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By Kelly Kries, MD
As a pediatrician, I truly wish masks worked. To stop the devastation of the coronavirus with something so simple would be monumental. Sadly, they don’t, and imposing masks on children makes no sense according to the data.
We were told by many experts last summer that if we had “80% compliance with masking for 6 weeks” that “we could make this virus go away.” Masks were even said to be better than vaccines. Personally, I was hopeful that this intervention with large scale compliance might work. In fact, when working with patients, I wore two masks before it was cool for most of July and August of last year!
Fast forward a year later and we as good scientists have to ask ourselves: Is there any evidence that masks made a difference? Can a mandate be justified?
The evidence is clear. Masks should have been tossed aside and NEVER mandated, especially in schools. Why?
1. COVID is aerosolized
The WHO and CDC finally acknowledged this spring the notable role of aerosolized viral particles that are the size of cigarette smoke (~0.3 microns). Therefore, it is no surprise to read that surgical and cloth masks DO NOT work on such tiny particles. Additionally, cloth masks may make spread worse.
2. COVID spreads in a seasonal geographic pattern
The fact that we observed identical patterns of COVID rates in similar climate regions is probably the most blatant evidence that masks did very little to stop the spread. This is what I call “what happens in reality” evidence. Many states had nearly identical curves despite having vastly different mitigation strategies. For example, Kentucky, Tennessee, Missouri, Illinois, and Indiana all had very similar case rate curves (see CDC COVID-19 data tracker) despite their differences in masking policies and adherence. Nothing can explain the similar curves except that COVID is seasonal and will be triggered to increase for still unclear reasons (like humidity or the susceptibility of hosts).
3. Children infrequently spread COVID
Unlike most other respiratory viruses, children have not been the super-spreaders of COVID-19. In fact, studies out of Hong Kong, Iceland, Norway, Germany, and Israel show that children are much less likely to contract and spread COVID.
4. Children are at low risk of bad outcomes
Thankfully, children have been largely spared from the harms of COVID. Out of 75 million children in the United States, there were only 335 deaths over the past 16 months and nearly all had significant pre-existing health conditions.
Even the much discussed MIS-C syndrome has occurred in only about 3,000 cases, which is very similar to what we see yearly with its cousin Kawasaki disease. Additionally, hospitalizations in children were shown to be overestimated by 40% in two recent studies once records were more closely analyzed.
5. There is no difference in COVID infection rates between masked and unmasked schools
What’s most disturbing is the absence of evidence for masking children in the school setting. And yet, the CDC is calling for all children K-12 to be masked - even if they are vaccinated. Luckily, a COVID-19 national school response database was compiled by Dr. Emily Oster at Brown University. Her own analysis of that database found no correlation between mask mandates and COVID-19 infection rates in schools.
In addition, there are numerous studies from multiple states and all over the world that show no difference in rates in schools with or without masks. Many countries such as Denmark, Norway, and the Netherlands do not generally wear masks in school. My favorite is Sweden that had no social distancing, no masks, no hybrid and had no pediatric deaths AND a lower overall rate than the United States.
If it doesn’t hurt and could possibly help, why not wear a mask?
The answer to that question is that masks do have significant consequences—both psychological and physical. Masks isolate us and dehumanize us, which is likely why we’re seeing the considerable spikes in anxiety, depression, drug overdoses, and suicide attempts. Because seeing facial expressions is so important to a child’s development of language and communication skills, Public Health England has issued a “strong recommendation for primary school children not to wear masks.”
Also worth mentioning is that wearing masks impacts concentration and causes headaches in our children. Several studies have demonstrated significant amounts of bacteria growing on the masks and increased yeast in mouths.
But didn’t masks stop the flu and RSV?
It is true we saw very little flu and RSV this past winter. But correlation does not equal causation. The levels of these two viruses dropped months before we were widely using masks or other mitigation strategies. We saw very little influenza and RSV likely because of a well know phenomenon since the late 1800’s called viral interference. Viruses compete for the same receptors and hosts. It was observed that in 2009 that swine flu did not circulate very well because it was outcompeted by a rhinovirus that year that made individuals impervious to the swine flu. We are now seeing RSV reappear because COVID-19 levels dropped to a level that it no longer outcompeted RSV and other respiratory pathogens.
At the end of the day…
Your mask DOESN’T protect me. For that matter, your mask doesn’t protect you either, and masking children harms them. Mandates satisfy the politicians' itch to appear as if they are “doing something” in response to the virus. Masks also serve to maintain the façade of a perpetual pandemic, therefore allowing emergency powers to remain in place.
We must fight mask mandates, especially of school children. If they try to obstruct our children’s breathing this year, they must PROVE that masks work…and trust me, they will lose.
Kelly E. Kries, MD, practices at Bowling Green Internal Medicine and Pediatrics in Bowling Green, KY. You can follow her on Twitter at @Kelly_Kries.
Editorial comments by Thomas Davis, MD:
The evidence that the CDC presents in support of masking children is based on low quality evidence. For example, its first referenced study reported on two hairstylists in Missouri who wore a mask while they were symptomatic and found that none of the interviewed clients developed COVID symptoms. A high schooler could have easily produced a research study of this caliber.
This is a far cry from the gold standard of medical research, which is a randomized controlled trial. Hypocritically, the CDC props up its own low quality data while simultaneously dismissing the only two randomized studies looking at masking. Is this because those studies did not support the CDC's desired conclusion?
Frankly, the medical research community has completely failed school children during the COVID-19 pandemic. While it has done an overall good job performing randomized studies on other therapies such as vaccines and steroids, the medical community has forced schools to make decisions based on incomplete data. This inaction over the past 20+ months is inexcusable given the known harms of masking children -- particularly young children.