After nearly two years of COVID-19-induced restrictions, millions of people鈥攊ncluding students and staff in K-12 schools鈥攁re ditching their masks.
But even as the omicron surge eases, and case counts fall, along with hospitalization and death rates, there are public-health experts who think the move to unmask indoors鈥攊ncluding in schools鈥攊s premature. They worry that the most vulnerable populations could pay the steepest price.
鈥淧eople are tired of masking. But the problem with that is, some people are going to suffer ill effects. There will be outbreaks,鈥� said Mercedes Carnethon, who heads the department of preventive medicine at Northwestern University鈥檚 Feinberg School of Medicine. 鈥淐ommunities of color have seen a disproportionate impact of lives lost and significant health problems.鈥�
States are quickly dropping their universal mask mandates for schools. Earlier this school year, 18 states had such requirements, but now it鈥檚 down to nine, according to EdWeek鈥檚 mask tracker. By the end of this week, only five states and the District of Columbia will still have such rules in effect.
The U.S. Centers for Disease Control and Prevention loosened its masking guidance in late February, clearing the way for thousands more counties to meet new mask-optional thresholds. And reports that as of March 1, 52 percent of the nation鈥檚 500 largest school districts do not require masks, a 46 percent increase since Feb. 4.
Some experts argue that mask requirements are becoming less important as new cases, hospitalizations, and deaths from COVID-19 plummet, and nearly three-quarters of the population鈥攂y 鈥攈as some degree of immunity because they鈥檝e had the virus or been vaccinated.
Dr. Leana Wen, a professor of public health at George Washington University, has been among the voices pressing the CDC to ease its COVID rules. 鈥淧andemic restrictions were always meant to be temporary鈥攖here needs to be a clear off-ramp that鈥檚 realistic & takes into account widespread availability of vaccines鈥� for children 5 and older, she on Feb. 8.
Taking a 鈥榙ial-up, dial down鈥� approach
Even those who favor relaxing COVID mitigation protections, though, don鈥檛 necessarily advocate dropping them altogether.
The PolicyLab at Children鈥檚 Hospital of Philadelphia revised its in January to 鈥減rioritize normalization鈥� of school life by dropping required weekly testing of asymptomatic students and staff, and letting those exposed to COVID stay at school, masked, if they have no symptoms. That guidance, however, didn鈥檛 recommend dropping masks altogether.
Dr. David Rubin, the PolicyLab鈥檚 director, said the trick is to link schools鈥� responses to local data, dialing up mitigation strategies like masking when there is greater risk of serious illness, and dialing them down when that danger fades. In less-risky times, families can choose what protections to use, guided by local health department data, he said.
鈥淭here was a period of time we were trying to eliminate all exposure risk, and it was incredibly important to do that. The risk was that significant in terms of severe disease,鈥� Rubin said. 鈥淏ut we鈥檙e not in that situation anymore.鈥�
Other public health experts urge more caution.
鈥淚t鈥檚 better to keep masks on a month too long than take them off a month too soon,鈥� said William Schaffner, a professor of preventive medicine and health policy at Vanderbilt University鈥檚 school of medicine. 鈥淚t鈥檚 not a matter of whether鈥� mask requirements should ease, he said, 鈥渋t鈥檚 more when and how.鈥�
Communities should choose mitigation strategies geared to their local metrics, such as new cases, COVID-specific hospitalizations, intensive-care-unit admissions, and deaths, he said. But it鈥檚 important that they wait and see that those trends are holding steady for eight to 12 weeks before peeling back protections, Schaffner said.
To complicate matters even more, a shows that the low-dose version of the Pfizer-BioNTech vaccine is less effective at protecting 5- to 11-year-olds against infection than the higher-dose version given to older kids and adults. The lower-dose vaccine did provide strong protection against serious illness and hospitalization, but offered almost no protection against infection from the omicron variant, the data show. Pfizer鈥檚 COVID shot is the only one currently authorized for use in the 5- to 11-year-old age group.
鈥業t鈥檚 not back to the old normal鈥�
Dr. Ezekiel Emanuel, one of the doctors who advised President Joe Biden on COVID as he prepared to take office, said it鈥檚 understandable that people are exhausted from two years of masks and other restrictions. But he doesn鈥檛 think the virus has eased enough yet to cast all caution to the wind.
鈥淭he jump to getting rid of masks is a little premature,鈥� Dr. Emanuel said. 鈥淭hings are improving, but they鈥檙e not improved enough.鈥�
Schools must focus energy on improving air quality, increasing vaccine uptake, and having some kind of COVID testing protocol in place to gauge the virus鈥� shifts, Dr. Emanuel said. Children and staff with medical conditions that make them vulnerable to serious illness must have access to high-quality masks.
鈥淚t鈥檚 not back to the old normal,鈥� he said. 鈥淭hat line of thinking is wrong.鈥�
As districts increasingly shoulder decisionmaking for COVID protections, some might find they need different policies for different schools. Dr. Carnethon noted that in Chicago, which reports individual schools鈥� vaccination data, some schools have rates of over 70 percent, while others dip as low as 15 percent. The less-vaccinated schools, she said, are typically in lower-income communities of color.
Schools that drop mask mandates must be prepared to provide adequate protection for students and staff who need it, said Tanji Reed Marshall, who oversees K-12 practice for The Education Trust, a group that advocates for marginalized populations. That might go beyond simply providing masks; It might involve making a plan to protect one at-risk student by having their teachers wear masks, she said.
鈥淲hat this should look like is schools really understanding their populations,鈥� Reed Marshall said. 鈥淭hey need to make a clear record of who will be most at-risk if masks mandates go away, and put safety plans in place for those people.鈥�
Patterns of disparate vulnerability found nationwide
A shows that the Black community has suffered a disproportionate share of COVID-19 deaths, and the Latino community a disproportionate share of cases, relative to their presence in the overall population.
Over the course of the pandemic, Black and Latino people have been less likely to be vaccinated than white and Asian people, although that disparity has now disappeared for Hispanics, according to another Kaiser analysis. The CDC doesn鈥檛 track children鈥檚 vaccination by race, but Kaiser, analyzing state data, found that Black children are less likely to be vaccinated than children in other racial groups.
Attitudes toward COVID mitigation have shown distinct patterns that reflect how hard-hit some racial groups have been. When the what their schools鈥� COVID mitigation policies should be, 6 in 10 white parents said students and staff should wear masks, but that figure rose to 8 in 10 for Black and Latino parents. Similar patterns emerged in a : parents from Black and Latino families, and those who earn less than $75,000 annually, were far more likely to worry their children would get seriously ill from COVID.
But people鈥檚 attitudes toward COVID risk are shifting, too, as the omicron surge eases. In an , only 47 percent of parents said they think it鈥檚 a moderate or big risk to send their kids to school or daycare, down from 63 percent two weeks earlier.
That doesn鈥檛 mean there鈥檚 a stronger consensus on how to respond to the improving picture, though.
The Axios/Ipsos poll found deep divisions, with each of these choices getting agreement from 20 to 30 percent of respondents: all protections should be kept in place; all protections should be dumped; some requirements should be eased; mask and vaccine requirements should be stepped up.
As school districts figure out their own responses to mask policy, Reed Marshall urged them to bear a guiding thought in mind.
鈥淲henever there are policies put in place, there are always, unfortunately, those who benefit more than others,鈥� she said, 鈥渁nd the person who is most vulnerable is always going to bear the brunt of what is decided.鈥�
