Child mask mandates for Covid-19: a systematic review
adc.bmj.com
adc.bmj.com
It certainly reads like it has an axe to grind (see Introduction and below).
Although there are certainly populations of children and adults that suffer disproportionately from masking (whether due to respiratory, auditory, or psychological issues, or just from being so young that the mask soaks through in minutes), my overall experience with elementary and middle school aged kids during the early years of the pandemic was that they found masking easy and didn't really care about it. They were thrilled to be in-person with each other.
Of course, their masking practices was not ideal, they often forgot them or wore them wrong, or used less effective materials, but the act of masking itself wasn't generally a big deal.
Our community has a huge Let Them Breathe presence, but even here it was the adults who were making all the anti-masking noise. The kids just didn't care.
I do wish we had better data on efficacy of masking mandates. This review doesn't bring any new clarity.
It truly is not a big deal to wear a mask, as long as you are choosing it for yourself. If somebody is forcing you, it feels extremely invasive.
The mandate folks should have spent their time cultivating and presenting an actually convincing argument.
For example I always masked indoors but thought the idea that my 3 year old needs to mask at an outdoor playground to be preposterous.
1. Most masks for children fit extremely poorly. I doubt they do much filtration of incoming air. Maybe they’re useful for source control, especially for pathogens that spread through large droplets (i.e. maybe not Covid).
2. They do have one major obvious effect: when worn even remotely correctly, they keep kid fingers and hands away from kid mouths and noses.
So I expect them to be quite useful at protecting kids from pathogens that are contracted by collecting the pathogens on one’s hands and sticking them in one’s mouth or rubbing one’s nose. And they may also have a strong source control effect for pathogens that come from kid mouths or noses, get on kid hands, and spread onto surfaces.
These are not descriptions of Covid! But there are a lot of diseases that kids get frequently that aren’t Covid. I bet they substantially reduce transmission by the fecal-oral route, for example. And they may help quite a bit against the kinds of viruses that kids actually get from outdoor playground, especially if the kids wash or sanitize their hands after playing.
One might reasonably debate whether it’s beneficial to a small child, and how much, to get sick less often. And one might reasonably debate the tradeoff between that benefit and the down sides of wearing a mask (e.g. more difficult communication). And one might extremely reasonably debate whether any of this would or could justify requiring other people’s children to wear masks.
Notably, I caught COVID for the first and only time when I had a flight just a few weeks after they dropped the mask mandate for flights.
One of the real issues for children is we didn't have a supply of masks designed for them. We only had access to cheap cloth and paper masks designed to fit adults.
Another is the cheap cloth and paper masks that were available the 1st year were not designed to prevent covid infections, they were only for reducing the distance covid would spread in the air when breathing and coughing.
Where I live, most of the very conservative folks who live here (78% of the population) flat out refused to wear a mask and made a point to boldly walk into stores cocked and primed to take anyone on who told them they must. I wore them and was snarled at everywhere I went. Fair to say their children were taught to refuse to wear them too, and that while required to wear them in school, almost none of the schools staff enforced that here.
So, yeah, if you analyze the effectiveness of masks reducing covid infections in children here you'd conclude they did not work, but you had to be here to know why.
This is curious as masks don’t protect from contracting covid. They protect from transmitting covid to others.
So it’s quite possible that your observation is accurate. But very unlikely it has anything to do with their mask usage. But there may be other behaviors responsible. Or just fortune.
Children and the general public may not care, but there's still plenty of analysis that will prove useful to medical and policy decision-makers in the future.
And here I am with a family of 5 who are all home sick with covid right now. :)
i.e., not dead i.e., not hospitalized
Different class of problem ;)
When someone is sick enough that they ought to stay home, but they go somewhere indoors anyway and wait around for a while, where is it? Likely a health care facility. And there are tons of nasty, often drug-resistant, pathogens that are largely transmitted in health care facilities. And a lot of people visitng said facilities are also vulnerable and/or immunocompromised and/or are taking medicines (e.g. antibiotics) that substantially increase the risk of getting infected by otherwise-not-so-harmful things.
So, please, bring on the infection control measures in health care facilities. Masks, air filtration, ventilation, far-UVC, hand washing, sanitizer, you name it.
I think what people are more interested in is whether people who are dutiful with covid pre-cautions actually work(kids are a tough cohort). I think we know the answer there too.
For example, a systematic review of professionals in a workplace with mask policies versus those without.
Or systematic reviews on other helpful topics like ventilation, filtration, and testing from different cohort perspectives like kids and adults.
The current consensus we all have today is just "don't get infected" which does humanity very little good. There are evidence-based approaches that need to inform public policy makers and for those policy makers to be very clear with the public on what the risk each person entails without pre-cautions.
In my experience, it’s at best and mild aversion, but usually tempered with a pragmatic indifference to being infected. Virtually no one here (UK) takes visible actions anymore. Only a few seem to care.
Get closer to healthcare settings, and things change a little, but not a lot. A few more people take preventative measures, but not many, and interestingly not healthcare staff themselves.
You also have countries like Germany who are starting to realize the actual burden of infecting the general population and necessity to follow what current evidence we have to tackle the long-tail issues:
The consensus now is quite different.
Maybe you were referring to March 2020, in which case I agree that it did humanity very little good, at least in regard of its application to children.
https://www.ncbi.nlm.nih.gov/research/coronavirus/
I'm not arguing for or against preventative measures. I am arguing that our health officials could do a better job discussing what we know about it now to help individuals make choices.
You highlight the quantity of publications. You’re right. The narrative is already set. The volume is so large.
But what is happening in practice, even in healthcare (at least in the UK), is that little of the theatre is performed anymore. Doctors are mostly unmasked, no one does distancing, and the mandates were unwound long ago. Not sure about testing, but the odd hacking cough here and there draws no petrified stare. So I guess that’s where I disagree: the consensus in practice is running far ahead of the average tone in published science.
I wonder how much that will percolate down. Perhaps we’ll just learn to live with a published scientific position that is grossly at odds with day to day behaviour — how odd! It will give the behavioural scientists something new to work on.
But your basic thesis (that “don’t get infected” is unhelpful advice) is right. It’s simply not actionable.
But forcing people who do not want to wear masks to wear them is just a waste of masks. They aren't wearing them properly or effectively. Hell, a large portion of people who support masks aren't wearing them properly. This is why you see so many people with masks around their chin or below their nose. Might as well have just thrown the mask straight into the garbage.
Any miniscule benefit from forced masking is outweighed by the oppositionary reaction to being forced to do something you don't want to do. Now you have people protesting masks and purposefully wearing them wrong in the name of "muh freedoms".
It's funny that it took 3+ years to get a reputable journal to admit what we basically already knew experientially.
You seem to be implying the people who spoke out against children masking are Joe Rogan watching, science denying, propaganda believing, "independent thinkers".
Funny place to post that analysis... in the comment section of a massive meta-analysis whose results include:
"Conclusions Real-world effectiveness of child mask mandates against SARS-CoV-2 transmission or infection has not been demonstrated with high-quality evidence. The current body of scientific data does not support masking children for protection against COVID-19."
Perhaps read the article and look at yourself in mirror before jumping to tribal us/them mentality... otherwise its you who may be the science denying, propaganda believing, "independent thinker"
It seemed like an odd comment to make given this seems like a decently rigorous paper in a reputable journal. So saying “only cool people believe in science, that’s not this science” seems really off and odd to me.
Do you think they shouldn’t study mask efficacy?