I can recall clearly the first day that each of my three children walked to and from school on their own. I worried about whether they would get there without mishap. But I took for granted that, once at school, they would be safe. (I am Canadian, so that is something I could take for granted).
My children have grown up and navigate the neighbourhood and the world independently for the most part. My back-to-school worries, however, are greater this year than ever. As schools reopen, I am concerned about safety, not on route to school, but within elementary, secondary and post-secondary schools.
As a family physician, I’ve lost count of the number of patients who have been infected with COVID-19, with some children and their parents reinfected for the third or fourth time. This year, we are sending children and educators back to school without mask mandates, without improvements to ventilation and without adequate HEPA filtration in classrooms, knowing full-well that COVID-19 is airborne and that rates of COVID-19 are still high (though we no longer test and report). Many of our youngest children still have not received their first and second doses of COVID-19 vaccine and are at risk of serious illness and hospitalization. The majority of children 5 and older haven’t yet had a booster dose. We know that there are long-term neurologic, cognitive, endocrine, cardiac, respiratory and other consequences to infection with COVID-19, and the risk of long-COVID increases with reinfection.
Stop right there if your response is, “But our politicians say that COVID-19 spreads in the community, not in schools,” or, “We aren’t required to wear masks outside of schools, so why should we bother at school?” There are so many flaws to that logic.
It is incontrovertible that mask mandates reduce the spread of COVID-19.
Yes, COVID-19 spreads in every environment. When you walk into a grocery store, a mall or a local shop and you are maskless, you put employees and every other patron at risk. Masks are most effective when EVERYONE wears one, indoors and in crowds outdoors. It is incontrovertible that mask mandates reduce the spread of COVID-19. Ideally, we would provide respirators such as N95s to every household (even if it isn’t fit-tested, it is designed to trap viral particles and has a better filtration system and fit than cloth or surgical masks). A study of Boston-area school districts analyzed the impact of lifting school mask requirements and demonstrated a significant worsening of outcome (spread of COVID-19) in schools that ended mask requirements compared with those that maintained mask requirements. The study estimates that approximately 30 per cent of all cases that occurred in Boston-area schools in spring 2022 can be attributed to the removal of mask mandates. Another study from Boston University shows that indoor masking and vaccine mandates at universities are sufficient to make in-class transmission rare.
Leaving it up to individuals to “choose” whether to mask discriminates against people with disabilities.
So, why should we require masks in schools if masks aren’t required indoors in other environments? Because we should be doing everything that we can, in every context, to take care of each other. A policy failure in one instance does not justify other policy failures. COVID-19 outbreaks in educational settings result in students, educators and their families missing school and work. Even if those same people limit their activities outside of school, and do what they can to mitigate their risk, they should not have to keep their children home from school to keep them safe.
Education is a right. Leaving it up to individuals to “choose” whether to mask discriminates against people with disabilities; it actively undermines the efforts by those who are masked (unmasked educators and classmates put them at risk); and it has psychological consequences (teasing of children, peer pressure).
To make matters worse, in many parts of the world, health care is in crisis. Hospitals are struggling with staff shortages; family doctors and pediatricians are overwhelmed and exhausted. We are bracing ourselves for the impact of the next wave of COVID-19 this autumn, at the same time as other respiratory viruses take hold. If my child in university or in high school brings home COVID-19, my office will close for weeks and there will be nobody to care for my patients. Magnify that by every health-care worker in your community to understand the impact of unmitigated spread of a preventable disease.
We have tools to substantially reduce COVID-19 transmission risk in schools. I implore parents: Send your child to school in a mask. Educators, wear an N95 mask to be a role model for your students. Demand that your educational institutions and workplaces go above and beyond the minimum health and safety requirements. Please.