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By Rebecca Karb
COVID cases are falling and the worst of the Omicron wave seems to be behind us. As the dust settles, more and more states and school districts are lifting mandatory mask requirements [Rhode Island’s statewide mask mandate ends March 4]. This is a long-awaited and welcome move; no one could have predicted how long mandated masking would last, but certainly no one wanted it to last forever. An important question moving forward is: how will we reflect on the last two years and frame our experience of masking? History will not look back on nearly 6 million worldwide deaths (known to be significantly undercounted) and lament relatively benign restrictions such as masking. When we finally take off our masks, we should do so with a sense of pride in what our community has accomplished together and an open mind for the future.
What we have learned over the past two years is that masking is an important part of a multi-pronged approach to mitigating spread beyond our healthcare system’s capacity. Overwhelming evidence from the past two years has shown that masks work and are effective across a range of settings. If one approaches the data with objectivity (and not with a preconceived belief in search of confirmation), it is clear that masks are an indispensable tool in our public health toolbox – easy to implement and quick to take effect. Evidence also shows that the effectiveness of masks at mitigating surges is dependent on the percentage of the population that masks. In other words, masks work better at the population level when more people wear them. It’s a real life parable on how a whole can be greater than the sum of its parts.
Outside of their isolated benefit in the context of a deadly pandemic, it’s obvious to everyone that our kids are better off without masks. There are very real downsides that should not be ignored. However, many concerns have been distorted, overstated, and hyperbolized by radical disinformation campaigns. For example, despite pervasive myths, masks do not affect respiratory mechanics or oxygen and carbon dioxide levels. Nor do they seem to interfere with effectively reading facial expressions any more than a pair of dark sunglasses. Rates of depression and anxiety among kids are up since the pandemic, but isolating masking as the cause independent of the effect of living through a pandemic (including school closures as well as sickness and death among family and friends) is impossible and frankly disingenuous. In fact, for many kids and adults (especially those not on the frontlines) the pandemic brought about feelings of helplessness, and masks offered an opportunity to regain agency and connection by participating in the larger fight against COVID. My children continue to feel like they are contributing to the greater good when they mask up, and this pride and sense of responsibility has been an unexpected but important part of their development.
Understandably, many are eager to feel unburdened by the obligation to others that masks embody. But humans are social creatures and living together requires collaboration, responsibility, and sometimes sacrifice. From the oldest parables to the newest children’s books, human history is saturated with lessons on the responsibilities that come with communal living and the value of teamwork. Caring for our neighbors and working together to protect the vulnerable is a part of the human story, and one that we should be honored to pass on to our children. COVID has taken so much from us; we cannot let it steal our compassion. If we emerge from this experience with nihilistic individualism as our new mission statement, then we have lost a part of our collective soul to COVID.
There will inevitably be new variants and new surges as we settle into a new normal of endemic COVID. Armed with growing (and evolving) evidence, we can hopefully approach future surges with scientific nuance and a common goal of balancing freedoms with safety. I will be relieved to take my mask off when it’s time. My kids will too. But we are all prepared to mask-up again in the future for short, well-defined periods if and when a surge hits our community and we need to work together to curb the spread. We should do so with pride and with compassion, and the understanding that nothing lasts forever.
Rebecca Karb, MD, PhD, an emergency room doctor and researcher at Brown University, has three children in EG schools.
As a provider, also with a degree from Brown, on the front lines of the mental health crisis in multiple hospital systems I disagree with the assessment that masks are merely an inconvenience to children. It is well documented for decades that learning includes seeing other peoples mouths for language, non verbal communication, empathy and more. I do agree with you that humans are social animals, however that makes social isolation even more harmful to developing minds. If we can be unmasked indoors socially, how can we continue to place this on the children. The choice to mask will still belong to you and your children. Please let the rest of us choose what is right for our children.
It’s interesting that people continue to say that children shouldn’t be the ones to carry the burden in this pandemic but when you say “unmask my children” when children under 5 and immunocompromised children are still at risk, you’re actually placing the burden specifically on those children for the comfort of your children.
Why is this so polarizing that we can’t share our real names? I wanna have real conversations about this with people with names. Either way I am 100% in agreement with protecting vulnerable. If you have a child who you feel like they’re vulnerable or you continue to want to mask for any reason. Make N95s free and available to anyone who wants one. Have them fitted properly. You will be protected. Other people may choose not to mask. We have the technology and the science for those who want to be protected, or believe the benefit outweighs the cost.
Didn’t see you complaining when a bunch of totally real “EGMOM” and “EGDAD”s posted under your opinion piece. Now an actual student responds and your best response to their carefully thought out reply is to use their real name?
Not a complaint Joe P just a desire to be able to discuss this freely without fear or needing to be anonymous. I had no idea it was a student commenting.
Use your real name.
N95 and K95 are available for families who wish to use them. And where was your deep concern for these individuals during past flu seasons? Study after study shows negative consequences of continuing to mask children. ALL children matter.
And I’m also not AFRAID to use my real name. Time to update the comment rules EG NEWS!
Per your LinkedIn profile, you earned your degree (a PsyD) from Nova Southeastern University in FL, not Brown, where you did a fellowship. Accuracy in reporting credentials is important.
I am so glad you asked, I had no intention of misleading anyone. I now understand why you are choosing to remain anonymous.
For anyone who is curious I have listed below my educational history. Had to start slow, I was waiting tables to support myself.
Associates Degree-Holyoke Community College
Bachelor Degree in Psychology- Springfield College
Masters Degree in Psychology-Nova Southeastern University
Doctorate in Psychology-Nova Southeastern University
Postdoctoral Appointment in Developmental Disorders of Childhood- Brown University
Thank you, Kristin, for clarifying that you did not earn a degree from Brown as you had initially stated. Neither a fellowship nor an appointment confers a degree. As I said, accuracy counts if you choose to state your credentials.
The relevance of comments is not tied to whether or not individuals choose to identify themselves by name on this site or any other news source, including The NY Times, where comments are moderated just as they are for EG News, and most choose not identify themselves by name. The dialogue itself is what counts, not the identity of the commenter. This is particularly true with polarizing issues such as the one under discussion, where insistence on identity only acts to discourage individuals from stating their views.
You’re welcome. My point is we are not the New York Times. We are East Greenwich a town of 14,000 people. I wish we could speak in a town hall together. This doesn’t need to be so polarizing. Let’s collaborate as a community. Also what opinion are you expressing that so polarizing? Whether or not my training at Brown constitutes a degree or not? Feels like you’re actually just trying to be divisive. What’s your goal here? Figure out what we need to do for our children or find some kind of “gotcha“ moment.
I’m grateful to Kristin David for her compassionate understanding of child development and her willingness to speak out about a topic of concern, despite becoming a target of criticism. Thank you.
I think if you read the letter in all of its detail, you’ll find that Dr. Karb doesn’t disagree with the fact that optional (or no) masking is the next best step for our community. Obviously new variants or novel viruses may make us reconsider masking. This issue doesn’t have to be divisive. It can be collaborative.
Also, a point of clarification, Dr. Karb did residency and is currently a physician/prof at Brown. She is a graduate of Harvard Medical School. (I know ‘cause I was there! 😉
Clare, I appreciate your response. Currently EG citizens are gathering indoors (venues, dinning, night life) mandate free, oddly schools are somehow last. The draft policy references school mask mandates can be reinstated by the superintendent’s authority. Mrs. Meyers is leaving. New one to be chosen by current SC. I’ve yet to hear a public statement by any of the involved regarding the mental health of kids as a reason to reevaluate the approach: Even though leaders in Mass. and other states freely express this consideration.
Kristin, I completely agree that kids should not carry the burden of masks if adults are not also doing so. In fact, I would hope that adults would take on more responsibility (masking and vaccination) to *prevent* the need for kids to mask in school.
I think everyone should be prepared to have to mask up at some point in the future because, regrettably, we have not set ourselves up for success with this virus.
I think if and when we have reasonable, well-defined on and off ramps, it will be easier to mask up knowing it’s for a discrete time period.
The individual “mask if you want” is fine for periods of low transmission, but it’s not a public health approach and that has to be understood.
Dr. Karb, I appreciate your response. Currently EG citizens are gathering indoors (venues, dinning, night life) mandate free, oddly schools are somehow last. The draft policy references school mask mandates can be reinstated by the superintendent’s authority. Mrs. Meyers is leaving. New one to be chosen by current SC. I’ve yet to hear a public statement by any of the involved regarding the mental health of kids as a reason to reevaluate the approach: Even though leaders in MA and other states freely express this consideration.
“Those who would give up essential liberty, to purchase a little temporary safety, deserve neither liberty nor safety.” -Ben Franklin
If you choose to wear a mask, whether out of fear, safety or just to feel good about yourself go right ahead. The mandating of others to do the same is extremely unamerican.
Your liberty ends where mine begins. Masks work. We wear them not only for our own protection but just as importantly for the protection of others. What is truly “unamerican” is caring about oneself over the greater good, particularly in the midst of a global pandemic still killing >2,500 Americans daily and overwhelming hospitals including here in RI, which requires assistance from the National Guard. I thank Dr. Karb for her excellent, balanced piece and for all her efforts as an ER physician who has worked on the frontlines caring for critically ill COVID patients over the past 2 years.
What is your response to the schools that have lifted or never had a mask mandate?
What is your response to the states who never had a mask mandate and have lower COVID case numbers than Rhode Island?
What is your response to all the politicians who touted the safety of mask wearing, only to be caught defying their own orders?
What is your response to the CDC coming out and flatly saying that cloth masks are ineffective?
What is your response to the fact that there are boosters, vaccines, and pretty much any flavor lollipop available to any/all? The argument that kids under 5 are “vulnerable” is inaccurate, not to mention that children under 5 are not eligible to be fully vaccinated against other diseases, but no one seems to care about that.
What is your response to why you didn’t mask your child during the flu outbreak in 2019 that killed more children than COVID even makes ill!?
What is your response to the fact that these kids leave school, ditch the masks, and have a free for all with friends and family?
But no- you want EVERYONE’S kids to mask so your child can “feel safe”. That’s what parent have already instilled in their kids- you’re not safe without a mask. That is your CHOICE to teach your child that, it is your CHOICE to mask you child. You do NOT get to make the decision for MY child.
There were 188 pediatric flu deaths in the US during the 2019-2020 season.
We’ve known for 2 years that COVID is far more lethal than flu across all age groups. There had already more than 1,000 pediatric COVID deaths in the US by Dec. 2021, which was before the Omicron surge hit, and pediatric hospitalizations have since hit an all-time high. By early January 2022, nearly 700 children were admitted to US hospitals with COVID each day. Of the more than 12 million pediatric COVID cases so far, a significant number of these children suffer from long COVID.
So no, flu has not killed more children than COVID makes ill.
And yes, properly worn and widely available high quality masks work, especially during periods of high viral transmission.
Personal choice does not work as a public health measure.
Look at your articles, MM, and try again. In the first article about the flu, the CDC even admits that the numbers were quite understated. They estimated that while it was reported around 188 deaths, there were most likely around 600 deaths. And that’s for one year – if your statistics are 1,000 pediatric deaths for up until December 2021, that would be two whole years of COVID, not just one. And – how many of those deaths are actually BECAUSE OF Covid, not just kids coming to the hospital and testing positive for Covid. Again, totally different numbers. In fact, the even Fauci said the numbers of kids in the hospital is not accurate:
What’s amazing about this particular article is that he says that death/hospitalization is much higher in adults than in children …. yet adults are now able to unmask in public places…..but children still must be masked in school. Sooooo, the population that is MOST at risk doesn’t have to mask, but the population that is the LEAST as risk must wear masks….
Deaths due to COVID are likewise undercounted. The fact remains that COVID is vastly more deadly than flu across all age groups, and nearly 1 million Americans have died thus far based on official counts, with the true number far greater. Your claim that flu kills more children than COVID makes ill is incorrect. With over 700 pediatric hospitalizations each day due to the Omicron surge alone, that daily number is higher than the number of pediatric flu deaths for the entire 2019-20 season.
More importantly, there was 1 pediatric flu death in the 2020-2021 season, with 2 pediatric flu deaths in the 2021-2022 season by the end of December. This sharp decline in flu has been attributed to COVID precautions, including masking, social distancing, and hand washing. So, there have been 3 pediatric flu deaths vs. 1,000 pediatric COVID deaths over the same roughly 2-year time period. Again, COVID has caused far more illness, long-term morbidity, and death than flu across all age groups, and use of masking reduces the incidence of both.
would like to lend my support to Dr Karb. I know her to be a thoughtful, intelligent, well informed and incredibly caring individual. I also agree that mask optional approaches are not a sound public health approach to disease. Wearing masks (particularly non-N95 masks) do far more to protect those around the person wearing them than the individual actually wearing the mask. Source control is always best. Our family masks not because we fear catching covid. It is because we care about others and fear giving it to someone else. That person could then give it to others like their parents or grandparents who may have a poor outcome. I have personally intubated many people with covid and watched quite a few die over the past two years. I have seen firsthand the toll it can take on patients and their families. I continue to see those who come in weeks or months after their illness far from the people they were before. My approach as a parent has been to use this terrible pandemic as a tool in teaching my children about the importance of caring for others. I agree with Dr. Karb that it will be wonderful to unmask when it’s appropriate and we will be excited to do so. However, our family will be fully prepared to do so again for the greater good if needed. It is such a small inconvenience and we will do so knowing we are helping others. – David Curley, MD PhD (parent of two EG students)
I too am glad that we are lifting masking requirements. But we can afford to be honest now and stop using fear as a tool. Let’s get some mask points first. There are three basic types of masks: 1. Cloth or homemade 2. Surgical, the ubiquitous blue and white, and 3. N95/KN95 respirators with or without a valve. The first doesn’t really do anything, it’s a placebo with some minor signaling properties, like stay away I could be sick. The second perhaps reduces the half-life of exposure 10%-20%, it’s really just a guess, from some combination of source control, which is your neighbors wearing them, and personal protection which is you wearing them. That won’t matter much to anyone in an environment with the same population for any extended period of time like office work, school or home. And we have never been accurate or confident enough in any risk estimates that that an 10%-20% extra should have altered any mitigation decisions regardless. That assumes they were worn correctly. We know that’s a flawed assumption, and if nothing else we didn’t ban beards which puts the nice blue ones back to placebos as well. Now, the N95s work great as long as you wear them properly (they train medical professionals how to do this, so will your average Joe be successful) and work as personal protection. So as long as you have that protection you don’t need to worry about your neighbor’s behavior, known as source control that, in theory, the surgical masks may provide in short durations. In short, if you have an N95 you don’t need anything from your neighbors to be safe. What’s not known is how they fair in repeated use as they were designed for single use.
The idea of isolating an independent cause used to discount some of the psychological toll of mask wearing is precisely the same logic as to why there are not good studies showing the effectiveness of masking, other than N95s. You’d be hard-pressed to find a study that wasn’t coupled with social distancing. I don’t think you can find more than one or two. We know that social distancing is highly effective in the case covid, even if the six feet rule was made up, so it’s impossible to draw any conclusion as to the contribution from masking . That’s the objective conclusion, anything more fits into that idea of wishful thinking or preconceived belief .
It’s correct that it would be hard to quantify the direct effects of masking on psychological and educational growth, but it’s foolish to minimize them because it makes some collective good story sound better. We’ve understood that facial expressions, nonverbal communication and emotional intelligence are a part of human and other animals like dogs makeup since at least Charles Darwin wrote about it. There’s a reason professional poker players often wear sunglasses, hats and face coverings or cover their mouth. There’s a reason they teach TSA agents to look for subtle cues when screening. We know from neuroscience that parts of our brain are built to process and incorporate all of these signals. So let’s not trivialize these costs, probably long-term in children, just because it’s inconvenient. Let’s treat all aspects of the cost-benefit analysis with the same objectivity and open-mindedness.