Masking the Science on Masks
The mask morass in Virginia.
The newly-inaugurated Governor of Virginia, Glenn Youngkin, issued an executive order that leaves it to parents to decide whether their kids should wear masks at public schools. Regardless, some Virginia school systems are sticking with their current mask requirements.
Where I live, Gregory Hutchings, the Superintendent of the Alexandria City (Virginia) Public Schools, issued a statement on the subject, which provides an opportunity to evaluate how public school officials address, or don’t address, the issue of masks in schools.
The Superintendent’s statement says “Masks, combined with multiple other ACPS mitigation measures, have been effective in helping to protect the collective health and safety of our students and staff and keep our schools open for in-person learning.”
The problem with this statement is that while Governor Youngkin’s executive order only addresses masks, the Superintendent’s statement does not, instead lumping the question of the effectiveness of masks together with “multiple other ACPS mitigation measures” when commenting on effectiveness. Superintendent Hutchings provides no citations to any science addressing whether or not masks, as an independent mitigation measure (separate from distancing and ventilation, for example), are effective in stemming the spread of COVID in any meaningful or measured way.
New York magazine published an article containing one of the most comprehensive analyses of the relevant studies on the issue of masks, and it’s worth quoting at length. It states:
[a] study published by the CDC … covered more than 90,000 elementary-school students in 169 Georgia schools from November 16 to December 11 and was, according to the CDC, the first of its kind to compare COVID-19 incidence in schools with certain mitigation measures in place to other schools without those measures … “That a masking requirement of students failed to show independent benefit is a finding of consequence and great interest,” says Vinay Prasad, an associate professor in University of California, San Francisco’s Department of Epidemiology and Biostatistics … Nobody was able to find a data set as robust as the Georgia results — that is, a large cohort study directly looking at the effects of a mask requirement.” The Georgia study found no independent benefit to masks … After the CDC and the American Academy of Pediatrics issued their student-mask guidance last month, I contacted both organizations asking for the evidence or underlying data upon which they had based their recommendations. The AAP did not respond to multiple requests. The CDC press office replied that since children under 12 cannot be vaccinated, the agency “recommends schools do universal masking” … [Now, of course, children under 12 can be vaccinated, and have been.] … “A year ago, I said, ‘Masks are not the end of the world; why not just wear a mask?’” Elissa Schechter-Perkins, the director of Emergency Medicine Infectious Disease Management at Boston Medical Center, told me. “But the world has changed, there are real downsides to masking children for this long, with no known end date, and without any clear upside.” She continued, “I’m not aware of any studies that show conclusively that kids wearing masks in schools has any effect on their own morbidity or mortality or on the hospitalization or death rate in the community around them …” This question of “relevant science” is what makes the Georgia study worth careful consideration. Over and over, studies and reports on children in schools with low transmission rates claim in their summaries that masking students helped keep transmission down. But looking at the underlying data in these studies, masks were always required or widely worn, and implemented in concert with a variety of other interventions, such as increased ventilation. Without a comparison group that didn’t require student masking, it’s difficult or impossible to isolate the effect of masks … I reviewed 17 different studies cited by the CDC in its K-12 guidance as evidence that masks on students are effective, and not one study looked at student mask use in isolation from other mitigation measures, or against a control. Some even demonstrated that no student masking correlated with low transmission.
A few weeks after that report was written, the CDC began touting an Arizona study that claims to show students without masks are at a 3.5 times greater risk of getting COVID. But as the Atlantic magazine reports:
the Arizona study at the center of the CDC’s back-to-school blitz turns out to have been profoundly misleading. “You can’t learn anything about the effects of school mask mandates from this study,” Jonathan Ketcham, a public-health economist at Arizona State University, told me. His view echoed the assessment of eight other experts who reviewed the research, and with whom I spoke for this article … [T]he data being touted by the CDC—which showed a dramatic more-than-tripling of risk for unmasked students—ought to be excluded from this debate … Noah Haber, an interdisciplinary scientist and a co-author of a systematic review of COVID-19 mitigation policies, called the research “so unreliable that it probably should not have been entered into the public discourse.” … The [CDC’s] decision to trumpet the study’s dubious findings, and subsequent lack of transparency, raise questions about its commitment to science-guided policy … The authors [of the Arizona study] defined an outbreak as being two or more COVID-19 cases among students or staff members at a school within a 14-day period that are epidemiologically linked. “The measure of two cases in a school is problematic,” Louise-Anne McNutt, a former Epidemic Intelligence Service officer for the CDC and an epidemiologist at the State University of New York at Albany, told me. “It doesn’t tell us that transmission occurred in school.” … Jason Abaluck, an economics professor at Yale and the lead investigator on a 340,000-person randomized trial of masking in Bangladesh, called the Arizona study “ridiculous” for failing to control for the vaccination status of staff or students. If more people had been immunized at the schools with mask mandates—or if those schools were more likely to have other mitigation measures in place, such as improved ventilation—then they likely would have seen fewer outbreaks regardless … A number of the experts interviewed for this article said the size of the effect should have caused everyone involved in preparing, publishing, and publicizing the paper to tap the brakes. Instead, they hit the gas … the publication and agency endorsement of the Arizona study is especially demoralizing. How did research with so many obvious flaws make its way through all the layers of internal technical review? And why was it promoted so aggressively by the agency’s director? I reached out to [CDC Director] Walensky’s office to ask about the study, noting its evident limitations and outlier result. How, if at all, does this research figure into the agency’s continuing guidance for schools around the country? The CDC did not respond to my inquiries. With Biden in the White House, the CDC has promised to “follow the science” in its COVID policies. Yet the circumstances around the Arizona study seem to show the opposite. Dubious research has been cited after the fact, without transparency, in support of existing agency guidance. “Research requires trust and the ability to verify work,” Ketcham, the ASU public-health economist, told me. “That’s the heart of science. The saddest part of this is the erosion of trust.”
The Atlantic report also adds that “under the Biden administration, the [CDC] has not always been apolitical. In May, it was revealed that the American Federation of Teachers, the nation’s second-largest teachers’ union, had private exchanges with CDC officials prior to new school guidance being issued under Walensky’s tenure, and some of the union’s suggestions were added nearly verbatim.”
Another review of studies regarding the effectiveness of masks in reducing virus transmission came to the following conclusion:
It would be an overstatement to say that cloth and surgical masks are unambiguously ineffective or harmful. But neither is there a firm case that they provide any meaningful benefit. Limited mask mandates may be justified in circumstances with unavoidable face-to-face contact within the range of droplet spread, such as public transport, and private businesses should be free to require masks if they like. Citizens at high risk should be free to wear effective N95 masks for their own protection, and federal regulators should clear away barriers to domestic production. But mandates of cloth and surgical masks impose major inconveniences and potentially serious health risks on citizens, for no clear benefit either to themselves or to others. Leaders who pride themselves on following the science should consider ending them and letting citizens protect their health as they see fit.
A May, 2021 University of Louisville study notes that “80% of US states mandated masks during the COVID-19 pandemic” and while “mandates induced greater mask compliance, [they] did not predict lower growth rates when community spread was low (minima) or high (maxima).” Among other things, the study—conducted using data from the CDC covering multiple seasons—reports that “mask mandates and use are not associated with lower SARS-CoV-2 spread among US states.” The study noted “Our findings do not support the hypothesis that SARS-CoV-2 transmission rates decrease with greater public mask use." The study also noted that the mandates put in place by many states in line with CDC guidance at the time were “poor predictors of COVID-19 spread.” As the researchers summarized their findings:
[M]ask mandates and use were poor predictors of COVID-19 spread in US states. Case growth was independent of mandates at low and high rates of community spread, and mask use did not predict case growth during the Summer or Fall-Winter waves. Strengths of our study include using two mask metrics to evaluate association with COVID-19 growth rates; measuring normalized case growth in mandate and non-mandate states at comparable times to quantify the likely effect of mandates; and deconvolving [that is, teasing out effects of a complex signal] the effect of mask use by examining case growth in states with variable mask use.
The University of Minnesota also published a universal review of mask studies and concluded: “We are well past the emergency phase of this pandemic, and it should be well-known by now that wearing cloth face coverings or surgical masks, universal or otherwise, has a very minor role to play in preventing person-to-person transmission. It is time to stop overselling their efficacy and unrealistic expectations about their ability to end the pandemic.”
More information regarding the data regarding the negative side effects of children’s wearing masks can be found here.
The Alexandria City Public Schools Superintendent then writes in his letter to the community, “We have begun to receive shipments of KN95 masks for students and staff, and expect deliveries to be completed by Wed., Jan. 19. ACPS will continue to be diligent in exploring all options to place additional orders for the KN95 masks and continue to work with a community partner to secure additional masks through a donation. We have also delivered additional surgical masks to schools for double-masking as an alternative option.”
Yet as the New York magazine article points out:
Higher-grade N95s, or KN95s, the Chinese equivalent, offer more protection, but are also much harder to tolerate over extended periods of time. Three physicians I talked with considered the idea of children wearing them all day at school — suggested recently by an aerosol scientist in the Times — “laughable,” “cruel,” and “unrealistic, because most adults can barely handle an N95 for even short durations,” since they are so uncomfortable.”
(If the entries in the latest issue of the local public high school’s literary magazine is any indication, even the existing mask policy is weighing heavily on kids’ psyches.)
Regarding masking policy at our local level here in Alexandria, Virginia, there’s a school board resolution that governs how the board should handle COVID-related issues. That resolution was passed by the board on April 24, 2020. It repeatedly cites the need to follow the Virginia Governor’s executive orders (at the time it was passed, the Governor was a Democrat), and states in particular “the Alexandria City School Board suspends such policies or provisions within such policies which reflect legal and/or regulatory requirements that have been waived by the governmental authority which enacted those requirements.” The former Governor, Ralph Northam, signed executive order 79, which states “All students, teachers, staff, and visitors must wear a mask over their nose and mouth while on school property.” Current Virginia Governor Glenn Youngkin has now waived those school mask requirements by executive order, leaving such policy to parents’ discretion. That would seem to require the Alexandria City School Board to suspend the mask policy of executive order 79, which has now been waived by executive order 2, which was issued by “the same governmental authority” (namely, the Governor’s Office) that issued executive order 79. (That is, provided the Alexandria City School Board wants to follow its own policy.)
Some have pointed to a Virginia statute enacted last year, which states: “For the purposes of this act, each school board shall … provide such in-person instruction in a manner in which it adheres, to the maximum extent practicable, to any currently applicable mitigation strategies for early childhood care and education programs and elementary and secondary schools to reduce the transmission of COVID-19 that have been provided by the federal Centers for Disease Control and Prevention.” But there’s lots of ambiguity, not only in this section of the statute, but in its surrounding language.
For the reasons cited above, it’s unclear whether the CDC’s guidelines “reduce the transmission of COVID-19” to any statistically significant degree, in which case it may not even be an appropriate “strategy” to “reduce the transmission of COVID-19.”
It’s also not clear that CDC mask guidance is “applicable” because CDC policy is not a requirement (it’s only a “recommendation”). Black’s Law Dictionary defines “apply” to mean, in this context, “to put to use with a particular subject matter,” which doesn’t seem to apply to suggestions or recommendations, which may or may not be “put to use.” And the Alexandria City Public Schools don’t seem to consider CDC guidelines as requirements in the first place. For example, CDC “recommends” people wear the “most protect [sic] mask” they can, but the Alexandria Public School System doesn’t apply that recommendation by rule (that is, kids can use all sorts of masks, including those providing relatively less protection). So ACPS itself doesn’t treat CDC recommendations as applicable requirements they “put to use” in their rules. (And as I’ve written elsewhere, one way of determining whether someone actually believes a certain principle is to see if they consistently apply that principle themselves.)
Indeed, as law professor Jonathan Turley writes:
The school districts [resisting Governor Youngkin’s executive order] are effectively stating that they will follow federal, not state, authorities in how to address such health concerns … This will create a difficult court challenge for the districts. These school officials could find themselves with two fronts to fight. First, they must argue that the state law allows them full discretion to refuse to follow the direction of state health officials and the governor in favor of the CDC. Second, they must argue that these masks are important to reducing the spread of Covid-19 and, specifically, the omicron variant (which is now virtually all of the cases in many states). The problem is that the thin paper masks and cloth masks commonly worn by students are viewed as largely ineffective for such protection … The school districts are not arguing for N95 masks for children but for these same discredited paper and cloth masks as a public health imperative.
So if a Virginia school board wants to argue that the Virginia statute requires it to follow CDC guidelines, then that board is going to have to, well, start requiring schools to follow CDC guidelines — including guidelines recommending the use of the most protective types of masks.
Adding more wrinkles to the argument, the entire sentence quoted from the statute above (requiring adherence to certain mitigation strategies) is conditioned on the phrase “to the maximum extent practicable.” Black’s Law Dictionary defines “practicable” as “reasonably capable of being accomplished,” and, in light of the widespread violations of proper mask use that have long been occurring in schools, any policy of universal masking by kids may already be unreasonable as shown by real-world experience.
The same Virginia statute also states “For the purposes of this act, each school board shall … adopt, implement, and, when appropriate, update specific parameters for the provision of in-person instruction.” It may well be “appropriate” for school boards to recognize the Governor’s new state policy (parental authority over masks for their kids) over any federal policy, especially since, in the case of the Alexandria City School Board, their own governing policy recognizes state authorities over federal authorities. It might also be “appropriate” to do so in light of the infeasibility of a universal mask policy for kids in real-world practice, and in light of the evidence questioning any statistically significant benefits of school masking policies.
If school boards are receiving legal advice on this issue (and others) it would be good policy for them to share that legal advice with the public, so there can be open communication and debate regarding exactly what that legal advice says, and the reasoning behind it. But from what I can tell, what all this means is that local school boards have lots of wiggle room to loosen their mask requirements in accordance with the Governor’s executive order and allow parents to evaluate for themselves the costs and benefits of their kids’ wearing masks, and what types. But it appears school boards in more Democrat-controlled districts don’t want to allow that.
As the New York magazine article reminds us, “Many of America’s peer nations around the world — including the U.K., Ireland, all of Scandinavia, France, the Netherlands, Switzerland, and Italy — have exempted kids, with varying age cutoffs, from wearing masks in classrooms. Conspicuously, there’s no evidence of more outbreaks in schools in those countries relative to schools in the U.S.” And the European Centre for Disease Prevention and Control (the European Union’s equivalent to our CDC) recommends against the use of masks for any children in primary school, stating “In primary schools, the use of face masks is recommended for teachers and other adults when physical distancing cannot be guaranteed, but it is not recommended for students.”
I’m not “anti-mask” myself, and I wear them when I think reasonable -- based on the science as I understand it today -- like in certain settings where there’s insufficient ventilation. My point is just that it’s best to take a step back from politics and evaluate the science and the law as it stands, as best we can as individuals and parents, not as it might be represented by one interest group or another.
And we should all appreciate the value of good faith discussions. A crucial step in that regard of course is to actually cite evidence, and critically evaluate it, not to simply state conclusions.