Top pediatricians recommend masks in school this fall, even for vaccinated children

Group’s recommendation contradicts recent federal guidelines.

Kindergarten students wore face masks and were separated by plexiglass during a math lesson at the Milton Elementary School in Rye, N.Y. in May.Mary Altaffer/Associated Press

A top pediatricians group is calling for everyone older than age 2 to wear masks in school this fall, even if they have been vaccinated against COVID-19.

The American Academy of Pediatrics’ recommendation contradicts federal guidelines and drew immediate rebukes from some parents, while a teachers union leader and some academics praised the idea.

The 67,000-member group on Monday strongly recommended a return to in-person learning and urged all who are eligible to be vaccinated.

But the academy noted that federal regulators have not yet authorized COVID vaccines for children under age 12, leaving millions of youngsters vulnerable to infection. The pediatricians’ group noted that universal masking is proven to reduce transmission of the virus and protect those who aren’t vaccinated.

“There are many children and others who cannot be vaccinated,” Dr. Sara Bode, chairperson-elect of the pediatrician academy’s Council on School Health Executive Committee, said in a statement. “This is why it’s important to use every tool in our toolkit to safeguard children from COVID-19.”

The academy’s recommendation is sure to be controversial, coming just over a week after the Centers for Disease Control and Prevention concluded that vaccinated teachers and students no longer need to wear masks inside school buildings. However, the agency continues to recommend that unvaccinated people wear masks indoors.

Massachusetts school officials have dropped all coronavirus-related protocols for the 2021-22 academic year, including social distancing and mask-wearing. In May, the state also dropped its requirement for students to wear masks during outdoor activities, such as recess.

The latest advisory from the pediatricians’ group has left parents confused and fuming.

“It’s really hard as a parent to truly know what to believe,” said Melissa Bello, a cofounder of Bring Kids Back MA, a parents’ organization. “It feels irresponsible to come out with conflicting guidance from the CDC.”

Bello said that many restaurants, stores, and other venues have not enforced CDC mask guidance since late spring when the mandates lifted, and returning to masks for school would be both unfair and misleading.

“It creates a false narrative that schools are inherently less safe than other places in society and life where children have been able to go maskless since the spring,” she said.

Leaders from the Department of Elementary and Secondary Education have said they’ll work with state public health officials this summer to determine if additional health and safety recommendations are needed. A state education spokeswoman said Monday that no updates have been made to the state’s fall school guidance in light of the new mask recommendation.

But the state could still call for more safety measures in schools within the next month, said Beth Kontos, president of the American Federation of Teachers Massachusetts. Kontos theorized that state leaders may be waiting to announce their decision to minimize chatter and criticism this summer.

“If I was in charge, there’d be a mask mandate” for everyone inside school buildings, Kontos said, emphasizing that she wants educators back inside classrooms this year, and universal mask-wearing could be one way to do it. “I would rather be cautious than roll the dice with our youngest children’s health.”

The state’s May guidance says that officials could recommend “masks for elementary school students” later this summer. But it’s unclear whether state officials will consider requiring or encouraging masks for everybody or only for unvaccinated people.

Even if the state doesn’t mandate masks, Kontos said, many adults will likely wear them in school out of an abundance of caution and to set an example for students.

“I believe that this is the safest way for children to be in school this fall,” she said. “Not forever, [just] until there can be a vaccine and enough people have participated in it.”

For Merrie Najimy, president of the Massachusetts Teachers Association, a one-size-fits-all mask policy from the state wouldn’t fit.

The academy’s recommendation shows the continued “gravity of the situation,” particularly for communities of color and low-income districts, Najimy said. However, the state should issue guidance about mask-wearing, leaving it to individual districts to determine what is best, she said.

“Masks are still an important precaution, but at the local level, they will know best when it is and isn’t necessary,” she said.

Dr. Louise Ivers, interim chief of infectious diseases at Massachusetts General Hospital, said a temporary return to masking in schools this fall is a relatively unobtrusive measure that is known to be highly effective — until more children are vaccinated.

“In terms of the tools we have, it’s a very smart one to apply,” said Ivers, whose own children, aged 6 and 9, aren’t yet eligible for a vaccine.

But Ivers said there are other effective interventions Massachusetts leaders can take, such as improving ventilation in many of the state’s aging school buildings, a step both teachers union presidents have also been pushing for.

“We can’t forever have masking as the intervention we put in place because we aren’t doing other things for our schools,” she said.

Ivers said the state also needs to more widely and wisely use rapid COVID tests in schools so children aren’t needlessly pulled out of classrooms if they aren’t infected.

Joseph Allen, an associate professor and director of the Healthy Buildings program at Harvard University’s T.H. Chan School of Public Health, took to Twitter to criticize the pediatricians’ recommendations.

“A vaccinated 16-year old in Vermont should be required to wear a mask in school?” Allen tweeted, noting that 85 percent of children 12 and over in Vermont are vaccinated.

“For me, the system needs a lot more nuance and flexibility to respond to what are wide variations by region due to differential vaccination rates, and extreme differences in risk by age,” he said. “Blanket guidance isn’t helpful at this point in the pandemic in the U.S.”

Others said a hybrid approach to mask-wearing in schools, with some following the pediatricians’ guidance and others not, could be tough to enforce.

“Trying to distinguish between vaccinated and unvaccinated and having different rules for different kids would be a disaster,” said Robert Hecht, an epidemiology professor at Yale School of Public Health and president of Pharos Global Health Advisors, a Boston nonprofit focused on global health matters.

But he said the problem could be significantly reduced if governments simply required young people to get vaccinated, following the example of some colleges that mandate student vaccinations.

“It’s a failure of social and political dynamics that we are not vaccinating all the 12- to 18-year-olds,” he said. “Our inability to require it for 12- to 18-year-olds, too, is a public health disaster.”