Vol. 270 January 15, 2022 Masks and School Kids

The issue of school kids wearing masks that reduce the spreading of COVID droplets is all tangled up in the polarized confrontations between teacher’s unions, school administrators, and angry parents who are accosting elected school committee members. Here are some reasons people reject mask wearing for school children, and why they don’t hold water? (pun intended)

Kids won’t wear masks.
Experienced pediatricians know that even three year olds will wear masks if their parents and other adults around them wear masks. This is consistent with the recognized adaptability of young children, even infants, to accept and cope very well with missing limbs, casts, or braces as they accept what they think is “normal”. If a classroom has only some children masked, the concept of what is normal is much more unclear to the child. Would school children in a “mixed masked” classroom learn to distrust science, to receive one of their first formal lessons in polarization? It reminds me of the story of the Pre-K children playing in the backyard wading pool when one of the boy’s suit drops off and a girl turns to another and says, “I didn’t know there was that much difference between Catholics and Protestants.”

There is no randomized controlled trial (RCT) research study that shows that masks on kids reduce infection.
True, but it is extremely difficult to do a reliable RCT of a healthy population when the subjects in the untreated (unmasked) arm in the study have the potential risk of dying or serious illness, when there are known preventative steps for the illness, and when so many other variables have to be eliminated by direct observations (video cameras with hours of analysis to follow). Also, you may not realize it, but there is no randomized controlled trial of the benefits of a school education! The familiar comparison of lifetime incomes between high school and college graduates is merely a litany of association. Perhaps the international Happiness Index of countries might be a better measure of the effectiveness of education.

So many variables would need to be controlled in such a RCT study. For example: “It is important to note that any commentary on the impact of face mask use during the pandemic needs to include some overarching psychological factors that may contribute to mask-wearing attitudes and behaviors. Several other factors include altruism, self-efficacy, risk assessment, need for control or certainty, self-serving bias, perceptions of fairness, ability to engage in hot vs. cold cognition, short-term vs. long-term orientation, restraint vs. indulgence, trust in science, socioeconomic status, education level, personal experience, and other personality or physiological individual differences. Commentary Sept. 2020 Oh, there’s that issue of “trust in science” again.

Everyone is going to get infected eventually.
I think that this is probably true with the Omicron variant. Let’s all get vaccinated, suffer our mild illness, develop herd immunity, and get on with life like we do with the flu. We may even benefit from a booster shot every year just like the flu. One of the problems with this train of thought is the risk of developing long haul syndrome, the incidence of which and its true burdens are not known.

Masks interfere with learning or cause other clinical problems
Multiple studies of masking in children and adults have shown no significant oxygen reduction, no increase of carbon dioxide trapping, no negative effect on respirations (except for the severe asthmatic), no effect on lung development, and no delay of speech and language development (blind children develop speech and language skills as fast as the seeing. Complaints of facial heat and skin irritation are real, but mild and easily remedied.

 “It seems that the potentially life-saving benefits of wearing face masks would largely outweigh the discomforts for most individuals. So why is there so much wide-spread resistance to wearing masks, when doing so seems to have only minor physiological drawbacks? The answers might lie in the psychological impact of wearing a mask during the COVID-19 pandemic. Specifically, theoretical evidence suggests that mask wearing may have important implications for meeting basic psychological needs, such as feelings of competence, autonomy, and relatedness.” [feelings of the PARENTS, I would add]

Post-script medical fun fact TIP: If you wish to use a N95 mask buy one made by 3M or DemeTech. A significant volume of Chinese-made KN95 masks do not meet U.S. standards, are less protective, and are referred to as “counterfeit”. KF94 or kn94 masks (both adult and children sizes) made in South Korea reportedly meet U.S. standards.

One Response to Vol. 270 January 15, 2022 Masks and School Kids

  1. Jim McSweeney says:

    The problem with RCTs is that the “masked”
    participants don’t wear their masks 24/7 and never will. I wore a fitted N95 mask while visiting an active TB patient and could not last more than 15 minutes. Surgical and cloth masks are more of a decoration than an effective barrier to a small inoculum of viral particles. I suspect the masked subjects also more attentive to other variables, e.g. handwashing,
    handshaking, and other confounding variables.

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