Kids can, and should, wear masks in schools

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The NSW Deputy Premier’s dismissal of Victoria’s new children’s mask policy as “ludicrous” reminds us that masks have a history of being at the top of a long list of vexed COVID issues.

A similar hysterical tone surrounded the debate in using masks for adults not long ago. Just as things changed for adults, so they will for kids.

Victorian students from grade three and up will be required to wear a mask in classrooms when face-to-face learning resumes.Credit:AP

Obviously, a mask works just as well for a child as it does for an adult – a piece of fabric doesn’t suddenly stop blocking respiratory particles just because a child wears it.

I’ve seen the politicisation of mask wearing firsthand. Back in March 2020, I wrote an article that, for the first time in the English-speaking press, made a call for everyone to wear masks.

Over the coming weeks I heard repeatedly why this would never work: people won’t comply; masks don’t work; they lower immunity; COVID is going away; people can’t breathe; mandates can’t be enforced; more face touching, etc.

In April 2020 I led a team that studied the evidence for masks, and our paper showed that yes, they work. Since that time, our analysis has helped universal mask-wearing catch on all around the world.

Children arrive at school wearing masks in Florida, US.Credit:AP

Australia was one of the last countries to take our advice, but eventually masks made their way over here too (although most are still wearing the wrong type).

Victorian kids from year 3 will be required to wear masks at school, and masks are “strongly recommended” for younger children. While this is going to take an adjustment to get used to, it is worth doing. It’s true that severe illness is far less likely than in adults, but if unchecked there could be millions of infected Australian children, over 10,000 kids in hospital, and far more with debilitating “long COVID”.

Of course, kids can also transfer COVID to others in their household, who may be much more vulnerable than they are. Keeping infections low at school is essential, including simply to keep schools open.

Recently I returned home to Australia after living in San Francisco, where masks are mandatory at schools for children aged two and over. The American Academy of Pediatrics recommends masks for all schoolchildren. At first, many San Francisco parents I spoke with were concerned that this wouldn’t be workable. But already, after just a few months, it’s become totally normal.

Los Angeles school students wear masks in April. Similar scenes await Victorian classrooms later this month.Credit:AP

The results have been stunning: in San Francisco schools there have been only seven cases of transmission this year. Contrast that to England, where last week 270,000 schoolchildren were infected. Of those, around 1 per cent may be hospitalised, with far more developing long COVID that make day to day life hard to cope with. Over 10,000 English children have had symptoms for over a year. Of course, it’s not just about masks, but they are a critical part of the recipe for success.

In reaction to the masks announcement we’ve heard the same discredited criticisms made a year ago– criticisms that have been debunked many times. Masks are just as effective for children as adults. Masks do not make it hard for children to breathe. Children really can wear masks – 90 per cent compliance was measured in North Carolina.

For children with specific needs or disabilities that prevent the wearing of masks, this won’t be required. It is about taking a child centred and common-sense approach.

In Australia, we have experience with new clothing requirements: “No hat, no play”. We know children can deal with change. We’ve seen how children are often more adaptable than their parents. They learn to wear shoes and socks, eat vegetables, and use the toilet. Masks are no different.

Primary school students wear masks in class at a school in Oakland, California. Credit:AP

Like with all rules at school, there will be some children who don’t comply. That’s OK – learning to follow rules is part of school life.

Vaccinating parents and teachers won’t be enough on its own. Vaccination reduces transmission by around 50-70 per cent, with effectiveness better soon after immunisation, but waning over the ensuing months.

Vaccinations are coming to children under 12 soon. Why wouldn’t we do what we can to keep them safe until they can get vaccinated?

Epidemiologists know that in an unprotected, unvaccinated population, such as primary schoolers, nearly everyone will get infected eventually. Seventy-five per cent of schoolkids may get infected in three months in the absence of vaccines and masks. It would be a tragedy if we needlessly let that happen in Australia when vaccine availability is just around the corner early next year.

Even with high vaccination coverage, and even more so before then, there is no one “fix-all” for COVID-19, multiple controls need to be used in parallel.

As the UK shows us, COVID will burn like wildfire through this cohort at school without strong control measures.

And the simplest, most effective control is a mask.

Jeremy Howard is a distinguished research scientist at the University of San Francisco, and a member of OzSAGE.

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