Optional masking in schools brings fears of COVID spread

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(First of two parts)

MANILA, Philippines—As the full implementation of in-person classes starts nationwide, students, teachers, and school staffers are being allowed to decide for themselves whether to wear masks against SARS-Cov2, the virus that causes COVID-19.

But at what expense?

After the Department of Education (DepEd) announced that it will make the wearing of face masks in schools optional, the Department of Health (DOH) said it defers to the education department on policy decisions regarding the wellbeing and safety of students.

READ: Wearing a mask in classrooms will be optional – DepEd

“In light of this, the DOH would like to reiterate that proper assessment of when to wear or not to wear masks and the right implementation and practice of ensuring our layers of protection (e.g. mask-wearing, sanitation, distancing, vaccination, and ensuring good ventilation) are keys to help in the prevention of virus transmission,” DOH said in a statement.

The DOH has been continuously reminding the public to continue wearing masks outdoors since September, when the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF) first recommended lifting the mandatory wearing of face masks outdoors.

READ: To wear, or not wear, face masks vs COVID: The zigzag road PH is taking

Several health experts have also warned about the implications and possible scenarios of the policy on the country’s COVID-19 situation, urging parents and children to keep wearing face masks.

Wear masks, health experts urged

Last month, before President Ferdinand “Bongbong” Marcos Jr. signed Executive Order (EO) No. 7—allowing the voluntary use of face masks in indoor and outdoor settings—an expert from the DOH had already recommended that children should continue wearing face masks.

“Maybe for me, from the pediatric infectious disease perspective, there is nothing to lose if children continue to wear masks, especially in school settings where implementation of full in-person classes is about to start,” said Dr. Anna Ong-Lim, a member of the DOH’s Technical Advisory Group Pediatric Infectious Diseases.

Lim also stressed that based on past COVID-19 infection trends, virus transmission is bound to increase, especially with full face-to-face classes by November.

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“I think we have learned enough in the past two years to realize that masking is very valuable. Although it’s not particularly difficult, I think we’ve all gotten used to this health habit that helps not just for COVID but for many other diseases, particularly respiratory symptoms,” she said.

“So let’s continue to use all the layers that we have at our disposal,” she added.

READ: DOH experts urge public to keep using all layers of COVID-19 protection available

On November 2, following DepEd’s announcement on the optional use of face masks in schools, Federation of Associations of Private Schools and Administrators-National Capital Region (FAPSA-NCR) president Dr. Reynaldo Chua Jr. encouraged private school students and teachers to wear face masks inside classrooms.

“We will still enforce the use of face masks in our private schools because we are still after the safety of students,” Chua said in an interview over ABS-CBN’s TeleRadyo.

Pediatric vaccination, flu season

For Dr. Benito Atienza, vice president of the Philippine Federation of Professional Association, the DepEd’s decision to allow the voluntary wearing of face masks in schools was alarming, noting that booster shots for COVID-19 have yet to be approved for children aged 5-11.

“It is alarming for our students if they will opt to remove their face masks. Many children do not have COVID-19 booster shots yet,” Atienza said in Filipino at a Laging Handa briefing on November 2.

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So far, only minors between 12 and 17 can get their first booster dose after receiving two primary series or the first two COVID vaccine doses. According to the DOH, children between 5-11 years old are not yet eligible for additional or booster doses.

READ: DOH says minors 12 to 17 years old can now get anti-COVID booster shot

At a press briefing last August, Health Undersecretary Maria Rosario Vergeire, also DOH officer in charge, explained that there is no scientific evidence to support the need for booster doses for the 5-11 age group.

“Until now, evidence is still incomplete, globally, regarding booster shots for 5 to 11 [years old]. For now, the [primary or] first two doses are still enough to protect them, especially against severe and critical infection,” Vergeire said.

Last May, the DOH announced that since pediatric vaccination started on February 17, at least 2.46 million children aged 5-11 years old had already been fully vaccinated against COVID-19.

Atienza, however, noted that many classrooms in the country still do not have proper ventilation and are overcrowded.

“Majority of the professionals in the medical community, especially our pediatricians, still advise children to wear face masks inside classrooms,” he said.

Face masks, according to him, would not only serve as protection against COVID-19 but also against flu and other diseases.

“[It’s the] rainy season, and many are coughing or sneezing. It is appropriate to wear face masks not only to protect children against COVID-19 but also to provide protection against flu,” Atienza said.

Young and infected

“If we keep ignoring the advice of our health experts, then some of the things that they are concerned about or worried about might happen,” former health secretary Esperanza Cabral warned in an interview over ANC.

“I’m not saying that it’s going to happen. Actually, it may not. It depends if more children are vaccinated if their classrooms are well ventilated and if there is no congestion, [and] if the community transmission of COVID is low in that particular area, then no bad thing will happen,” she said.

“On the other hand, if the opposite conditions prevail, then COVID [cases] might increase,” she added.

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According to Cabral, one of the possible scenarios stemming from DepEd’s decision is an increase in COVID-19 cases among children.

As of November 2, data from DOH showed that there are 91,243 recorded COVID-19 cases among children between 5-9 years old. Among the 10-14 age group, there were 114,954 total cases, while for the 15-19 age group there were 168,369 cases documented.

The same data also showed:

• 5-9 years old: 90,737 recovered, 138 deaths
• 10-14 years old: 114,369 recovered, 209 deaths
• 15-19 years old: 167,320 recovered, 336 deaths

Experts had warned that children are as likely to get COVID-19 as adults.

A quick explainer: SARS-CoV-2, the virus that causes COVID-19, spreads mainly when respiratory droplets from an infected person—either through coughing, sneezing, talking, or singing—get into the mouth, nose, or eyes of people nearby.

People can also get infected by touching their mouth, nose, or eyes after touching surfaces contaminated with the virus, Unicef explained.

Studies also found that airborne or aerosol transmission of the virus is also common in crowded and poorly ventilated areas, such as classrooms.

“Children, including very young children, can develop COVID-19. Many of them have no symptoms. Those that do get sick tend to experience milder symptoms such as low-grade fever, fatigue, and cough,” said Harvard Health Publishing by Harvard Medical Schools.

“Some children have had other severe complications of COVID-19, but this has been less common. Children with underlying health conditions may be at increased risk for severe illness,” it added.

Health experts also warned about a potentially severe and dangerous complication of COVID-19 that can occur in children called multi-system inflammatory syndromes in children (MIS-C).

The US Centers for Disease Control and Prevention (CDC) defined MIS-C as a condition where different body parts—including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs—can become inflamed.

“We do not know yet what causes MIS-C. However, we know that many children with MIS-C had the virus that causes COVID-19 or had been around someone with COVID-19,” US CDC said.

To help reduce the risk of COVID-19 transmission in schools and prevent infections and complications caused by COVID-19, World Health Organization (WHO) urged teachers, school staff, parents, and students to follow the ‘do it all’ approach.

This includes encouraging everyone to wear a mask when in school and when physical distancing isn’t possible.

(Next: Masking in school reduces COVID, benefits over risks)

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