What Would Gandhi Say About Masks in Schools?

I am seeing lots of concerning Covid news out of Florida this week. For example, this:

“Last week, 6,999 children under the age of 12 contracted Covid-19 in Florida, which was nearly 10 percent of the 73,199 new cases across the state last week, according to the Florida Department of Health, which no longer does daily reporting.

Last week, the positive rate for those under 12 — a segment of the population that can’t get vaccinated yet — was at 15.4 percent, higher than the 15.1 percent average for all ages. A Jacksonville TV station on Wednesday reported that the city’s Baptist Health is treating 13 children who contracted Covid-19, five of whom are in intensive care.”

The Delta variant surge seems to be breaking records and breaking rules. No longer can we rely on the idea that Covid doesn’t “threaten kids.” Children are definitely getting infected, admitted to hospitals and, sadly, some are dying. As the numbers soar, battle lines are being drawn regarding whether schools should (or even can) mandate masks in the rapidly approaching school year. Governor Ron DeSantis held a closed door “roundtable” on Monday, where he expressed his concerns “about moves to “muzzle” children in the fight against the virus.”

On Tuesday, the CDC issued updated recommendations that all students and staff mask in K-12 schools, regardless of vaccination status (similar to the guidelines released by the American Academy of Pediatrics on July 19, 2021). Also on Tuesday, anti-mask protests caused the delay of a Broward County School Board Workshop and masks were burned in the anti-mask rally outside. On Wednesday, Broward announced they would require masks for the beginning of the school year. A few hours later, tiny Gadsden County made a similar announcement. Governor DeSantis has vowed to call lawmakers back for a special session to ban mask mandates in public schools. On Thursday, the Florida Chapter of the American Academy of Pediatrics (FCAAP) supported “the continued, universal use of masks and physical distancing in schools by all individuals including students, faculty members, and staff through the end of the 2021-2022 school year.”

Political lines have been drawn. Still the Delta virus surges on.

I wasn’t planning on jumping into the fray. And then I saw this photo from the Broward anti-mask protest (I have edited it to avoid”doxxing” anyone):

It says “Zero children have died from Covid without pre-existing conditions.” As a pediatrician this sign makes me ill. Are children with pre-existing conditions expendable? As a school board member, I would like to remind everyone that public schools have an obligation to educate all children, even those with medical conditions that might put them at increased risk of death from Covid.

According to the CDC, children with complex medical conditions (like genetic, neurologic, metabolic conditions, or those with congenital heart disease) can be at increased risk for severe illness from COVID-19. Also, like adults, children with obesity, diabetes, asthma or chronic lung disease, sickle cell disease, or immunosuppression can also be at increased risk for severe illness from COVID-19. These conditions are relatively common in school aged children. Insulin-dependent diabetes affects approximately 1 out of every 1,000 children under the age of 18. Sickle cell disease affected 1.2/1,000 children. Asthma is much more common, affecting more than 40 per 1,000 children. Significant Congenital heart disease occurs in 15.2/1,000 babies and Down syndrome occurs in approximately 1 out of every 700 births.

These conditions are common. There are children at your child’s school with these “pre-existing conditions.” The increased virulence of the Delta variant will put these children, if not your own, at even great risk.

In a report issued at the end of June, researchers from Duke University looked at 100 school districts and 14 charter schools across North Carolina, totaling more than 850,000 students and 160,000 employees and evaluated effectiveness of Covid mitigation efforts, finding that masks were a major deterrent in preventing potential spread in schools. The report follows the science and provides recommendations for the safe reopening of schools this fall.

“The findings demonstrate that:
•    Proper masking is the most effective mitigation strategy to prevent COVID-19 transmission in schools when vaccination is unavailable or there are insufficient levels of vaccination among students and staff; 
•    With masking in place, Plan A – full, in-person instruction – is appropriate for all grades and all schools;
•    Full-capacity bus transportation can and should resume, with the seating of up to three masked students per bus seat;
•    Some within-school guidelines can be relaxed, e.g., quarantine can be modified for people who were exposed to COVID-19 but are either vaccinated or were appropriately masked when exposed; and
•    Schools should examine safety protocols surrounding athletics. With proper safety protocols in place, particularly vaccination, schools could resume fall athletics while limiting the spread of COVID-19.”

Dr. Daniel Benjamin, a lead author on the report, described supporting research in an interview with the Herald Tribune:

“Benjamin pointed to a study done in Israel that documented a much higher secondary attack rate when students didn’t wear masks.

“Masking works,” Benjamin said, noting studies of COVID-19 in Utah, Missouri and Georgia schools produced results similar to his North Carolina research.

Benjamin is a medical doctor who also has a PhD in epidemiology. He said among “well-trained physicians and epidemiologists it’s not disputed” that masks protect against COVID-19 in schools.”

https://www.heraldtribune.com/story/news/coronavirus/2021/07/30/governor-ron-desantis-clashing-experts-school-masks/8075781002/

Remember, the public health benefits of masking include protecting others from the inadvertent spread from an asymptomatic, yet infected, individual. Your child, without a mask, could unknowingly spread Covid to a high risk child in their class (whether that child was wearing a mask or not). Is that a risk you are willing to take?

Gandhi reportedly said “The true measure of any society can be found in how it treats its most vulnerable members.”

We need to do better.

As I wrote this, Governor DeSantis signed an Executive Order to issue emergency rules for “protecting the rights of parents” to let them make the decision whether or not to wear masks in schools.

My children, both vaccinated, will be wearing masks to protect those most vulnerable.