It’s too soon to lift the school-mask mandate

A mask mandate lifted in the middle of winter, when schools have few options for shifting activities outdoors, could result in a reversal of the positive trajectory we are witnessing today and a widening of health inequities.

A student gets items from her locker at the Horace Mann School in Salem in August 2021.John Tlumacki/Globe Staff

Governor Charlie Baker just announced that Massachusetts is joining other states in lifting the public school mask mandate on Feb. 28. For many, this is deeply troubling; for others, it is welcome news. As a social epidemiologist, a parent of three young children, and an elected official in Brookline, I occupy three distinct spaces where nuanced debates on this topic have been taking place. Yet, while the questions vary in each setting, the conclusion to me is clear and consistent: Despite the governor’s decision, it is premature and irresponsible to remove masks in schools at this stage. I hope local jurisdictions will delay shifting to an optional mask policy until at least late spring.

Masks, along with building ventilation, testing, and vaccinations, are a key ingredient in a multi-layered approach to keeping a school community safe. Mask mandates have been shown to protect children and teachers, enabling schools to remain in-person with limited in-school transmission. Yet, as vaccination rates have increased and fatigue around the coronavirus pandemic has grown, so have the voices calling for off-ramps. The question that preoccupies most public health officials is simple: Is it safe to remove masks now and what metrics should guide this decision?

On safety: While children, on average, are unlikely to die of COVID-19, schools serve all children, including those at heightened risk for complications. Schools are also workplaces for many teachers and staff who would not be characterized as low risk. And while school policy is often discussed as a standalone issue, school-age children live in households, often with vaccine-ineligible younger siblings or in multigenerational homes with grandparents or other vulnerable adults. Indeed, over 175,000 children have lost a parent or another primary caregiver to COVID-19, and the impact has been disproportionately felt among Black, Indigenous, and Latinx families. School safety should be seen as a core pillar for ensuring community safety.

Of course, there is much to be optimistic about at this moment. Dashboards displaying vaccination coverage and community rates of infection, hospitalization, and death, along with local wastewater data, document a promising trend for Massachusetts. But these dashboards often mask inequities within and between communities and ignore the uncertainty, and potential serious risks, of long COVID (a particular concern for children). Since Omicron demonstrated that vaccines effectively protect individuals from serious harm and hospitalization but alone do not alone stop the spread, masks remain one of the best public health tools for prevention. A mask mandate lifted in the middle of winter, when schools have few options for shifting activities outdoors (a well-supported harm-reduction measure), could result in a reversal of the positive trajectory we are witnessing today and a widening of health inequities.

A very different conversation is happening among parents who are increasingly asking: What about the potential harm of prolonged mask use, especially vis-a-vis mental health, language development, and socio-emotional learning? As a mother to a third-grader, and four-year-old twins who have now spent half their life wearing masks, I share these worries.

When one of my children developed a stutter in August 2020, I wondered if speech therapy with a mask on would work. Luckily, for him, it did. It is reassuring to see that there is no evidence, even two years in, to suggest masks have adverse impacts on learning or building emotional connections. And while many parents may hope that removing masks in schools could be the silver bullet to cure the anxiety, isolation, and depression that so many of our kids are experiencing, this is unlikely without significant investments in making mental health services available and creativity in schools to foster friendships and meaningful peer interactions. I also wonder if this narrative may unintentionally do these same children a disservice. What if a teacher instinctively recoils when a child without a mask approaches? What if optional mask policies result in group dynamics that foster exclusion or bullying?

Parents, of course, are not a monolithic community. In the school mask mandate conversation, less attention has been given to the voice of parents of children under 5 who are still ineligible for the vaccine. This is understandable. These children are not yet in school. But for many parents, like myself, who have children in school and younger siblings at home, the prospect of removing mask mandates at school, before all children in a household have received their vaccine, is deeply worrisome. Friday’s news that Pfizer will wait for more data on a three-dose series of the vaccine, expected in early April, and thus postponing its application to the Food and Drug Administration, is disappointing, but a late spring timeline could still be possible.

Of course, as an elected Town Meeting member in Brookline, I know that the debate around masks is also fundamentally a political one. And a tremendously divisive one at that. Within schools, there are different stakeholders, and practical and logistical issues to consider. If lifting a mask mandate prematurely without the support of teachers (or unions) could result in disruptions to schedules or lower staff morale, that shouldn’t be taken lightly. While the governor’s announcement will trigger a push for local jurisdictions to align their policies toward optional masking, time should be given to school districts to have the necessary consultations and build political support for any shift in policy.

More fundamentally, I worry that masks are the main visual reminder that we are still in a pandemic. With the death toll from COVID-19 in the United States quickly approaching 1 million and hospitals and health care workers at a breaking point, the coordinated response among governors across the country to lift mask mandates in schools sends the wrong political message. We are not yet in the clear. Concerted efforts and investments at every level of government are needed to keep our schools and workplaces safe, and masks are a low-cost, proven intervention. They also remain popular. According to a January poll the majority of Americans (69 percent) support requiring masks to be worn in public places.

In Brookline, as a member of the Advisory Council on Public Health, I will encourage our health department to maintain the indoor mask mandate for all until at least late spring, when activities can shift outdoors and our youngest children are vaccinated. We also need time to collectively agree on key metrics for how to handle future surges and set the path for an equitable recovery. I urge other jurisdictions to do the same.

Natalia Linos is a social epidemiologist, Town Meeting member in Brookline, and acting director of the Francois-Xavier Bagnoud Center for Health and Human Rights at Harvard University. Follow her @DrNataliaLinos.