Masks likely blunt spread at school, but children—even more than adults—find them uncomfortable to wear for hours and may lack the self-discipline to wear them without touching their faces or freeing their noses. Does discomfort override a potential public health benefit?
“For me, masks are part of the equation” for slowing the spread of COVID-19 in schools, especially when distancing is difficult, says Susan Coffin, an infectious disease physician at the Children’s Hospital of Philadelphia. “Respiratory droplets are a major mode of [virus] transmission,” she says, and wearing a mask places an obstacle in those droplets’ path.
In China, South Korea, Japan, and Vietnam—where masks are already widely accepted and worn by many during flu season—schools require them for almost all students and their teachers. China allows students to remove masks only for lunch, when children are separated by glass or plastic partitions. Israel requires masks for children older than age 7 outside the classroom, and for children in fourth grade and above all day—and they comply, says Aflalo, who has 8- and 11-year-old boys. On the bus ride to school, “all the kids are sitting with masks on,” she says. “They don’t take them off. They listen to the orders.”
Elsewhere, masks are less central. In some schools in Germany, students wear them in hallways or bathrooms, but can remove them when seated at their (distantly spaced) desks. Austria reopened with this approach, but abandoned masks for students a few weeks later, when officials observed little spread within schools. In Canada, Denmark, Norway, the United Kingdom, and Sweden, mask wearing was optional for both students and staff.
Not all countries have the luxury of instituting a mask policy driven by science and comfort. Benin requires masks in public spaces, but because the cost can be prohibitive for families, schools do not turn maskless students away. Students in Ghana returned to school in May wearing masks—if they had them. South Africa, which faces a rising COVID-19 caseload, is racing to provide free masks to all students who need them.
For Aflalo, the potential value of masks was underscored after a record-setting heat wave struck Israel in mid-May. As temperatures rose to 40°C, masks became intolerable, and with the health ministry’s blessing, students and teachers largely put them aside for almost a week.
For 2 weeks—the typical COVID-19 incubation period—things seemed fine. Aflalo left to go camping in the desert with her family. But then, a crisis: While on vacation, “I started getting calls about the Gymnasium,” says Aflalo, referring to Gymnasium Rehavia, the school in Jerusalem with the large outbreak. Aflalo can’t say for sure that the outbreak was fueled by a lack of masks, but she believes the timing is suggestive.