Decisions about mask use in children should be driven by what is in the best interest of the child. Mask use should be flexible, so that children can continue play, education and everyday activities. These activities are an important part of child development and health. No child should be denied access to school or activities because of lack of a mask.
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There is little information from Australian State governments on the subject so we have looked to the Unites States to discover the studies.
In the panicked spring of 2020, as health officials scrambled to keep communities safe, they recommended various restrictions and interventions, sometimes in the absence of rigorous science supporting them. That was understandable at the time. Now, however, two years into this pandemic, keeping unproven measures in place is no longer justifiable. Although no district is likely to roll back COVID policies in the middle of the Omicron surge, at the top of the list of policies we should rethink once the wave recedes is mandatory masks for kids at school.
The CDC guidance on school masking is far-reaching, recommending “universal indoor masking by all students (age 2 and older), staff, teachers, and visitors to K–12 schools, regardless of vaccination status.” In contrast, many countries—the U.K., Sweden, Norway, Denmark, and others—have not taken the U.S.’s approach, and instead follow World Health Organization guidelines, which recommend against masking children ages 5 and younger, because this age group is at low risk of illness, because masks are not “in the overall interest of the child,” and because many children are unable to wear masks properly. Even for children ages 6 to 11, the WHO does not routinelyrecommend masks, because of the “potential impact of wearing a mask on learning and psychosocial development.” The WHO also explicitly counsels against masking children during physical activities, including running and jumping at the playground, so as not to compromise breathing.
But in America about half of the country’s 53 million children remain compulsorily masked in school for the indefinite future. Sixteen U.S. states and the District of Columbia follow the CDC guidance closely and require masks for students of all ages, regardless of vaccination status; other states rely on a patchwork of policies, usually leaving decisions up to local school districts. (Nine states have banned school mask mandates, though in five of them, lawsuits have delayed implementation of the ban.) Many deep-blue areas such as Portland, Oregon; Los Angeles; and New York City have gone beyond CDC guidance and are masking students outdoors at recess, in part because of byzantine rules that require an unmasked “exposed” student to miss multiple days of school, even if the putative exposure is outside.
Read: The CDC’s flawed case for wearing masks in school
Many public-health experts maintain that masks worn correctly are essential to reducing the spread of COVID-19. However, there’s reason to doubt that kids can pull off mask-wearing “correctly.” We reviewed a variety of studies—some conducted by the CDC itself, some cited by the CDC as evidence of masking effectiveness in a school setting, and others touted by media to the same end—to try to find evidence that would justify the CDC’s no-end-in-sight mask guidance for the very-low-risk pediatric population, particularly post-vaccination. We came up empty-handed.
To our knowledge, the CDC has performed three studies to determine whether masking children in school reduces COVID-19 transmission. The first is a study of elementary schools in Georgia, conducted before vaccines became available, which found that masking teachers was associated with a statistically significant decrease in COVID-19 transmission, but masking students was not—a finding that the CDC’s masking guidelines do not account for.
A second and more recent study of Arizona schools in Maricopa and Pima Counties concluded that schools without mask mandates were more likely to have COVID-19 outbreaks than schools with mask mandates. Yet more than 90 percent of schools in the “no mask mandate” group were in Maricopa County, an area that has significantly lower vaccination rates than Pima County. This study had other serious shortcomings, including failure to quantify the size of outbreaks and failure to report testing protocols for the students.
The third CDC study found that U.S. counties without mask mandates saw larger increases in pediatric COVID-19 cases after schools opened, but again did not control for important differences in vaccination rates. The CDC has cited several other studies conducted in the previous school year to support its claim that masks are a key school-safety measure. However, none of these studies, including ones conducted in North Carolina, Utah, Wisconsin, and Missouri, isolated the impact of masks specifically, because all students were required to mask and no comparisons were made with schools that did not require masks.
Therefore, the overall takeaway from these studies—that schools with mask mandates have lower COVID-19 transmission rates than schools without mask mandates—is not justified by the data that have been gathered. In two of these studies, this conclusion is undercut by the fact that background vaccination rates, both of staff and of the surrounding community, were not controlled for or taken into consideration. At the time these studies were conducted, when breakthrough infections were much less common, this was a hugely important confounding variable undermining the CDC’s conclusions that masks in schools provide a concrete benefit in controlling COVID-19 spread: Communities with higher vaccination rates had less COVID-19 transmission everywhere, including in schools, and those same communities were more likely to have mask mandates.
This isn’t to say that these studies conclusively demonstrate that masks have no benefit in schools, but that any effect they have, if they have one, is tangled up in these other variables. To demonstrate any independent effect of masks on COVID-19 transmission would have required comparing communities with similar vaccination rates or statistically controlling for differences in vaccination rates, including by specific groups such as teachers and students. Without making these adjustments, it is impossible to attribute differences in case rates, let alone differences in in-school transmission, to mask wearing in school.
At least pre-Omicron, adjusting for vaccination rates in the surrounding community was vitally important when looking at case rates. Comparisons of counties in California that did and did not have mask mandates showed that vaccination rates were highly predictive of hospitalization rates, but mask mandates were not. Neighboring Los Angeles and Orange Counties, which had similar vaccination rates but differing masking requirements, had similar case and hospitalization rates. Likewise, our analyses of data from Maryland show a tight correlation between hospitalisations and immunity rates by county, despite some counties requiring masks in all indoor facilities, some requiring masks only in county buildings, and some not requiring masks at all.
Vinay Prasad: The downsides of masking young students are real
To justify mask requirements in school at this point, health officials should be able to muster solid evidence from randomized trials of masking in children. To date, however, only two randomized trials have measured the impact of masks on COVID transmission. The first was conducted in Denmark in the spring of 2020 and found no significant effect of masks on reducing COVID-19 transmission. The second is a much-covered study conducted in Bangladesh that reported that surgical masks (but not cloth) were modestly effective at reducing rates of symptomatic infection. However, neither of these studies included children, let alone vaccinated children.
Other studies—not randomized trials—have looked at the effects of masks in schools, and their results do not support pervasive, endless masking at school. A study from Brown University, analyzing 2020–21 data from schools in New York, Massachusetts, and Florida, found no correlation between student cases and mask mandates, but did see decreased cases associated with teacher vaccination. A study published in Science looking at individual mitigation measures in schools last winter found that, although teacher masking reduced COVID-19 positivity, student masking did not have a significant effect.
Even though the first half of this school year was dominated by the highly transmissible Delta variant, the picture in more recent studies looks similar. In Tennessee, two neighboring counties with similar vaccination rates, Davidson and Williamson, have virtually overlapping case-rate trends in their school-age populations, despite one having a mask mandate and one having a mask opt-out rate of about 23 percent. One would expect a quarter of the students opting out of masking to affect transmission rates if masks played any significant role in controlling COVID-19 spread, but that was not the case. Another recent analysis of data from Cass County, North Dakota, comparing school districts with and without mask mandates, concluded that mask-optional districts had lower prevalence of COVID-19 cases among students this fall. Analyses of COVID-19 cases in Alachua County, Florida, also suggest no differences in mask-required versus mask-optional schools. Similarly, the U.K. recently reported finding no statistically significant difference in absences traced to COVID-19 between secondary schools with mask mandates and those without mandates.
Despite how widespread all-day masking of children in school is, the short-term and long-term consequences of this practice are not well understood, in part because no one has successfully collected large-scale systematic data and few researchers have tried. Mental and social-emotional outcomes are hard to observe and measure, and can take years to manifest. Initial data, however, are not reassuring. Recent prospective studies from Greece and Italy found evidence that masking is a barrier to speech recognition, hearing, and communication, and that masks impede children’s ability to decode facial expressions, dampening children’s perceived trustworthiness of faces. Research has also suggested that hearing-impaired children have difficulty discerning individual sounds; opaque masks, of course, prevent lip-reading. Some teachers, parents, and speech pathologists have reported that masks can make learning difficult for some of America’s most vulnerable children, including those with cognitive delays, speech and hearing issues, and autism. Masks may also hinder language and speech development—especially important for students who do not speak English at home. Masks may impede emotion recognition, even in adults, but particularly in children. This fall, when children were asked, many said that prolonged mask wearing is uncomfortable and that they dislike it.
This last reason is important in considering a pivot to requiring children to wear N95 or KN95 masks, which are thought to be more effective at preventing the spread of Omicron. A few school districts, in response to the growing awareness of the ineffectiveness of cloth and surgical masks, have decided to escalate rather than scale back masking by requiring these types of medical-grade masks, which are significantly less comfortable to wear and can hinder communication more than other types of masks.
Read: Why are Americans still—still!—wearing cloth masks?
As with our existing school-mask policies, no real-world data indicate that these masks decrease transmission in school settings—data that matter greatly, as these masks require a very tight fit to function effectively, and that may not be possible for many kids. N95s are not approved or sized for children, proper fit is hard to achieve even with adults, and a June 2020 study shows they have very high failure rates when taken on and off or worn for multiple hours. Though KN95s, the manufactured-in-China equivalent, are available in kids’ sizes, they also require a very tight seal to function properly, which is unrealistic for schoolchildren to maintain for multiple hours a day. Early-pandemic recommendations to mask at school, soon followed by mandates, were laid down in the absence of data. We should not repeat this mistake with a new generation of masks.
Over the past 21 months, slowly and with much resistance, the layers of mythology around COVID-19 mitigation in schools have been peeled away, each time without producing the much-ballyhooed increases in COVID-19. Schools did not become hot spots when they reopened, nor when they reduced physical distancing, nor when they eliminated deep-cleaning protocols. These layers were peeled away because the evidence supporting them was weak, and they all had substantial downsides for children’s education and health.
Masking is the last and most stubborn layer, possibly because its drawbacks are more subtle and not yet well documented. We understand that many public-health professionals and parents may want to keep that layer in place, perhaps because they think the possible drawbacks to masking are even less well quantified than the possible benefits. They may point to the low vaccination rate among children to argue against any loosening of mitigation measures, even if they cannot directly connect those measures to reduced transmission. They may also point to the Omicron surge increasing children’s hospitalizations. But hospitalisations have risen among all age groups, and, even at the country’s peak, remained extremely low among children, on par with pediatric flu hospitalisations during a typical season.
Imposing on millions of children an intervention that provides little discernible benefit, on the grounds that we have not yet gathered solid evidence of its negative effects, violates the most basic tenet of medicine: First, do no harm. The foundation of medical and public-health interventions should be that they work, not that we have insufficient evidence to say whether they are harmful. Continued mandatory masking of children in schools, especially now that most schoolchildren are eligible for vaccination, fails this test.
Margery Smelkinson is an infectious-disease scientist whose research has focused on influenza and SARS-CoV-2.
Proof that Masks Do More Harm than Good
- Face masks have been proven to do harm but not proven to do good. Forcing citizens to wear them is a form of oppression. Support for mask wearing comes from individuals promoting face masks for political rather than health reasons. There is now considerable support for masks to be worn out of doors and even in the home. There is absolutely no scientific reason for this.
- Over a dozen scientific papers show clearly that masks are ineffective in preventing the movement of infective organisms. They also reduce oxygen levels and expose wearers to increased levels of carbon dioxide.
- Nine medical authors from Australia and Vietnam studied cloth face masks and concluded that cloth masks should not be recommended for health care workers.
- Wearing a mask for long periods could cause pulmonary fibrosis. Loose fibres are seen on all types of masks and may be inhaled causing serious lung damage.
- Researchers in France proved that wearing a surgical mask causes breathlessness.
- Masks should be changed every couple of hours and old masks should be disposed of safely. If cloth masks are worn, they should be washed at high temperatures twice a day. Disposable masks should be discarded after one use. (Masks thrown down in the street are a serious health hazard.)
- Evidence proving the danger and ineffectiveness of masks has been banned, blocked or deleted. Discussion and debate about the value of face masks is suppressed.
- In September 2020, 70 Belgian doctors claimed that mandatory face masks in schools are a major threat to child development.
- A leading German virologist claims that face masks are a wonderful breeding ground for bacteria and fungi.
- Dentists in New York have reported that mask wearing causes gum disease and dental cavities. The dentists say that face coverings lead to mouth dryness and an increase in the build-up of bacteria.
- Exemption certificates/cards can be obtained online for those who are unable to wear a mask.
- Some face masks may have pores five thousand times larger than virus particles.
- Masks should never be touched once in place. If a mask is touched it must be replaced immediately.
- No one should wear a mask while exercising. There have been several reports of masked children dying while exercising. There is evidence showing that mask wearing reduces blood oxygen levels even when the wearer is standing still. Individuals who exercise are likely to sweat. Masks then become damp more quickly and the damp promotes the growth of microorganisms.
- There is a risk that viruses may accumulate in the fabric of a mask – thereby increasing the amount of the virus being inhaled.
- Putting a mask on a baby or unconscious patient is dangerous. The mask may result in the wearer choking on vomit.
- Some of the carbon dioxide exhaled with each breath is trapped behind the mask.
- One study of health workers wearing masks showed that a third developed headaches requiring painkillers. Another study showed that 81% developed headaches – and their work was affected.
- A mask can reduce blood oxygenation by up to 20% – leading to a possible loss of consciousness. At least one road crash has been blamed on a driver wearing a mask. Police reported that the driver of a single car crash in New Jersey is believed to have passed out behind the wheel after wearing a mask for too long.
- Over a dozen studies failed to show that wearing a mask provides protection against infection.
- Masks are being used as a conditioning tool to make us more compliant.
- A study of 53 surgeons showed that there were statistically significant falls in blood oxygen levels after masks had been worn for a few hours. It is important to remember that surgeons who wear masks (and not all do) work while standing, rather than walking, and they work in a controlled, air conditioned environment. They do not touch their masks and they change them regularly.
- The fact that the rules about mask wearing vary from place to place proves that there is no `science’ behind the advice to wear masks. So, for example, why should the coronavirus spread from person to person in a shop but not in an office?
- There were no mask requirements in Sweden, and the mortality rate there remained below a bad flu season. The average age of Swedish citizens who died of covid-19 was well over 80 years.
- A meta-analysis of controlled trials of face masks published in May 2020 by the Centers for Disease Control in the US, concluded that masks `did not support a substantial effect on transmission of laboratory confirmed influenza, either when worn by infected persons or by persons in the general community to reduce their susceptibility’.
- A meta- analysis published in May 2016 concluded that masks did not have any useful effect but that reuse of contaminated masks did transmit infection.
- In 2019, a paper involving 2,862 volunteers and published in the Journal of the American Medical Association showed that both surgical masks and N95 respirators `resulted in no significant difference in the incidence of laboratory confirmed influenza’.
- In 2011, a meta-analysis of 17 separate studies showed that none of the research showed masks to be useful in preventing influenza infection.
- In 2009, a paper published in the Journal of Occupational Environmental Hygiene concluded that particles passed through masks and that expelled particles were deflected around the edges of masks.
- Research published in 2005 concluded that there was more transmission of virus laden particles from masked individuals than from unmasked individuals because of `leakage’ jets of air. Backward unfiltered air flow was found to be stronger with mask wearers (suggesting that standing behind someone wearing a mask could be dangerous).
- A study published in the BMJ in 2015 found that the penetration of cloth masks was almost 97%.
- N95 masks are made with a 0.3 micron filter. The name comes from the fact that 95% of particles having a diameter of 0.3 microns are filtered by the mask. Unfortunately, coronaviruses are approximately 0.125 microns in diameter.
- An article entitled `Is a mask necessary in the operating theatre?’, published in the Annals of the Royal College of Surgeons in 1981 found no difference in wound infection rates with or without surgical masks. A paper published in 1991 showed that the use of masks slightly increased the incidence of infection.
- It was proved in 1920 that cloth masks do not stop flu transmission. It was concluded then that the number of layers of fabric required to prevent pathogen spread would be suffocating. It was also recognised that there was a problem with leakage around the edges of masks.
- Mask wearers are encouraged to demonise non-mask wearers (even if they are disabled in some way). This is part of the psychological warfare battle being fought.
- There have been suggestions from various authorities that mask wearing and social distancing will need to be permanent. It has also been suggested that masks should be worn in the home.
- Masks collect fungi, bacteria and viruses and because of the moist air exhaled they are an excellent breeding ground.
- `We know that wearing a mask outside health care facilities offer little, if any, protection from infection…In many cases the desire for widespread masking is a reflexive reaction to anxiety over the pandemic.’ – New England Journal of Medicine, 2020
- Research published in June 2020 suggested that the reduction in blood oxygen and the increase in carbon dioxide, resulting from mask wearing, might cause a strain on the heart and kidneys.
- Mask wearers are more likely to develop infection than non-mask wearers. This may be due to the fact that masks reduce blood oxygen levels and adversely affect natural immunity. It is likely that anyone who wears a face mask for long periods will have a damaged immune system – and be more susceptible to infection. Studies have shown that hypoxia can inhibit immune cells used to fight viral infections. Wearing a mask may make the wearer more likely to develop an infection – and if an infection develops it is likely to be worse.
- Masks can cause hypercapnia (increased carbon dioxide). Symptoms of hypercapnia include drowsiness, dizziness and fatigue.
- A mask worn by a child in school was examined in a laboratory. Tests showed 82 bacterial colonies and 4 mould colonies growing on the mask.
- In May 2020, Dr Fauci, the American covid-19 expert, concluded that masks are little more than symbolic – virtue signalling.
- Although they have not been tested extensively, visors are probably just as useless as masks but they may be less dangerous to wearers.
Having studied the evidence I believe that mask wearing is likely to do no good but a great deal of harm. The available evidence shows clearly that masks do not work but do have the potential to cause a variety of health problems. Any individual or organisation dismissing the information above as `fake news’ is requested to give their name and address. They will then receive a writ for libel. Please note that I am already in the process of planning two libel actions.