Opinion: To mask or not to mask: Why’s that even a question in schools?

With a new COVID variant and no vaccine for young kids, study affirms masks matter

Almost all Georgia school districts will leave it to parents to decide whether their kids wear masks when they return to school next month, despite the lack of a COVID-19 vaccine for children under 12.

On local parent forums, there is clear relief about the planned return to full-time, face-to-face classes next month. Parents are engaged in the normal back-to-school chatter about teacher assignments, band camps and which store stocks three-ring binders. There is scant discussion of masks or mask mandates.

On Friday, the Centers for Disease Control and Prevention said fully vaccinated teachers and students don’t need to wear masks inside school buildings, but still advised those kids and adults who are not immunized against COVID-19 to wear masks indoors.

Among metro districts, Fulton, Gwinnett, Marietta and Cobb have made masks optional for students and staff. DeKalb is reviewing the new CDC guidance. Atlanta Public Schools and Clayton County Schools will require masks, but an APS spokesman said the district will review its COVID-19 protocols and announce any changes before classes resume on Aug. 5.

Outside of metro Atlanta, many districts in Georgia never required masks, only encouraged them. The policy reflected parental resistance as demonstrated by angry crowds at school board meetings insisting there was not sufficient evidence to support children wearing masks.

A new study out of North Carolina provides that evidence. Reaffirmed by results in several other states, the North Carolina data showed masks were a key factor in limiting the spread of the coronavirus in school buildings. Released last week, the North Carolina study comes on the heels of a CDC finding that Georgia elementary schools that required staff wear masks experienced a significantly lower rate of COVID-19 infection.

Researchers at Duke University and the University of North Carolina School of Medicine found schools were highly successful in preventing the spread of COVID-19 through the use of masks — even without physical distancing in schools and on buses. The study, which looked at schools with 864,515 students and 160,549 staff, found a less than 1% within-school transmission rate when everyone wore masks.

“In the mask-on-mask environment or among the vaccinated students, the risk of death from acquiring COVID and dying from it in North Carolina this past year was less than the risk of riding to school in your parent’s automobile. We can effectively prevent morbidity and mortality from this disease, full stop,” said researcher Dr. Danny Benjamin, a professor of pediatrics in the Duke School of Medicine and chair of the National Institute of Child Health and Human Development’s Pediatric Trials Network.

“With masking, the schools clearly can safely deliver face-to-face education for children and adults. The amount of distancing, whether it’s less than 6 feet, less than 3 feet or no distancing at all, it didn’t make any difference at all … providing there was masking in place,” said Benjamin in a recent press briefing.

The study looked at districts that required 6 feet of distancing between students; 3 to 6 feet and less than 3 feet. “Even on buses where there were one, two or three children to a bus seat ... there were no differences between those three distinctions in distance. So, this suggests we can have full in-person instruction with masking in place,” said Duke researcher and pediatrician Dr. Kanecia Obie Zimmerman, co-leader of a pilot project funded by the National Institutes of Health studying the safe reopening of schools.

As to the fall, Zimmerman said, “We know that if our goal is to reduce transmission of COVID-19 in schools, there are two effective ways to do that. 1: Vaccination. 2: Masking. In the setting of schools, the science suggests masking can be extremely effective, particularly for those who can’t get vaccinated while COVID-19 is still circulating.”

The study also found “nil’' benefit from student quarantines. “In the mask-on-mask environment, kids who are coming in contact with a positive person are having to quarantine for a substantial period of time. That means collectively in North Carolina we had more than 40,000 people who had to quarantine during the 10 to 12 weeks (of the study). And yet the benefit that we’re seeing is nil. This is something that I think we should think very carefully about as we move forward,” said Zimmerman.

However, the findings do suggest athletics, especially indoor, pose a higher infection risk than outdoor spaces or classrooms. “We need to have special policies in place to protect athletes,” she said.

Among the health experts concerned about a possible rise in infections once schools reopen is Dr. Rochelle Walensky, leader of the Atlanta-based Centers for Disease Control and Prevention. At a recent symposium, she said COVID-19 has resulted in 471 U.S. pediatric deaths, more than the flu in recent years. She warned that children could suffer long-term symptoms, including MIS-C, a dangerous inflammatory condition.

A new study out of Norway that followed mild to moderately ill COVID patients who were never hospitalized found 13% of patients aged 15 and younger experienced symptoms six months after contracting COVID. Rates jumped for young people aged 16 to 30, 52% of whom still experienced symptoms a half year later, including loss of taste and/or smell, fatigue, impaired concentration and memory problems.

With lagging vaccination numbers, Georgia faces a higher risk from the highly contagious delta variant of COVID-19. The more transmissible delta variant will likely be the predominant form of COVID-19 in the fall, said Benjamin.

“With options of either masking or vaccinating, the school environment should be a safe environment, and there should not be a need to change any kind of plans,” he said. “Now, there are states where there are currently not mask mandates in the school setting and, in those states and in those settings, one could anticipate a much higher rate of transmission in the humans-close-to-each-other environment, whether summer camps, schools or church.”

Asked about whether masks should be mandated in schools, especially those serving students too young to be vaccinated, Benjamin said such policy decisions are outside his realm but warned transmission with the delta variant is likely to be substantially higher.

Would the two Duke experts be comfortable sending their kids to schools that don’t insist on masks? Benjamin said his four children are older and all of them, including two high school students, are vaccinated so are protected whether or not masking is in place.

However, Zimmerman has a young son not yet eligible for a vaccine. “Certainly, he will be wearing a mask, but, unfortunately, masking and its protection and maximum effectiveness don’t work like that. My mask protects you, and your mask protects me. So, for this to be maximally effective, particularly in those under the age of 12, it’s best when there is masking in place for both people.”