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  • A new study from the CDC found that COVID-19 cases in children increased more in counties where schools did not require masking than they did in those areas where universal masking was mandated.
  • In areas with no mask mandates, there was an average of about 35 new pediatric cases per 100,000 children.
  • This is compared to roughly 16 new pediatric cases per 100,000 children per day in counties requiring masks in school.

New research from the Centers for Disease Control and Prevention (CDC) finds that school mask mandates may protect children in classrooms from COVID-19.

According to the CDC study, case rates in children increased significantly in counties where schools did not require classroom masking than they did in those areas where universal masking was mandated.

Pediatric COVID-19 cases twice as high in counties with no mask requirement

The CDC studied pediatric COVID-19 case rates from 520 counties where mask rules were consistent in all schools, and were applied to either all students or none of them.

The CDC adjusted findings to control for child vaccination rates at this level, but excluded vaccination rates for teachers and school testing data. 

In areas with no mask mandates, there was an average of about 35 new pediatric cases per 100,000 children each day over a 2-week span, according to the study findings.

This is compared to roughly 16 new pediatric cases per 100,000 children per day in counties requiring masks in school.

Dr. Eric Cioe-Peña, director of global health at Northwell Health, New Hyde Park, New York, told Healthline that the Delta variant is a potential factor in these findings.

“Delta has increased infections in children,” he said. “There are higher levels of virus in respiratory secretions, and this is a big difference in children compared to Alpha.”

Lower cases in schools that mask and use other interventions

“There’s no question that counties without school mask requirements tend to have larger increases in transmission than those schools with mask requirements,” said Dr. Henry Bernstein, pediatrician at Cohen Children’s Medical Center in New Hyde Park, New York.

He added that there are lower daily case rates of pediatric COVID-19 in those schools that use masks as well as other, non-pharmacological interventions.

“Like ventilation in the school, proper cohorting, social distancing, screening those who are symptomatic — and most importantly emphasizing the importance of vaccination,” he said.

According to the CDC study, school mask requirements, in combination with other prevention strategies, including COVID-19 vaccination, are critical to reduce the transmission of COVID-19 in schools.

Study had several limitations

According to researchers, the findings are subject to limitations that include:

  • This was an ecologic study, a type of observational study that can’t prove causation.
  • Researchers say that pediatric COVID-19 case counts and rates included all cases in children and adolescents under 18 years old, and a later analysis will focus on cases in school-age children and adolescents.
  • County-level teacher vaccination rate and school testing data weren’t controlled for in their analysis, which will be done in future research.
  • They used a small sample size of counties for the analysis, so the findings might not be generalizable.

Protecting children in schools without mask mandates

When asked what parents with children in schools with no mask requirements can do to protect them, Cioe-Peña advised, “In order of decreasing effectiveness: lobby for rule changes. Move to a district that requires masking. Mask their children anyway.”

Bernstein noted that we have to use “all the tools at our disposal.”

“I think that teachers and other staff within schools need to recognize that children can be infected with the SARS-CoV-2 virus,” he said.

He emphasized that children can have symptomatic COVID-19 disease and end up requiring hospitalization, and pointed out that “children can also develop a multisystem inflammatory syndrome (MIS-C).”

Make mask use fun, but practice what you preach

According to Bernstein, while it’s important to teach proper mask use, parents need to lead by example.

“I also think that they can also consider [using] fun mask designs at times,” said Bernstein.

“But I think parents need to role model mask wearing and teach kids to avoid touching their face,” he continued. “Encourage them to do good handwashing and practice physical distancing.”

How long before a vaccine for children is available?

Bernstein, who’s an immediate past member of the CDC Advisory Committee on Immunization Practices (ACIP), said there are many steps to approval.

“Vaccine manufacturers present their formal study data for different age groups to the FDA,” he said. “There’s an independent advisory committee of the FDA, known as VRBPAC, that makes recommendations to approve or authorize a vaccine for emergency use.”

Next, he said, the FDA recommendation goes to ACIP, which makes “clinical considerations for the American population based on its underpinnings of science, implementation, and equity.”

For those impatient to protect their children, he warned that it takes time to review the available science and data.

“Because we want to ensure that the safety, immune response, and efficacy of these vaccines are carefully taken into account,” he explained.

However, Bernstein also said the timeline seems to be moving quickly.

“I expect a lot of activity over the next 4 to 8 weeks with these different vaccine products for different age groups, especially younger children,” he said.

The bottom line

A new CDC study found that schools without masking requirements experienced significantly greater cases of COVID-19 in students.

Experts say that the Delta variant has increased cases in children, and causes a much higher level of virus in their respiratory passages.

They also say besides mask use, we need to use all the tools at our disposal to prevent disease transmission, including social distancing, handwashing, and vaccination once it’s available for younger children.

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