Forced mask-wearing in schools has become one of the signature shames of our era. It is a monstrous act of adult cowardice, indifference to parents’ concerns, and dereliction of duty to look after the full welfare of the children placed in their care.

Two years in, and the research literature hasn’t changed: face masks are ineffective against airborne viruses. The Brownstone Institute has produced a compilation of 167 comparative studies and articles attesting to the harm and ineffectiveness of compulsory masking. In 2020 I showed, one by one, how Gov. Roy Cooper’s own cited research (22 studies plus one added in a later executive order) failed to make the case for his emergency orders to force face masks on people. Not surprisingly, for each of the 12 times he re-upped and even strengthened his face mask order, not once were case numbers lower than the day before he leveled the original order on people.

But sometimes the worst tyrants can be found among those given little fiefdoms of authority over people who cannot fight back, and they can include school boards making decisions affecting small children. Most school boards in North Carolina, to our great shame and to schoolchildren’s manifold harms, still continue to require compulsory masking against students. The count currently is 85 out of 115 school boards.

Perhaps finally the horrid politics of Covid is thawing toward schoolchildren. Consider that just within the past two days, several well-reputed liberal establishment media outlets have allowed themselves to publish articles arguing to free children’s faces:

The New York Times, Jan. 28:

Elissa Perkins, the director of infectious disease management in the emergency department of the Boston Medical Center, told me she spent most of 2020 “imploring everybody I could in every forum that I could to mask.” In the beginning, she said, this was to flatten the curve, and later to protect the vulnerable. But masking, she said, “was intended to be a short-term intervention,” and she believes we haven’t talked enough about the drawbacks of mandating them for kids long-term.

“If we accept that we don’t want masks to be required in our schools forever, we have to decide when is the right time to remove them,” she said. “And that’s a conversation that we’re not really having.” …

The debate about masks in schools can quickly turn vicious because it pits legitimate interests against one another. Many people who are immunocompromised, or live with those who are, understandably fear that getting rid of mandates will make them more vulnerable. But keeping kids in masks month after month also inflicts harm, even if it’s not always easy to measure.

“I think it would be naïve to not acknowledge that there are downsides of masks,” said Perkins. “I know some of that data is harder to come by because those outcomes are not as discrete as Covid or not-Covid. But from speaking with pediatricians, from speaking with learning specialists, and also from speaking with parents of younger children especially, there are significant issues related to language acquisition, pronunciation, things like that. And there are very clear social and emotional side effects in the older kids.” …

There’s some question about how well masks in school really work; many studies are confounded, since communities with school mask mandates tend to adopt other Covid mitigation measures as well. Much of The Atlantic’s “The Case Against Masks at School” is devoted to reviewing studies either conducted or cited by the Centers for Disease Control and Prevention, and it concludes that the “overall takeaway from these studies — that schools with mask mandates have lower Covid-19 transmission rates than schools without mask mandates — is not justified by the data that have been gathered.”

NPR, Jan. 28:

Good masks are hard to find  

Danny Benjamin is a pediatrician with Duke University and the ABC Science Collaborative, which has long advised school districts that masking can be highly effective against COVID spread. “If you’re in a school district that masks, the risk of COVID is much less at school than it is outside of school, because school is one of the few places where people actually enforce mitigation measures.”

But in his view, while respirators offer superior protection, mandating them for children is impractical: Some kids find them uncomfortable, they may not fit small faces well and they need to be replaced often. For the nation’s 55 million schoolchildren, Benjamin says, “now we’re talking about 100 million masks that you’re mandating each week. And that’s kind of the best-case scenario, where you reuse most of them, no child ever loses their mask and no child ever soils their mask, which, I don’t know what planet that is.”

It’s hard for children to wear masks properly

Teachers and parents often report that proper mask-wearing is difficult and requires constant reinforcement by teachers. That’s especially true for young children and those with special needs. …

Masks can interfere with young children’s brain development

Numerous scientific papers have established that it can be harder to hear and understand speech and identify facial expressions and emotions when people are wearing masks. (Some of these studies also suggest workarounds, which many practitioners are using).

These are critical developmental tasks, particularly for children in the first three years of life.

The United States is an outlier in recommending masks from the age of 2 years old. The World Health Organization does not recommend masks for children under age 5, while the European equivalent of the CDC doesn’t recommend them for children under age 12. …

Manfred Spitzer is a psychiatrist and a cognitive neuroscientist in Germany. … “Kids need to train up their face recognition,” he says, and they need to see full faces to learn to identify emotions as well as to learn language. “Babies were never designed just to see the upper half of the face and to infer the lower half; even adults have a hard time doing this.”

Masks can make it harder to hear and understand speech …

Diane Paul is with the American Speech-Language-Hearing Association, the national professional association representing speech therapists. She says referrals of children to speech therapy have increased since the pandemic began. …

Donna Smiley is an audiologist — a hearing-impairment specialist — also with ASHA. “We all use visual input to help understand the message,” she says — watching a speaker’s lips and mouth, which are covered by masks. “By putting on a mask, you’re also making the teacher’s voice less loud.” …

Masks can inhibit social interactions

For school-age children, Spitzer, the psychiatrist, is most concerned that masking interferes with nonverbal communication and emotional bonding.

Gonzalez says her students who are on the autism spectrum withdraw behind masks. “They have almost started adopting the masks as their face. It’s part of their identity, it’s their security blanket. I almost have to be like, ‘Hey, you are allowed to take it off right now.’ Like, say, if they’re going to run the lap at P.E. or going into lunch to sit down — they want to eat a bite, put it back on, eat a bite, put it back on.” …

Balancing children’s needs and pandemic safety

On Jan. 25, a group of physicians and scientists announced a national campaign to “restore normalcy” in children’s lives by putting them first in line for the lifting of restrictions, including mask mandates, once the omicron wave has subsided.

Dr. Jeanne Noble, who directs COVID-19 response for the UCSF Emergency Department at the University of California, San Francisco, is part of the coalition. “Kids don’t need to be masked. Full stop. They have minuscule risk of serious illness or death from COVID,” she says. She and colleagues are suggesting that especially vulnerable children continue to mask while other vaccinated children can safely go without.

San Francisco Chronicle, Jan. 27: 

Meanwhile, kids are bearing the brunt of restrictions: all-day masking and “punitive mask culture,” as one of the many physicians speaking out recently put it; disruption to their social and emotional learning, to literacy and speech, and worrisome impacts on their mental health. My 8-year-old son brought home a self-portrait this week — it had no nose or mouth.

Should little humans see each other’s faces and see their teachers’ faces? If our answer is “yes, but not until everyone is safe,” we need to put some numbers behind that rhetoric. In every recent winter except the last, between 200 and 1,200 kids in the U.S. died of the flu, the physicians point out. During the entire pandemic, some 900 deaths of children are attributed to COVID. Any death of a young person is achingly tragic. But when will all children be “safe”? … 

Parents are legitimately asking what the benefits are — at this stage — for policies like masking and whether they outweigh the harms. We have to engage with the science showing that the masks we’ve been donning for two years don’t work all that well. The most rigorous study in adults found that surgical masks reduced infection by about 10 percent — in adults. And that was before omicron. Dr. Leana Wen called cloth masks “facial decoration.” There are no approved N95 respirators for kids and no data to justify knockoff varieties. We have to ask: How have so many European countries managed to keep kids in school and barefaced and their death rates lower than ours?

In evidence-based medicine, the burden of proof is on the intervention, not the norm. The norm is seeing human faces. The intervention is endless masking. …

The goal of “ending COVID” was once laudable, but at this point it’s driven by a mixture of naivete, hubris and entitlement. We can all be furious and devastated by the death and illness this virus is still causing, but we can’t misread people’s desire for normal as indicating callous disregard for human life. One of the first rules of parenting is to never take out your own anger on your children. That’s what turns us into monsters.

The Atlantic, Jan. 26:

Many public-health experts maintain that masks worn correctly are essential to reducing the spread of COVID-19. However, there’s reason to doubt that kids can pull off mask-wearing “correctly.” We reviewed a variety of studies—some conducted by the CDC itself, some cited by the CDC as evidence of masking effectiveness in a school setting, and others touted by media to the same end—to try to find evidence that would justify the CDC’s no-end-in-sight mask guidance for the very-low-risk pediatric population, particularly post-vaccination. We came up empty-handed. …

Despite how widespread all-day masking of children in school is, the short-term and long-term consequences of this practice are not well understood, in part because no one has successfully collected large-scale systematic data and few researchers have tried. Mental and social-emotional outcomes are hard to observe and measure, and can take years to manifest. Initial data, however, are not reassuring. Recent prospective studies from Greece and Italy found evidence that masking is a barrier to speech recognition, hearing, and communication, and that masks impede children’s ability to decode facial expressions, dampening children’s perceived trustworthiness of faces. Research has also suggested that hearing-impaired children have difficulty discerning individual sounds; opaque masks, of course, prevent lip-reading. Some teachers, parents, and speech pathologists have reported that masks can make learning difficult for some of America’s most vulnerable children, including those with cognitive delays, speech and hearing issues, and autism. Masks may also hinder language and speech development—especially important for students who do not speak English at home. Masks may impede emotion recognition, even in adults, but particularly in children. This fall, when children were asked, many said that prolonged mask wearing is uncomfortable and that they dislike it. 

This last reason is important in considering a pivot to requiring children to wear N95 or KN95 masks, which are thought to be more effective at preventing the spread of Omicron. A few school districts, in response to the growing awareness of the ineffectiveness of cloth and surgical masks, have decided to escalate rather than scale back masking by requiring these types of medical-grade masks, which are significantly less comfortable to wear and can hinder communication more than other types of masks.

As with our existing school-mask policies, no real-world data indicate that these masks decrease transmission in school settings—data that matter greatly, as these masks require a very tight fit to function effectively, and that may not be possible for many kids. N95s are not approved or sized for childrenproper fit is hard to achieve even with adults, and a June 2020 study shows they have very high failure rates when taken on and off or worn for multiple hours. Though KN95s, the manufactured-in-China equivalent, are available in kids’ sizes, they also require a very tight seal to function properly, which is unrealistic for schoolchildren to maintain for multiple hours a day. Early-pandemic recommendations to mask at school, soon followed by mandates, were laid down in the absence of data. We should not repeat this mistake with a new generation of masks. …

Masking is the last and most stubborn layer, possibly because its drawbacks are more subtle and not yet well documented. We understand that many public-health professionals and parents may want to keep that layer in place, perhaps because they think the possible drawbacks to masking are even less well quantified than the possible benefits. They may point to the low vaccination rate among children to argue against any loosening of mitigation measures, even if they cannot directly connect those measures to reduced transmission. They may also point to the Omicron surge increasing children’s hospitalizations. But hospitalizations have risen among all age groups, and, even at the country’s peak, remained extremely low among children, on par with pediatric flu hospitalizations during a typical season.

Imposing on millions of children an intervention that provides little discernible benefit, on the grounds that we have not yet gathered solid evidence of its negative effects, violates the most basic tenet of medicine: First, do no harm. The foundation of medical and public-health interventions should be that they work, not that we have insufficient evidence to say whether they are harmful. Continued mandatory masking of children in schools, especially now that most schoolchildren are eligible for vaccination, fails this test.