School is starting. And, with it, the contentious debate on what schools should and should not do. While the pandemic ravages on, the landscape continues to morph, and because of that, every subsequent school year has looked very different (hopefully for the better).
I strongly disagree with the idea that masks shouldn’t be required in schools if they’re not required elsewhere in the community. Children have to go to school, so given that masks are most effective when everyone is wearing them, I’d feel much better about my child’s chances of not getting COVID in school if everyone were masked, even if masks aren’t required elsewhere in the community. True, it wouldn’t make sense for me to send my child in a mask, and then have him hang out maskless at a crowded arcade, but I can choose not to bring him to the arcade. I can’t choose not to bring him to school (unless I homeschool). There may be other reasons not to require masks in schools, but not having masking elsewhere in the community doesn’t seem to be one of them.
Can we talk about the fact that for the third year in a row the CDC is not releasing return to school guidance until after most of the schools in the south have already started (including in their home base of Atlanta!)? How do they expect to have any influence when schools had to come up with their COVID policies by early July to be ready for the August start date? Just frustrates me as a Houston pediatrician. We don't all live in the Northeast!
I hope you will consider reframing your mention of having kids wear masks in schools when communities are not as placing the burden on them. As a pediatrician and parent, I think that this is an unfair comparison. Kids do need to go to school and there are vulnerable kids (and staff) who need to be there. I think that we should see it as a unique space, in the same way masks are required in health care when they are not necessarily in the community. We do need to protect the safety of school for all the kids, teachers, staff, and their families. The burden only happens when not everyone in the school is required to wear a mask, which places a burden on only some of the kids. When everyone wears them, the masks are not a burden, they are a protection that keeps schools and communities safe, healthy and functional.
Thank you for all of your hard work. Please reconsider this messaging.
Our district has reduced the number of excused days after a pos to 3, principals can choose to excuse another 2. I'm absolutely furious. As a parent of a (masked) child who was infected by a pos child being sent to school unmasked (and that child returned on day 6 and infected are least 3 more), it feels like a punch in the gut to parents who believe covid should be taken seriously. My kids tested pos on rapid for 9 days and 10 days. I feel helpless knowing I cannot homeschool them and they attend a great school, but that we are rolling the dice with their long term health daily. ETA: our district returned to school yesterday, so many schools are already at least a week in!
I absolutely love this, and am so grateful for all you do to help sort through what we need to be thinking about, what's sensible and what's not, and especially what the data are telling us. I'm particularly pleased to see what you're saying about going back to school/what happens in school, as that's so important for millions of children! The one comment I'll make is that when you say "I don’t think it makes sense for a school to mandate masks if the larger community does not do so either. We shouldn’t ask students to hold down the fort if the larger community hasn’t also committed either", the difference is that other students are forced to be in school, whereas (some) adults do have options as to how much they want to be out and about in the community. I'm coming from a perspective of seeing how much terrified parents can absolutely disrupt a school year (as can parents who think all restrictions should be lifted entirely), so to me, mandating masking for positive cases in schools might be a bit of a sensible middle ground?
Unfortunately I think we need to have a higher standard in schools, as another commenter started, because they're not optional. We have different rules about who and what are allowed in schools. Masks are working well in the hospitals I work at. The kids in our daycare do a great job with masking, albeit in a community that masks. I am skeptical we'll be able to get vaccines and ventilation upgraded, especially in low SES schools. Until then, masks can be a great equalizer.
Every time my kid gets sick, my patients get cancelled. They get rescheduled weeks, months later. If I were in different circumstances, I'd be unemployed by now. This is not just about the kids. Who is going to watch them when they're home? We need to do better for the kids, parents, women...it all leaks outside the school. If we don't take proper mitigation measures, it will keep repeating.
I have the privilege of living in a community that shares this view and I understand it's not typical. But it doesn't mean we don't advocate for better.
Well, it has happened. Your "Isolation" paragraph above shows that protecting others is not as important as keeping parents in the work force and kids in school. Quoting the CDC now huh? Wow. Just, wow.
I am very disappointed about your statement regarding student masking. I must respectfully request that you reconsider telling children not to mask in areas of high transmission. Children should be learn to protect themselves and their friends and vulnerable family members by wearing masks despite the stupidity in the larger community.
"The study results showed that a total of 1,539 subjects were analyzed from 13 studies, including four community-based and nine healthcare-based studies. Among these, 243 subjects had SARS-CoV-2 infections, including 97 who did and 146 who did not wear facemasks. The team noted that the probability of contracting a COVID-19 disease was 7% for mask wearers and 52% for non-mask wearers. The relative risk of getting infected by SARS-CoV-2 was 0.13 for mask wearers" Given the number of vulnerable children, those who have vulnerable family members, the inevitability of further COVID mutations, new variants and the high level of transmission, it seems more important than ever to teach students to do the right thing and set an example for their foolish elders. We must ensure that the next generation takes infectious disease more seriously than the multitude of adults currently trying to pretend that an active pandemic is over.
So up to this point, I have thought you were reasonable. You spent time in Washington DC and now you sell the public, especially children and school staff, down the river. Thanks a lot. 😢🙄. It is not okay to minimize the effects of this disease that is running rampant with no effort to prevent it, and to tell us it is okay to get it because there are treatments, and that if we do get it, maybe we can mask, but we shouldn't isolate or quarantine. Wtf kind of public health info is this? No mention of long term effects of a virus that effects every system in the body. As someone who has post viral syndrome from EBV, no one wants to be consigned to this the rest of their life. How can we tell which people will be affected? We can't. And no mention of monkeypox, another virus that affects children the most. Unsubbing.
I have appreciated your column ever since I first started reading it. I am very disappointed in this article - except for some of the information about ventilation - because it seems to "parrot" the suggestions/"guidance" from authorities (like the CDC) whose advice seems to be too driven by concerns about how they will be greeted and adopted by the general society. The "science" should be the focus of this article - not what is deemed socially feasible.
I work with classroom ventilation systems every day to try to manage infectious disease risks and am concerned about the advice to 1) limit CO2 levels to less than 800 ppm and 2) to set up cross ventilation in classrooms. This is because 1) there has been no correlation in the data that I have collected between CO2 levels (a gas) with virus levels (particles) and 2) because the potential sources of Covid virus are in the classroom, strong directionality in air movement risks creating a superspreader event, if, for example, an unknowingly infectious individual is upwind (i.e. next to the fan) of the rest of the class. As you note, there is little science available that explains what "improving ventilation" means in this context. In my experience, mask use, which is a significant challenge in a high communication environment such as a classroom, is likely to be much more effective than ventilation measures.
Regarding your recommendations for schools: I think you're dead wrong. I get that very few children get severely ill from covid. I also get that missing a bunch of school is bad for kids. But what about the accumulating evidence of damage to the body from covid? For instance, here's a study of decline in cognitive skills after covid:
And then there's the possibility that some damage covid does to the body will not manifest itself for a decade or 2. I know none of this is for sure, but there seems to be enough indirect evidence for parents to be legitimately concerned about their child having covid -- especially since it seems likely that with such weak protective measures in the schools, kids are likely to have covid SEVERAL TIMES A YEAR.
The CDC guidelines indicate the unvaccinated (with no prior COVID in the last 90 days) should quarantine if exposed. As you indicated, most pre-school and grade-school students are unvaccinated. Per the CDC, they should quarantine if exposed.
You don't remind people that infectiousness begins before symptoms, and that there is a reasonable percentage of asymptomatic cases that shed as much virus. Your position seems to be that these infectious periods should be spent in the classroom.
It appears that "masking is not legally required" is effectively practiced as "masking is only for the other person". When schools aren't legally required to enforce masking, they won't require masks of even those obviously sick, much less those that should quarantine, lest they get sued.
Consider a policy of all students in a classroom wearing a mask if any student in the classroom is out sick. The masking acts as a pseudo-quarantine. Those students exposed (by the sick student) who might be infectious but not (yet) symptomatic are in class, but wearing a mask. No one's Civil Rights are stomped on by this. It can be uniformly applied. Parents will be happy that the schools are taking care of the otherwise quarantined child.
Then there is the issue of children that are sent to school when sick, or develop symptoms while in school. Especially, if the child refuses to wear a mask properly & consistently. To avoid more absences in the future., the school should isolate these children from the apparently healthy children. How should this be done if, say, 5% of the children are dropped off while sick?
Consider a no-fault drop-off of sick children at school, like some jurisdictions allow babies to be dropped off at fire stations? The parents won't/can't deal with the sick child. Allow them to drop the child off with notification that the child is sick so he/she can be isolated with other sick children rather than sit in the classroom. (This grates on my sensibilities, but I can see it might reduce in-classroom spread.)
The utility of ventilation & filtration is good in theory & practice, but if it wasn't already budgeted & implemented, it isn't going to be in place for this back to school season.
I'd love a future post on how to assess risk in the long term for Covid, especially for kids- not only long Covid, but things that may come up later (diabetes, chronic issues, reactivation akin to shingles). My daughter is finally vaccinated (hooray!!!), and I'm still struggling with risk calculations because I'm concerned about the long term. Usually, I feel like I'm the only one, but from the fb comments today, it seems like there are others among your readers who share those questions.
1. Beef up the public health curriculum probably starting in middle school and move it out of the elective category. But be prepared for political fights at the school boards.
2. Add sections on virology, microbiology, pathogens, to the electives for the STEM tracking students. Add history of pandemics to the electives for everybody, college track or cte track. Such courses can be career changers.
3. In general, the trend has been increasing emphasis on engineering and applied in 9- 12, so add bio engineering, bio informatics, etc. to the electives for grades 11 and 12.
Thank you so much for continuing to keep us updated on the latest guidance. I'm wondering if I have misunderstood the masking data, or if the data has changed? I want to follow the science! I have asking (not requiring) my students to mask. I was hoping that by doing so, I was limiting the spread. I know that very few students mask outside of my classroom, but I thought the masking provided a layer of protection during the time they were with me. Is the data showing that masking is largely ineffective, if it's not practiced consistently in and out of the classroom? I don't have control over school-wide ventilation, so masking seemed to be the area where I could contribute. If that's not the case, then I definitely want to know.
I strongly disagree with the idea that masks shouldn’t be required in schools if they’re not required elsewhere in the community. Children have to go to school, so given that masks are most effective when everyone is wearing them, I’d feel much better about my child’s chances of not getting COVID in school if everyone were masked, even if masks aren’t required elsewhere in the community. True, it wouldn’t make sense for me to send my child in a mask, and then have him hang out maskless at a crowded arcade, but I can choose not to bring him to the arcade. I can’t choose not to bring him to school (unless I homeschool). There may be other reasons not to require masks in schools, but not having masking elsewhere in the community doesn’t seem to be one of them.
Can we talk about the fact that for the third year in a row the CDC is not releasing return to school guidance until after most of the schools in the south have already started (including in their home base of Atlanta!)? How do they expect to have any influence when schools had to come up with their COVID policies by early July to be ready for the August start date? Just frustrates me as a Houston pediatrician. We don't all live in the Northeast!
I hope you will consider reframing your mention of having kids wear masks in schools when communities are not as placing the burden on them. As a pediatrician and parent, I think that this is an unfair comparison. Kids do need to go to school and there are vulnerable kids (and staff) who need to be there. I think that we should see it as a unique space, in the same way masks are required in health care when they are not necessarily in the community. We do need to protect the safety of school for all the kids, teachers, staff, and their families. The burden only happens when not everyone in the school is required to wear a mask, which places a burden on only some of the kids. When everyone wears them, the masks are not a burden, they are a protection that keeps schools and communities safe, healthy and functional.
Thank you for all of your hard work. Please reconsider this messaging.
Our district has reduced the number of excused days after a pos to 3, principals can choose to excuse another 2. I'm absolutely furious. As a parent of a (masked) child who was infected by a pos child being sent to school unmasked (and that child returned on day 6 and infected are least 3 more), it feels like a punch in the gut to parents who believe covid should be taken seriously. My kids tested pos on rapid for 9 days and 10 days. I feel helpless knowing I cannot homeschool them and they attend a great school, but that we are rolling the dice with their long term health daily. ETA: our district returned to school yesterday, so many schools are already at least a week in!
I absolutely love this, and am so grateful for all you do to help sort through what we need to be thinking about, what's sensible and what's not, and especially what the data are telling us. I'm particularly pleased to see what you're saying about going back to school/what happens in school, as that's so important for millions of children! The one comment I'll make is that when you say "I don’t think it makes sense for a school to mandate masks if the larger community does not do so either. We shouldn’t ask students to hold down the fort if the larger community hasn’t also committed either", the difference is that other students are forced to be in school, whereas (some) adults do have options as to how much they want to be out and about in the community. I'm coming from a perspective of seeing how much terrified parents can absolutely disrupt a school year (as can parents who think all restrictions should be lifted entirely), so to me, mandating masking for positive cases in schools might be a bit of a sensible middle ground?
Unfortunately I think we need to have a higher standard in schools, as another commenter started, because they're not optional. We have different rules about who and what are allowed in schools. Masks are working well in the hospitals I work at. The kids in our daycare do a great job with masking, albeit in a community that masks. I am skeptical we'll be able to get vaccines and ventilation upgraded, especially in low SES schools. Until then, masks can be a great equalizer.
Every time my kid gets sick, my patients get cancelled. They get rescheduled weeks, months later. If I were in different circumstances, I'd be unemployed by now. This is not just about the kids. Who is going to watch them when they're home? We need to do better for the kids, parents, women...it all leaks outside the school. If we don't take proper mitigation measures, it will keep repeating.
I have the privilege of living in a community that shares this view and I understand it's not typical. But it doesn't mean we don't advocate for better.
Well, it has happened. Your "Isolation" paragraph above shows that protecting others is not as important as keeping parents in the work force and kids in school. Quoting the CDC now huh? Wow. Just, wow.
I am very disappointed about your statement regarding student masking. I must respectfully request that you reconsider telling children not to mask in areas of high transmission. Children should be learn to protect themselves and their friends and vulnerable family members by wearing masks despite the stupidity in the larger community.
Please consider this article : 8-2-22 Study shows probability of getting COVID for mask wearers vs. non-mask wearers By Bhavana Kunkalikar Reviewed by Aimee Molineux https://www.news-medical.net/news/20220802/Study-shows-probability-of-getting-COVID-for-mask-wearers-vs-non-mask-wearers.aspx
"The study results showed that a total of 1,539 subjects were analyzed from 13 studies, including four community-based and nine healthcare-based studies. Among these, 243 subjects had SARS-CoV-2 infections, including 97 who did and 146 who did not wear facemasks. The team noted that the probability of contracting a COVID-19 disease was 7% for mask wearers and 52% for non-mask wearers. The relative risk of getting infected by SARS-CoV-2 was 0.13 for mask wearers" Given the number of vulnerable children, those who have vulnerable family members, the inevitability of further COVID mutations, new variants and the high level of transmission, it seems more important than ever to teach students to do the right thing and set an example for their foolish elders. We must ensure that the next generation takes infectious disease more seriously than the multitude of adults currently trying to pretend that an active pandemic is over.
So up to this point, I have thought you were reasonable. You spent time in Washington DC and now you sell the public, especially children and school staff, down the river. Thanks a lot. 😢🙄. It is not okay to minimize the effects of this disease that is running rampant with no effort to prevent it, and to tell us it is okay to get it because there are treatments, and that if we do get it, maybe we can mask, but we shouldn't isolate or quarantine. Wtf kind of public health info is this? No mention of long term effects of a virus that effects every system in the body. As someone who has post viral syndrome from EBV, no one wants to be consigned to this the rest of their life. How can we tell which people will be affected? We can't. And no mention of monkeypox, another virus that affects children the most. Unsubbing.
I have appreciated your column ever since I first started reading it. I am very disappointed in this article - except for some of the information about ventilation - because it seems to "parrot" the suggestions/"guidance" from authorities (like the CDC) whose advice seems to be too driven by concerns about how they will be greeted and adopted by the general society. The "science" should be the focus of this article - not what is deemed socially feasible.
I work with classroom ventilation systems every day to try to manage infectious disease risks and am concerned about the advice to 1) limit CO2 levels to less than 800 ppm and 2) to set up cross ventilation in classrooms. This is because 1) there has been no correlation in the data that I have collected between CO2 levels (a gas) with virus levels (particles) and 2) because the potential sources of Covid virus are in the classroom, strong directionality in air movement risks creating a superspreader event, if, for example, an unknowingly infectious individual is upwind (i.e. next to the fan) of the rest of the class. As you note, there is little science available that explains what "improving ventilation" means in this context. In my experience, mask use, which is a significant challenge in a high communication environment such as a classroom, is likely to be much more effective than ventilation measures.
Regarding your recommendations for schools: I think you're dead wrong. I get that very few children get severely ill from covid. I also get that missing a bunch of school is bad for kids. But what about the accumulating evidence of damage to the body from covid? For instance, here's a study of decline in cognitive skills after covid:
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00324-2/fulltext
Here's one of brain changes showing up on scans after covid
https://media.nature.com/original/magazine-assets/d41586-022-00503-x/d41586-022-00503-x.pdf
And then there's the possibility that some damage covid does to the body will not manifest itself for a decade or 2. I know none of this is for sure, but there seems to be enough indirect evidence for parents to be legitimately concerned about their child having covid -- especially since it seems likely that with such weak protective measures in the schools, kids are likely to have covid SEVERAL TIMES A YEAR.
Do you recognize that your position on quarantine is contrary to the CDC's position?
https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html (last updated Mar. 30, 2022)
The CDC guidelines indicate the unvaccinated (with no prior COVID in the last 90 days) should quarantine if exposed. As you indicated, most pre-school and grade-school students are unvaccinated. Per the CDC, they should quarantine if exposed.
You don't remind people that infectiousness begins before symptoms, and that there is a reasonable percentage of asymptomatic cases that shed as much virus. Your position seems to be that these infectious periods should be spent in the classroom.
It appears that "masking is not legally required" is effectively practiced as "masking is only for the other person". When schools aren't legally required to enforce masking, they won't require masks of even those obviously sick, much less those that should quarantine, lest they get sued.
Consider a policy of all students in a classroom wearing a mask if any student in the classroom is out sick. The masking acts as a pseudo-quarantine. Those students exposed (by the sick student) who might be infectious but not (yet) symptomatic are in class, but wearing a mask. No one's Civil Rights are stomped on by this. It can be uniformly applied. Parents will be happy that the schools are taking care of the otherwise quarantined child.
Then there is the issue of children that are sent to school when sick, or develop symptoms while in school. Especially, if the child refuses to wear a mask properly & consistently. To avoid more absences in the future., the school should isolate these children from the apparently healthy children. How should this be done if, say, 5% of the children are dropped off while sick?
Consider a no-fault drop-off of sick children at school, like some jurisdictions allow babies to be dropped off at fire stations? The parents won't/can't deal with the sick child. Allow them to drop the child off with notification that the child is sick so he/she can be isolated with other sick children rather than sit in the classroom. (This grates on my sensibilities, but I can see it might reduce in-classroom spread.)
The utility of ventilation & filtration is good in theory & practice, but if it wasn't already budgeted & implemented, it isn't going to be in place for this back to school season.
I'd love a future post on how to assess risk in the long term for Covid, especially for kids- not only long Covid, but things that may come up later (diabetes, chronic issues, reactivation akin to shingles). My daughter is finally vaccinated (hooray!!!), and I'm still struggling with risk calculations because I'm concerned about the long term. Usually, I feel like I'm the only one, but from the fb comments today, it seems like there are others among your readers who share those questions.
Some other random ideas for the schools.
1. Beef up the public health curriculum probably starting in middle school and move it out of the elective category. But be prepared for political fights at the school boards.
2. Add sections on virology, microbiology, pathogens, to the electives for the STEM tracking students. Add history of pandemics to the electives for everybody, college track or cte track. Such courses can be career changers.
3. In general, the trend has been increasing emphasis on engineering and applied in 9- 12, so add bio engineering, bio informatics, etc. to the electives for grades 11 and 12.
That's it!
Thank you so much for continuing to keep us updated on the latest guidance. I'm wondering if I have misunderstood the masking data, or if the data has changed? I want to follow the science! I have asking (not requiring) my students to mask. I was hoping that by doing so, I was limiting the spread. I know that very few students mask outside of my classroom, but I thought the masking provided a layer of protection during the time they were with me. Is the data showing that masking is largely ineffective, if it's not practiced consistently in and out of the classroom? I don't have control over school-wide ventilation, so masking seemed to be the area where I could contribute. If that's not the case, then I definitely want to know.