Dr. Nicole Saphier: CDC, kids and masks – COVID guidance continues to miss the mark

It is time to regain a centrist perspective regarding public health as it pertains to schools, respiratory infections, and children

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The updated CDC guidance announced on Tuesday endorsing universal indoor masking in K-12 schools is an open-ended recommendation that will have negligible benefit in lowering severe outcomes and community transmission of SARS-CoV-2.

Last year the concern was that children would be the silent super-spreaders putting teachers and other adults at risk. As adults are now able to be vaccinated, the concerns of last year have diminished. Today the narrative has changed to "we have to protect the children by wearing masks until they can be vaccinated." 

This switch comes as a mountain of evidence has demonstrated not only are young children probably less likely to become infected and transmit the virus, but their risk of a severe outcome following infection is about 100 times less than an adult over 65 years. 

So why the recommendation to mask children heading into the new school? The rising cases of the Delta variant has people on edge; and it should. 

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Delta has proven much more contagious and is causing higher viral loads, which is sending more people to the hospital. While children are making up a higher percentage of new cases, which is expected since over 163 million Americans are fully vaccinated, severe disease in kids still appears to be rare. 

If we compare what has occurred in the U.K., which is coming down from its Delta wave, the younger people (15-39 years) drove new cases but hospitalizations and deaths in those <15 years approached zero. Not to mention, the U.K. had their schools open without mask mandates for much of the Delta wave.

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According to the CDC, in the United States 337 COVID-related deaths have occurred in kids under 18 years since the start of the pandemic, virtually none in otherwise healthy children without pre-existing illness. Over 4 million children have reportedly been infected by SARS-CoV-2 and the CDC estimates the true number of infections is up to four times that.  If the U.S. did a deep dive into pediatric deaths like England did, it’s quite possible the number of actual pediatric deaths directly caused by COVID-19is even less.

Bottom line: the risk of severe outcomes in healthy kids is extremely low.

There remains a pervasive narrative around COVID-19 that has upended our previously acceptable level of risk when it comes to children and public health. It has divided the country into polar extremes: universal masking until zero cases or let the virus have a free-for-all. 

It is time to regain a centrist perspective regarding public health as it pertains to schools, respiratory infections, and children.  

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For example, schools should consider levels of community transmission and risk of severe outcome when making any decisions about policy changes, similar to what occurs when there is a flu outbreak. If there is a local outbreak of COVID-19, the school can utilize mitigation efforts to lessen transmission (temporary masking, testing etc) until the local outbreak and surrounding community transmission has lowered.  

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While the majority of children are at minimal risk from COVID-19, children with chronic illnesses or in lower socioeconomic settings are at slightly higher risk.  Because of difficulties navigating social norms amongst children, it challenging to tell children only the high risk should be wearing a facemask because segregating kids in such a way can lead to insecurities, bullying and other mental health consequences.  

It is crucial that communities increase their vaccination rates to lessen local transmission, while other measures are implemented in schools to further reduce risk of exposure, such as cohorting, improving ventilation and maximizing outdoor spaces. 

The CDC continues to miss the mark in helping Americans understand the risk of severe outcomes of COVID-19 in children.

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Since the mantra during the pandemic has always been to "follow the science," unless there is overwhelming new evidence showing children wearing facemasks in a school setting where the adults are vaccinated significantly lessens viral transmission and saves lives, mask policies should be reserved for high-risk scenarios based on local infection rates with clear metrics of when they should be instituted and removed. 

The best way to protect our children is to get vaccinated and allow them to return to school without masks so they can resume some level of normalcy.

The opinions expressed in this op-ed belong solely to the author and not her employer.

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