Behind the state’s school masking policy: a collision of science and politics

Baker administration listening closely to mask skeptics

Anti-mask and anti-vaccine protesters shouted during a march from Boston Common to the Massachusetts Department of Public Health on Aug. 25.Lane Turner/Globe Staff

Opponents of school mask mandates have often been louder and more insistent than supporters — even though polls suggest they’re in the minority. Parent groups opposed to making students wear masks in school have filed at least six lawsuits across Massachusetts to stop the policy.

Now, internal state e-mails suggest that anti-masking activists are having a significant impact on the Baker administration, which has resisted full compliance with federal guidance that students should wear masks at school even if they’ve been vaccinated. Current policy will soon allow schools with high vaccination rates to drop mask requirements for vaccinated students and staff.

The determination to follow this middle path may be in part political. When a Massachusetts General Hospital doctor asked in an e-mail why the state was not following Centers for Disease Control and Prevention guidance, a top state health official was blunt: pressure.

“There has been considerable pushback from parents groups that feel that masks interfere with social interactions and speech and language development,” wrote Dr. Larry Madoff, medical director for the state health department’s Bureau of Infectious Disease and Laboratory Sciences, in a July 30 e-mail to Dr. Regina LaRocque, his former student at Brigham and Women’s Hospital.

The e-mail was obtained through a public records request to the state health department.

The administration tightened its mask policy about a month after the exchange between LaRocque and Madoff, but current policy still falls short of the recommendations of both the CDC and the Massachusetts Medical Society. Those two groups argue that even vaccinated students and staff can be infected with the more contagious Delta strain of COVID and spread it to others, so all for now should wear a mask.

“What’s driving the policy in Massachusetts are ... parents who are vociferous, who don’t want masks for their kids in schools,” said LaRocque, an infectious disease specialist who has previously criticized Baker’s COVID policies, in an interview. “Who decides who the stakeholders are, what values are being applied and where does the buck stop?”

A lot is at stake as Massachusetts students return to in-person classes after a year and a half of home learning due to the pandemic. Under the Baker policy, thousands of Massachusetts students may soon be attending school mask-free. That stands in sharp contrast with states like neighboring Connecticut, with a similar percentage of its residents vaccinated, where Governor Ned Lamont recently extended his executive order for school masking until at least mid-February.

The Baker administration is requiring indoor masking in the state’s schools until at least Nov. 1. But that policy, crafted with aid from doctors who are recommending the state ease mask requirements, has a significant caveat. It provides the option for middle and high schools where 80 percent or more of students and staff are vaccinated to lift the requirement as early as Oct. 15 for those who have received their shots.

The Baker administration declined to make Madoff, who wrote the e-mail about pushback from parents, available for an interview. It also has not released some documents about school mask policy sought by the Globe in a public records request two months ago.

But in an interview, Education Commissioner Jeffrey Riley said parents did not have an influential role in the state’s decision-making.

“We hear a lot more from parents who don’t want masks on their children, but we are going to go with what the best medical advice is,” he said. ”There may be a silent majority who support the mask mandates, but we don’t hear from them as much.”

Riley said the CDC guidance that calls for universal masking in schools does not account for higher vaccination rates in states like Massachusetts and much of New England. He said those rates, along with advice from the department’s medical advisers, are why the state chose to allow some vaccinated students and staff to soon remove their masks. Riley also noted that neighboring Vermont, with the highest vaccination rate in the country, has a similar school mask policy that will allow vaccinated students in buildings with rates above 80 percent to remove their masks in November.

Riley said the state’s current policy requires school districts to be flexible. “I could envision a scenario when there are times when you have to put masks back on and when you can take masks off,” he said.

Part of the reason that the Baker administration policy on masking is less strict than CDC guidelines may have to do with the state’s three unpaid COVID advisers. All three — Dr. Westyn Branch-Elliman of Harvard Medical School, Dr. Shira Doron of Tufts Medical Center, and Dr. Elissa Perkins of Boston Medical Center — have argued in favor of relaxing mask requirements.

Perkins and Doron said in interviews that allowing schools with high vaccination rates to relax indoor masking makes sense. They said the 80 percent threshold schools must meet for vaccinated people to go without masks assumes an unknown portion of the remaining 20 percent have acquired immunity from a COVID infection. That, they said, would produce a building-wide protection higher than 80 percent.

They chose 80 percent based on unsettled-science about how contagious the Delta variant is and how that affects so-called herd immunity. That is, what percentage of the population will need to be immune to the coronavirus, either through vaccination or previous infection, to reduce the likelihood of infections for those who lack immunity.

“Regardless of science, and there isn’t a lot of science, it’s important that parents feel strongly and that needs to be at the forefront of decision-making,” Doron said.

Some parents have worried that masks inhibit development of social and emotional skills, though research is lacking on that. The American Speech-Language-Hearing Association has noted that while there is some concern particularly for younger children, “there is no evidence that use of face masks prevents or delays speech and language development.”

But many experts agree that when masks come off in highly vaccinated schools, there will likely be an increase in cases, though mostly mild ones.

One critical issue that has yet to be accounted for in these mask-or-no-mask calculations is the impact of even mild cases, said Dr. Sandra Nelson, an associate clinical director of the division of infectious disease at Mass General and an assistant professor at Harvard Medical School.

“Even if not severe or fatal, mild cases have impact, including to the child for lost learning, to the family with potential work loss [to care for their child at home], and to the schools in resource intensity for contact tracing and testing,” she said.

Nelson, who has served as a paid science adviser on COVID issues for the state Department of Elementary and Secondary Education, said she is hearing from infectious disease colleagues who are “not anxious for their kids to have their masks removed in schools.

“Most of us feel the case count is too high to support removal of masks,” Nelson said.

Major medical groups also are not in favor of masks coming off now in schools. Several, including the Massachusetts Medical Society and the state chapter of the American Academy of Pediatrics have backed universal school masking this fall.

“Our preference would be to err on the side of extra safety and to take our time and make sure that community rates are dropping,” said Dr. Carole Allen, a retired pediatrician and president of the Medical Society.

“Nothing is black and white and we don’t have all the answers,” Allen said. “This is a learning experience pretty much every day and we are trying to go with the best information.”