Masking Children Belies Honest Cost-Benefit Considerations

Citing the Delta variant, Vermont officials have extended universal masking for all K-12 students until early October (after which it applies to the unvaccinated). Though a mandate cannot be enforced absent a state of emergency, psychological and social pressures to ensure student compliance abound.

A “zero COVID-19” strategy cannot be pursued without medicine to treat the disease. The government and pharmaceutical industry have not developed new antiviral drugs or invested in exploring the off-label use of generic drugs against the virus. Thus eighteen months into the pandemic, COVID-19 management still consists of prevention alone. Unless the goal is to lock down society until the FDA approves a treatment, policymakers and the media must stop conflating positive cases with infections that result in ICU admissions and deaths.

Minimal Risk of Pediatric Transmission and Fatality

An Israeli study showed that children aged 0 to 9 years do not play a substantial role in viral transmission. British clinical researchers surveyed global studies to determine the extent of asymptomatic spread by children. They found that children do not spread the virus and specifically, there was no evidence of children infecting teachers. Clinicians in Texas discovered that children are significantly less likely to become infected or spread the virus because of differences in their lung physiology and immune function.

Though the Delta variant is hospitalizing adults including the vaccinated, pediatric hospitalization and death rates have declined since last summer. The New York Times, USA Today, and the Atlantic confirm that the Delta variant is not causing more severe disease in children. Note that the three aforementioned articles contain evidence that contradicts their respective misleading headlines. As with the original COVID-19 strain, the vast majority of children experience mild cold-like symptoms and recover with supportive care at home.

The COVID-19 childhood case fatality rate is 0.01 percent, that is, around 520 children have died since the pandemic began. Let’s put this statistic into context. During the 2018-19 influenza season, over 46,000 children were hospitalized and 480 children died. The CDC reports 675 total pediatric deaths (annual average of 113 deaths) due to influenza between 2010-11 and 2015-16. Rather than the Delta variant, the influenza morbidity and mortality rates offer a stronger basis to mask children for protection. Why have we never made that argument or mandated flu shots?

The intention here is not to make light of any death or COVID-19 infection. It is to emphasize that prudent policymaking entails an honest cost-benefit calculus and considers all relevant factors such as the efficacy of masks and the impact of their extended use on children. 

Prudent Policy is Based on Scientific Evidence, Not Appeals to Authority

The following claims are informed by scientific evidence from randomized control trials (RCT) and clinical observational studies. They are not based on an appeal to the authority of public health agencies, which are in fact divided about masking children. The European CDC does not recommend masks for students in primary school (i.e. from the ages of 4 to 11 years and sometimes up to 13 years).

Norway explicitly discourages masks for children under the age of 13 years, and has never required masks at any level of schooling. Sweden has similarly never recommended masks for students. Denmark, England, Ireland, and Switzerland no longer require masks in schools. In the Netherlands, primary school students do not wear masks, while secondary school students do not wear them in the classroom. An argument for masking children that is based on the authority of some experts, while ignoring others, is fallacious.

Cloth and surgical masks offer poor protection from COVID-19. A July 2021 study by engineering researchers at the University of Waterloo demonstrated that cloth and surgical masks filter only 10 percent of the exhaled aerosol droplets that accumulate indoors and spread SARS-CoV-2 to others. Expensive N95 and KN95 masks filter over 50 percent of the exhaled aerosols. Students rarely, if ever, use N95 masks.

However, the harms caused by extended mask use are manifold. Prolonged mask use changes the respiratory physiology causing breathing difficulties, headaches, fatigue, and diminished cognitive performance. German researchers analyzed 65 scientific papers to investigate the adverse effects of everyday mask use. The results showed that masks induce quantifiable respiratory impairment that is associated with reduced oxygen, increased body temperature (likely cause of headaches), and increased moisture under the masks. The study found a statistically significant correlation between blood oxygen depletion and fatigue. The authors refer to the mask-related “psychological and physical deterioration,” documented across various fields of medicine (including neurology, psychology, and pediatrics), as a Mask-Induced Exhaustion Syndrome.

In a Wall Street Journal article, Dr. Marty Makary (Johns Hopkins School of Medicine) and Dr. H. Cody Meissner (Tufts Children's Hospital) explain that obstructive masks could force children to breathe through their mouths. Studies prove that chronic mouth breathing impacts the facial muscles and bones of a growing child, leading to severe and permanent deformities. Further, they warn that masks hide facial expressions without which children can develop “robotic and emotionless interactions, anxiety, and depression.”

More young children are falling behind in speech and social development, as masks do not allow for lip reading and access to nonverbal cues for communication. This is why Ireland decided against masking students. In March 2021, the Irish Department of Health stated that masks heighten anxiety and negatively impact the “development of communication and language skills, particularly for younger children.”

We can all agree that the steps to contain this virus must not inflict irreparable damage on the developing minds and bodies of children. The modus vivendi would be to make masks optional for them. 


Meg Hansen (MBBS) is a writer and former executive director of a health policy think tank called Vermonters for Health Care Freedom. She ran for state-level public office last year.



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