American Academy of Pediatrics: All kids should mask up in school this fall, vaccinated or not

AP Photo/Mary Altaffer, File

Wasn’t it 10 days ago that the CDC said vaccinated kids *don’t* need to mask up?

And wasn’t it 10 days before that that a study published in JAMA Pediatrics indicated certain kinds of masks could expose kids to levels of carbon dioxide beyond the recommended limit?

Now we have the American Academy of Pediatrics recommending masks for all students age two and over regardless of vaccination status.

It sure would be nice if the experts could all get on the same page here. The fall semester is, what — a month away?

I’m going to accentuate the positive by noting that the AAP and the CDC are on the same page in the most important respect, which is that they both strongly recommend keeping schools open this fall come hell or high water. The choice shouldn’t be between unmasked kids learning remotely and masked kids learning in class, as there’s robust evidence by now that children are at basically zero risk from COVID. But if we’re given that choice, masked and in class is a no-brainer.

“We need to prioritize getting children back into schools alongside their friends and their teachers — and we all play a role in making sure it happens safely,” said Sonja O’Leary, MD, FAAP, chair of the AAP Council on School Health. “The pandemic has taken a heartbreaking toll on children, and it’s not just their education that has suffered but their mental, emotional and physical health. Combining layers of protection that include vaccinations, masking and clean hands hygiene will make in-person learning safe and possible for everyone.”

AAP recommends universal masking because a significant portion of the student population is not yet eligible for vaccines, and masking is proven to reduce transmission of the virus and to protect those who are not vaccinated. Many schools will not have a system to monitor vaccine status of students, teachers and staff, and some communities overall have low vaccination uptake where the virus may be circulating more prominently.

Research has shown that opening schools generally does not significantly increase community transmission with masking and other safety measures in place. Recently, COVID-19 variants have emerged that may increase the risk of transmission and result in worsening illness. Given the effectiveness of safety precautions when used consistently, children are at higher risk of suffering mental health issues and developmental setbacks if they miss out on in-school learning, according to AAP.

They’re worried about kids who can’t get vaccinated for health reasons ending up infected. “They will not be popular amongst parents and kids who are sick of masks, but you know what? The virus doesn’t care that we’re sick of masks,” said NIH chief Francis Collins to NBC about the AAP’s recommendation. “The virus is having another version of its wonderful party for itself. And to the degree that we can squash that by doing something that maybe is a little uncomfortable, a little inconvenient … if it looks like it’s going to help, put the mask back on for a while.”

Is this about protecting kids or about protecting everyone else, though? I wrote this morning that, although doctors keep dancing around the subject, it’s clear that the rules for the post-Delta phase of the pandemic may be different from the rules for the pre-Delta phase a few months ago, when the CDC was finally declaring a return to normal. Is Delta meaningfully more threatening to kids than original COVID was? The evidence is thin so far but you can always find doctors who are “concerned”:

Dr. Fatma Levent specializes in pediatric infectious diseases in Orlando, where COVID-19 cases are on the rise. “Now what we’re seeing is younger children, younger adults, are getting the infection and bringing it to their families.”

As the powerful Delta variant sweeps the country, Dr. Levent says it’s affecting children more than previous strains. And more of them are ending up in the hospital. “When they get it, it’s usually mild. However, they can get hospitalized, they can get pneumonia, and other complications,” Dr. Levent says.

It’s the “bringing it to their families” part that I think has scientists worried. Kids weren’t major vectors of transmission for the original virus but the fact that Delta is so much more contagious means doctors aren’t sure if that still holds true, just like Scott Gottlieb isn’t sure that it’s still true that vaccinated adults aren’t infecting others. “Last year, for example, you would have to give a child a really high infectious dose to make them sick, but with the virus that’s more contagious, even what would be an insignificant exposure could get them sick,” said a professor of pediatrics at Yale to NBC about Delta.

The reason schools were shut last spring is because experts feared initially that classrooms would be viral factories the way they are for flu. That didn’t happen, but we all know the teachers unions are going to argue that Delta Is Different and therefore they should stick with remote learning this fall. Which, again, is why it’s welcome that the AAP and CDC are being full-throated in insisting that kids need to be back in class, come what may. There’ll be opposition to that idea. The experts need to get out in front of it, as they’re now doing, and hold fast this time.

But if it does turn out that kids are more likely to infect each other with Delta than they were with the original virus, and that they’re more likely to infect adults than they were with the original virus, then we’re facing a massive surge in the fall when class resumes. I don’t think the experts should be pushing masks on kids until there’s more data to support the idea that Delta Is Different for them but you can see why people like Fauci have started shifting again towards soft recommendations for even vaccinated people to wear masks indoors. He backed the AAP’s guidance for vaxxed kids to mask up today, calling it a “reasonable thing to do”. And in his interview with Bloomberg below, he continued his message of late that masking up ain’t a bad idea even if you’ve had your shots if you’re in a high-risk community. Soon the entire U.S. will be a high-risk community due to Delta, which means the experts will be formally recommending masks again for everyone. They’re just taking their time getting there so as not to have to reverse themselves so soon after the CDC relaxed its guidance in May.