The Rest of the Story (updated)

My column in Sunday’s Arizona Daily Star on ending masking for children had to be cut by many inches. Below is the entire column with the things that had to be cut highlighted in bold italic.

The National Public Radio announcer read the report with appropriate concern, emphasizing the final three words: A Bronx apartment fire killed 19 people, including nine children. The focus on children highlighted the deep sorrow and shock we feel when children are hurt. That’s because humans are hard-wired to protect the young.

And yet, during the two years of COVID-19, the assumption of adults protecting children has been upended. We’ve asked children to protect adults, viewing kids as vectors of disease and inadvertently teaching them to think of themselves and their friends that way. It’s time to stop.

At the beginning of the pandemic, before we understood how COVID worked, before vaccines and treatments, all of us – including the kiddos – had to pull our weight in mitigation efforts.

But we now have more than enough data to show that the risks of the pandemic were rarely to children, and that schools are not a huge cause of community spread. And yet we still encourage – and sometimes mandate – mitigation measures that are having an increasingly negative effect on our children’s social, emotional and mental health. The most obvious of these measures is masking.

I was a huge proponent of masking in schools until this September, when I started teaching a 90-minute Tuesday afternoon class to first graders. This experience has shown me what masking means in a classroom.

Masks are optional in this educational setting – as they are in about half of Pima County public schools – and about half the class wears masks. That half is less participatory, more easily frustrated and decidedly more fatigued as they try, again and again, to be heard from behind a mask. The joy and abandon – much less excited learning – that normally permeates early-childhood classrooms is gone. My teacher friends in schools with mandated masking report something similar, an unnerving zombie-like presentation among children of all ages; I’m ashamed to say I didn’t believe them until I saw it myself.

Educators aren’t the only ones raising the alarm. A group of pediatricians, psychologists and family doctors launched “The Urgency of Normal” website at the end of January calling for an end to all mandatory masking in schools.

This is not an anti-vax, anti-mask, Tucker Carlson devotee group. They are pro-vaccine medical professionals who “celebrate the continued high effectiveness of vaccination while growing gravely concerned about the effects of extended restrictions on children’s lives,” according to their mission statement.

Additionally, three national medical groups representing pediatricians, child psychiatrists and children’s hospitals declared “a national emergency in child and adolescent mental health,” last month, detailing a marked national increase in anxiety, depression and suicidal ideation in children and teens, much of it tied to the complete disruption of “normal” school.

In other words, our kids are unhealthy – but it isn’t because they have COVID.

The primary argument for school masking has been that children don’t live in a vacuum. As Pima County Public Health Director Theresa Cullen has told me, these children go out into the community and, in some cases, home to live with grandparents. Ergo, masking children protects the wider community.

While I do not dismiss the virus’ danger for older adults and the immunocompromised, I believe we must put that danger into perspective, especially in Pima County, where we have a fully vaccinated rate in all ages of nearly 67% and a nearly 93% fully vaccinated rate in ages 65 and over. So here goes:

 According to the Centers for Disease Control, before the omicron variant, a typical vaccinated 75-year-old had a 1 in 200 risk of death from COVID. The death rate for the flu for that same 75-year-old has ranged from 1 in 75 to 1 in 160 in recent years, according to the CDC Mortality and Morbidity reports.  Ergo, my elderly aunt currently has a similar chance of dying from the flu her teenage grandson may bring home from school than the COVID he might carry.

And yes, I know COVID is more infectious then the flu – which is part of what makes it so dangerous for our health care system – but, at this point, it is not more deadly for the typical vaccinated 75-year-old.

And the danger from COVID for the vast majority of children is even less. According to the CDC, the coronavirus presents a flu-like mortality risk to healthy unvaccinated children and almost zero risk to vaccinated children. In the 2012-2013 school year, more than 1,000 U.S. children died of the flu. In 2014-15, it was near 800 and in 2017-18, those deaths amounted to slightly more than 700.

Compare those flu statistics to the U.S. childhood deaths from COVID since the pandemic began: 998 deaths in children ages birth through 17 (based on CDC data from Feb. 1; numbers may have changed). In Pima County we’ve had fewer than 10 pediatric deaths from COVID and only a total of 392 hospitalizations under age 19 since the pandemic began.

Each one of those deaths was tragic. I am not trying to minimize them. But I also believe the increased mental health stress being observed in children is dangerous and is affecting many more children. We cannot ignore it.

The United States is the outlier in requiring masking for children under the age of 12. The WHO sets the low range of masking at 5 years old, whereas the CDC sets it at 2. If you’ve seen any of the dozens of videos of day care employees trying to keep masks on crying toddlers, you will understand how insane – and inhumane – this practice is.

Additionally, until this last week, our peer countries – Spain, France, Britain, etc. – never required masking for children under the age of 12. As omicron threatened to overwhelm their hospitals, France and Britain instituted masking in elementary schools, emphasizing the requirement will be removed immediately upon hospitalizations dropping to pre-omicron levels. Our health leaders have never even attempted to give us an off-ramp for our kids’ continued un-normal school experience.

Masks were promoted as a needed, effective place-holder while we developed vaccines and treatments. We now have vaccines for everyone who wants them, and treatments for everyone who is high-risk. Yes, children under five cannot yet be vaccinated, but data shows that – just like their older brothers and sisters – preschoolers are at more risk of death by car accidents than having a serious COVID outcome.

Ending mandatory masking does not mean we should give up protecting the elderly or immunocompromised. But we can protect them and give most children normal school, because research shows one-way masking works. If a person wears a well-fitted KN95 or N95 mask – not cloth or surgical– she is protected regardless of what others do around her. Teachers and students who want or need to mask can continue to do so. Perhaps the rare class that has a severely immunocompromised child (the child returning to school after cancer treatment, for example) could ask all children to mask to protect their classmate. But masking shouldn’t be the default once omicron fades.

We also know that certain conditions – most notably obesity – make adults more likely to have  poor COVID outcomes. But is it appropriate to require children to mask to protect the overweight adults in their lives, or should those adults work to reduce their COVID risk with lifestyle changes? (Also, is it a coincidence that the United States has had more COVID deaths than our peer countries and we also have much higher rates of obesity?)

Some people say kids wearing masks is no big deal. And for some children, that might be the case. I’d argue no child likes it but the youngest ones are afraid to say so because they see their parents encouraging it and, like all children, are desperate to please parents. But mask-wearing, especially in the young, actually is a big deal. Kathleen M. Pike, a professor of psychology at Columbia University and Director of the WHO Collaborating Centre for Capacity Building and Training in Global Mental Health, wrote an article in April 2020 explaining why.

It centers on the “basic building blocks of emotional experience” – joy, anger, fear, surprise, sadness, contempt and disgust – and how they are written on our faces. We have to master those unspoken messages, and the way we do that is through seeing faces, especially early in life. A standard exercise is showing photos of various expressions to young children so they can hone identifying emotions. Many parents are familiar with board books featuring various facial expressions and the questions, “Who is happy?” “Who is sad?” “Who is angry?”

In November, I had to do something similar in my class and the children had a very hard time distinguishing between the emotions shown. I realized it was because they have spent much of the past two years seeing only the top half of faces.

The antidote to fear isn’t avoiding all risks at all costs. It is looking at the facts – COVID provides less risk to the average child than getting in the car on any day; the vaccine provides more than 80% protection against serious illness and death for all age groups; one-way masking works for vulnerable people – and balancing those facts with the increasingly awful harm of continued “unnormal” school. It means, for parents, asking themselves a honest question: “Am I afraid my child will get seriously harmed by COVID or am I afraid my child might get me sick?” and then being brave enough to center the child’s need for normal life while doing what you need to do to protect yourself (get vaccinated and boosted, lose weight and eat healthily, wear a well-fitted KN95 or N95 mask yourself in crowds.) Remember: The best way to protect children is to surround them with vaccinated adults!

As I’ve written 1,000s of times before, there is zero reason to not get vaccinated. If you’re an adult concerned with restrictions on children, do your part to end this pandemic by getting vaccinated!!! Will vaccination alone stop you from getting COVID? Maybe not. But it greatly lowers your chance of contracting it and it also keeps you from getting seriously ill or dying and it reduces your chance of spreading it to others and lowers the chance of variants keeping us in this nightmare Groundhog Day forever. (All of this is supported by actual data, as opposed to the guy on Twitter telling you Vitamin D is your COVID salvation.)

We’ve been acting as if children are infinitely resilient. They are not. Some break. I see it in my grandson’s meltdowns – pandemic-fatigue behavior that looks like the 4-year-old he was when this crisis began instead of the 6-year-old he is. I see it in the clinging 8-year-olds who were once independent and exploratory before two years of pandemic loss. I observed it in the severe anxiety of my great niece, and hear about it weekly from counselor friends with months-long waiting lists of children in need. Mostly, I see it in the despair in the middle schoolers at my neighborhood bus stop, who used to be talkative and playful and now sit, masked and silent, looking like they are facing a firing squad.

Ending mandatory masking for children will not be a cure all. We’ve got a lot of damage to reverse by helping children unlearn the “I’m dangerous/I’m in constant danger” message our fears inadvertently laid upon them. But tossing the masks is a good first step because, with the virus here to stay – and it is staying – we must return childhood to its rightful owners before those precious, joyful, once-in-a-lifetime years are lost forever.

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