Back to School: the Case for Masks
Your kid bringing home their backpack and lunchbox: good
Your kid bringing home COVID-19: bad
You can AirTag the backpack, but how do you stop the COVID?
While vaccines are helpful for reducing severe illness and, to some extent long COVID, vaccines do not stop transmission of COVID and do not totally prevent infection. Based on the levels of virus in the wastewater, we can estimate that 1 in 28-38 people are infectious right now. How many kids are in your kid’s class? How many in the lunch room?
How can you help keep your child healthy?
1. Ask your child to wear a mask, especially during surges like this one.
2. Help get air filters into their classroom. (A study from Helsinki found air filters in daycare centers cut kids sick days by one third)
3. Get COVID and flu boosters when available.
You may be surprised about your child’s willingness to wear a mask! During the first year back to school, everyone wore a mask. The more kids wear masks now, the more normal it will feel.
Kids' KF94 and KN95 masks are easy to find and wear. Not only do they fit better on small faces than surgical masks, but they're designed to filter the air better than surgical masks.
Not sure which mask to pick?
MaskNerd has a whole spreadsheet and a video!
BeHealthyUSA.net lets you browse by mask size -- my kids like the Tiger KF94 masks and the BOTN KF94 masks. Both are the 3d “boat” style designs. They have earloops and are easy to take on and off. BOTN has adjustable ear loops, which is helpful for my younger kid. They also love the Posh KF94 masks for special occasions, since they’ve got cool designs and colors.
The best part about masks (and cleaning the air in general) is that it protects against all the airborne viruses, not just COVID. Rhinovirus, enterovirus, RSV, parainfluenza, influenza… none of them are fun, and for some people, especially young babies and elders, they can cause serious problems. Help keep your kid healthy by giving them clean air to breathe!
Daily infections are roughly twice what they were at this time last year
But is it worth asking your child to do something not everyone else is doing? You may have been told that kids’ COVID infections are mild, and you may have even seen your kid have a mild infection. So what’s the big deal?
The short term/acute infection is not the only impact COVID has on the body. Many viruses with unimpressive short term symptoms have long term impacts, like human papilloma virus causing cervical cancer, HIV causing AIDS, Epstein Barr virus causing multiple sclerosis, and poliovirus causing muscle weakness and atrophy.
In fact, poliovirus infections had no symptoms for 70% of people, cold-like symptoms for around 24% of people, and caused muscle weakness and loss in only 1% of people – you could even call it “long polio.”
We now know that:
Even asymptomatic and mild COVID infections can affect the brain (Safadieh, El Majzoub, and Abou Abbas 2024; Hampshire et al. 2024)
COVID infection increases the risk of developing type 1 diabetes (Rahmati et al. 2023; Kendall et al. 2022)
Long COVID in kids much more common than previously thought and looks different in different age brackets. While adolescents have significant overlap with adults (like loss of taste and smell), and pain and fatigue were common in all age groups, school age children tend to have more headaches, psychiatric and sleep problems, and GI-related symptoms (Gross et al. 2024)
Kids with long COVID are much more likely to have impaired heart function (Baldi et al. 2024)
And they’re bringing it home to you: more than 70% of household transmissions originated with a child (Funk et al. 2024)
Early in the pandemic, there was emphasis on testing and staying home if you were sick. The federal government plans to resume sending free tests at the end of September, but school policies have changed radically, and they now encourage kids to come back once they are fever-free for 24 hours and their symptoms are improving overall. But in a study that looked at rapid testing and viral cultures, 40% of kids in the study were still infectious the day after their symptoms resolved. A quarter of participants were still infectious at 7 days post symptom onset, and 10% were still infectious at 10 days after symptom onset. (Science et al. 2024)
Lastly, the immediate illness isn’t mild for everyone. COVID is the number one cause of death by infectious or respiratory disease in the 0-19-year-old age bracket, causing 2% of all deaths in this age group (Flaxman et al. 2023). Colds don’t do that, and COVID causes 24x as many deaths as the flu. But masks and cleaning the air prevent those too!
In summary: there’s a lot of COVID going around right now, and it’s worth wearing a mask and cleaning the air to prevent becoming infected.
Death reporting is slow, but we can tell by wastewater levels that COVID levels are very high. Compare the orange COVID bars to the blue influenza bars. COVID is 24x as deadly as influenza.
Baldi, Fabiana, Cristina De Rose, Francesco Mariani, Rosa Morello, Francesca Raffaelli, Piero Valentini, and Danilo Buonsenso. 2024. “Cardiopulmonary Exercise Testing in Children With Long COVID: A Case-Controlled Study.” The Pediatric Infectious Disease Journal 43 (8): 795. https://doi.org/10.1097/INF.0000000000004371.
Dias, Cristiane S., Lilian M. Diniz, Maria Christina L. Oliveira, Ana Cristina Simões e Silva, Enrico A. Colosimo, Robert H. Mak, Clara C. Pinhati, et al. 2024. “Outcomes of SARS-CoV-2 and Seasonal Viruses Among Children Hospitalized in Brazil.” Pediatrics 153 (2): e2023064326. https://doi.org/10.1542/peds.2023-064326.
Flaxman, Seth, Charles Whittaker, Elizaveta Semenova, Theo Rashid, Robbie M. Parks, Alexandra Blenkinsop, H. Juliette T. Unwin, et al. 2023. “Assessment of COVID-19 as the Underlying Cause of Death Among Children and Young People Aged 0 to 19 Years in the US.” JAMA Network Open 6 (1): e2253590. https://doi.org/10.1001/jamanetworkopen.2022.53590.
Funk, Anna, Todd A. Florin, Nathan Kuppermann, Yaron Finkelstein, Alissa Kazakoff, Michael Baldovsky, Daniel J. Tancredi, et al. 2024. “Household Transmission Dynamics of Asymptomatic SARS-CoV-2-Infected Children: A Multinational, Controlled Case-Ascertained Prospective Study.” Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America 78 (6): 1522–30. https://doi.org/10.1093/cid/ciae069.
Gross, Rachel S., Tanayott Thaweethai, Lawrence C. Kleinman, Jessica N. Snowden, Erika B. Rosenzweig, Joshua D. Milner, Kelan G. Tantisira, et al. 2024. “Characterizing Long COVID in Children and Adolescents.” JAMA, August. https://doi.org/10.1001/jama.2024.12747.
Hampshire, Adam, Adriana Azor, Christina Atchison, William Trender, Peter J. Hellyer, Valentina Giunchiglia, Masud Husain, et al. 2024. “Cognition and Memory after Covid-19 in a Large Community Sample.” New England Journal of Medicine 390 (9): 806–18. https://doi.org/10.1056/NEJMoa2311330.
Kendall, Ellen K., Veronica R. Olaker, David C. Kaelber, Rong Xu, and Pamela B. Davis. 2022. “Association of SARS-CoV-2 Infection With New-Onset Type 1 Diabetes Among Pediatric Patients From 2020 to 2021.” JAMA Network Open 5 (9): e2233014. https://doi.org/10.1001/jamanetworkopen.2022.33014.
Rahmati, Masoud, Dong Keon Yon, Seung Won Lee, Raphael Udeh, Mark McEVoy, Min Seo Kim, Razak M. Gyasi, et al. 2023. “New-Onset Type 1 Diabetes in Children and Adolescents as Postacute Sequelae of SARS-CoV-2 Infection: A Systematic Review and Meta-Analysis of Cohort Studies.” Journal of Medical Virology 95 (6): e28833. https://doi.org/10.1002/jmv.28833.
Safadieh, Ghida Hasan, Rania El Majzoub, and Linda Abou Abbas. 2024. “Neuroimaging Findings in Children with COVID-19 Infection: A Systematic Review and Meta-Analysis.” Scientific Reports 14 (1): 4790. https://doi.org/10.1038/s41598-024-55597-2.
Science, Michelle, Julia Orkin, Bryan Maguire, Ari Bitnun, Laura Bourns, Antoine Corbeil, Jennie Johnstone, et al. 2024. “Viral Dynamics of the SARS-CoV-2 Omicron Variant in Pediatric Patients: A Prospective Cohort Study.” Clinical Infectious Diseases 78 (6): 1506–13. https://doi.org/10.1093/cid/ciad740.
