With most students unable to be vaccinated by fall, the Centers for Disease Control and Prevention announced that even vaccinated students and teachers in K-12 schools should wear masks indoors to prevent the spread of the coronavirus.
The CDC recommends that “everyone in K-12 schools wear masks indoors, including teachers, students, and visitors, regardless of vaccination.”
“Now, with more cases in this country and our real effort to try and make sure that our kids can safely get back to in-person learning in the fall, we’re recommending that everybody wear masks for now,” CDC Director Rochelle Walensky said in a briefing on the change.
The announcement reverses the CDC’s earlier decision that fully vaccinated people no longer need to wear masks indoors, though shortly after the CDC initially relaxed mask rules, the American Academy of Pediatrics came out in favor of universal masking in schools.
At the start of summer, COVID-19 cases had been on the decline for more than four months and the Food and Drug Administration had just approved the Pfizer-BioNTech vaccine for emergency use among adolescents ages 12 to 16, clearing the way for secondary schools, at least, to be fully vaccinated come fall.
As summer has worn on, however, the number of children and teenagers contracting COVID-19 has more than doubled, in large part due to the spread of the Delta variant, which is more than twice as contagious as the original SARS-COV-2 coronavirus and which now accounts for more than 83 percent of all new COVID-19 cases. Walensky said new data on the Delta variant drove the CDC’s decision; studies of recent outbreaks have found the Delta variant can cause breakthrough infections and transmission in people who had already been fully vaccinated.
Only 30 percent of students 12 to 15 have been fully vaccinated, and according to the Infectious Diseases Society of America, the FDA has asked vaccine developers for more safety data and larger numbers of children to be involved in the trials needed to approve vaccines to protect children under 12. Experts now predict those vaccines for elementary and some middle school students may not be available until early 2022.
When the CDC relaxed masking guidance, Walensky said, “we had less Delta variant in this country, we had fewer cases in this country, and importantly, we were really hoping we would have more people vaccinated, especially in the demographic between 12 to 17 years old.”
Risk calculus changed for schools
The arrival of the Delta variation and the vaccination shortfall could put U.S. schools at greater risk for outbreaks when they bring students back for in-person classes, as the Delta variant has already sparked similar outbreaks in schools in the United Kingdom.
“We do know right now that there has been an increase in the amount of disease being seen in younger children,” said Tina Tan, a professor of pediatrics at Northwestern University, Feinberg School of Medicine in Chicago and a board member for the Infectious Diseases Society.
“In the majority of cases, these kids have either very mild symptoms to no symptoms at all, but that being said, there still are children that will go on and develop severe COVID requiring hospitalization,” Tan said. “So, you know, this notion that, ‘oh, it’s OK for kids to get COVID,’ is really a bad notion, because there are kids that will go on to develop severe disease, and just remember that they can also transmit disease to other people that are around them that may not be able to handle COVID as well as someone who’s healthy.”
U.S. Education Secretary Miguel Cardona said his agency supported the CDC’s tighter masking requirements. “Students are provided the best opportunity to learn and thrive when learning in person,” he said. “We must do everything to ensure that our students do not have to compromise any more of their educational experiences due to increases in community spread.”
The change also drew support from the nation’s largest teachers’ union. Said National Education Association President Becky Pringle:
“To ensure we have safe, equitable in-person instruction for every student in America, we must follow the science and listen to the medical experts at CDC.”
Guidance could ease fraught implementation
The CDC’s revision may bring more clarity and political cover for school and district leaders who have been embroiled in widespread and heated debates over whether they should require indoor masking and how they could implement a policy requiring masking for some, but not all, on campus.
“Superintendents, principals, teachers, and other school staff have enough on their plates without asking them to be detectives as well, figuring out who is vaccinated and who is not,” said Chip Slaven, the interim executive director and CEO of the National School Boards Association.
States and districts vary on how much flexibility to give. For example, revised rules in New Mexico will allow secondary school students who provide proof of vaccination to go without face coverings, while Hawaii’s new guidance calls for universal masking indoors and face coverings suggested for outdoors whenever students will be in crowds or closer than 3 feet apart for prolonged periods of time. Ohio won’t require masks, but its chief health official has strongly recommended districts require universal masking, the Associated Press reports. In Iowa, even as Gov. Kim Reynolds barred mask mandates in schools, individual district leaders urged their communities to keep up voluntary masking.
Daniel Domenech, the executive director of AASA, the School Superintendents Association, said he doubts the CDC’s revised guidance will stop those debates. “It’s likely to continue to be the same confusing lack of consensus that we’ve seen already,” he said.
“Back in June, when we saw states getting [the pandemic] under control—particularly when the vaccine came out for 12 years and up—it seemed like, wow, this is great; we’re going to be able to open school,” Domenech said. “And now what we’re seeing is a backlash against vaccinations, the continuation of a backlash against wearing masks, and people not providing the permission for children to be vaccinated.
“When school starts in September, when there are high infection rates, kids are going to start coming down with it [COVID-19],” he continued, “and schools are going to have to go back to quarantining, go back to closing schools, go back to remote learning.”
Extracurricular activities could be an incentive
Preeti Malani, the University of Michigan chief health officer and a professor of medicine for the university’s division of infectious diseases, said universal masking could be critical to helping students not only get back to school in person safely, but to restart extracurricular activities that students have largely missed for the last 18 months.
“The [extracurricular] space is so important and those connections are so important, what I’m really focused on is not so much, ‘you can’t do this, you can’t do that,’ but how can we do things safely? And it may mean fewer numbers, it may be [staying] outside or maybe opening a window, maybe wearing a mask. Frankly, in the older students with high vaccination rates, you can indeed do those things safely,” Malani said. “I think that that is a compelling reason in that age group,” he added, “the ability to get back to so many of these important activities as safely as possible, not with zero risk, but acceptable risk.”
The CDC and infectious disease experts also have pointed out that schools likely will need more regular testing of unvaccinated students and teachers to catch asymptomatic Delta infections before they blow up into outbreaks.
Schools also “need a culture in which people are not coming to class sick, whether that’s flu or COVID or another viral illness, people shouldn’t be coming to school sick,” Tan said. “I think systems need to be in place to allow that flexibility for students, but this is where the local surveillance and good relationships with the public health colleagues are really important.”