Risks, benefits of dropping mask mandate in schools

INQUIRER FILE PHOTO

(Second of two parts)

MANILA, Philippines—The Department of Education’s recent decision to make the use of face masks optional in schools as the full implementation of in-person classes began nationwide drew concerns and fears from health experts.

While the Department of Health (DOH) reminded the public that the right implementation and practice of ensuring our layers of protection—such as mask-wearing, sanitation, distancing, vaccination, and ensuring good ventilation—help prevent transmission of the SARS-CoV-2 virus, some health experts stressed the need to mask up despite DepEd’s order.

READ: Optional masking in schools brings fears of COVID spread

In a television interview, former health secretary Esperanza Cabral said voluntary masking in schools is “concerning,” stressing the possible consequences of the policy—including the increase in COVID cases among children.

“It is concerning, it is a political decision, and now we are going to just make the best of it. Our message should be very comprehensive about what to do in the face of the voluntary face mask mandate,” Cabral said.

“It is obvious that many doctors do not agree with it, and yet it was mandated. It is a decision of our political leaders rather than our health leaders,” she added.

“We need to be ready our doctors and health facilities just in case there is an increase in the number of children catching COVID because they are not wearing face masks.”

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.

COVID: from children to adults

Aside from the increase in COVID-19 cases among children, Cabral also warned about the possibility of children infecting more people, especially individuals with comorbidity, or pre-existing health conditions that weaken their defenses against COVID.

“The possible scenario that we are worried about is the increase in COVID among these children, as well as the number of people who have comorbidity and have not been vaccinated who can catch COVID from these children,” Cabral explained.

Previous studies had shown that most children who get infected with COVID-19 usually have no symptoms or have milder symptoms, including low-grade fever, fatigue, and cough.

GRAPHIC Ed Lustan

However, according to a November 2021 study conducted by Harvard researchers, children who carry live viruses are capable of spreading the infection.

“Many of the children, or most of them, even if they catch COVID, are just going to have a very mild illness. But if they bring this home and they have a grandfather or grandmother who has diabetes or who has cancer or is generally frail, and this person catches COVID from the grandchild, that is a different story,” Cabral explained.

“Now our health facilities have to be ready, not just for the children but for these people [as well],” she added.

According to the Harvard study, even children without symptoms could easily spread the infection to others.

“There had been the question about whether the high viral load in children correlated with the live virus. We’ve been able to provide a definitive answer that these high viral loads are infectious,” said Lael Yonker, assistant professor of pediatrics and pediatric pulmonologist at Massachusetts General Hospital, and co-author of the study.

“Children can carry the virus and infect other people,” Yonker added.

The Harvard Medical School also noted: “The bottom line? Public health measures are as important for kids and teens as they are for adults.”

According to World Health Organization (WHO) and Unicef’s guidelines, children under the age of 5 “should not be required to wear masks […] based on the safety and overall interest of the child and the capacity to appropriately use a mask with minimal assistance.”

But “[s]pecific settings and interactions the child has with other people who are at high risk of developing serious illness, such as the elderly and those with other underlying health conditions” should be considered when deciding whether children aged 6-11 should wear masks.

Masking in school reduces COVID

According to Dr. Benito Atienza, vice president of the Philippine Federation of Professional Association, the use of face masks could provide students protection against COVID-19 infections.

But how effective is masking in preventing COVID-19 infections in schools?

Several studies in the US found evidence of how mask requirements impact the incidence of coronavirus cases in several schools.

One study published last May—which was approved by the US Centers for Disease Control and Prevention (CDC)—found that out of 233 school districts in Arkansas, those with mask requirements saw a 23 percent lower incidence of COVID-19 cases.

GRAPHIC Ed Lustan

The study noted that COVID incidence was 23 percent lower among students and staff members in districts with full mask policies than in districts with no mask policy.

COVID incidence was 24 percent lower among staff members only and 23 percent lower among students only.

“Universal mask use, in coordination with other prevention strategies such as vaccination of students and staff members in K–12 schools, remains an important tool for preventing SARS-CoV-2 transmission,” the study concluded.

READ: SARS-CoV-2 Incidence in K–12 School Districts with Mask-Required Versus Mask-Optional Policies — Arkansas, August–October 2021

A separate study published last June found that compared to optional masking, mandatory masking was associated with a 72 percent reduction of in-school COVID-19 cases.

It also found that:

• School districts with mandatory masking had 7.3 cases of in-school infection for every 100 community-acquired cases.
• Districts with optional masking had 26.4 cases of in-school infection for every 100 community-acquired cases.

According to the authors of the study, masking is a “critical mitigation effort” to help students attend school safely when the community COVID infection rates are high.

The American Academy of Pediatrics (AAP), which cited the study, advised families to consider the following when deciding on masking:

• whether their child is vaccinated;
• whether their child is immunocompromised or at high risk for severe COVID-19
• whether family members are unvaccinated or at high risk for severe disease
• whether they live in a community with a high level of COVID-19.

Weighing in risks and benefits

During the interview over ANC, Cabral also mentioned how mask-wearing could possibly affect children psychologically.

“We know that mask-wearing for children is something that affects them psychologically more than adults. So, if they don’t wear a mask, that is going to free them from this particular emotional concern,” she said.

“So that is something that is good about not wearing a mask.”

However, she stressed that there are also “many bad things” children can get from not wearing a mask.

In September, OCTA Research fellow Fr. Nicanor Austriaco called for the lifting of the face mask mandate among students citing analysis by US-based health policy expert Dr. Leana Wen, who claimed that the use of face masks affected the language development of her child.

However, DOH officer-in-charge Maria Rosario Vergeire emphasized that “masks don’t hurt children.”

“It protects our children from infections,” Vergeire added.

An article published by National Geographic also tried to discuss the masks’ possible impact on children’s social, emotional, and learning development.

Walter Guilliam, a child psychiatry and psychology professor at the Yale Child Study Center, suspects that it was not the masking that caused emotional stress in classrooms.

“It’s the trauma of COVID that the masks were intended to prevent,” Gilliam told National Geographic.

“When you have an ache and a pain, it’s the cut on your arm, not the Band-Aid that went over it, that’s causing the problem. The purpose of the mask is to reduce all the other traumas—traumas that we know for an absolute fact harm children,” he added.

TSB