The Checkup With Dr. Wen: Why I decided that my 4-year-old son can go maskless at school

Thursday, March 10, 2022

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Guidance on navigating the pandemic and other public health challenges

By Leana S. Wen
Opinions columnist

Last Tuesday, my 4-year-old son's preschool went mask-optional. It was the same day that our city, Baltimore, lifted its indoor mask mandate.

Of course, just because masks aren't required doesn't mean that all the children have to stop wearing them. My husband and I discussed this decision at length.

On the one hand, our son is not yet vaccinated. Some kids in his class have already turned 5 and have received their vaccines, but they are in the minority. Our son isn't bothered by wearing a mask and has never complained about needing one at school.

On the other hand, the covid-19 level in our community is low, according to the Centers for Disease Control and Prevention's new tracker. At least half of the preschool class has already had covid-19, including some who were infected during the omicron wave. It's unlikely that those who recently recovered from covid-19 will become reinfected so soon.

In addition, just because children are fine with masking doesn't mean that they should mask in perpetuity. Kids are resilient and can adapt to many circumstances. Common sense tells us that young kids need to see phonation for speech development, something that I'm particularly attuned to as someone who grew up with a severe speech impediment.

Our choice came down to this: Does the reduced risk of viral transmission outweigh the possible downsides that could come with continued masking in school?

Given the very low likelihood that he would contract covid-19 from his classmates, we felt that masking at this point in the pandemic would provide minimal risk reduction. On the other hand, we thought that he could benefit a lot from being able to see others' faces and for his teachers to see his.

So, last Tuesday, our son went to school with his mask in his backpack and not on his face. (Masks are still required in large gatherings, such as school assemblies and chapel.)

At the end of school, my husband and I were eager to find out how the first maskless day had gone. Our son's response was, well, anticlimactic. He said he didn't really notice any difference. When pressed, he said that it was nice to see other kids' smiles.

So far, we are happy with our decision, with the understanding that it could change depending on evolving circumstances — for example, if a new concerning variant arises or if covid-19 levels surge. And we are hardly throwing caution to the wind. Our whole family masks when going to the grocery or pharmacy, and we're still staying away from crowded indoor restaurants.

I also very much understand families that make a different choice. No one should be made to feel uncomfortable if they decide to keep masking.

The one thing I'd urge everyone to do is to use high-quality masks. A simple one-layer cloth mask is just not protective enough against the very contagious omicron variant. If you're going to wear a mask, use the highest-quality mask that you can tolerate, ideally an N95, KN95, or KF94, but at least a three-ply surgical mask. One-way masking with such a mask remains a very effective way to prevent the wearer from contracting covid-19.

I'd love to hear from you: Are you parents or guardians who are also facing masking decisions at school? How are you approaching your thought process for masking at school and at work? I'll include responses in next week's newsletter.

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"As I'm hoping to plan some social indoor events in the next several months, I'm wondering what types of covid-19 protocols I should put in place to help my guests (anywhere from five to 60 people) feel safe. For example, should I require proof of vaccination? Would a negative test suffice in its place? Do I still need to follow the 'two out of three' rule for indoor events (vaccine, test, and/or mask), or are numbers lessening to the point that even one of these things would suffice?" –Melanie from Washington, D.C.

It depends. Consider each gathering separately: Depending on who is expected to attend, how low-risk does it need to be?

The "two out of three" rule would provide a fairly high level of safety: If everyone is vaccinated and just had a negative test, they can all forgo masks with very low risk to each other. If some attendees are immunocompromised and/or have a low tolerance of covid-19 risk, requiring vaccination and a test would provide a lot of reassurance.

In communities with low covid-19 levels, I think "one out of three" is very reasonable too — that is, someone who's unvaccinated can test, and those vaccinated don't need to test. People who are vaccinated, boosted, and generally healthy may even be fine with "zero out of three," since their risk of infection is very low.

"I am in very good health and have no covid-19 risk factors other than being over 70. However, my husband has multiple health risk factors. Should I continue to mask in any situation where he would?" – Lynn from Indiana

Yes. In deciding what protective measures to keep, you should consider the risk of all members of your household. If one person still needs to mask in certain settings because they are susceptible to severe illness, everyone else should mask in those same settings, too. In your case, you would want to prevent contracting covid-19 yourself so that you don't pass it on to your medically vulnerable husband, and I'd encourage you to mask in all situations that your husband does.

"I'm fully vaccinated and boosted. I work in a small, poorly ventilated office with an unvaccinated co-worker. Two unvaccinated field workers come into the office daily. No one wears masks except me. My husband is a cardiac patient; I have asthma. Should I continue to wear a mask regardless of dropping infection numbers in my community because of my co-workers?" – Lynne from Ohio

This a question to ask your doctor and your husband's doctor: Are you two considered to be high-risk from severe outcomes because of covid-19? Asthma generally isn't a high-risk condition, but cardiac issues can be. If one or both of you and your husband are considered medically vulnerable, then yes, I would continue to wear a mask in your office. Make sure it is a high-quality N95, KN95, or KF94.

"Can N95 masks be hand-washed in scalding-hot water with detergent, air-dried, and then reused?" – Harry from Maryland

No, please don't wash your N95 mask. These masks have special electrostatic fabric that could be disrupted with water and detergent. They can be safely reused without washing. My recommendation is to have at least three N95 or equivalent masks that you use in rotation — one today, the next tomorrow, and so forth, no cleaning necessary. If they get wet or lose their shape, it's time to throw them out.

The Post has also compiled Q&As from my previous newsletters. You can read them here.

What I'm reading

Britain's Health Security Agency released a briefing that summarizes how effective vaccination is against long-haul covid-19. Several studies it cites found that people who are vaccinated are less likely to develop long-lasting symptoms following infection, compared to those who were not vaccinated prior to infection. While there are still many unanswered questions about long covid, including what the true prevalence actually is, there is growing consensus that vaccination reduces both the chance of infection in the first place and, even if someone does become infected, the likelihood of developing long-lasting symptoms.

This summary in Wired captures the dramatic decline in routine childhood immunizations since the onset of the pandemic. By 2021, American children had received almost 12 million fewer doses of routine vaccines than in a similar period before covid-19. Worldwide, in 2020, 30 million children missed doses of the tetanus-diphtheria-pertussis vaccines and 27 million missed shots for measles. The reasons are multifaceted and include fear of the coronavirus, lack of health-care access, and diversion of scarce resources away from routine health care. These are issues that can be rectified over time as covid-19 recedes as a daily threat, but another problem — heightened disinformation about vaccines — may well complicate immunization efforts for many years to come.

According to a study published in the CDC's Morbidity and Mortality Weekly Report, Americans residing in rural areas are much less likely to be vaccinated against covid-19 than those living in urban areas. In rural counties, the rate of eligible people who have received first doses is 58.5 percent, compared to 75.4 percent in urban areas. Among 5-to-11-year-olds, fewer than 15 percent of rural residents received one dose, a rate that's less than half that (30 percent) in urban areas.