Dr. Marc Siegel: COVID, schools and our kids – forget mask mania, teachers need to be vaccinated first

It's a sign that this debate is more politics than public health when mandates are applied to masks but not vaccines

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"Follow the science" is the adage coming far too frequently from government and the media. It sends a message that the speaker may know something that you don’t, something science based, or even irrefutable. And yet, when it comes to masks and mask mandates, the insistence that all kids mask up in schools and that everyone (immune and non-immune) mask up in close quarters in areas where the virus is spreading does not focus on the kind of mask used or how well cloth or surgical masks actually work at blocking the highly contagious delta variant.

Not only that, but mask mania is a diversion from the more effective tool, vaccination, and yet, not all teachers are vaccinated

Masks are useful for children but should not be used as an extra layer of protection so that some teachers can refuse to be vaccinated.

An overall strategy to keep schools open that makes the most sense is vaccination for all who are eligible, masking, distancing, good ventilation, and perhaps most important, regular rapid testing. Masking is a part of this strategy but vaccination is the most important part.

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No one has yet studied whether a cloth or surgical mask (even properly worn) presents an effective barrier to the delta variant or not. In fact, there is reason to believe it won’t help as much as with previous versions of the virus when you consider that this variant is several times more transmissible than the original SARS COV 2 virus and some studies have shown 1,000 times more virus early in an infection than the original virus. So many viral particles should be able to find their way through a cloth mask more easily. And a just released study from Clinical Infectious Diseases showed that the virus is far more aerosolized than we realized, making source control very difficult without at least higher quality masks such as N95 or FDA approved KN95 masks being used.

Previous mathematical models do indicate that masks play a role in decreasing viral transmission, but are far from perfect. 

Masks are useful for children but should not be used as an extra layer of protection so that some teachers can refuse to be vaccinated.

In fact, the very same science on the spread of the delta variant that politicians use to justify mask mandates actually call into question whether a cloth mask, a porous barrier that doesn’t generally fit a person’s face well, especially a young child’s face, will work well in stopping spread. 

A recent CDC study called for double masking for an effective protection in areas of increased spread, but that was pre-delta variant too. Can you imagine a 3-year-old struggling to wear a triple cloth or N95 mask? Some KN95 masks that have been approved by the FDA would seem to be a better alternative provided they are worn properly. 

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Don’t get me wrong, I do agree with Dr. Daniel Benjamin at Duke who told me he thinks that masks played a role in limiting school spread in North Carolina, Nebraska and Utah. These studies (Dr. Benjamin was a principle investigator) also found that young children (very poor spreaders of COVID – only 1% secondary spread from someone with COVID), were far more likely to spread COVID in the communities than in schools that obeyed three feet of distancing, masking and good ventilation. 

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But not only didn’t these population studies prove that the main barrier to spread was the mask, they also did not look at the effect of the delta variant, since it was not present in the U.S. at the time.

The only thing spreading faster than the delta variant of the SARS COV 2 virus these days is the fear-driven political response to it. 

The proof that this is more politics than public health is when mandates are applied to masks yet not applied to vaccines, which have been shown to dramatically decrease the severity of disease from the delta variant as well as slow its spread. None other than teachers union boss Randi Weingarten this past week refused to call for a vaccine mandate for teachers before flip-flopping, while at the same time openly promoting mask mandates for children. 

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These mandates are being put in place in Illinois, Denver, California, Louisiana, New York and many other school districts throughout the country. Noncompliance or protest could lead to school closure. This despite the fact that young children do not always tolerate masks.

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Last year, a frequently cited study by the Department of Defense looked at the impact of masks on mannequins placed on a plane to prevent the spread of SARS COV 2 particles sufficient enough to infect. Of course, these were mannequins, not humans, so the conclusions were merely suggestive. But even these mannequins have not yet been used to study the effect of masks to stop the spread of the delta variant.

Bottom line: recommend high quality masks in schools in areas with high viral spread, just don’t mandate them without the latest science to back it up.

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