Some public health officials and school boards in New Hampshire are revisiting the question of whether to drop school mask mandates, as recorded COVID-19 infection rates decline and nearby states lift school mask requirements.
The debate comes as attitudes about masking shift among doctors and other advocates for COVID-mitigation measures in schools. And it reflects an increased acceptance that COVID-19 could be part of our daily reality for years to come.
State health officials still strongly recommend masks for almost everyone in school, particularly with high COVID-19 transmission rates in all New Hampshire counties.
But Dr. Benjamin Chan, the state’s top epidemiologist, said that recommendation might change with declining infections and the likelihood of a vaccine for children under five soon.
“The goal is to be able to pull back on some of the mitigation measures further, to try and get our society or schools back to more normal operations,” he said at a press conference on Wednesday.
Recent changes in Londonderry and Windham
Though many schools have followed state guidance on masks, the ultimate decision is up to local school districts, as New Hampshire lacks a statewide mask mandate for school children. And some schools that have weathered bitter fights over COVID safety are no longer requiring universal masking.
This week in Londonderry, mask rules are now determined by the number of positive cases within a school building, rather than community-wide spread. In its explanation for the update, the school board wrote:
“Most likely the NH defined metrics around community spread will remain in the ‘substantial community spread’ levels for much of the rest of the school year for Londonderry. However, universal masking is not a sustainable practice for our school district.”
In Windham schools, masks are optional as of Feb. 1, even with positive COVID cases or clusters in a building. Masks are only required in the five days after a staff or student who tested positive for COVID-19 returns to school.
Some teachers in Windham said the change was partly because of the lack of reliable data on positive cases within the building. Some families do not report positive cases to the school, and the state is no longer tracking all COVID cases nor helping schools with contact tracing.
The risks and benefits of masking as one method of COVID mitigation
Many point to masks as one of the reasons New Hampshire schools have been able to stay open relatively safely this year. But there is a growing debate nationally in the medical and public health community over whether the battles over masks and the drawbacks of continued mask-wearing are worth the benefits to public health. The relatively low risk of COVID-19 to young children is also part of that discussion.
Dr. Sharon Vuppula, a pediatric infectious disease specialist in Nashua, said schools should wait until transmission rates fall and vaccination rates increase before dropping mask rules altogether. But she has concerns about the sustainability of the current approach.
Ill-fitting cloth masks may not be as effective in stopping the spread of highly-contagious variants. But not all kids have access to or want to wear the more effective KN95 masks.
And masking in schools is considered effective in part because it’s accompanied in many schools with other mitigation measures, such as vaccinating most staff, social distancing, keeping kids with COVID-19 symptoms home and improving air ventilation in buildings.
Vuppula said many published studies on the masks in schools predate the omicron variant and may need an update, and new studies will likely prompt changes in public health guidance on masks.
"Something that parents, educators and public health agencies need to get accustomed to is constantly re-evaluating our health policies based on the upcoming and latest scientific data.” Vuppula said. “That's not easy for anyone because we, as humans, like consistency."
Calculating risk changes as the state changes tracking methods
But in New Hampshire, it’s hard to make decisions based on accurate data on a local level.
Due to the rise in home testing, of which thousands of positive results have likely gone unreported, the state Department of Health and Human Services is no longer attempting to track every positive test.
That change means levels of community transmission, which school districts use to evaluate mask requirements, may need to be adjusted.
The availability of vaccination, another metric schools examine for evaluating the need for masking requirements, is likely to shift too. Children aged 6 months to 4 years old are expected to become eligible for a COVID-19 vaccine soon.
Kris van Bergen of the North Country Health Consortium suspects some schools will drop masking requirements when vaccines are available to kids under 5, but she finds that rationale worrisome.
“The protection isn't provided by the opportunity, it's provided by the vaccine” she said.
Due to data tracking issues, it’s difficult to know vaccination rates in students district to district. But from the data that is available, kids’ vaccination rates are lagging. State data show around 40% of kids aged 12 to 19 are fully vaccinated. The state is not sharing vaccination data for kids aged 5 to 11.
While the actual rate of vaccination is likely higher, they’re still not at the 80% rate the state’s health department set as a threshold for dropping masks.
COVID concerns weighed against social and emotional concerns
The CDC and American Academy of Pediatrics recommend masking for children over the age of 2 years. Most in the public health and medical community agree that during the pandemic’s crisis phase, masking and preventing transmission via masking was the obvious priority.
But two years later, many pediatricians and educators are wondering what the social, developmental, and emotional costs for kids once COVID-19 reaches an endemic stage.
In many districts, young students who are still learning to speak and read facial expressions have worn masks their entire school career. And some teachers say constant vigilance around COVID has other effects on school culture.
Jill Brewer, a school counselor at Profile School in Bethlehem, worries about the negative interactions between staff and some students who flout COVID mitigation rules like masking and not mixing cohorts in the hallway or lunch room.
"Every time I see [these students] I have to say, ‘Hey, so and so, please put your mask up,’ because it's under the chin,” she said. “That just doesn't help in terms of fostering a positive relationship with these students.”
Brewer said the vast majority of students comply with mask rules, but there is a feeling of resignation among teachers and others who supported COVID-safety protocols for the first two years of the pandemic. She said some of it is because omicron has ripped through the community and caused a number of breakthrough cases among those fully vaccinated.
“So many people are getting [COVID] that it’s almost a sense of powerlessness” she said.
What’s ahead
Much of the decision in school districts about when to drop a mask mandate may turn on a risk/benefit analysis that includes shifting societal attitudes towards the virus, even as it claims more and more lives across the country and in the state.
New Hampshire has not had a statewide mask mandate for nearly a year. And many elected officials, including Gov. Chris Sununu, often attend public events without masks. Some say it’s unfair to ask kids to wear masks while everyone else goes without.
Brewer hopes that local COVID rates will fall enough for her North Country school to start making masks optional, but she worries the messaging may be confusing to some.
“I think a small population will feel vindicated that they were right along and these protocols were ridiculous and hurt kids,” she said. “I think that’s really unfortunate, because I think our masking has allowed us to be in person safely this whole school year.”
