‘Let us also be clear, wearing a mask does not represent a medical or psychological threat to any of our children.’ 

This is a letter to Rhode Island school superintendents from the Rhode Island Chapter of the American Academy of Pediatrics, dated Aug. 8: 

Dear Superintendent,

As pediatricians, pediatric leaders, and parents, we write in support of universal masking of all students and school personnel for the start of this school year, the third academic year affected by the pandemic. 

Rhode Island successfully completed last school year with low COVID-19 transmission rates in schools thanks to a layering of several mitigation strategies which included masking, social distancing, improving ventilation, a robust K-12 testing system, and a vaccine distribution program that prioritized educators and students as soon was feasible in the statewide rollout.  As rewards for this collective hard work we all had hopes that the pandemic would be in the rear view mirror by now. However, given the exponential rise in COVID-19 infection rates across our state and nation, both the American Academy of Pediatrics and Centers for Disease Control released statements recommending universal masking in school settings for everyone age 2 and up, in addition to other noted infection control measures, as the best policy to ensure that in-person return to school can be as safe as possible for all children.  

Our state and communities now face new challenges, as the Delta variant of the COVID-19 virus has driven an increase in COVID-19 cases and hospitalizations.  Rhode Island’s COVID infection rate has risen from 0.4% to 3.6% in just the past 4 weeks, which represents 135.4 cases per 100,000 residents. By current CDC guidelines, Rhode Island now falls into the high transmissibility category which means that all persons, even vaccinated, should resume wearing masks indoors.  Across the nation, the rates of COVID infections in children has risen an astounding 84% with pediatric hospitalizations increasing 45.7% just in the last week, many of these children sick enough to require the intensive care unit. This represents a major change in the Pandemic itself.  Thanks to the widely circulating and much more contagious Delta variant, the idea that COVID-19 infection is not a major threat to children is being re-examined. A recent Lancet study reports that nearly 5% of COVID infected children, especially school-aged children, have lingering symptoms such as MIS-C, fatigue, and brain fog, more than 4 weeks after their symptoms started which results in additional missed school and learning loss. 

Last year school districts and teachers worked admirably to meet the demands of remote learning. While zoom classrooms allowed for unmasked full face teaching, which truly has benefits, remote learning came at the price of social isolation, academic underachievement and loss of academic skills, anxiety, depression, eating disorders, to name a few. 

As pediatricians, we see children, adolescents, and families in crisis because of the ongoing stressors the COVID-19 pandemic presents.  Further, we have seen how the pandemic has only increased the healthcare and educational inequities between communities in our state. In that context, it is critical that in person learning, supported by scientifically successful infection risk lowering measures, be preserved for all communities this academic year. Let us also be clear, wearing a mask does not represent a medical or psychological threat to any of our children.  Without universal masking requirements as a critical piece of these protection efforts, more children and staff will get sick resulting in students missing in person school opportunities.  In southern states such as North Carolina, Florida and Texas, where the academic year has already started without a mask mandate, COVID exposures and infections have already forced classrooms and schools to close.  It doesn’t take much for COVID-19 to shut down an entire school, so Rhode Island can and should learn from these experiences. 

Therefore, to protect our state’s children and families and to preserve a safe in-person learning environment, Rhode Island pediatricians ask for your support of the following measures: 

1. Vaccinate all who are eligible.  Statewide Rhode Island’s fully vaccinated rate is 62.1%, which includes 9% of 12-14 year olds and 51% of 15-18 year olds.  Children under the age of 12 are not yet eligible for the vaccine. Vaccines are a safe and effective method to reduce the burden of infectious disease.   Improving statewide vaccination rates will protect against the spread of COVID in schools and in the community.
2. Universal masking. A significant portion of the student population is not eligible for COVID vaccination at this time, so universal masking protects the unvaccinated and reduces transmission of the virus, which is most important given the continued concerns for variants such as the Delta variant that are more easily spread among children, adolescents and adults. 

It is vital that we work together to enable schools to re-open for in-person learning this fall. It is so critical for our children’s education as well as their social and emotional health.  We can achieve this with the combination of vaccines, masks and other infection control strategies that we know can help make that environment safe for everyone at this juncture in the pandemic’s course.  Thank you for your efforts in caring for all of our children and for your work implementing a universal masking program for in school activities for the start of this school year.  The pediatric community looks forward to partnering with you during this pivotal year. Please feel free to reach out to any of us, or your school physician for further guidance and support.

Sincerely,

Allison Brindle, MD FAAP*
Peter Pogacar, MD FAAP
Gregory Fox, MD FAAP
Patricia Flanagan, MD FAAP
Elizabeth B. Lange, MD FAAP

https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools/

https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-12-guidance.html

*Fellow of the American Academy of Pediatrics