Experts Clash Over Masking Kids in Schools During House Hearing

Expert witnesses offered conflicting perspectives on whether masking children in schools prevents transmission of the SARS-CoV-2 virus during a hearing of the House Committee on Energy & Commerce’s Subcommittee on Oversight and Investigations on Wednesday.

Several Republican committee members said that protecting children from the virus has had unintended consequences for their overall well-being.

Cathy McMorris Rodgers (R-Wash.), ranking member of the full committee, argued that the policies that emerged as a consequence of the “fearmongering” around COVID-19 have harmed children’s mental health more than the virus itself.

“I know the Delta variant is scary. It’s more infectious, but from what we’ve seen so far, it is not more severe,” she said.

If a child 9 years old or younger is infected with COVID-19, that child’s chance of being hospitalized is about 0.1%, and the risk of hospitalization for a person ages 11 to 19 is about 0.2%, McMorris Rodgers noted, citing data from a preprint published on medRxiv.

“Rather than accept this reality, too many of our leaders and people like President Biden want us to continue to live in fear” and are forcing “cruel restrictions” on children, she added.

“Where is the consideration of other aspects of health, children’s overall well-being and mental health?” she asked.

She noted that mental health-related emergency room visits increased by 24% for children ages 5 to 11 and by 31% for those ages 12 to 17. Visits related to suicidal ideation, suicide attempts, and self-harm more than doubled.

“Mask wearing and social isolation has taken a toll, shutdowns and isolation contributed to children and teens gaining weight, at an alarming rate,” McMorris Rodgers pointed out. These policies have made children “more unhealthy, and more at risk to COVID-19. How is that following the science?”

Risk of COVID in Children

Tracy Beth Høeg, MD, PhD, an epidemiologist and physical medicine and rehabilitation research associate at the University of California Davis, echoed McMorris Rodgers’s concerns, stating that children’s risk of infection was lower than most people initially thought.

According to the same seroprevalence data cited by McMorris Rodgers, death rates are approximately “five to six per million in children,” Høeg noted.

Unvaccinated children have nearly the same risk for hospitalization as fully vaccinated adults ages 40 to 50, she added.

SARS-CoV-2 is generally “not as severe in children as adults,” said Lee Beers, MD, president of the American Academy of Pediatrics (AAP), but countered that “lower risk does not mean no risk.”

“To date, more than 5.5 million children have been infected by the virus [and] since the start of the pandemic. Over 21,000 children have been hospitalized and 480 children have died as a result of COVID-19,” she said, citing data collected by the AAP and the Children’s Hospital Association.

Beers noted that in many instances these deaths could have been prevented “through safe and simple measures.”

For most of the pandemic, Margaret Rush, MD, of Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, said that her hospital “averaged a daily census of two to four patients.” During the Delta surge, the hospital saw a maximum number of 27 pediatric patients and needed to open a second COVID unit.

A quarter of these patients were in intensive care, and half of those in ICUs were “on alert for cardio bypass technology that would support their organs that were failing,” she added.

But Rush also pointed out that behavioral health concerns are just as much of a concern for pediatricians.

“I have consistently had equally, if not more, numbers of children admitted to my hospital in the last 6 weeks with a behavioral health primary diagnosis, as I have COVID,” she said.

Rep. Annie McLane Kuster (D-N.H.) praised the ranking member of the subcommittee, Morgan Griffith (R-Va.), for underscoring the importance of getting vaccinated in his opening statement. She then addressed McMorris Rodgers, noting that she wished “the ranking member of the full committee would focus on that as well … I think your effort to diminish the risk [of COVID-19] rings hollow. I’m a parent. I also have 12 great-nieces and great-nephews; I want to do everything I can to keep them safe.”

With regard to mental health, Kuster said that no one is recommending that those concerns not be recognized and addressed. The pandemic has indeed added to children’s stress, she said, but that’s an even stronger argument for supporting vaccination and “put[ting] this pandemic behind us.”

Arthur Evans Jr., PhD, CEO of the American Psychological Association, also called on lawmakers and others to “avoid perpetuating a false choice between [protecting] children’s education and mental well-being, and their physical health and safety … we can and should be doing everything possible to reopen schools safely, adhering to proven public health measures, [and] providing virtual options if they become necessary.”

The Science Behind Masking Kids

On the specific issue of masking children, Høeg argued that Europe has been better about prioritizing children’s education, and experts there tend to admit “that we actually don’t really have solid data showing that … masking children in schools particularly has had any impact on preventing the spread of disease.”

Høeg, who conducted her postdoctoral research in Denmark and maintains ties there, noted that the country recently “dropped all mitigation” related to children.

She pointed out that there isn’t “robust science or randomized control trials” on masking; an observational study based on the COVID-19 School Response Dashboard in Florida found no impact of cloth mask mandates for children and teachers. She also pointed to a CDC study conducted in Georgia that demonstrated no significant reduction in disease spread in schools that mandated cloth masks for kids.

She did highlight one randomized study from Bangladesh, which found that wearing surgical masks was protective against COVID-19 in adults over 50 when increased distancing was also practiced; however, cloth masks “did not have any detectable impact in terms of SARS-CoV-2 rates,” she said.

Beers countered that the AAP “reviewed hundreds of studies to develop its interim guidance for children in schools” and found that “the science is robust.”

“And we are seeing … this in action… where schools who have implemented strong mitigation policies have much lower rates of COVID than schools who have not implemented universal masking,” she noted.

She pointed to recent examples from Florida in the Morbidity and Mortality Weekly Report, as well as another group in North Carolina “that saw the same thing. So, it really is strong, robust evidence.”

Rep. Kim Schrier, MD, (D-Wash.), a pediatrician, asked about the quarantine protocols for children who test positive for COVID in schools.

Beers noted that the rules vary depending on whether children are vaccinated or masked. If children are unvaccinated and “not consistently masking,” they may be required to stay home from school for 7 to 14 days, she said.

Schrier also asked Beers for her take on a new protocol being implemented in some Los Angeles schools in which if one person tests positive, the whole classroom can be tested daily while continuing to wear masks and follow other safety precautions instead of quarantining the whole class at home for 2 weeks, which is known as the “test to stay” model.

Beers agreed that this could be “a really effective strategy” for keeping kids in school.

“Again, it has to be in the context of other important strategies, including vaccination and, at least for right now, masking,” she said.

Høeg also supported the model and urged the CDC to “highly recommend” its implementation.