We write as physicians who have been at the forefront of caring for children and adolescents with COVID-19 during the pandemic, as parents and as residents of Texas. We strongly oppose Governor Greg Abbott’s order that after June 4, “no student, teacher, parent, or other staff member or visitor should be required to wear a face covering” in Texas public schools. We are very concerned about this order as the majority of schoolchildren are still not eligible for vaccination against COVID-19 and thus remain highly vulnerable to infections. In addition, only 1 in 3 Texans is fully vaccinated against COVID-19.
As physicians who cared for hundreds of children with COVID-19 during this pandemic, we know that previously healthy children can get, transmit, and get sick with COVID-19. Fortunately, although it is rare, some children and adolescents become seriously ill or die from COVID-19.
Some patients initially have a mild course of the disease, but go on to long-term COVID-19, including chronic headaches, weakness, difficulty breathing, palpitations, and fatigue, which can be severe enough to interfere with their daily function. We have also seen an increasing incidence of post-COVID-19 complications such as Multisystem Inflammatory Syndrome in Children (MIS-C) and myocarditis, which require intensive care treatment and can lead to heart failure. These are completely preventable tragedies.
We sympathize with the desire to return to “normalcy”. The pandemic has taken its toll on children, teachers, families, patients and health professionals. However, because the vast majority of school-age children are still not eligible for vaccination, we unequivocally recommend that schools in Texas continue to require masks for unvaccinated children at least through December of this year. We hope that emergency use consent for vaccination of children under 12 years of age will be granted after evaluation of clinical trials in the fall. Once the vaccine is approved for younger children, they will need a minimum of six weeks to complete both doses and achieve full immunity.
The CDC recently updated its guidelines on facial covering based on the most current scientific data. According to these recommendations, vaccinated persons may be maskless outdoors or indoors, except on public transport, in health care facilities and in other specifically exempt situations. However, these recommendations quite explicitly do not apply to unvaccinated individuals. The CDC guideline for unvaccinated people clearly states that masks should continue to be worn in public areas indoors, such as public schools. Until we achieve herd immunity in Texas (70-80 percent vaccination rate), all unvaccinated individuals are still at risk of being infected by this deadly virus, including all children under the age of 12. effective public health measure endangers unvaccinated children.
The American Academy of Pediatrics strongly recommends that adults and children 2 years of age and older apply universal masking in school. The AAP states: “There is growing evidence of the importance of universal face masks in interrupting the spread of SARS-CoV-2. The CDC has advised that the combination of source control (masks that protect others) and personal protection (masks that protect the wearers) could be “ synergistic, ” with individual protection increasing as the community uses more masks. ”
While masking provides itself with a level of protection, masking is also important. Several studies have shown that masking prevents the spread of COVID-19 in schools. The CDC has advised continuing current COVID-19 precautions, including masking and social distance, for the remainder of this school year, and expects to update its guidelines for the 2021-2022 school year in the coming weeks.
Masking should continue until children can be vaccinated against this horrific and highly communicable disease. Having optional masking for unvaccinated schoolchildren at this point in the pandemic is not only against medical advice, it is also actively endangering their health. This is not a partisan issue, nor is it a matter of personal freedom; it’s just an evidence-based safe and easy way to reduce some of the risk associated with sending our children back to school and the activities they enjoy.
Again, we strongly oppose Abbott’s order prohibiting Texas public schools from requiring the use of masks on unvaccinated children in school facilities. To protect the children of Texas, we strongly recommend that schools continue to require indoor masking until all sensitive students are eligible for and have access to COVID-19 vaccines.
Haq, Chan, and Propst are doctors, board-certified in pediatrics, and parents in Houston. They are among the more than 700 doctors who signed a letter to Abbott opposing his mask policy.