What Does The Science Actually Say About Face Masks For Children?

Many Democratic leaders’ orders to relax or abolish mask mandates contain a notable exception: schoolchildren. While adults in many blue states may go maskless — as their leaders have for some time — children who are at far less risk of contracting a serious case of COVID-19 must continue wearing masks throughout the school day in 4,035 public school districts, which represent about 50% of all districts in the country. What does the science say about children wearing masks to prevent transmission of COVID-19?

Junk science creates junk policy

Despite declining cases of the Omicron variant and children’s relatively low rate of severe COVID-19 cases, the CDC continues to recommend masks for everyone from the age of two up. The official CDC guidance “recommends universal indoor masking by all students (ages 2 years and older), staff, teachers, and visitors to K-12 schools, regardless of vaccination status,” even during “indoor physical education.”

The CDC’s single-minded commitment to masking infants has made the U.S. a global outlier. The World Health Organization has stated, “Children aged 5 years and under should not be required to wear masks.” (Emphasis in original.) The European Centre for Disease Control states mask-wearing is “not recommended for students” in primary school, exempting all children under the age of 12.

One study posted by the CDC found that the lower incidence of COVID-19 transmission “in schools that required mask use among students was not statistically significant compared with schools where mask use was optional.” Two of the CDC masking studies did not control for vaccination rates, essentially rendering their results flawed and limited.

Students who wore masks had the same, or worse, COVID-19 rate as those who did not

CDC Director Rochelle Walensky testified before the Senate on January 11 that masks significantly reduce COVID-19 outbreaks. In September, she told MSNBC that a study taken “in Arizona demonstrated that schools that had masks were 3.5 times less likely to have a school outbreak than schools that didn’t have masks.”

“Schools that have masks were 3.5 times less likely to have a school outbreak than schools that didn’t have masks—This is an independent effect of masks,” says CDC director Dr. Rochelle Walensky on a new study out of Arizona. pic.twitter.com/ZjHzZSH4uI

— All In with Chris Hayes (@allinwithchris) September 25, 2021

But the study in question, which looked at Arizona schools last July and August, suffered from numerous defects: It studied “outbreaks” in which more than one person (student or teacher) was infected, rather than total cases; some of the schools in the study had been open only half as long as others; it did not control for differences in vaccination rates; and it included virtual schools and vocational programs in the data.

One scientist deemed the study “so unreliable that it probably should not have been entered into the public discourse” — yet it continues to influence the Biden administration’s school masking recommendations.

These problems have not dissuaded the CDC from continuing to promote the wearing of masks in school. A poster commissioned by the CDC proclaims the results of a new mask study, which was released on February 4, claiming that wearing a cloth mask at indoor public settings made the individual 56% less likely to test positive for COVID-19. At first blush, this would seem a precipitous drop from Walensky’s claim less than a month earlier that Arizona schools with mask mandates “were 3.5 times less likely to have a school outbreak had.” This study also has two significant caveats.

First, as the bottom of the poster acknowledges, the findings are “not statistically significant.” Second, it found that cloth masks could reduce transmission — or make the wearer 17% more likely to test positive than someone wearing no mask. The broad range of outcomes places the study’s overall conclusions in doubt. (The test also did not control for whether the subjects who got negative COVID-19 tests we were either symptomatic or vaccinated.)

Studies observing the real-world effect of mask usage in public schools have fluctuated significantly. A study of schools in Florida, New York, and Massachusetts concluded, “We do not find any correlations with mask mandates” and the number of COVID-19 cases among public school students or teachers. This study was a preprint and had not yet been peer-reviewed.

A study in Cass County, North Dakota, last December compared two school districts in the same county and found the district with a mask mandate had a higher percentage of COVID-19 cases.

Many are asking for an update on our North Dakota masking study. Two K-12 public school districts in the same county: Cass, ND, both w/around 12,000 students
Active school cases in 2021 ⬇️
FPS (🔵)= mask mandate
WF (🟡)= masks optional
FPS slightly higher staff vax rate
(1/2) pic.twitter.com/ABg3Ue5zuI

— Tracy Høeg, MD, PhD (@TracyBethHoeg) December 12, 2021

Health departments around the world came up with similarly fuzzy results. The U.K. Department of Education released a report this January on a study of 123 secondary schools nationwide; the results were “not conclusive,” it said.

As long ago as July 2020, The Netherlands’ Minister for Medical Care said the nation would not impose a mask mandate on Dutch schoolchildren, because “[f]rom a medical perspective, there is no proven effectiveness of masks.”

Do cloth masks prevent transmission?

Numerous studies called into question the efficacy of cloth masks long before U.S. public health officials admitted most offer little protection from the novel coronavirus. In 2015, the BMJ publication reviewed the way health care workers used cloth masks and found, “Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection.”

They found that cloth masks provided “almost 0%” filtration of viruses. In a concerning development related to the coronavirus, they found, “Observations during SARS suggested double-masking and other practices increased the risk of infection … These effects may be associated with cloth masks.”

How about N95 respirators?

Searching for greater protection, California’s Berkeley Unified School District announced on January 11 it would “transition all students and staff” to wearing KN95 masks. BUSD later walked back the mandate, saying the masks will be optional. But how protective are those mask’s more protective cousins, the N95 respirators?

It’s hard to assess how protective N95 respirators would be in schools, because there are no child-sized N95 masks. The FDA says, since “N95 respirators are not designed for children…a proper fit cannot be achieved on children.”

That means children won’t get all, or possibly any, of the benefits an N95 mask provides adults. Furthermore, the National Institute for Occupational Safety and Health (NIOSH) notes that it “does not approve any type of respiratory protection for children.”

Most evidence shows N95 masks are the best protection available to adults. A study last May found that N95 respirators offer robust protection for the wearer, even when others wear no mask.

This should hardly be surprisingly, since “N95 respirators … are the mainstay of protection against airborne pathogens,” noted a 2020 article co-authored by Rochelle Walensky.

Yet some researchers have questioned the effectiveness of N95 respirators compared to surgical masks for some infections for those over the age of 18, as well. A March 2020 study from the Journal of Evidence-Based Medicine concluded that “there were no statistically significant differences in preventing laboratory-confirmed influenza, laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection and influenza-like illness using N95 respirators and surgical masks.”

Dr. Margery Smelkinson, a specialist in infectious diseases at the National Institutes of Allergy and Infectious Diseases, summarized the science when she rejected forcing children to wear N95 masks. “As with our existing school-mask policies, no real-world data indicate that these [N95] 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,” she wrote in a co-authored piece in The Atlantic. “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.”

Do masks harm children in any way?

One study found that the most protective masks may have some negative impact on adults. A July 2020 study in Germany studied the results when “healthy males” wore no mask compared with wearing a surgical mask or an N95 respirator.

“Ventilation, cardiopulmonary exercise capacity and comfort are reduced by surgical masks and highly impaired by FFP2/N95 face masks in healthy individuals,” found the Clinical Research in Cardiology study, which had an admittedly small sample size.

Global studies revealed that children may suffer cognitive harms even when adults wear masks around them. The UK study — which, again, admitted its results were not conclusive — found that listeners showed lower levels of confidence and performance when the person speaking wore a mask. This would mean that children with autism, or developmental or hearing issues would face the biggest impact.

Researchers in Greece and Italy also stated that children and others who cannot see other people’s facial expressions may experience negative impacts as a result.

The great uncertainty of this data is amplified by the fact that there has never been a major study of long-term mask use for children. The United States’ unprecedented experiment in masking children for a prolonged period of time is a real-time experiment with our children’s mental, physical, and cognitive health. We have only the faintest idea of the harms these policies may have caused our youngest and most vulnerable citizens.

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