control and Prevention

When can kids take off their masks? Not now.

In a statement to NPR, a spokesperson said, "CDC continues to recommend universal indoor masking for all teachers, staff, students, and visitors to K-12 schools, regardless of vaccination status or community transmission levels. At this time, there are no changes, however, as the science changes, we will update our guidance as needed." CDC director Rochelle Walensky has backed keeping masks on in schools "as we head into these winter months."

Massachusetts State Department of Elementary and Secondary Education

When? Immediately — with enough vaccinations.

How? A school must demonstrate a vaccination rate of 80% or more of both staff and students. The decision can be made "by local school and district leaders in consultation with local health officials." Schools must collect proof of vaccination of everyone from administrative assistants to after-school staff. Unvaccinated people must keep masking.

Joseph Allen, Harvard T.H. Chan School of Public Health

When? Jan. 1, 2022, once younger children have a chance to get vaccinated.

How? Allen, whose expertise is healthy buildings, is not in favor of a vaccine threshold for unmasking students, given the low risk of COVID-19 to children. He thinks schools should mandate vaccines for adults in school buildings, hold vaccination clinics on-site and provide education to encourage vaccines for kids, and use rapid antigen testing, ventilation and air filtration to lower risk even further.

"I've been a big proponent of mask wearing for a long time, for over a year, but at this point in the pandemic, it no longer makes sense to me," he tells NPR. "If we don't offer paths to removing masks at this point in a pandemic, when risks are low and the tools for protection are there — the vaccine specifically — then we lose trust."

Danny Benjamin, distinguished professor of pediatrics at Duke University, co-chair of the ABC Collaborative

When? January 2022, once younger children have ample chance to get vaccinated.

How? Benjamin of the ABC Collaborative, which has done some of the largest studies showing the efficacy of universal masking in schools, would prefer that 100% of adults in the building are vaccinated or masked, and at least 70% of the children are vaccinated. At "70 to 80 percent, there's a good chance you're going to be successful." And, because risk tolerance varies by district, he says, some districts might go mask-free with as few as half the children vaccinated — if they can accept more COVID-19 transmission as a result.

Amy Falk, pediatrician, Wisconsin Rapids, Wis.

When? "In my heart of hearts," not for a while, but realistically, once children's vaccines have been available for at least several weeks.

"My big holdout is getting every kid protected who wants to be protected. And that, you know, whatever happens after that, I guess everyone's made their choice with it."

Falk is lead author of a widely cited study showing that 90% mask compliance cut COVID-19 transmission within several schools in Wisconsin last fall, even when the spread in the community was high.

Vaccination rates in her community are low — around 50% for adults and even lower for teenagers — and she doesn't expect much better for her younger patients. Opposition to mask mandates, meanwhile, has grown intense. Falk, who offers medical advice to her local school district, has been personally afraid to attend school board meetings since the May 2021 meeting, which she describes as "a very unsafe situation. There was a mass of anti-masking parents and some students. They were heckling us. They were not letting us leave. It was very, very heartbreaking."

Public pressure led to the mask mandate in high schools being lifted this fall, which led in turn, she said, to "massive spread. It was unreal." The board reinstated masking after two weeks. Falk wishes for continued masking, but, she says, "I actually don't know if I think, at a state level, they could pull it off."

Ali Mokdad, professor of global health at the Institute for Health Metrics and Evaluation at the University of Washington

When? Let's not even talk about it until the spring.

Mokdad sees signs of a coming winter COVID-19 surge and of waning immunity from adult vaccination. He implores, "We should not celebrate prematurely. We should be very wise about what's happening right now. We're talking about our children. We're talking about our future."

Jeanne Noble, associate professor of emergency medicine at the University of California, San Francisco, and director of COVID response for the UCSF Emergency Department

When? Dec. 28 in the Bay Area, eight weeks after the FDA's emergency authorization of the vaccine for 5- to 11-year-olds.

How? Noble's recommendation is for schools to follow the metrics the Bay Area has set for unmasking adults in public spaces: low community transmission, low and stable COVID-19 hospitalizations, and high rates of vaccination — currently at 80% of San Francisco residents over 5 years old.

Like Benjamin and the state of Massachusetts, Noble thinks that unmasking once schools reach a threshold of 70% to 80% vaccination rates for students would be fine, even conservative. But she says going by community metrics is preferable because it's simpler and more consistent. Dr. Noble is one of the authors of a petition signed by 150 Bay Area medical professionals, asking the state of California to create a clear masking off-ramp for schools.

"People are tired of this," Dr. Noble says. "There's a sense, I think, in a child's life, particularly, that things are never going to change." She says that parents need to be able to give kids hope by telling them that a day is coming when they will be able to play at school with their friends without masks on. ​​

Pennsylvania Gov. Tom Wolf

When? Jan. 1, 2022

On Nov. 9, Wolf, a Democrat, announced the statewide K-12 mask mandate will lift on Jan. 1. He's not tying it to any requirements around student vaccination but is leaving the decision to local jurisdictions.

Outgoing New York City Mayor Bill de Blasio

When? Not yet. The Democratic mayor, who oversees the country's largest school district, said at a news conference that the mandate would stay in place "out of an abundance of caution."

Incoming New York City Mayor Eric Adams:

When? He told CNN he "looks forward to it ... if we can find a safe way to do it."

Copyright 2021 NPR. To see more, visit https://www.npr.org.

RACHEL MARTIN, HOST:

Now that vaccines are authorized for children ages 5 through 11, many parents want to know when their kids can take their masks off, especially at school. Coming up, we'll visit a district where students are taking off masks for the first time.

But first, education correspondent Anya Kamenetz has the latest on the intensely polarized debate over masks. Hey, Anya.

ANYA KAMENETZ, BYLINE: Hey, Rachel.

MARTIN: Before we get into this, can we just start by understanding what the official guidance on masking for kids is right now?

KAMENETZ: The CDC says everyone in a K-12 school should stay masked, period. And Rochelle Walensky recently said, you know, at least through the winter months - although we know there are many states and districts where masks in school are optional and even some where they are banned.

MARTIN: Right.

KAMENETZ: But now what's changed, I think, is that there are more and more kind of mainstream medical experts saying, we need to set a timeline for lifting these remaining mask mandates safely. So for example, when the vaccine for children has been around for, let's say, eight weeks or when 80% of the students are vaccinated, it should be time to take these masks off.

MARTIN: Right. So tell us more about the medical professionals you talked to.

KAMENETZ: So Dr. Jeanne Noble at UC San Francisco is, fair to say, pretty fed up with masking. She's been really concerned about students' mental health in California and these continued restrictions in a part of the country with very few infections right now and very high rates of vaccination.

JEANNE NOBLE: We're soon going to be entering the third year of this pandemic, and kids have sacrificed a lot. And I think families need to know, when is it that our kids' lives are going to go fully back to normal?

KAMENETZ: So Noble is one of the authors of a petition signed by 150 Bay Area health professionals asking the state of California to state clearly, when can students take off these masks? If it were up to her, it would be happening by the end of next month, after these Pfizer vaccines for children have been around for a while.

MARTIN: Are there any places, Anya, that are actually moving in that direction?

KAMENETZ: Yeah, across the country. In the state of Massachusetts, the department of education has said, as soon as a school demonstrates a vaccination rate of 80% or more - that's including both staff and students in the building - everyone who is vaccinated can take their masks off. And our member station colleague Carrie Jung at WBUR visited a school in Massachusetts that has done just that.

CARRIE JUNG, BYLINE: The town of Hopkinton is usually known for its role as the starting line of the Boston Marathon. But it's in the spotlight again as the first district in Massachusetts that's attempting to phase out mask mandates for vaccinated students and staff. To test out the idea, the school committee recently approved a three-week trial run. I stopped by in the middle of Week 2, just as school was letting out. The scene looked pretty normal as the hallway flooded with students. Many greeted their friends after a day apart. But only about half of the kids were wearing masks.

OWEN SCHNUR: Today I am unmasked.

EVANYA MATHUR: I am a masked sophomore at the high school.

JUNG: Senior Owen Schnur and sophomore Evanya Mathur say their decisions are personal. Mathur wants to wear a mask until her younger sibling gets vaccinated. But Schnur says he feels safe without one because about 98% of his classmates are vaccinated. So far, both say they've been surprised at how much they've enjoyed this trial period.

MATHUR: It's been really important to me to see my teachers' faces and see their face light up when someone gets a question right.

JUNG: But not everyone is excited about the idea, like Madison Loos, who's a senior.

MADISON LOOS: I was absolutely against it. I still am not sure I support it. I just don't - I haven't really established an opinion yet. But so far, I still wish we were all masked.

JUNG: Still, Loos says despite her reservations, she has noticed a lot of unexpected emotional benefits.

LOOS: You're communicating more than, like, before when it was just, like, looking at someone's eyes to read their cues (laughter).

MENA YOUSSIF: Like, my English teacher always say to me, like, it's hard to recognize what we are saying with masks. You cannot see our lips.

JUNG: For students like Mena Youssif, who moved here from Egypt two years ago, the policy has also made it easier to understand and speak English.

YOUSSIF: So like, when we take the mask off, it makes it much easier.

JUNG: All of the students I spoke to said this trial run has been an unexpected morale boost, even for those who have to stay masked because they aren't vaccinated yet, like Andrew Gaughan.

ANDREW GAUGHAN: I personally think it's great. I really enjoy seeing people's faces. I mean, it just makes for a better experience in school.

JUNG: Hearing such positive reports on the ground from students is a relief for district leaders like school committee chair Nancy Cavanaugh. She says making the decision wasn't easy because of the intense debate in the community.

NANCY CAVANAUGH: We got a lot of people that couldn't imagine that we would even entertain such a decision. And then we got the other side of that of people who are really angry that we won't entertain unmasking our vaccinated students.

JUNG: In the end, the school committee voted to try it with a few safeguards, like starting with a trial period, requiring vaccination proof and parent permission forms.

CAVANAUGH: It's baby steps. We have been really, I think, very cautious.

JUNG: So far, one student has tested positive for COVID-19, but health officials believe transmission of that case happened outside of the high school. The trial period wraps up next week. After that, the school committee will analyze what happened and decide if they want to make the policy permanent. In the meantime, students like Jessica Ianelli say she's going to enjoy this mask-free time with her friends while it lasts.

JESSICA IANELLI: I, like, forgot what the bottom half of their face looks like, which sounds so weird to say. But it's nice to see that come back to normal.

JUNG: For NPR News, I'm Carrie Jung in Hopkinton, Mass.

MARTIN: So interesting to hear all those kids reflecting on the pros and cons of wearing their masks. I mean, it sounds like the experiment, though, in this one district in Massachusetts is sort of working. Anya, are you seeing other districts likely to follow suit?

KAMENETZ: You know, I - and I agree with you. I think - you know, we didn't talk so much about the downsides of masking. But you can definitely hear in these students' voices, you know, the impact that it's had even on their moods.

MARTIN: Right.

KAMENETZ: I do see other districts following suit. There's been so many battle lines drawn over masks, so it's remarkable to see communities like this one that have been so COVID cautious start taking the masks off. You know, but this is a special place. This is a school where 98% of the people are vaccinated. And there are many communities around the country where people are rejecting both masks and, in many cases, vaccines. So in those places, I think it's going to be a lot harder to line up the science with rules that are going to make everybody happy.

But the public health experts - and I should underline this is still a really small group that are calling on states and the CDC to update their guidance - told me that they're speaking, you know, not only to the impatience that a lot of families may have to get back to normal, but to a real risk as well from a public health perspective. And that's if we keep extending restrictions and refuse to even talk about when they're going to be eased, that that could erode public trust in health authorities. And you know, if there's a new surge, a new variant, even a new virus that people might refuse to put the masks back on when they really need to.

MARTIN: All right. NPR education correspondent Anya Kamenetz. Anya, thank you so much for bringing us this story. We appreciate it.

KAMENETZ: Oh, thanks, Rachel. Transcript provided by NPR, Copyright NPR.