The American Academy of Pediatrics recently released new COVID-19 guidance that called for students and school staff over the age of 2 to wear masks in the school setting, regardless of their vaccination status. This marked a departure from the CDC which recently updated its school guidance to recommend that only unvaccinated students and staff wear masks in schools.
Why Was This Recommendation Made?
In the guidance the APA explained the thinking behind this recommendation was:
- a significant portion of the student population is not eligible for vaccination
- protection of unvaccinated students from COVID-19 and to reduce transmission
- lack of a system to monitor vaccine status among students, teachers and staff
- potential difficulty in monitoring or enforcing mask policies for those who are not vaccinated; in the absence of schools being able to conduct this monitoring, universal masking is the best and most effective strategy to create consistent messages, expectations, enforcement, and compliance without the added burden of needing to monitor vaccination status
- possibility of low vaccination uptake within the surrounding school community
- continued concerns for variants that are more easily spread among children, adolescents, and adults.
The guidance notes that an added benefit of universal masking is protection of students and staff against other respiratory illnesses that would take time away from school.
What Do Experts Think of the Guidance?
Dr. Richard Webby, a virologist at the St. Jude Children’s Research Hospital, agreed with the APA guidance on masks. “I think it's really driven by this Delta variant,” he says. “There's no doubt if classes go back to in class learning with no masks, this virus is going to tear through schools.”
In addition to cutting down on the spread of the virus, masking can limit the number of students that need to be quarantined if a classmate contracts the virus, he says.
Dr. Gigi Kwik Gronvall, an immunologist at the Johns Hopkins Bloomberg School of Public Health, says geography and local infection rates will also be a factor going forward. “It really will depend on the particular area that we're talking about whether or not masks are important for COVID,” she says. “But will they work? Will they help? Yes.”
“CDC needs to change their guidance too,” Dr. Leana Wen, an emergency physician and professor at George Washington University and CNN medical analyst, Tweeted in support of the APA guidance. “If there is no proof of vaccination, and vaccinated & unvaccinated people are mixing, indoor masking need[s] to be required.”
But Why Should Vaccinated Students and Staff Wear Masks in Any Instance?
Gronvall says that when considering whether vaccinated students and staff should still wear masks, it’s important to remember how vaccines work. “It's not some sort of protective gear that prevents something from coming in,” she says. “It's an education program for your immune system so that if you actually get infected and the virus gets into your body and starts making copies of itself, your immune system sees that and takes care of it.”
Depending on the exposure level and each person’s unique anatomy, fighting off the virus may take more time and effort for your immune system.
“The best-case scenario is that you don't even need to use your vaccine, that you never get exposed; your immune system is ready, but there's no intruder,” says Gronvall, who still wears a mask in public indoor settings despite being vaccinated. “People who have been vaccinated right now they're doing very well against all the variants, including Delta, but it's still a process.”
Additionally, there are questions about how infectious vaccinated individuals are and about whether immunity could eventually wane.
“We don't really have a good handle yet on how much a vaccinated individual can actually transmit the virus,” Webby says. “We don't think it's a lot, but it's probably not zero.”
He adds, “Teachers were one of the earlier groups of people to get vaccinated in some places. If there is such a thing as antibody waning, immunity waning over time, maybe they're a little bit further out from their vaccination, so the virus can replicate just a little bit better.”