With Covid-19 mask restrictions set to lift in US, a haze of uncertainty lingers

School mask mandates have been among the most contentious public health measures implemented in response to the Covid-19 pandemic. PHOTO: AFP

WASHINGTON (NYTIMES) - As the Omicron surge begins to recede in many regions of the United States, the governors of New Jersey, Connecticut and Delaware have announced that they will lift school mask mandates in the coming weeks.

But the move to loosen these politically charged restrictions has divided scientists and public health experts.

"I think it's entirely appropriate that we start lifting school mask mandates now," said Dr Joseph Allen, a Harvard University researcher who studies indoor environmental quality, including in schools.

"We're in a much better place than we were before, and it's time to update our strategies to reflect the moment," he said.

Others noted that the virus was still exacting a significant toll on the country, with cases about as high as during last winter's peak and more than 2,500 Americans dying each day.

Lifting school mask mandates too early could jeopardise the progress that the country has made over the last few weeks, some health experts said.

"We're just starting to get it back under control," said Dr Seema Lakdawala, a respiratory virus researcher at the University of Pittsburgh, noting that many young children remain unvaccinated.

"I don't think we should be abandoning the interventions we have that are still helpful," she said.

Experts agreed that mask mandates should not last forever and that officials needed to clearly explain what criteria would be used in deciding when to lift them. But there is still debate over what those metrics should be and whether certain places in the country had met them.

"I think we're moving to a place where it will make complete sense to remove mask mandates," said Dr Justin Lessler, a public health researcher at the University of North Carolina at Chapel Hill.

"Maybe we'll be there in two to three weeks. Personally, I would like to see people wait until cases are low rather than anticipating that they will be low at some future date," he said.

School mask mandates have been among the most contentious public health measures implemented in response to the pandemic. Opponents of mask mandates have often pointed to the lack of randomised, controlled trials on the effects of masking in schools and have highlighted flaws with specific studies that have documented benefits of masking.

"You can pick apart any one study," said Dr Linsey Marr, an aerosol scientist at Virginia Tech. But she noted that "there's overwhelming evidence that masking has a beneficial and small effect on reducing transmission in schools".

Even the experts who believe that it is time to lift school mask mandates said that such policies have been an important strategy at certain phases of the pandemic. But, they noted, the country is no longer in the same position it was in 2020 during the first waves of the Covid-19 pandemic in the US.

Vaccines are now widely available for all adults and for children aged five or older. And although Omicron can evade some of the body's immune defences, making breakthrough cases more likely, the vaccines continue to provide protection against hospitalisation and death.

In communities where vaccination rates are high and the Omicron wave is receding, it makes sense for officials to begin thinking about lifting mask mandates, including in schools, some scientists said.

"Once you don't have a lot of virus, and you have a highly vaccinated community, you move from masking required to masking optional," said Dr Carlos del Rio, an infectious disease specialist at Emory University.

Dr del Rio recommended that communities also pay close attention to local hospitalisation rates and capacity when making decisions about masking policies. If local hospitalisation rates are below 10 new Covid-19 admissions per 100,000 residents per day and intensive care units are less than 80 per cent full, it makes sense to remove mask mandates, he said.

"But for kids with the same risk, even unvaccinated kids with the same risk, we're keeping more strict policies in place," said Dr Allen, the Harvard researcher.

A nurse administers a Covid-19 pediatric dose to a girl at a vaccination clinic in California on Jan 19, 2022. PHOTO: AFP

States that lift school mask mandates now, however, may find it difficult to reimpose them in future, said Dr Julia Raifman, a health policy expert at Boston University, who leads the Covid-19 US State Policy database.

Dozens of states had mask policies in 2020, she said; now few of them do.

"So that shows you how hard it is for anywhere to turn back on mask policies after they've turned them off," she said.

And while the absolute risk to children may be small, child hospitalisation rates have increased during the Omicron surge, she noted.

Moreover, school mask mandates are not simply about protecting children, some scientists said.

"People will say, I am sure, that it is a mild disease in kids, so why are we concerned?" Dr Lakdawala said. "The concern is that it can then continue to spread in our communities."

The lifting of school mask mandates means that many parents will have to make health risk-benefit calculations on their own. PHOTO: AFP

Children who catch the virus at school could also pass it on to more vulnerable adults, said Dr Mercedes Carnethon, a public health researcher at the Northwestern University Feinberg School of Medicine.

The lifting of school mask mandates means that many parents will have to make these risk-benefit calculations on their own, deciding whether to have their children continue wearing masks in the classroom.

"The things that you'd want to think about is: Is your kid vaccinated?" Dr Marr said. "Does your kid have underlying health conditions that might put (the child) at higher risk? Is your kid in an especially crowded classroom that has poor ventilation? All of those factors would increase the risk."

Studies suggest that masks, especially high-quality, well-fitted ones, can protect the wearer.

"If you're looking for a good mask, focus on filtration and fit, the two Fs," Dr Allen said.

Although N95 masks are not designed for children, there are other respirators, such as KF94s, that come in children's sizes. But even a well-fitting surgical mask or multi-layered cloth mask can help provide protection, scientists said.

"Masks are most effective when everybody wears them," Dr Lessler said. "But they are still effective individually when only you wear them."

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