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Facemasks have not been shown to decrease transmission of respiratory viruses in children

After the SARS outbreak in 2003 (which was also a coronavirus that originated in Asia), there were many studies that looked at respiratory virus transmission and the impact of Non Pharmaceutical Interventions such as hand hygiene, facemasks, and distancing. Unfortunately, that research was focused on adults and we know that children are not "little adults" when it comes to medical interventions and treatment. COVID-19 is no different. This and upcoming blog posts will discuss the evidence for Non Pharmaceutical Interventions in children.

Without scientific evidence or even support from Washington state COVID-19 data, Superintendent Reykdal and Department of Health issued a requirement for facemasks for all students. From the Reopening Washington Schools 2020 Planning Guide (page 20): "Wearing cloth face coverings may help prevent the spread of COVID-19 and is required for staff and students." (BOLDED words are my annotation). Further it states: "Younger students must be supervised when wearing a cloth face covering or face shield and will need help putting them on, taking them off, and getting used to wearing them."

Facemasks are not something that our youngest learners are developmentally ready to wear correctly without assistance. This probably speaks to their limited effectiveness in young children which was noted in a Japanese study that found masks were not particularly effective in preventing transmission of respiratory viruses in young children (article linked below). In a study on the University of Michigan dorms a randomized intervention trial found that facemasks did not reduce transmission of respiratory viruses, but hand hygiene did (article linked below).

Our teachers cannot be expected to "supervise" their students to ensure they are wearing facemasks "help put them on" when their primary responsibility is to teach our children. We need to use the evidence that shows that the transmission of COVID-19 among young children is low and that facemasks have not been shown to be effective in reducing transmission of respiratory viruses in young children, age less than 4th grade. For students in late elementary and beyond wearing facemasks would be developmentally much more reasonable, but not certain that it would be helpful or necessary given the lack of evidence to support that asymptomatic children spread COVID-19.

Robust, consistent, daily screening practices will be essential to safely reopening our schools and likely much more effective that facemasks, hand hygiene, or distancing.

Effectiveness of vaccination and wearing masks on seasonal influenza in Matsumoto City, Japan, in the 2014/2015 season: An observational study among all elementary schoolchildren

"In contrast to vaccination, wearing a mask was found to be much more effective in higher than in lower grade schoolchildren."

Facemasks, Hand Hygiene, and Influenza among Young Adults: A Randomized Intervention Trial

"Our findings show a significant reduction in the rate of ILI [influenza like illness] among participants randomized to the face mask and hand hygiene intervention during the latter half of the study period, ranging from 48% to 75% when compared to the control group. There were no substantial reductions in ILI [influenza like illness] or laboratory-confirmed influenza in the face mask only group compared to the control."

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