We are writing as physicians who have been on the front-lines caring for children and adolescents with COVID-19 throughout the pandemic, as parents, and as residents of Texas. We strongly oppose Gov. Greg Abbott’s order mandating that after June 4, “no student, teacher, parent, or other staff member or visitor may be required to wear a face covering” in Texas public schools. We are deeply concerned by this order given that the majority of school children are still not eligible for COVID-19 vaccination and thus remain highly vulnerable to infection. Moreover, only one in three Texans are fully vaccinated against COVID-19.
As physicians who have cared for hundreds of children with COVID-19 during the course of this pandemic, we know that previously healthy children can and do acquire, transmit and get sick from COVID-19. While fortunately rare, some children and adolescents get severely ill or die from COVID-19. Some patients may have an initial mild course of illness, but go on to suffer from “long haul” COVID-19, including chronic headaches, weakness, respiratory problems, heart palpitations and fatigue, which can be severe enough to impair 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 treatment in the intensive care unit and can result in heart failure. These are entirely preventable tragedies.
We empathize with the desire to return to “normalcy”; the COVID-19 pandemic has taken a toll on children, teachers, families, patients and health care workers alike. However, since the vast majority of school-aged children are still ineligible to be vaccinated, we unequivocally recommend that Texas schools continue to require masks for unvaccinated children at least through December of this year. We are hopeful that emergency use authorization for vaccination of children under age 12 will be granted upon review 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 attain full immunity.
The CDC recently updated its guidance on face coverings based on the most current scientific data. Per these recommendations, vaccinated individuals can be maskless outdoors or indoors except on public transportation, in health care settings and in other specifically exempted situations. However, these recommendations quite explicitly do not apply to unvaccinated individuals. The CDC guidance for unvaccinated people clearly states masks should continue to be worn in indoor, public spaces such as public schools. Until we reach herd immunity in Texas (70-80 percent vaccination rate), all unvaccinated individuals still remain at risk of being infected by this deadly virus, including all children under age 12. Imposing a ban on mask requirements in schools, a simple and effective public health measure, places unvaccinated children in danger.
The American Academy of Pediatrics (AAP) strongly recommends that adults and children age 2 and older practice universal masking in school settings. The AAP states, “Evidence continues to mount on 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 protecting others) and personal protection (masks protecting the wearers) may be ‘synergistic,’ in which individual protection increases with increasing community mask use.”
Though masking provides a level of protection for oneself, others masking is also important. Several studieshave found that masking prevents the spread of COVID-19 in schools. The CDC has advised continuing current COVID-19 precautions, including masking and social distancing, throughout the rest of this school year, and expects to update its guidance for the 2021-2022 school year in the coming weeks.
Masking must continue until children are able to be vaccinated against this horrific and highly communicable disease. Having optional masking for unvaccinated school children at this time in the pandemic is not only against medical advice, it actively endangers their health. This is not a partisan issue nor an issue of personal freedom; it is simply an evidence-based safe and easy way that we can mitigate some of the risk involved in sending our kids back to school and to the activities they love.
Again, we strongly oppose Gov. Abbott’s order that prohibits Texas public schools from requiring mask use among unvaccinated children in school facilities. To protect the children of Texas, we strongly advise that schools continue to require masking indoors until all susceptible students are eligible for and have access to COVID-19 vaccines.
Haq, Chan and Propst are physicians, board certified in pediatrics, and parents in Houston. They are among over 700 doctors who signed a letter to Gov. Abbott opposing his mask policy.