So, the exciting news of this week is that we will finally be returning to school on the 8th of March. After months of school closures, I am hopeful that this week should be the last week of online learning that has to be endured.
However, reading the plans for the government’s reopening, I was surprised to see that face masks will now be required in the classroom, over an indefinite time scale. This is a decision that strikes me as being of some contention; one online petition to reverse the measure has already received over 20,000 signatures.
As such, I have decided to look a little further into this issue, to decide whether this decision is really necessary, or, indeed, whether the impacts may even be detrimental.
Firstly, it’s worth noting that this is not an issue of the safety of the children themselves; it has repeatedly been shown that those < 18 are rarely negatively impacted by the symptoms of Covid-19, if they do even exhibit symptoms. Most recently, on the 23rd February, Professor Chris Whitty himself stated that “The risk to children is incredibly low from going to school and from catching Covid.”
Instead, this is an issue of transmission. Some have argued that schools are a driver in the pandemic, citing figures linked to PHE reports such as “38% of infections caught outside the home are in schools, compared to 4% in pubs and restaurants.” This has been proved untrue, however, as the assumption is based on data collated solely from Covid-19 acute respiratory infection (ARI) incidents reported to Health Protection Teams. These are situations where ≥ laboratory-confirmed cases are linked to a particular setting, or an outbreak is suspected, and do not reflect total case figures.
Additionally, much evidence exists to suggest that schools are not a major, or even minor driver of the spread of Covid-19. One study conducted by the University of Warwick, which looked at sick days taken because of Covid-19 during the Autumn 2020 term in schools across England, determined that there was no link between schools and major spread. Professor Sarah Lewis, an epidemiology expert at the University of Bristol, said it appeared that cases in the community were spilling into schools rather than vice versa, based on the available data.
On a more global scale, UNICEF, following a study of 191 different countries, concluded that there is no association between schools being open and COVID-19 infection rates in the community, as well as showing that in-person schooling does not appear to be the main driver of infection spikes.
This evidence above would suggest that the addition of any further measures (alongside the pre-existing social distancing, hand washing, use of masks in communal spaces…) would need to be taken very seriously. Ian Noon, the National Deaf Children’s Society head of policy has stated that “With England’s 35,000 deaf pupils close to a return to education, the goalposts on face masks have moved yet again.”
However it is not only specific groups of children that will suffer as a result of this course of action. In a study of 158 health care workers during the Covid-19 pandemic, the most common side effect of prolonged face mask use was bilateral headache, reported by about 80% of the participants - a symptom that may well be apparent in children following long-term usage as well. Additionally, long-term face mask usage may further cause perioral dermatitis with rashes and redness, i.e., an infection of the skin around the mouth because of saliva, sweat, and moist vapour between the mask and the skin. This could provide a breeding ground for bacteria, especially in adolescent populations. However, the negative side-effects of face mask use in the classroom are not only physiological. If we take an empirical approach, it is clear to see face masks will impede communication, facial recognition, and emotional signalling between teachers and students. The effects of face masks on verbal communication have been found, by some studies, to be considerable. This poses a huge problem for educational settings, which rely on ease of communication from teacher to student. Furthermore, as Dr Manfred Spitzer, the German neuroscientist states in a recent article: “The outward emotional displays of one's peers’ faces is a critical and necessary component of social interaction in schools. It helps pupils and teachers to modify their behaviour in order to align with social communication and behavioural norms.” When commenting on face masks specifically, he states: “When these emotional displays are inhibited by face masks, our ability to communicate effectively with one another is reduced and we are primarily left with mimicking negative (frown) emotions… since emotions are a major driver of group cohesion, the decreased emotionality, and decreased positive emotionality in particular, may interfere with smooth classroom action.”
To conclude, I am not here to say that face masks do not work (one of the largest comprehensive reviews and meta-analysis, which used data from 172 observational studies across 16 countries found that face masks reduced infection risk by < 85%), or indeed social distancing, regular testing and other measures are not sensible. However, this evidence begs the question of whether face masks in the classroom are really necessary. If our aim is to reduce the spread of Covid-19 at all costs, then yes, face masks are necessary. By that argument, however, the question of whether schools should even reopen in the first place is perhaps more relevant. Personally, I would be more inclined to take a more balanced approach, but I’ll leave it up to you to decide.
Bibliography + sources
Ong J.J.Y., Bharatendu C., Goh Y., Tang J.Z.Y., Sooi K.X.X., Tan Y.L., Tan B.Y.Q., Teoh H.-.L., Ong S.T., Allen D.M., Sharma V.K. Headaches associated with personal protective equipment – a cross-sectional study among frontline healthcare workers during COVID-19. Headache. 2020;60:864–877.
Phelamei S. The Times Now; 2020. Wearing Face Masks Is The “new Normal”: Know These Tips and Tricks to Avoid Common Side Effects. June 10th, 2020.
Atcherson S.R., Mendel L.L., Baltimore W.J., Patro C., Lee S., Pousson M., Spann M.J. The effect of conventional and transparent surgical masks on speech understanding in individuals with and without hearing loss. J. Am. Acad. Audiol. 2017;28:58–67.
Chu D.K., Akl E.A., Duda S., Solo K., Yaacoub S., Schünemann H.S., COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020;395:1973–1987.