The Case Against Masks In Schools
The Case Against Masks In Schools
A survey of the data on risks for kids and why I oppose mask mandates in schools
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As kids get back to school this fall, there is a small war being waged over whether or not schools should implement mask mandates for students. This week, the White House has jumped into the fray, saying that they will fight states that insist on children being given the option to attend school maskless.
I want to get into none of the politics of this here. I’m not going to talk about federal vs state vs local control. Those are procedural questions to me, a sideshow to the core question: Are mask mandates necessary to protect children in schools?
I’m going to “spoiler alert” this by saying that I think that mask mandates in schools are not a good idea. In this post, I’m going to lay out how I’ve come to this conclusion and give every paper and piece of data that has brought me there.
I’m also going to spend some time pointing to a few papers that have been used to make the case for mask mandates in schools. I don’t think anyone benefits from ignoring those studies & we’re all mature enough to read everything we can and make up our own minds.
When Do Masks Come Off?
The Risk To Children Is Low
Masking Children Does Not Reduce The Risk
The Case For School Mask Mandates Is Weak
Most European Children Do Not Wear Masks In School
Masks Should Be Permitted, Not Required
When Do Masks Come Off?
The masking debate suffers from the fact that people are coming at it from a number of different angles. The most prominent angle that I see is: “Masks are a low-cost solution. They don’t hurt and they might help, so requiring them is an easy way to reduce risk.” I made this case myself a year ago when I talked about risk vs value.
The problem I have with the “let’s mandate masks, they can’t hurt” view is that there is no point at which that argument expires. You could easily say that we should have mask mandates forever because respiratory viruses will always exist and, if masks are a zero-cost solution for reducing risk, there is no reason to ever stop wearing masks.
My line of reasoning starts at the other end. I‘m asking “When is the risk low enough that masking doesn’t provide enough benefit to justify a mandate?” I don’t know exactly how to quantify the negative side of masks other than to casually observe that most people take their masks off whenever they can. There is clearly discomfort in wearing a mask and people view mask-wearing as a sacrifice they make to protect others. Things that have zero cost are not sacrifices, so masking must cost something.
As a sort-of-libertarian, I believe that if you’re going to force people to do something, you have to make a compelling positive case for it. That case can not be “it probably doesn’t hurt”. If you’re going to make people do something they don’t want to do, you have to clearly prove that your policy helps enough that the benefits outweigh the costs.
The burden of proof is on the people who want mask mandates in schools. They have a responsibility to show, without a doubt, that this policy makes things better by reducing the risk to children.
I don’t believe that case has been made. Here is how I came to this position.
The Risk To Children is Low
One of the most wonderful pieces of news that I came across early in this crisis was during the summer of 2020 when we started seeing studies about how COVID impacted kids. Most pandemic viruses (including the flu) are most dangerous for the very young and the very old, so it was a huge relief when we started seeing reports that COVID simply was not a very dangerous disease for children.
The first study that stuck in my mind was this massive review of COVID transmission in educational settings in England. This study looks at the entire country and tracks all COVID cases within schools from January 2020 to August 2020. This study was one of the early indicators that children were not at risk in an in-person school setting, but the thing that really caught my eye were the details about COVID transmission.
Within this study, we first discovered that rates of COVID detected in schools were not a result of schools being in session, but a reflection of COVID rates in the larger community. Plainly stated, when there is a COVID surge in a given region, the kids in school are more likely to test positive for COVID. This doesn’t mean they got it at school, it just means that school is where they are being tested.
Next, this study demonstrated that the most vulnerable people in a school were not the children but the staff. Looking at all the in-school transmission events, staff-to-staff transmission made up half of all outbreaks. The second most common transmission event was from a student to a staff member (30% of all outbreaks). The lowest risk transmission was staff-to-student and, finally, student-to-student.
This means that the highest risks of COVID transmission are not from kid-to-kid, but among the teachers. In a world with vaccines where teachers can be protected, the staff-to-staff and student-to-staff scenarios hold minimal risk. The risks of student-to-student transmission are incredibly low (only 5 cases in the entire country during this study!).
Almost every study I’ve seen on transmission in schools (masked or unmasked) tells the same story: Cases in schools mirror community spread and children are far more likely to contract COVID from a family member than in school.
Additionally, when children do contract COVID, their risk of complication is incredibly low. I mentioned in my previous newsletter that vaccinated seniors have much higher rates of COVID hospitalization than unvaccinated children. We are currently at over 90% of all seniors vaccinated and 0% of children under 12 vaccinated and yet the rate of hospitalization with COVID for people over 70 is 20 times higher than the rate of child hospitalization.
As Emily Oster notes, the rate of hospitalization for children who have caught COVID is lower than the flu hospitalization rate. The risk of death is comparable to the yearly risk of death in an automobile accident.
One of the most jaw-dropping results I’ve seen about the risk of COVID in children came from another UK study in which they tracked *every* child who presented COVID symptoms (a whopping 258,790 children) between March 2020 and February 2021 to see what the effects of COVID might be in the long term for kids. Stunningly, the children who did *not* have COVID experienced a greater symptom burden than the ones who tested positive for COVID. This implies that contracting COVID is less dangerous to children than getting some other random respiratory disease.
If masks are meant as a tool to mitigate risk, they should only be made mandatory in situations where there is a clear and unambiguous risk. Given what we know about COVID and children, the data repeatedly suggests that such a risk simply is not present in a school environment.
Masking Children Does Not Reduce Their Risk
I chose the statement here to be as precise as possible. I’m not talking about masking adults here, I’m talking very specifically about masks on children in a school setting. I am not at all convinced that masks in school reduce the rate of COVID transmission among children.
At the beginning of the summer, there was a study published in Science that looked at 15 kinds of in-school mitigations meant to reduce the spread of COVID. The only two mitigations that showed statistically significant results in reducing COVID spread were teacher masking and a daily symptom screen.
This result is consistent with the UK study above, in which that staff-to-staff transmission was by far the most common form of in-school transmission. Because the adults at school are far more likely to spread COVID to each other, they actually see a reduction in COVID spread when they wear masks.
That is why I’m so keen to make note that this is about mask mandates for students. I am not saying that masks have no benefits in any circumstance. Masks *do* seem to help reduce COVID spread among adults. But they don’t reduce the risk for children.
This is not the only study that came back with this result. A meticulous survey of 1.6 million students across 64 school districts showed nearly identical rates of COVID in schools with mask mandates vs schools without mask mandates. The same study found that COVID rates *were* higher among adult staff when masks were not required for the staff.
In other words, these two distinct studies produced very similar results that are incredibly consistent with all the previously mentioned studies about COVID transmission among children and adults in a school setting.
We see this again and again. When we look at COVID rates across Florida school districts, the rates among students were not at all correlated with whether or not the district had a mask mandate.
Given the fact that having a mask mandate does not reduce the risk of COVID to children, I don’t find the demand for mask mandates to be particularly compelling. Forcing every student to wear a mask for 6 hours a day when we can’t demonstrate that the mask reduces COVID transmission or student risk makes it seem to me like more of a political consideration than a science-based public health policy.
The Case For School Mask Mandates Is Weak
I’ve come to the this conclusion that school mask mandates are unnecessary slowly over the last year as I’ve tried to digest the risk vs reward proposition of in-school masking. I think the case *against* mask mandates is strong, but I’ve also been incredibly underwhelmed by the case for school mask mandates.
I’ll do my best here to share here the studies and arguments that I’ve seen people make in favor of mask mandates because we don’t do ourselves any favors by ignoring the other side of this debate.
The most commonly cited piece I’ve seen has been the Duke study, made popular in a New York Times piece in which the authors studied a million North Carolina students and concluded that masks were responsible for the low rates of child transmission in schools. The authors assert that “if we send children to school without masks, we increase their risk of acquiring Covid-19.”
But what I found in that study was the utterly flabbergasting fact that they authors only studied schools that had mask mandates and did not compare them to schools that did not have mask mandates. They simply saw that schools had low COVID transmission rates and just asserted that this was due to mask mandates without any kind of control group. Furthermore, when questioned about this lack of a control group, the authors refused to answer questions about how they could claim mask mandates were effective if they didn’t study any schools without mask mandates.
A more compelling study in favor of masks is this study on masking and ventilation in Georgia schools last fall. In this study, the researchers found that COVID incidence was 37% lower in schools with mask mandates.
But I think this study has some pretty substantial flaws that limit the value of its conclusions. The school data was collected through an online survey sent to public and private schools that only had an 11% response rate. The study also only covered a 4 week time period (which included the Thanksgiving holiday). This limited time period makes me think that the results are going to necessarily be limited in scope since four weeks isn’t nearly enough time to study a full COVID surge and it seems likely that different parts of the state are going to be at slightly different points in the pandemic curve, which would confound the results.
I would very much like to see a study like this that covers a region more comprehensively and over a longer time period. That’s part of the reason I prefer the studies I cited above, which do both those things.
Most European Children Do Not Wear Masks In School
I have not been impressed with the CDC over the last several months. I’ve found their guidance to be unrealistic and easily swayed by political considerations and mask mandates in schools has tragically become a political football.
This does not seem to be the case in Europe, where there seems to be an earnest desire to make sure children have a safe and normal classroom experience. Anthony LeMesa has compiled an excellent list of the school masking situation across Europe and it’s like looking into a parallel universe.
England doesn’t require masks. Ireland requires them only for older students (over 13). Norway advises *against* masking school children. Most Nordic countries do not require masks in schools. Austria requires masks when walking through the school hallways but students may remove them when in their classrooms.
LeMesa notes that, for a variety of reasons, pandemic mitigation policy in Europe has not been politicized and that higher levels of interpersonal trust may have a role in citizens who are more comfortable with their children attending schools without masks.
This is not to say that unmasked student are the universal rule in Europe. France, Spain, and Italy all require masks for school students, but none of those countries require masks for children under 6 in any circumstances.
In contrast, the CDC’s recommendation is that all children be masked at all times starting at age 2. This is in direct contradiction with virtually all public health guidance across the world. The fact that the CDC continues to mandate masks for children this young leaves me skeptical about the value of their other masking guidance.
Masks Should Be Permitted, Not Required
I am a heavy advocate, perhaps even a zealot, in favor of the right of parents to make medical decisions for their children. I personally think parents should be allowed to vaccinate their children under 12 against COVID if they think that is appropriate. Only in dire circumstances and with strong evidentiary support should the wishes of the parent be over-ridden in favor of a one-size-fits-all policy regarding masks in school. That goes just as much for parents who want their kids to wear a mask as for parents who want them to attend without a mask.
I can’t believe we’ve been having this debate for well over a year and it still has not sunk in for many people that a lack of mask mandates does not mean that no one wears a mask. My son started kindergarten this week at a school that allows students to go maskless and, at a glance, I would say there are more children wearing masks than not.
If there is a politician or school principal out there who is trying to ban masks in schools, I will eagerly fight on the side of parents who want their kids to wear a mask. But that isn’t what is happening.
The appropriate policy is to present people with clear information, let them sort through the risks themselves, and allow them to make what they deem to be the appropriate choices for themselves and their children.
Looney Tunes: Ain’t She Tweet? (1952)
I just realized how surreal it must be for people who are unfamiliar with my newsletter to get to the end of a long essay and suddenly see a review of some random cartoon. Rather than explain myself, I’m just going to say this is part of the charm of this newsletter, that no topic is ever so important or severe that we can’t just drop everything and watch some cartoons.
This cartoon has Sylvester chasing Tweety from the pet store to Granny’s house where he must traverse a grand chasm of dogs to get to the window sill where Tweety’s cage sits. There is some strong Wile E Coyote energy here as Sylvester concocts ever more elaborate and absurd plans to get to Tweety while suffering ever more devastating defeats.
My only complaint here is that the short ends so abruptly with a fairly weak gag. I enjoy the drama of desperation and the elaborate escalations as Sylvester tries and tries and tries to get at his goal. My favorite cartoons in this genre build up the final gag into a glorious piece of doomed genius that plays out with the intricacy of a Rube Goldberg machine and that’s just (in my opinion) the best way to end these shorts.
I would also point to Philippe Lemoine's piece - what do things look like five, or twenty years from now (you know, that question public health never seems to ask itself anymore)? His answer was, COVID is always here but it's no longer serious. Why is it no longer serious? Because people are first infected when they are young and it is harmless, setting them on a path of lifelong immunity during which they are constantly reinfected, but it is never serious until they are old and weak. Eventually, he said, the only people who will be vaccinated are the elderly.
So if that is the eventual situation, and a central piece of that eventual situation is "kids get infected when young but that's fine because the disease is nearly harmless to them and that helps protect them for the rest of their lives"... then why are we fanatically attempting to prevent them from being infected now?
I would not be opposed to a mask mandate for unvaccinated kids in high school, but that's about it. My kids elementary school is making kids wear masks full time, including outside at recess. I'd pull them out except that my wife is a teacher at the school and that would be really awkward for everyone. It's ridiculous.