We are writing you representing the Maine Chapter of the American Academy of Pediatrics, to urge parents and school boards to continue to listen to pediatric experts, the American Academy of Pediatrics and the Centers for Disease Control and Prevention, who continue to strongly recommend masking in U.S. schools.

Pediatric COVID-19 cases and hospitalizations are being seen at higher levels than ever before, both locally and nationally. Death rates remain astoundingly high, with around 2,500 people dying each day in the U.S. Nearly 1,000 children in the U.S. have died during this pandemic, far greater than in any influenza season, and this is with mitigation strategies, including masking, in place. The omicron variant has driven this rise, with over 600,000 children infected in recent weeks.

Amid this surge, there are renewed calls to unmask in schools. Proponents of unmasking children raise alarms on pediatric mental health, and they are right – pediatric mental health issues have reached crisis levels. However, at a time when over 200,000 children have lost a caregiver to COVID, parents have lost employment and children’s routines have been disrupted, can we say definitively that removing masks will restore mental health? Maine’s current COVID protocols have encouraged normal routine for children. Throughout the 2021-2022 school year, Maine has not had a statewide mask mandate for schools. Instead, districts have chosen to follow CDC and AAP recommendations for safe schools, which allow unvaccinated children to be exempt from school quarantine if there is a COVID case in a classroom in which universal masking is employed. In other words, masking serves to keep children in school, where many youths access vital services including counselors, and continue their much-needed routines, furthering their mental health.

What about encouraging at-risk children to mask, and letting others go mask free? The challenges with this proposal are many. Encouraging one child out of a classroom to mask sets that child up for failure because of peer pressure and singles out that child based on medical or social conditions. Medical-grade N95 masks are not available for pediatric patients, and KN95 masks are not well studied and not fitted and are expensive. A quick Google search reveals a box of 10 KN95 masks available for $15-$20, and most children require two masks a day – this is one week’s supply. For a family with three children, one of whom is high-risk, one-way masking could quickly cost more than their weekly grocery bill. Equity issues abound with this proposal, particularly as public education is to be accessible for all.

Our children have the chance to be vaccinated, and that is the most essential thing we can do for them to protect them against serious outcomes. However, in Cumberland County, the highest vaccinated county in the state, more than 40 percent of elementary-aged children are unvaccinated. Statewide, fewer than half of adults are boosted. These vaccine rates are insufficient to prevent school and community outbreaks without other mitigation strategies.

Multiple studies, from Wisconsin, North Carolina, Arizona, California, Georgia, Florida and other states, describe benefits of masking in schools to prevent spread, or provide cautionary tales of when masks are not worn. Absolutely no studies describe negative outcomes of masks; indeed, in many Asian countries, masking, even of children, during cold and flu season is a cultural norm. There are data describing 2-year-olds as better able to understand spoken words through a face mask as compared to a clear face shield, and there are data that pediatric patients in the hospital have no preference for unmasked caregivers over masked caregivers.

Schools are essential, and they need to be safe. The AAP recognizes this and recognizes that universal masking is the safest and surest way to keep them safe and open. A time will come when the omicron surge is behind us, community rates have reached a sustained low level and vaccine rates are high enough that masks can come off in schools. But at a time when hospitals are seeing more pediatric COVID patients than ever, masks are the easiest way to keep kids in schools, keep them learning and support their mental health.

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