San Francisco must be like Europe in the case of COVID, youngsters, masks and colleges
This week, San Francisco is expected to once again ease certain indoor mask mandates for portions of the adult population. Mayor London Breed has celebrated this news “because it will allow offices to have more normal routines and interactions.” Noticeably lacking in the new guidance is any update for school and child care mask mandates or even any acknowledgment that kids might also need more normal routines and interactions. Considering they are in peak development years, children need these things even more than adults.
It’s not as if mask relief for kids couldn’t safely become a reality. In fact, Mayor Breed and the San Francisco Department of Public Health recently acknowledged what has been known almost from the beginning: Serious COVID-19 illness in those under 18 is extremely rare, pediatric cases make up a small percentage of total cases, and this percentage has been relatively consistent over time, including during our delta wave. In fact, numbers indicate that COVID-19 poses a significantly lower risk to kids than drowning, homicides, suicides, cancer, car accidents, common flu and heart disease — all risks we’ve previously accepted without dramatically altering the school environment.
San Francisco has also acknowledged that the majority of pediatric COVID-19 cases in the city are a result of household adult-to-child transmission. The simple truth is even when they are infected, children rarely pass on the infection at high rates. A study suggests that less than 4% of household outbreaks are caused by children, meaning approximately 96% are not. Since March 2020, there have been a total of 13 pediatric hospitalizations among San Francisco residents at San Francisco hospitals, and hospitalizations are so low that the city says “the data cannot be publicly reported without concern for privacy and confidentiality.” There also hasn’ t been a single COVID-19-related death under the age of 20 in San Francisco.
The Centers for Disease Control and Prevention’s COVID-19 risk assessments by age estimate that simply being a child aged five to 17 is 99.9994% protective against the risk of death and 98% protective against hospitalization. While any death of a child is tragic, of the 74 million Americans age 17 and under, there have been just 499 deaths attributed to COVID-19 since January 2020, while more than 57,000 deaths in that age group have been attributed to other causes. Additionally, any concern around the risk of long COVID in kids appears to be unsubstantiated.
Even with this established good news, San Francisco remains an outlier on child mask mandates compared to the vast majority of Europe. The CDC’s European counterpart the European Center for Disease Prevention and Control only recommends masking for children ages 12 and up. After consulting an “international and multidisciplinary expert group” on COVID-19 disease and transmission in children, and taking into consideration “childrens’ psychosocial needs and developmental milestones,” UNICEF and the World Health Organization have not recommended masks on age 5 and under. They also allow for nuance when it comes to masking children ages 6 to 11, including a “child’s proximity to other people who are at high risk of developing serious illness, such as the elderly.”
This guidance is likely why England, for example, has never masked children in school, reasoning that “there is greater use of the system of controls for minimizing risk, including through keeping in small and consistent groups or bubbles, and greater scope for physical distancing by staff within classrooms. Face coverings can have a negative impact on learning and teaching and so their use in the classroom should be avoided.” During the UK’s delta wave in June, the country actually saw lower case rates in schools compared with the previous fall and the general population, and have since removed any recommendations around classroom bubbles.
Similarly, Sweden has continued to run school as normal, even during their peak COVID-19 wave. An analysis from March through June 2020 took a look at roughly 2 million preschool- and school-age children (ages 1 to 16), where there was no masking, no social distancing and no school building ventilation improvements. Just 15 total kids (0.00075%) required hospitalization from COVID-19, with zero deaths. Another significant finding is that there was no greater COVID-19 illness risk for the preschool and school teacher population than members of the general public.
Norway has also never recommended face masks for any age of schooling, while Finland, Denmark, Iceland, Ireland, the Netherlands and Switzerland have either never recommended masks on elementary age students or have shifted to no masks for the current school year. Switzerland instead focuses on maintaining good ventilation and testing. Denmark, Norway and Sweden all have lower adult vaccination rates than San Francisco, yet have removed most, if not all, COVID-19 restrictions. Spain and Italy make mask exceptions for ages six and under, while France is in the midst of removing elementary mask requirements in communities with low case rates.
As the above examples demonstrate, Europe has consistently acknowledged children’s incredibly low risk of serious illness from COVID-19 and the importance of the learning environment and children’s developmental and psychosocial needs. We believe that faces are essential to early speech and language development, as well as social skills, and that masks can impair face recognition and nonverbal communication for young children. It’s not until they are teenagers that children are able to move beyond a reliance on facial features, and that was before we entered a 20-month phase of heavy mask wearing. It seems very few are actually studying any potential downstream impacts.
While there continue to be articles on how schools and parents can help kids compensate for mask wearing, the bigger question should be: Why concern ourselves with any of that if mask wearing by kids is simply unnecessary? The onus should be on SFDPH and Mayor Breed to demonstrate that the benefits of masking kids outweigh the costs. They have been enforcing a fundamental, risky shift in classroom interactions and childhood development indefinitely, and they should prove with certainty there is no other way. Neither have offered such proof.
It’s incredibly illogical that SFDPH doesn’t mandate face coverings for children under 10 in indoor public buildings, yet requires them for children ages 2 and up in child care and school settings, where learning and socialization are key components. In addition, school interactions happen in much more stable groups than interactions at a grocery store or restaurant, for example, yet masks are only required for them at the former, often for eight to 10 hours a day.
As San Francisco parents, educators and concerned adults, we believe city officials are long overdue in balancing public health requirements with the medical necessity for kids, and the impact on their overall well-being, psyche and development. We ask SFDPH and Mayor Breed to allow for mask choice for chilren ages 12 and under in child care, youth programs and in-person school, as much of Europe has. This would also be in line with California Department of Public Health guidance, which allows for local flexibility. Parents who prefer that their kids still wear masks would of course be free to make that decision.
Our duty as adults is to not only protect the younger generation, but also to do as much as possible to ensure they thrive. Their incredibly low COVID-19 risk should be celebrated and reflected in public health policy. It is well past time for our children to return to “normal routines and interactions” and to be freed from this singular focus on virus mitigation.
This op-ed was submitted by a group of 41 Bay Area parents and residents. Their names follow:
Laura Fagan (12-year San Francisco resident, professional, and parent of three)
Ram Duriseti (Menlo Park parent of three)
Michelle Koskella (Burlingame parent of two)
Lelia Glass (San Francisco resident, educator, academic linguist)
Anh Shah (San Francisco parent of two)
Pradyut Shah (San Francisco parent of two)
Kathleen Laipply (San Francisco parent of three)
Ashwin Krishnan (San Francisco parent of three)
Daniel Bryant (Windsor Unified parent of three)
Anne Woodward (San Francisco resident)
Mercedes Hoglund (San Francisco parent of three)
Heath Hoglund (San Francisco parent of three)
Lesley Fisher (San Francisco parent of two)
Katja Wishart (San Francisco parent of one)
Robin Attia (San Francisco parent of three)
Jenny Gillespie Mason (Berkeley parent of two)
Mary Wellhausen (Antioch parent of three)
Sally Hwang (San Francisco parent of one)
Eric Passetti (San Francisco parent of one)
Elizabeth Woods (Berkeley parent of two)
Michael Senger (San Francisco resident)
Reza Musavi (San Francisco parent of two)
Markus Shayeb (Marin parent of four)
Meghan Weber (San Francisco parent of two)
Geoff Weber (San Francisco parent of two)
Julia Sterling (San Francisco parent of two)
Eva Chung (San Francisco parent of two)
Kai Sparnas (San Francisco parent)
Justen Sepka (San Francisco resident)
Michelle Gyorke-Takatri (San Francisco resident parent of three)
Katelyn Ribero (San Mateo resident)
Ashton Wilson (San Francisco parent)
Alexandra Gutentag (Berkeley resident)
Erica Sandberg (San Francisco parent of one)
Evan Bailyn (Berkeley parent of one)
Eileen Godsey (San Francisco parent of two)
Jed Godsey (San Francisco parent of two)
Robert Chappell (Berkeley resident)
Marie Hurabiell (San Francisco parent of two)
Matthew Ryan (San Francisco and Marin County parent)
