Monday, December 19, 2022

Do Masks Harm Children?

There's some shock and outrage that I'd suggest encouraging masks in class to curb the spread of the three-plus viruses inundating pediatric wards in hospitals right now. Some have accused me of wanting masks in order to virtue signal or to feed my ego, but it's actually just about saving the health and lives of children.

I'm hearing that some think masks are completely ineffective at preventing illness and cause learning loss. Let's take a Pascal's wager approach to this:

  • If I'm completely wrong, and masks do significantly affect learning loss and aren't at all effective against a virus, and we do encourage them in class, then it will be inconvenient, and some kids might need to ask for extra help or, at the very worst, take an extra year to graduate. 
  • If this group of parents (or random people, some from the U.S.) are wrong, however, and masks are effective against the virus, but we don't encourage anyone to wear them, then some kids might die or become disabled by Long Covid, and other people might not be able to access a hospital because they're overflowing.

What we're seeing already, though, is many kids are suffering learning loss from being sick two or three times so far this term, sometimes for weeks at a time. A recent CBC article included an interview with a Cambridge dad about his son, 

"He's had the flu at least four times, which has had a 'detrimental impact' on his education. 'I think he's been at school three and a half, maybe four weeks total this year. He's definitely missed more time than there's been school. Every time our son goes back to school he catches something from someone and he's off for another week or two, sometimes longer. . . . There are some parents that are not able to keep their child home because they need to go to work."

Provincially, the rules still state that sick children can return to school if they don't have a fever and if symptoms have been improving for 24 hours, or 48 for intestinal symptoms. The province recognizes that children will likely still be contagious at that point, so they require masks for 10 days from the start of symptoms. Nobody is monitoring that this ten days of masking is happening, so it would really help if everyone just wore a mask as much as possible.

So, even if it's true that students could experience learning loss from masks, we can see that already kids are suffering learning loss from the number of viruses in schools this year. I've heard from many parents with experiences like this Cambridge dad. It's not just learning loss from being absent, but from the teacher's absence, from rotating supply teachers, and from students trying to learn when they're sitting in class but not feeling 100%. 

But my bigger concern here is Long Covid. Covid hibernates in the blood stream similar to how chicken pox shows up later as shingles, except Long Covid can be much worse. It's estimated that it affects 20% of people, and one of those effects is brain damage. That is definitely going to affect learning loss. (By comparison, polio can be like a flu then later becomes paralysis in only 0.5% of people.)

Some people are concerned that students wear poor-quality masks or don't wear them properly anyway, but we can fix those problems with education! One study found that even a loose cloth mask can still offer an almost 40% reduction in transmission. It's not great, but it's not nothing

And we can teach everyone what masks work best (N95) and how to wear a mask properly (no pulling them down to talk), how they work, and why they're so important. 

Some parents have been embolden by that one sentence Dr. Moore said recently, that wearing masks might have harmed immunity, despite him clarifying in that same article that we should keep wearing masks. There is a lot of compelling evidence that masks don't cause immunity debt. The Gauntlet explains that immunity debt,

"is a convenient explanation for a lot of reasons. First, it allows us to preserve our national delusion that COVID ended and is not longer a problem. Second, it allows us to continue living our best, unmasked lives. . . .  There are obvious and less obvious flaws with this concept . . . First: pediatric illness is surging even in regions that never had lockdowns or masking. . . . Second, your immune system is not like a muscle - it doesn't need exercise to continue functioning. . . . Third, immunologists do not use this term and their reactions have ranged from 'what the hell are you talking about,' to 'no, this isn't a thing.' . . . Further, when we look closely at the different cohorts of children (meaning different segments of the pediatric population grouped by age), we see that children who did not get RSV as babies did better with their delayed RSV infections than children infected earlier." 

Here's a list of studies that explain the rise in illnesses as due to Covid causing harm to the immune system and not to any type of need to get sick in order to avoid getting sick (aka immunity debt).

McGill University's Office for Science and Society's article, "The Masked Kids are Alright," says that any concerns around suffocation or development delays point to "an ill-founded panic": 

"Six studies looked to see if wearing a mask impaired a child's respiratory function, and there was no objective evidence of this, only reports of subjective complaints. Some kids (like some adults) didn't like wearing a mask and felt like they couldn't breathe as well, but when this was measured, there was nothing wrong. There's even a study that tested three-layer surgical masks in hockey players aged 9-14. . . . Oxygen and CO2 are small enough molecules that they do not get trapped in the masks. . . . Surgeons and dentists don't drop dead from wearing them day in, day out. . . . 

The other claims of physical harm include the idea that wearing a mask will weaken your child's immune system. . . . In studies of schools with and without a mask mandate, those with the mandate have fewer cases of COVID-19. . . . Some have argued that masks are bathing kids' mouths in microbes. . . . If microbes are found on the outside surface of a mask, it is not evidence of harm to the child; it is evidence of the mask doing its job. Soiled gloves in the operating room do not imply the surgical staff got infected. It means the protection was necessary. . . . 

Some worry that children who are learning to identify emotional information from looking at people's faces might fall behind. Studies have been done getting children to match a masked or unmasked face to an emotion, and the results are mixed. . . . It is important to remember, once again, that children still get to practice this skill at home and outdoors, where masks are not used. . . . 

In some cultures, wearing a mask or partially veiling the face is common. . . . There is no evidence that children growing up in those cultures are any worse at recognizing faces or emotions. . . . As Canadian psychiatrist Tyler Black told TVOntario, we don't seem to panic about the wearing of sunglasses around children, even though they also obscure our faces. 

Masks can make it harder to be heard. . . . Kids can still develop verbal skills at home. [As a teacher, I fell in love with wearing a mic, which made it much less of a strain trying to project my little voice all day.]

Some children are unable or unwilling to wear a mask . . . This is not an argument for foregoing masks in children; it is an argument for other children to mask up to protect the more vulnerable among them. . . . And yes, COVID-19 does not affect children as much as adults and doesn't kill as many of them, but are we really OK with kids preventatively dying of COVID?" 

More specifically, an oxygen molecule is 16 daltons and carbon dioxide is 44 daltons, so they pass through a mask easily, but a single Covid-19 virion is 6 billions daltons, so it gets stuck in the mask. It actually works! If masks affect learning, we're also not seeing it in other cultures that have kept masks, like Taiwan or Japan, or in students with visual challenges.  

The American Academy of Pediatrics clarified further,

"Masks are made from breathable materials that will not block the oxygen your child needs. Masks have not been shown to affect a child's ability to focus or learn in school. The vast majority of children age two or older can safely wear face masks for extended periods of time. . . . Wearing a face mask will not affect your child's lungs from developing normally. This is because oxygen flows through the mask, while blocking the spray of spit and respiratory droplets that may contain the virus. Keeping your child's lungs healthy is important, which includes preventing infections like COVID-19. . . . Wearing a face mask does not weaken your immune system or increase your chances of getting sick if exposed to the COVID-19 virus. Wearing a mask, even if you do not have symptoms of COVID-19, helps prevent the virus from spreading."

And here's an article in National Geographic: Science, "Do masks really harm kids? Here's what the science says." that reports, 

"There's no question that masking reduces the spread of disease. . . . We haven't seen those fears of health risks realized. . . . Most evidence suggests that masking doesn't harm children--and that it benefits them in more ways than one. Not only do masks protect kids from COVID-19 and other respiratory disease, but studies show that schools with mask policies in place are more likely to stay open. . . .  The fluctuation of carbon dioxide and oxygen levels among adults and children wearing masks was 'well within normal range.' . . . Two years into the pandemic, hospitals just aren't seeing an influx of children with dangerously low oxygen or high carbon dioxide levels due to masking. . . . 

Studies have shown that masks muffle sound. . . . Another study suggests that surgical masks offer the best acoustical performance, followed by KN95 and N95 masks, then cloth masks--with transparent masks again coming in last. But experts say there's no clear evidence that this significantly impairs a child's ability to communicate--perhaps because people can compensate by talking more slowly and loudly. . . . Mitsvan led a recent study analyzing audio recordings of preschoolers--one classroom that was observed over multiple visits before the pandemic and another classroom that was observed when the children and teachers were required to mask. The study found no difference in how much the children spoke or the diversity of the language they used. This was true even for children with hearing aids and cochlear implants, a population that made up half of each class. The vocalizations are on par with children their age. . . . 

A study published in Frontiers in Psychology showed that children between the ages of three and five were less adept at recognizing the emotions on photographs of people wearing masks compared to photographs of unmasked people. But Walter Gilliam, a child psychiatry and psychology professor at the Yale Child Study Center, says this study and others like it are limited by their reliance on still photographs. . . . He points to another study showing that children have no more difficulty reading the emotions of a person wearing a face mask than they do a person wearing sunglasses. These studies are also only a snapshot in time--they can't tell us how quickly children would be able to adapt to these challenges if given the chance. 'Everything I know about child development would tell me that they'd adjust quickly. I wish that we had more faith in the capacity of children." . . . Over the course of two years, evidence has grown that masking policies help schools stay open by reducing the number of outbreaks.

Similarly, while some argue that school masking mandates are harmful to a child's mental health, experts say the evidence suggests the opposite. . . . Gilliam says blaming masks for the depression and anxiety in kids stems from a natural desire to protect them. But he suspects it's not the masking that causes stress in classrooms. 'It's the trauma of COVID that the masks were intended to prevent. When you have an ache and a pain, it's the cut on your arm not the Band-Aid that went over it that's causing the problem. The purpose of the mask is to reduce all the other traumas--traumas that we know for an absolute fact harm children.'

According to a 2012 study published in the journal Cognition, when children aged 3 to 8 viewed faces covered with face masks, they didn't show any impairment in classifying expressions. This suggested that children under 9 preferred studying the eye area even when they could see full faces. When children wear masks, if one child smiles, another will smile back. 

Today's Parent repeats all of these same things: 

Plenty of research indicates the benefits of mask-wearing during the pandemic. A recently released study funded by the National Institutes of Health, for example, found that schools with mandatory masking during the Delta wave had approximately 72% fewer cases of COVID transmitted at school compared to schools where masking was optional. . . . It's important to know that not all masks are equal. A well-fitting medical mask or respirator offers much better protection than a cloth mask.

I'm not sure what more proof I can offer that masks are not only not harmful, but they do help to reduce the spread of dangerous viruses. There are no kids in the hospital right now because of harm from a mask, but the hospitals are overflowing with children who were exposed to a virus.  

One other concern I have about all this outrage about masks harming children, is that we voted on a motion that would just encourage more kids to wear masks in school and teach them some biology and physics and engineering to help them understand how this virus works and the many things we can do to protect ourselves. The fact that encouraging masks hit so many nerves, means, I think, that it's possibly not about the masks. Many parents adamantly against masks in class have coupled this issue with my "woke agenda." The fact that so many argue that masks aren't effective at all and also argue that mask harmed kids by causing immunity debt furthers this concern. I worry that this is just another disruption fostered by Trump-like group such as Action4Canada. I worry that, for some who have contacted me, it isn't about finding the best possible understanding of the current science, but about undermining democratic systems and arguing in order to be obeyed despite so much evidence to the contrary. If that's the case, then it's absolutely horrific in the face of so many children unable to access a doctor or medicine as needed. A toddler died on the floor of a hospital because there weren't enough beds. This is not a typical year of illnesses, and we need to do everything we know how to in order to prevent the spread of viruses right now. 

ETA: This fascinating article on sentinel intelligence by the brilliant non-fiction writer, Jessica Wildfire. 
"If you have sentinel intelligence, it probably infuriates you how the vast majority of people can't or won't connect all the threads. . . . Research in psychology has associated sentinel intelligence with higher levels of empathy, compassion, and overall intelligence. Sentinels care about people and want to keep them safe, even strangers. . . . Conspiracy theorists show higher levels of narcissism and psychopathy. They place a great deal of importance on their own personal rights and freedoms. . . . prone to trivialize and dismiss actual threats. . . . 'Trojan brains' have a special kind of logic. It goes like this:
  • That will never happen.
  • Okay it's happening.
  • It's not that bad. 
  • Okay, it's bad.
  • It won't last long.
  • Okay, it will never end.
  • What's your solution?
  • That won't work.
  • It's too late to do anything.
  • Everyone's worn out.
  • There's no way we could've known.
  • We should just let it happen.
  • Everyone's on their own
This kind of thinking has gotten popular over the last few years. . . .  called 'reactance' . . . not many are big fans of being told what to do. On the other hand, persisting in your obstinance can feel pretty satisfying. . . . We have to resist the dopamine hit that comes from dismissing warnings and minimizing threats."
I don't think I necessarily have sentinel intelligence. I think I just read a lot of science journals, which is unusual, and I have, what I've always considered to be normal, an instinctive concern for the well-being of children! To the people who think I'm doing this out of some self-serving agenda: Is it really so hard to believe that some people take this job for the kids??

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