On December 1, 2021, the Fifth U.S. Circuit Court of Appeals temporarily restored Texas Governor Greg Abbott’s executive order banning school districts from mandating masks. This temporary stay reverses the rulings issued by a federal district court and a Texas state appeals court that both struck down Abbott’s order. For many parents, particularly those with children who have special health needs or disabilities, these conflicting rulings add to the confusion over whether or not their children can go to school safely. With further court actions pending, the debate over school mask mandates still rages across the state and nation unresolved.
As we enter into year three of the COVID-19 pandemic, researchers have a much better understanding of how the virus behaves.1 The data demonstrate that mask-wearing is effective at preventing the spread of COVID-19 in schools,2 and thus mask mandates should remain an option for state and local officials to combat the virus—especially as it continues to mutate. Both the Alpha and Delta variants have increased transmissibility, and recent evidence suggests that the Delta variant is more aggressive in children than the original virus. Additional variants are to be expected, with a new variant that has far more mutations than either Delta or Alpha—Omicron—identified by researchers in late November 2021.3 Further, according to the American Academy of Pediatrics, approximately 1 million children contracted COVID-19 from August to September 2021 alone—just as schools were reopening in the fall.4
As public health officials try to stay abreast of an ever-changing virus, the political debate around mask-wearing has impeded local municipalities and districts from implementing the protocols needed in their communities to reduce the spread of COVID-19. Without proper protections for children to attend school in person, many parents have been faced with the difficult decision of whether to keep their children in school and risk their health, or search for virtual or homeschooling options and risk a decline in their learning. In some cases, parents do not have a choice. For example, due to high rates of COVID-19 at the beginning of the school year, 45 school districts in Texas switched back to virtual instruction in the fall, irrespective of parental choice.5
Evidence demonstrates that keeping schools open is the best option for students and parents.6 Children benefit from social interaction with their peers, and social and academic isolation can negatively impact their mental well-being as well as their academic performance. Nearly all states reported significant declines in state testing scores during the 2020-2021 academic year, especially among underrepresented student populations. Lower academic performance during this time was likely due to a multitude of factors, including the pressures on parents to balance their children’s schooling at home with their own work schedules. This balancing act can be particularly difficult for families who have additional challenges, such as employment uncertainty, lost wages, or heightened food insecurity.
Local communities attempting to enforce public health guidelines have been stymied by political debates and partisanship. The recent ruling by the federal appeals court further complicates the ability of local school districts to choose how to best protect their school community. Despite this, schools should be allowed to use mask mandates as a way to stay open because of the proven efficacy of masks in reducing the spread of COVID-19 and the low risk of harm associated with mask-wearing.7 Research has shown that as the percentage of mask-wearers increases, so too does the effectiveness of masks at preventing the spread of disease.8 Yet mask mandates should not be universally applied across all school districts. Instead, policies should be decided upon at the local level. For some school districts with low COVID-19 rates and/or a culture of mask-wearing in the community, a mask mandate may not be necessary. Additionally, now that the Pfizer vaccine is available for all school-aged children, school districts may decide that masks are no longer needed to keep their school community safe.
However, even with vaccines, there is still a risk of transmission, and the vaccines may not be as effective against new variants. Therefore, school districts should be allowed to require students and staff to wear masks and/or require proof of their vaccination status in order to protect those most at risk of hospitalization and death from COVID-19. With many people still unvaccinated and the virus still circulating, a school mask mandate could provide meaningful protection to children, teachers, and their families—especially in areas where vaccine hesitancy is high.
While partisan debates continue about mask use, it is important for parents to recognize that they can advocate for their children’s well-being and safety in school by using science and facts. In recent months, school district meetings have erupted into chaos, as tempers and frustrations have flared regarding school mask mandates. Many board members have even resigned as a result. But it is vital to note that the views expressed in these meetings do not represent the perspectives of most parents. Policymakers are ultimately responsible to their entire constituency, not just a tiny share of their most vocal voters, and the fact remains that a plurality of parents supports school mask mandates for both children and teachers.9 With clear research surrounding masks, parents can advocate for the implementation of mask mandates as a tool to combat COVID-19.
In light of the high rates of vaccine hesitancy across the United States and the uncertainty surrounding the effectiveness of vaccines against new variants—especially the newest variant, Omicron—mask use should continue in schools. Local and state policymakers should allow school districts to implement mask use for both students and teachers until the COVID-19 pandemic has subsided. However, while masks are effective at reducing transmission rates, they are not a permanent solution to the COVID-19 pandemic and should not be treated as such. Parents should not expect masks to become a permanent fixture in classrooms, nor should they be concerned that their children will be required to wear a mask if they have a preexisting medical condition that would make mask-wearing untenable. Further, policymakers must do a better job of communicating with parents. Parents and students must be given sufficient information to understand the strategies schools are implementing to keep COVID-19 cases at a minimum.
We provide the following recommendations for schools based on recent research findings:
1. Establish mask mandates in schools that do not already have a culture of mask-wearing.
Unfortunately, the public debate around mask requirements does not accurately represent their positive impacts on school safety. With numerous studies showing that masks are an essential and safe way to reduce the spread of COVID-19 in schools, parents can be assured that their children will benefit from their use. The most recent evidence from the Centers for Disease Control and Prevention (CDC) clearly indicates that masks effectively reduce COVID-19 cases for children. According to the CDC, Georgia schools that required masking during their 2020 reopening saw a 37% lower incidence rate in comparison to their counterparts.10 Specifically, schools that required masks experienced 16.32 cases per 100,000 children at the beginning of the school year, compared to 34.85 cases per 100,000 children in schools without a mask requirement. Similar results were found in Arizona, where schools without mask mandates in the two most populous counties were 3.5 times more likely to have COVID-19 outbreaks.11 This new evidence demonstrates that masks can successfully reduce the number of school outbreaks and supports the need for mask policies in schools.
Despite the vast amount of research that reveals the effectiveness of mask-wearing, many parents remain understandably hesitant. Masks became an unnecessary part of political debates in part because policymakers were not clear about their usefulness, especially during the early days of the pandemic. In February 2020, Surgeon General Jerome Adams infamously tweeted, “(masks) are NOT effective in preventing general public from catching #Coronavirus, but if health care providers can’t get them to care for sick patients, it puts them and our communities at risk!” Even today, several governors and state legislative leaders downplay the effectiveness of masks and have blocked schools from implementing mask requirements, despite the fact that they have meaningfully reduced the number of COVID-19 cases.
The early uncertainties about the effectiveness of masks against COVID-19 have abated as researchers are learning more about how COVID-19 spreads.12 Science is not static, and there were many unknowns—even among scientists—when COVID-19 was first starting to circulate in early 2020. The effectiveness of masks has become more evident as researchers have had time to study their impact on the virus’ transmission rates. Parents can be confident that they have an effective tool to keep their children safe with masks. And while policymakers might be unwilling to enact statewide mask mandates, they should allow local governments to make their own choices about how to protect their students.
Mask requirements in each school district should acknowledge and reflect the number of teachers, students, and parents voluntarily wearing masks. If a school district’s voluntary mask-wearing is high and their positivity rate is low, a mandate may not be necessary. That said, should infection rates increase and voluntary mask-wearing rates decrease, parents should feel comfortable asking their school district to require masks to keep their children safe.
2. Create exceptions for students who have medical conditions.
Mask requirements may be challenging for some students and their parents, particularly those with extensive support needs.13 However, parents of children with medical conditions should feel that their child can be accommodated under their school’s mask policies. Schools should recognize that each student’s medical needs are different, and mask requirements and strategies for implementing them should account for these needs. A mask requirement must allow exceptions for students with severe medical conditions. Schools must be sufficiently flexible when enforcing mask mandates to meet the needs of their student populations.
Schools must also find the appropriate balance between granting exemptions and keeping student populations safe. Mask exemptions should only be tailored around students with medical needs diagnosed by doctors. In some states, such as Pennsylvania, students and parents took advantage of loopholes in their schools’ policies that allowed a significant proportion of students to attend school without masks.14 The high number of exemptions that were granted caused many parents to question the effectiveness of the mask requirements. Indeed, research indicates masks work best when a large portion of the population uses them15 and therefore exemptions must be based only on the medical needs of the child. Schools must grant these exemptions specifically to students who have conditions where mask-wearing would harm their physical or mental well-being. According to the American Academy of Pediatrics, these medical conditions are exceptionally rare and include only those with developmental delay or physical disabilities.16 Most children with medical conditions, including asthma, may wear masks without any potential for harm.
3. Set clear guidelines of how and when mask mandates will end in schools.
COVID-19 is not going anywhere—at least in the short term. Vaccine hesitancy combined with practical limitations and the adaptability of the virus makes it highly unlikely the virus will stop circulating in the coming year.17 Breakthrough infections are becoming more common, and initial evidence suggests that vaccine effectiveness wanes over time.18 Masks should be worn in school at least through the end of the 2020-2021 academic year to keep infections down and reduce the risk of disruptions for in-person learning, especially in areas with elevated transmission rates. Indeed, even if cases significantly decline in that time span, it would be prudent to continue mask use for the near term. In the United Kingdom, schools are now struggling with new surges of COVID-19 infections among teachers and children, and many highly vaccinated nations in Europe are similarly struggling to keep infections down. Austria’s recent return to a full lockdown is one example that could indicate the United States may also soon see a rise in cases. In fact, Michigan health officials recently recommended that all residents above two years of age wear masks, regardless of vaccine status.
Still, masks cannot become a normal and permanent part of school for children and teachers. Many parents might be left wondering if we are in a never-ending cycle of mask policies. Schools must have an endgame and demonstrate an understanding that masks are a temporary measure. At some point, educators should eliminate the requirements and allow children to interact with one another without masks. Thus, schools must set clear benchmarks for when they believe COVID-19 mitigation strategies can be relaxed or ended. It is vital that any plan includes information that can be easily understood by parents. These benchmarks should include easily interpretable metrics concerning the test positivity rate in schools, vaccination rates, the number of active cases among students, teachers, and administrators, and trends in community spread. Schools should further regularly report these metrics to students and parents so they can plan appropriately. Open communication and a clear plan to end these mandates can help ease the anxiety felt by parents who have resisted masking their children. Unreasonably prolonging a mask mandate could risk creating stronger divides between parents and school administration and undermine any future efforts to combat COVID-19 through vaccinations.
As previously mentioned, parents should also expect policies that are developed specifically by and for their districts. States should not be quick to develop plans that inappropriately bind school districts to a specific course of action that could reverse their progress in dealing with COVID-19. There is not a single strategy that should be applied to all schools to end mask mandates. Instead, policymakers should acknowledge that school districts each face their own challenges that can make any universal policy counterproductive, and therefore they should be given the freedom to develop their own plans. Further, school districts should actively engage parents to understand when they will feel most comfortable relaxing their mask requirements. It is important that parents see their concerns reflected in the school’s exit strategy.
Educators and administrators should also feel comfortable adjusting their timelines based on parental feedback and the success of other schools. It is not necessary for each school and their parents to have to learn how to end their masking policies on their own. Instead, schools should learn from one another to develop the best COVID-19 exit strategy. Should certain strategies seem too stringent or lax based on the experiences of other schools, administrators and educators would do well to adjust their plan of action.
information about the effectiveness of masks from policymakers. They have also been caught in the middle of a political debate that is increasingly detached from evidence. With COVID-19 cases on the rise yet again—as can be seen in Europe, where cases are currently increasing even in nations with high vaccination rates, and in states like Vermont that also have high rates of vaccination—it is important to look at the facts. The recent emergence of the Omicron variant, which reinforces scientific evidence that the virus can mutate, means that mask use is as important now as ever. Research demonstrates that masks are an effective and safe tool for reducing COVID19 cases among students. As discussed earlier, school districts that implemented mask requirements experienced fewer cases of COVID-19 among their students and teachers. Thus, parents can rest assured that masks will help keep their children safe while attending in-person classes.
However, schools cannot continue to use masks for an unlimited period. It is important for schools to develop plans to remove mask mandates based on the number of cases they are experiencing and local transmission rates. To avoid eliminating mask mandates at the wrong time, schools must regularly engage parents to understand the risks and challenges they face. Further, parents should advocate for policies they believe will keep their children safe from the COVID-19 pandemic.
It is important for parents to be aware that masks alone will not end the pandemic. While masks are an effective tool, they are only one of many that will lower COVID-19 transmission rates and cases. The only way out of the COVID-19 pandemic is through widespread vaccination, and even though the Pfizer vaccine has been approved for children age 5 and older, there are still ongoing studies about the effects of vaccines on children. There are also important questions about how effective the current vaccines will be against the Omicron variant. While all indications suggest that the vaccines are safe and effective, masks provide a less invasive option to protect children until all the data are assessed. Parents should feel comfortable with their children using masks while vaccine studies continue.
1. Olga Morozova, Zehang Richard Li, Forrest W. Crawford, “One year of modeling and forecasting COVID-19 transmission to support policymakers in Connecticut,” Scientific Reports 11 (October 2021), https:// doi.org/10.1038/s41598-021-99590-5.
2. Samantha E. Budzyn et al., “Pediatric COVID-19 Cases in Counties With and Without School Mask Requirements—United States, July 1–September 4, 2021,” Morbidity and Mortality Weekly Report 70, no. 39 (October 1, 2021): 1377-1378, http://dx.doi. org/10.15585/mmwr.mm7039e3.
3. Elizabeth Piper and Toby Sterling, “Omicron variant detected in more countries as scientists race to find answers,” Reuters, November 28, 2021, https://www.reuters. com/world/new-coronavirus-variantomicron-keeps-spreading-australiadetects-cases-2021-11-28/.
4. Brett Haensel, “Nearly 1 million U.S. children have contracted COVID in the past 4 weeks,” Fortune, September 21, 2021, https://fortune.com/2021/09/21/covidcases-children-schools-1-million-casescoronavirus-update/.
5. Allyson Waller, Kalley Huang, and Mandi Cai, “At least 45 districts shut down in-person classes due to COVID-19 cases, affecting more than 40,000 students,” Texas Tribune, September 3, 2021, https:// www.texastribune.org/2021/09/03/texascovid-school-districts-shut-down/.
6. Tricia Korioth, “AAP urges in-person learning, masking in updated guidance on safe schools,” AAP News, July 18, 2021, https://publications.aap.org/aapnews/news/ 17241?autologincheck=redirected.
7. Martin Eberhart, Stefan Orthaber, and Reinhold Kerbl, “The impact of face masks on children—A mini review,” Acta Paediatrica 110, no. 7 (February 2021): 1778-1783, https:// doi.org/10.1111/apa.15784.
8. John T. Brooks and Jay C. Butler, “Effectiveness of Mask Wearing to Control Community Spread of SARS-CoV-2,” JAMA 325, no. 10 (2021): 998–999, https://doi. org/10.1001/jama.2021.1505.
9. Megan Brenan, “K-12 Parents Divided Over Mask Mandates in School,” Gallup, August 31, 2021, https://news.gallup. com/poll/354203/parents-divided-maskmandates-school.aspx.
10. Jenna Gettings et al., “Mask Use and Ventilation Improvements to Reduce COVID19 Incidence in Elementary Schools—Georgia, November 16–December 11, 2020,” Morbidity and Mortality Weekly Report 70, no. 21 (May 28, 2021): 779–784, https://www.cdc.gov/ mmwr/volumes/70/wr/mm7021e1.htm.
11. Megan Jehn et al., “Association Between K–12 School Mask Policies and School-Associated COVID-19 Outbreaks— Maricopa and Pima Counties, Arizona, July–August 2021,” Morbidity and Mortality Weekly Report 70, no. 39 (October 1, 2021): 1372–1373, http://dx.doi.org/10.15585/ mmwr.mm7039e1.
12. Jason Abaluck, Laura H. Kwong, and Stephen P. Luby, “We Did the Research: Masks Work, and You Should Choose a High Quality Mask if Possible,” New York Times, September 26, 2021, https:// www.nytimes.com/2021/09/26/opinion/ do-masks-work-for-covid-prevention.html.
13. Robert C. Pennington, Melissa C. Tapp, Janet Sanchez Enriquez, and Fitz Sanchez, “MASK UP! Supporting Mask Wearing of Children with Extensive Support Needs,” TEACHING Exceptional Children, (September 2021), https://doi.org/10.1177/0 0400599211046277.
14. Michael Rubinkam, “Thousands of Pennsylvania students request mask exemptions,” AP News, September 17, 2021, https://apnews.com/article/healtheducation-pennsylvania-coronaviruspandemic-1051de52f95c419de054b115fa913 60e.
15. Jeremy Howard et al., “An Evidence Review of Face Masks Against COVID-19,” Proceedings of the National Academy of Science 118, no. 4 (January 26, 2021), https:// doi.org/10.1073/pnas.2014564118.
16. American Academy of Pediatrics, “Face Masks,” 2021, https://www.aap.org/ en/pages/2019-novel-coronavirus-covid19-infections/clinical-guidance/cloth-facecoverings/.
17. Nick Wilson et al., “We Should Not Dismiss the Possibility of Eradicating COVID19: Comparisons With Smallpox And Polio,” BMJ Global Health, 2021, http://dx.doi. org/10.1136/bmjgh-2021-006810.
18. Barak Mizrahi et al., “Correlation of SARS-CoV-2-breakthrough infections to time-from-vaccine,” Nature Communications 12, no. 6379 (2021), https:// doi.org/10.1038/s41467-021-26672-3.
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