State remains mum on whether school mask mandates will return
Public health experts urge indoor face coverings for unvaccinated students
FOR MONTHS, there was hope that by the time children returned to school this fall, they could be vaccinated against COVID-19. But with approval of vaccines for children still months away, many public health experts believe students – particularly in elementary school – need to continue wearing masks inside school buildings. The topic is becoming a significant debate in Massachusetts, where the Baker administration has not yet imposed any statewide COVID-related precautions on schools this fall.
“Masking in schools until we can ensure we’ve reached a critical mass of children [with vaccines] is almost a no-brainer,” said Vincent Chiang, chief medical officer at Boston Children’s Hospital, at a legislative hearing Monday.
The Legislature’s Joint Committee on Public Health and Joint Committee on COVID-19 and Emergency Preparedness and Management held a hearing Monday at the Museum of Science, with many committee members participating virtually, on COVID-19 vaccinations for children. They invited 30 speakers to participate, primarily experts in pediatric health care. Committee chair Rep. Marjorie Decker, a Cambridge Democrat, said the Department of Elementary and Secondary Education was invited to testify, but chose not to, a decision Decker said she was “baffled” by. (Education officials said the Office of Health and Human Services testified on the administration’s behalf.)
Much of the hearing focused on how vaccines will be rolled out once they become available to children under 12. Secretary of Health and Human Services Marylou Sudders said the state is primarily focused on administering vaccines through pediatric and primary care doctors and school-based clinics.
But the reality is as school begins, many children will remain unprotected against the deadly virus. Sudders said today in Massachusetts, 58 percent of 12 to 15-year-old children have had at least one dose of a COVID-19 vaccine, and 64 percent of the 16 to 19-year-old population has had at least one shot.
Children under 12 remain ineligible, and on Sunday, former FDA commissioner Scott Gottlieb, who sits on the Pfizer board, said on CBS News’ “Face the Nation” that it will likely be mid-winter before a COVID-19 vaccine is approved for children ages 5 to 12.
Gottlieb said clinical trial data is expected to be available in September from a trial using a lower dose of the existing Pfizer COVID-19 vaccine on children, but the FDA has said it wants four to six months of data on those children who participated in the trial. Both Moderna and Pfizer started clinical trials on children in March.
Dr. Estevan Garcia, chief medical officer at Northampton-based Cooley Dickinson Health Care, said at the legislative hearing that data will likely come first from clinical trials for ages five to 11, followed by trials on ages two to five, then ages six months to two years. Dr. Paul Biddinger, vice chairman for emergency preparedness at Massachusetts General Hospital, said he hopes some FDA approval could come by October, but winter is a possibility.
So far, the Department of Elementary and Secondary Education has lifted all COVID-19-related precautions, even as all schools are required to return fully in-person this September. The agency said in May that it will develop additional guidelines over the summer, which could include masks for elementary school students. But so far, those guidelines have not been released.
The Boston Public School superintendent has announced that all Boston students and staff will be required to wear masks this fall.
Gov. Charlie Baker, speaking at a press availability after meeting with legislative leaders Monday, did not rule out mask requirements in schools, but said he wants to hear more guidance from the White House, the CDC, FDA, and other federal agencies. He said he is more interested in expanding the state’s pooled testing program, which let schools regularly test asymptomatic students and staff to catch COVID cases before they spread.
Biddinger, who also chaired Massachusetts’ COVID vaccination advisory board, said there is “strong logic” around that recommendation until there are higher vaccination rates among children. “We have to drive transmission back down,” Biddinger said.
Dr. Benjamin Linas, associate professor of medicine at Boston University School of Medicine and an infectious disease specialist at Boston Medical Center, said while last year there was debate about whether to return students to school in person, the question this year is how to do it.
Linas said one important lesson from last year was that mitigation measures – masks, three-foot distancing, and basic ventilation – work. Linas said he believes elementary schools should adopt indoor mask mandates and distancing where possible. In the older grades, where many students are vaccinated, mask mandates could fluctuate depending on case numbers and vaccination rates in the community.
Linas said he recognizes there is a cost to mask-wearing in children, and preventing vaccinated individuals from returning to fully normal life also has a cost – which is why he is recommending mask mandates that depend on vaccinations and community transmission. Allowing people to return to pre-pandemic life after vaccination has been held up as a “promised land,” he said. “If we snatch that away, it will take away a big reason to become vaccinated.”
Linas said he would also recommend getting rid of unnecessary precautions – quarantining objects, deep cleaning surfaces, outdoor mask mandates, and surveillance testing. While the state created the pooled testing program that Baker touted Monday, and many schools have implemented regular surveillance testing of asymptomatic individuals, Linas argued that the testing is mainly good for peace of mind and probably prevented very few infections, given the low rate of in-school transmission to start with.
Baker, asked about the public health experts’ testimony, said the facts around COVID are constantly changing. While epidemiologists agree masks are effective, he said, “You get into discussions about how, where and when, they tend to have different points of view.”
Some Democratic lawmakers have already been pushing Baker, a Republican, to institute a mask mandate in schools. Sen. Jo Comerford, a Northampton Democrat who chairs the public health committee, called indoor masking in schools a “no-brainer.” Sen. Becca Rausch, a Needham Democrat, wrote a letter calling on Baker to require masks indoors in childcare centers and K-6 schools next year.
Senate President Karen Spilka said Monday if case numbers keep rising, the Delta variant keeps spreading, and the CDC continues to recommend masks for unvaccinated individuals, policy makers “seriously need to think about” having unvaccinated students wear masks, whether they be children under 12 or unvaccinated teenagers.
House Speaker Ron Mariano said he is waiting to hear more from the CDC about when the vaccine will become available to children under 12 and “what masking requirements will be necessary to have a very productive school year.”
The public health experts say even once vaccines are available, it is unclear how many parents will vaccinate their children. Statistically, children are much less vulnerable to COVID-19 than adults. Chiang said while 14 percent of COVID cases nationally have been in children, less than 0.1 percent of COVID deaths were in children. Biddinger said of the 4 million children who have had the virus, fewer than 2 percent were hospitalized, and the death rate was less than 0.03 percent. There have been 4,000 cases of a rare multi-system inflammatory disease associated with COVID that affects children and 37 deaths from it, Biddinger said.
But medical experts say there are still benefits to vaccination of children.“While severe illness is uncommon, it can occur,” said Lloyd Fisher, president of the Massachusetts chapter of the American Academy of Pediatrics. There is some evidence that children may be vulnerable to long-term effects from COVID-19, even if they get a mild form of the disease. Experts also noted that children can transmit the virus, and having as many people vaccinated as possible reduces community transmission.
“Because we have a safe, well-researched highly effective vaccine, it makes sense for as many children as possible to receive it, to protect them and benefit children’s families and the community at large,” Fisher said.