Public Health Experts Warn Against Premature End of School Mask Mandates

With several Democratic governors heeding the calls of what public health experts call a "vocal minority" and doing away with school mask mandates, epidemiologists and physicians from across the U.S. are warning that ending Covid-19 mitigation measures as thousands of Americans are still dying each day will "will inevitably lead to a rise" in cases.

In an open letter written Wednesday and spearheaded by four experts at Columbia University, nearly two dozen public health researchers and practitioners expressed concern that calls from "pundits on cable news and national media outlets...for mask 'off-ramps'" have pushed the governors of New Jersey, Rhode Island, and Connecticut to announce end dates for school mask mandate despite ongoing risk.

"The best way to address fatigue from the pandemic is to implement evidence-informed strategies we know reduce Covid-19 transmission."

"These calls... are not guided by rigorous accumulated scientific evidence. Removing indoor mask mandates by a particular date--as opposed to tying them to a threshold of community transmission and hospitalizations--is unscientific," wrote the experts, including Drs. Seth Prins of Columbia, Uche Blackstock of Advancing Health Equity, and Julia Raifman of Boston University.

The letter was publicized days after New Jersey Gov. Phil Murphy, who has for the past two years imposed some of the nation's strictest Covid-19 mitigation measures, announced the state's school mask mandate would end in March, around the time that other Democrat-led states including Oregon and Connecticut plan to stop requiring masks in schools.

Murphy suggested this week that his decision was a response to widespread calls to end universal masking in schools, saying, "The overwhelming sentiment on both sides of the aisle is we want to get to a place where we can live with this thing in as normal a fashion as possible."

"The end of mask mandates while new cases remain this high is as much politics as it is public health," tweeted Dr. Abraar Karan, an infectious diseases physician at Stanford University. "And it is probably more of the former."

The experts in Wednesday's letter argue that public eagerness to regain a sense of normalcy does not mean people want to end public health safety measures prematurely.

"Recent public polling data indicate that seven in 10 Americans support mask mandates to slow the spread of Covid-19," wrote the experts, citing a survey conducted in early January by research group Navigator. A separate poll taken last month by Monmouth University found that 52% of respondents still supported mask mandates.

The letter pointed to evidence that young students themselves are in favor of continuing to require universal masking in schools, with adolescents in several school districts staging walkouts and circulating petitions to demand greater public health protections.

Also on Wednesday, Boston Mayor Michelle Wu posted a photo on social media of high school students expressing disagreement with Massachusetts Gov. Charlie Baker's recent decision to end the state's school mask mandate on February 28.

The decision to end mask mandates goes against the advice of the American Academy of Pediatrics (AAP), wrote the experts, which "currently recommends universal masking in school, with an emphasis on indoor masking."

According to the AAP, two million of the nation's 12 million total pediatric Covid-19 cases occurred in January 2022.

"Strikingly, roughly 2.4% of all Covid-19 hospitalizations are among children," the experts wrote Wednesday, adding that the disease is now the sixth leading cause of death among school aged children, having killed more than 900 children since the beginning of the pandemic.

"It is incongruent to see calls for the removal of masking as the most recent seven-day death toll average exceeds 2,500 and the U.S. passed 900,000 total deaths from Covid-19 just last week, a higher rate per capita than any other wealthy nation," they wrote. "The normalization of preventable deaths should not guide our policy choices. The best way to address fatigue from the pandemic is to implement evidence-informed strategies we know reduce Covid-19 transmission."

The experts' call was echoed by doctors and scientists on social media, some of whom noted that the push to end mitigation measures for school children is coming as the Food and Drug Administration (FDA) appears poised to approve a low-dose Covid-19 vaccine for children under the age of five. An FDA advisory panel is set to meet next week to make a recommendation regarding emergency-use authorization.

"It would be detrimental to remove indoor mask mandates while community transmission is still so high, especially given that rates of vaccination uptake among children ages five to 11 years old are low, and before children under the age of five years have a vaccine approved for emergency use," wrote the experts. "The removal of indoor mask mandates in schools by an arbitrary date is premature and threatens to place children, their school communities, and their families at greater risk for illness, disability, and death."

Instead of tying the end of mask mandates to demands by the minority of Americans who are ready to end them, the letter continued, "calls to end universal indoor masking in schools should, at minimum, be grounded in good quality data and clear metrics. Those benchmarks, they said, shoulkd include:

• High rates of vaccine uptake among all eligible children and adults within a school community;
• Low community Covid-19 prevalence; and
• At least moderate hospital capacity.

With only 22.6% of children ages five to 11 vaccinated and current transmission rates high across the U.S., the experts said, the end of school mask mandates is likely to result in a rise in cases.

"'Learning to live with the virus' means using data--not arbitrary dates--to accurately assess risk," said the doctors. "Universal indoor mask mandates for schools are an effective and evidence-informed strategy to reduce rates of preventable illness, disability, and death among children across the country."