Massachusetts Governor Charlie Baker announced this week that the mask mandate for public schools will be lifted on Feb. 28. With the Omicron surge winding down and a combination of natural and vaccine-induced immunity at the highest point ever, this is the right policy change.
While health officials and the public have spent the past two years carefully tracking data on the presence and severity of COVID-19, there has been a lack of quality research on the downsides of masking. Studies around potential mask harms are harder to conduct, since outcomes such as socialization and learning impacts are less easily measured than case counts and take more time to manifest. We probably won’t know the true, full impact of school mitigation policies for decades to come.
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However, the absence of evidence is not the same as evidence of absence. Denying that masks have any downsides for children is to dismiss the lived experience of millions of families, who see negative effects in their children. Most people would admit masks make communication harder, even without a randomized controlled trial to confirm. We don’t know definitively that masking makes learning to read harder, but we also don’t know definitively that it doesn’t. What is known is that children who are not able to read by the end of third grade are much more likely to drop out of school and we also know that that academic achievement in Massachusetts has fallen. The causes for the educational gaps are multifactorial, but the reality is that children need to catch up — and that communication should be easier, not harder.
Massachusetts has one of the highest vaccination rates in the country — including the second-highest uptake among children ages 5 to11 —and strives to continue to vaccinate. Because some estimates are that 50 percent of the world will be infected with Omicron before the wave is over, many of those who are unvaccinated will have protection from serious disease, at least for a period of time. The difference between the protection provided by masks and the protection provided by immunity (from vaccines or infection) is that masks provide protection you can see and feel, day-in and day-out. The protection provided by vaccines is not tangible — we don’t have constant reminders that it is there. At the same time, unlike masks, which only work when you are wearing them, immunity is protecting you from severe outcomes all the time.
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Of course, many challenges persist. Some may choose to remain masked to ensure maximum protection against infection — and they should be fully supported in their choice. Others may need to protect themselves due to high-risk conditions.
Individual protection can be achieved through one-way masking, but only if high-quality masks are readily accessible and affordable for anyone who wants one — the Biden plan to distribute free respirators is only a first step. Equity must be paramount in any initiative. The reality is that different children have different needs. It is true that some are immunocompromised and therefore at higher risk of complications from infection, but it is also true that some have hearing impairment, neurocognitive disabilities, and physical limitations that make mask-wearing more detrimental to them.
Research shows that removing interventions is harder than starting them up in the first place. In 2020, National Institutes of Health scientists Wynne Norton and David Chambers wrote about this phenomenon, concluding that ending health interventions that are no longer necessary “is essential for minimizing patient harm, maximizing efficient use of resources, and improving population health.” Further, achievement of successful de-implementation is hindered by three factors: “fear and anxiety, inaccurate perceptions about health interventions and health care, and lack of trust in health care and public health establishments” — factors that loom large in the evolving debate about how to mitigate COVID-19 in schools.
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Ending mask mandates is not abandoning public health in favor of no mitigation measures. Instead, it is a policy move grounded in public health, which dictates that policy should adapt when the context changes. As mandatory mask policies are removed, there must be continued vaccine advocacy (including boosters for adults) as well as the scaling up of rapid easy access to testing and treatments.
The end of the all-hands-on-deck, red-alert phase of the pandemic will not arrive with a bang. It will be a gradual return to normalcy driven by individuals’ levels of comfort as the virus goes from being something often deadly to something rarely so, for children and for those with immunity. Last week, citing a “twindemic” of the virus and social isolation, James Peyser, Massachusetts secretary of education, and Marylou Sudders, secretary of health and human services, sent a letter to higher-education leaders regarding the need to transition to an approach that treats COVID-19 more like other viruses. We agree with the importance of a shift to normalcy for all students, and believe this approach should be extended to K-12 schools as well.
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For now, cases and hospitalizations are falling. The visual and tangible nature of the protection of the masks is part of what makes moving away from mandated mask-wearing so much harder than the other pandemic mitigation measures. We don’t know what the future might hold, and we may have to revisit masks again, if a variant causing more severe disease arises in spite of our highly vaccinated population. But, in the meantime, we all deserve to enjoy the lull that we hope will come this spring. Our children, who have borne the brunt of pandemic restrictions and have suffered from two years of unstable school, deserve it most of all.
Dr. Shira Doron, an infectious disease physician, is hospital epidemiologist at Tufts Medical Center and an associate professor at Tufts University School of Medicine. Westyn Branch-Elliman, also an infectious diseases physician, is an associate professor of medicine at Harvard Medical School. Elissa Perkins is an associate professor of emergency medicine and director of emergency medicine infectious disease management at Boston Medical Center/Boston University School of Medicine. All three authors have served as unpaid advisers to the Massachusetts commissioner of education. Doron has served as an unpaid adviser to the governor.
