The COVID-19 pandemic is not yet over. At least, it isn’t for millions of unvaccinated people around the world including almost 50 million American children under 12 years old who are too young to be eligible for vaccination. And yet with the lifting of the statewide and citywide mask mandate on July 1, some local summer camps and Baltimore County Public Schools are dropping their masking requirements not just for vaccinated adults and teenagers, but for unvaccinated elementary school aged children as well. As a pediatrician specializing in infectious diseases and a proud Baltimore City Public School parent, I believe this is a huge mistake.
Over the past year and a half, the pandemic has exacted enormous costs on our children through school closures and hybrid learning. Ensuring our children can safely return to full-day school this fall is essential to address both learning loss and the pediatric mental health crisis precipitated by COVID-related social isolation. Although teachers heroically worked to translate their classes to the virtual environment, their skills cannot compensate for the reduced class time and the inferiority of remote learning that most area public school children experienced.
Early elementary school aged children, whose grasp of foundational concepts in phonics and mathematics are crucially important to both their future educational success and earning potential, are particularly vulnerable due to their short attention spans and lack of independent learning skills. Multiple studies have shown that these risks are multiplied for children from disadvantaged backgrounds, whose families may lack the resources to support their children’s education, and for children of color, who were more likely to remain learning remotely even when in-person options became available. In Baltimore city and county, where 33% and 12% of our children respectively live below the poverty rate, many of our children are at risk falling further behind.
As we head into the third academic year affected by the pandemic, it is crucial that schools safely open for full-day, in-person learning in a way that avoids further closures. The latest Centers for Disease Control recommendations distinguish between vaccinated individuals, who can safely resume many pre-pandemic activities, and unvaccinated individuals, including children less than 12 years old, who should remain masked in indoor public spaces.
Ignoring this guidance led to a recent outbreak of more than 80 teens and adults at an Illinois summer camp, where indoor masking was not required. Despite high rates of vaccination among Israeli adults, multiple recent outbreaks in their schools have led to closures and re-institution of mask mandates, which had been relaxed. And although cases are currently low in the Baltimore area, the rapid spread of the Delta variant combined with resumption of pre-pandemic activities and increased transmission during the colder months make it possible that yet another peak will emerge in the fall.
As other vaccine-preventable diseases, such as measles, have shown us, outbreaks can and will occur in populations with low vaccination rates. The COVID-19 vaccination rate among elementary school aged children is zero, which makes it not a question of whether there will be outbreaks if other mitigation measures are not used, but when and how bad.
Masks are easy to use, inexpensive and effective, and when used in combination with other measures such as distancing and testing, they allow children to attend school and camps safely until vaccination is available to them, which may be as early as mid-fall based on the timelines released by Pfizer and Moderna. Proponents for unmasking school-aged children point to the low rates of COVID-related deaths within this age group but ignore the significant morbidity associated with COVID-19. While many children recover from COVID-19, others may develop “multisystem inflammatory syndrome in children” (MIS-C) several weeks after initial infection, which can be fatal, as it tragically was for one Baltimore resident, Dar’yana Dyson whose story was chronicled in a Baltimore Sun article last year. Other children, despite relatively mild cases of COVID-19, develop persistent symptoms, often referred to as “long COVID.” Ultimately, the long-term consequences of COVID-19 infection in children remain unknown.
In their short lives, children have experienced enormous disruption to their normal academic and social development due to COVID-19. As we head into summer and look forward to the fall, let us demonstrate the value of delayed gratification to them. Their vaccines are coming, but we cannot let down our guard until they are here. Our children are counting on us.
Dr. Jeanette Beaudry (firstname.lastname@example.org) is a pediatric infectious disease fellow at Johns Hopkins Hospital Bloomberg Children’s Center.