“I FEEL LIKE my throat is closing,” said a 9-year-old boy, between raspy breaths and a barking cough. He was admitted to the hospital with COVID croup, a condition where the upper airway closes due to inflammation from a respiratory virus. Like most children admitted during the Omicron surge, he had no medical risk factors for severe illness.
A friend texts for medical advice, concerned her son Hugo will catch a cold. For months he has been wearing a jacket to school to sit by an open window, afraid he may bring COVID home to his grandmother, a transplant recipient.
These children understand what Gov. Charlie Baker and Massachusetts Education Commissioner Riley do not. Ending the mask mandate in schools on Monday will not bring us back to normal. Rather, it will lead to more preventable infections and outbreaks, at the expense of our society’s most vulnerable. As primary care physicians who care for children and adults, and a parent of two children under 3, we are appalled to see the Baker administration once again prematurely lift data-driven policies that are needed to keep our children and communities safe.
The pandemic is far from over. Just a few weeks ago, our ERs were overflowing and our primary care colleagues were pulled in to cover hospital shifts. While we are relieved to see the decline in Omicron cases, more variants are sure to emerge. Just last week, the World Health Organization announced a newly detected, even more contagious Omicron subvariant.
In the ongoing pandemic, kids remain at risk. An unprecedented number of children were hospitalized during the Omicron surge, and over 900 US children have died from COVID. Baker will also drop mask requirements for childcare, although no vaccine is even available for children under 5, who were recently hospitalized at the unprecedented rates. We must also remember the potential short- and long-term impacts of COVID in children for which data is still emerging. These include the risk of Multisystem Inflammatory Syndrome in Children (MIS-C) and long COVID, which can follow even mild infections, and a possible increased risk of diabetes following COVID infections in children.
Masking is a crucial, scientifically-proven tool for preventing COVID infection in schools. High quality masks protect the wearer and others around them by halting the release of virus-containing particles. Even if an individual student chooses to keep a mask on, if others around them are unmasked, the amount of virus in the air could overwhelm the capacity of the mask. This is why mandates are so important – so that everyone protects one another, including those most vulnerable to severe infection. In spite of the “urgency of normal” hype, national poll data consistently shows that a majority of Americans support school mask mandates.
While vaccination is helpful, it is not a substitute for masks. On December 15, Hopkinton High School – the first Massachusetts school to allow students to forego masks – reversed its decision to end school masking after only six weeks, due to a COVID outbreak in a community where nearly 90 percent of all residents, and more than 95 percent of youth 12 to 19 were fully vaccinated.
School-based outbreaks can easily spread to the entire community, disproportionately impacting people at highest risk for severe COVID and exacerbating disparities. People who are elderly, immunocompromised, or have chronic diseases face higher rates of hospitalization or death from COVID, even with the vaccine. Black, Indigenous, and people of color (BIPOC), working class people, and the disabled, who have suffered disproportionate illness and death throughout the pandemic, are more likely to live in crowded, multigenerational homes where infection easily spreads. Furthermore, because of structural barriers, vaccination rates for American Indian, Black, and Latinx residents lag behind Whites across Massachusetts.
Eliminating COVID protections is tantamount to sacrificing the lives of elderly, chronically ill, disabled, and BIPOC communities for the sake of “normalcy.” As Mia Mingus famously writes, “You are not entitled to our deaths.”
Meanwhile Commissioner Riley says he is ending COVID masking protections for the mental health and academic success of our youth. There is no evidence that masks cause psychological trauma or impair children’s learning or emotional development. Children, like my friend’s son, Hugo, rather, fear bringing the infection home to harm a loved one. As they should. Over 200,000 US children have lost a parent or caregiver to the pandemic. Perhaps this is why the American Academy of Pediatrics and CDC agree that the benefits of school masking outweigh any theoretical risks.
Instead of fixating on a return to a “normal,” pre-pandemic society, our leaders should focus on building a new and equitable future, with enhanced social support systems, robust public health infrastructure, and safe schools. Policy makers should use a data-driven approach, as Massachusetts Medical Society and emerging research recommend, with clearly identified triggers to implement and roll-back public health protections. If there is a new normal to urgently strive towards, it should be a world where we value others’ lives over our own inconvenience, and make sure no one is left behind.
Lara Jirmanus is a family doctor in Revere and an instructor at Harvard Medical School. Juliana Morris is a family doctor in Chelsea and an instructor at Harvard Medical School.