LETTER FROM MEDICAL PROFESSIONALS AND PARENTS TO THE SLSD SCHOOL BOARD
LETTER FROM MEDICAL PROFESSIONALS AND PARENTS TO THE SLSD SCHOOL BOARD
The Issue
20 August 2021
To the Members of the Southern Lehigh School Board:
We, the undersigned, are medical doctors, nurses, pharmacists and other medical professionals whose children are students in the Southern Lehigh School District. The purpose of this letter is to lend our voices as parents and clinicians in support of a dynamic, data-informed universal mask mandate while local SARS-CoV2 transmission levels are high.
Quoting from the School Board’s 2021-2022 Health and Safety Plan, it is the Board’s goal to:
1) “Utilize the up-to-date guidance and recommendations from the Centers for Disease Control and Prevention (CDC) and the Pennsylvania Department of Health (PADOH)
2) “Focus on the maximization of in-person instructional opportunities…[while implementing safety protocols that consider] the level of community spread in the SLSD community
3) “Engage in active consultation with medical staff and public health officials…in an effort to ensure that the information within the SLSD Health and Safety Plan is relevant”
In summary, the School Board’s position appears to be a strategy of integration of objective data and expert guidance with real-time monitoring of local conditions.
We recognize that difficult decisions often are often made in the setting of uncertainty. Under these circumstances, choices should be made from analysis of objective data, and policy should be updated as new data becomes available. When considering differing viewpoints, we urge the Board to evaluate and consider only those analyses that rely on objective data that consider both the quality and preponderance of the evidence. High quality data is that which is peer-reviewed and replicable, with multiple studies making the same or similar conclusions though isolated conflicting reports may exist.
Data collected during the 2020-21 flu season demonstrated a pediatric hospitalization rate of nearly three times that of a typical flu season, with the difference attributable to COVID-19 hospitalizations (1). Notably, this data antedates spread of the delta SARS-CoV2 variant, which is now the dominant strain in the USA and which demonstrates increased infectivity and possibly increased pathogenicity compared to earlier strains (2). To date, there have been over 4,000,000 infections in children resulting in nearly 800,000 hospitalizations for COVID-19, comprising 2.3% of all hospitalized patients (3). With over 1900 children currently hospitalized from COVID-19 filling some pediatric hospitals to capacity, to conclude that COVID-19 is a benign disease in children is unjustified (4).
Regarding universal mask mandates, there is clear evidence that mask mandates are associated with reduced of spread of SARS-CoV2 (5). For healthcare workers (HCW) like us, implementation of universal mask mandates have been strongly associated with a fall in rates of HCW infections (6,7). Mask mandates have persisted in the health care setting and are so well accepted by HCWs that there is virtually 100% compliance and minimal controversy over their use (8). The importance of universality over optionality when case levels are high is reinforced by the following facts: SARS-CoV2 is primarily unknowingly spread by pre-symptomatic or asymptomatic individuals; masking is intended to reduce spread by the mask wearer, not necessarily to protect the wearer from infection; yet despite this, masking may still reduce the severity and duration of COVID-19 (9). Because the CDC provides an exception in defining close contact for students who were masked at the time of exposure, an additional benefit of universal masking mandates will be a reduction in high-risk exposures that result in missed school days associated with quarantine. In Mississippi where universal masking is not mandated, a reported 20,000 students are under home quarantine during the first week of school alone (10). It cannot be stressed enough: a key factor in maximizing effectiveness of masking is universal compliance (11). A masking mandate is likely to reduce spread of SARS-CoV2 in our schools, reduce home quarantine time associated with high risk exposures, and maximizing in-person learning opportunities for our children.
An alternative way to conclude that a universal mask mandate is rational policy while community transmission level is high is to assess the potential for harm from face masks. A minority of studies report on potential negative effects from mask-wearing such as increased carbon dioxide and acne. These isolated findings are either of poor scientific quality or have yet to be replicated in peer-reviewed literature. Indeed, a controversial research letter published in the journal JAMA Peds suggesting unacceptably high carbon dioxide levels was subsequently retracted by the editors due to serious methodologic flaws (12,13). Furthermore, even if true, the clinical impact of such findings with respect to child health is unlikely to approach the benefit of reducing the risk of COVID-19 in children.
We consider it an honor and a privilege to help the members of our communities make personal medical decisions and hope that our extensive experience as medical-decision making guides lends weight to the following statement: we resolutely support the Board’s evidence-based and expert-guided approach towards COVID-19 prevention and risk mitigation. We note that both current medical evidence and expert guidance from both the Center for Disease Control (14) and the American Academy of Pediatrics (15) both support universal masking for vaccinated and unvaccinated individuals in the indoor setting and urge the Board to institute a dynamic, data-informed universal mask mandate in the Southern Lehigh School District, consistent with its stated position to utilize up-to-date guidance that focuses on the maximization of in-person instructional opportunities. Importantly, rather than blindly supporting any policy, we urge the Board to make ongoing assessments for the need for such a dynamic mandate and be willing to incorporate new data to update policy as it becomes available.
Sincerely,
The Undersigned Medical Professionals and Parents of SLSD Students
REFERENCES
1. Havers et al. Hospitalization of Adolescents Aged 12-17 with confirmed COVID019.MMWR Morb Mortal Wkly Rep 2021,; 70:851-857.
2. Boehm, E et al. Novel SARS-CoV-2 variants: the pandemics within the pandemic. Clin Microbiol Infect. 2021 Aug;27(8):1109-1117. doi: 10.1016/j.cmi.2021.05.022. Epub 2021 May 17.
5. The Science of Masking https://www.cdc.gov/coronavirus/2019-ncov/downloads/science-of-masking-full.pdfg to Control COVID-19 (cdc.gov)
6. Wang, X et al. Association Between Universal Masking in a Healthcare System and SARS-CoV-2 Positivity Among Health Care Workers. JAMA 2020;324(7):703-4
7. Seidelman, JL et al. Universal masking is an effective strategy to flatten the severe acute respiratory coronavirus 2 (SARS-CoV2) healthcare epidemiologic curve. Infect Control Hosp Epidemiol. 2020 Jun 25 : 1–2.
9. Brooks, JT. Universal masking to prevent SARS-COV2 transmission—the time is now. JAMA 2020; 324(7): 635-37
10. https://www.forbes.com/sites/jemimamcevoy/2021/08/18/tens-of-thousands-of-school-children-already-in-covid-quarantine-20000-in-mississippi-alone/?sh=46926e282c2af Thousands Of School Children Already In Covid Quarantine—20,000 In Mississippi Alone (forbes.com)
11. The Reopen Our Schools Act of 2021 ABC Science Collabotive Final Report June 2021
12. Walach H, et al. Experimental assessment of carbon dioxide content in inhaled air with or without face masks in healthy children: a randomized clinical trial. JAMA Pediatr. 2021. Published online June 30, 2021
14. https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-12-guidance.htmlntion in K-12 Schools | CDC
The Issue
20 August 2021
To the Members of the Southern Lehigh School Board:
We, the undersigned, are medical doctors, nurses, pharmacists and other medical professionals whose children are students in the Southern Lehigh School District. The purpose of this letter is to lend our voices as parents and clinicians in support of a dynamic, data-informed universal mask mandate while local SARS-CoV2 transmission levels are high.
Quoting from the School Board’s 2021-2022 Health and Safety Plan, it is the Board’s goal to:
1) “Utilize the up-to-date guidance and recommendations from the Centers for Disease Control and Prevention (CDC) and the Pennsylvania Department of Health (PADOH)
2) “Focus on the maximization of in-person instructional opportunities…[while implementing safety protocols that consider] the level of community spread in the SLSD community
3) “Engage in active consultation with medical staff and public health officials…in an effort to ensure that the information within the SLSD Health and Safety Plan is relevant”
In summary, the School Board’s position appears to be a strategy of integration of objective data and expert guidance with real-time monitoring of local conditions.
We recognize that difficult decisions often are often made in the setting of uncertainty. Under these circumstances, choices should be made from analysis of objective data, and policy should be updated as new data becomes available. When considering differing viewpoints, we urge the Board to evaluate and consider only those analyses that rely on objective data that consider both the quality and preponderance of the evidence. High quality data is that which is peer-reviewed and replicable, with multiple studies making the same or similar conclusions though isolated conflicting reports may exist.
Data collected during the 2020-21 flu season demonstrated a pediatric hospitalization rate of nearly three times that of a typical flu season, with the difference attributable to COVID-19 hospitalizations (1). Notably, this data antedates spread of the delta SARS-CoV2 variant, which is now the dominant strain in the USA and which demonstrates increased infectivity and possibly increased pathogenicity compared to earlier strains (2). To date, there have been over 4,000,000 infections in children resulting in nearly 800,000 hospitalizations for COVID-19, comprising 2.3% of all hospitalized patients (3). With over 1900 children currently hospitalized from COVID-19 filling some pediatric hospitals to capacity, to conclude that COVID-19 is a benign disease in children is unjustified (4).
Regarding universal mask mandates, there is clear evidence that mask mandates are associated with reduced of spread of SARS-CoV2 (5). For healthcare workers (HCW) like us, implementation of universal mask mandates have been strongly associated with a fall in rates of HCW infections (6,7). Mask mandates have persisted in the health care setting and are so well accepted by HCWs that there is virtually 100% compliance and minimal controversy over their use (8). The importance of universality over optionality when case levels are high is reinforced by the following facts: SARS-CoV2 is primarily unknowingly spread by pre-symptomatic or asymptomatic individuals; masking is intended to reduce spread by the mask wearer, not necessarily to protect the wearer from infection; yet despite this, masking may still reduce the severity and duration of COVID-19 (9). Because the CDC provides an exception in defining close contact for students who were masked at the time of exposure, an additional benefit of universal masking mandates will be a reduction in high-risk exposures that result in missed school days associated with quarantine. In Mississippi where universal masking is not mandated, a reported 20,000 students are under home quarantine during the first week of school alone (10). It cannot be stressed enough: a key factor in maximizing effectiveness of masking is universal compliance (11). A masking mandate is likely to reduce spread of SARS-CoV2 in our schools, reduce home quarantine time associated with high risk exposures, and maximizing in-person learning opportunities for our children.
An alternative way to conclude that a universal mask mandate is rational policy while community transmission level is high is to assess the potential for harm from face masks. A minority of studies report on potential negative effects from mask-wearing such as increased carbon dioxide and acne. These isolated findings are either of poor scientific quality or have yet to be replicated in peer-reviewed literature. Indeed, a controversial research letter published in the journal JAMA Peds suggesting unacceptably high carbon dioxide levels was subsequently retracted by the editors due to serious methodologic flaws (12,13). Furthermore, even if true, the clinical impact of such findings with respect to child health is unlikely to approach the benefit of reducing the risk of COVID-19 in children.
We consider it an honor and a privilege to help the members of our communities make personal medical decisions and hope that our extensive experience as medical-decision making guides lends weight to the following statement: we resolutely support the Board’s evidence-based and expert-guided approach towards COVID-19 prevention and risk mitigation. We note that both current medical evidence and expert guidance from both the Center for Disease Control (14) and the American Academy of Pediatrics (15) both support universal masking for vaccinated and unvaccinated individuals in the indoor setting and urge the Board to institute a dynamic, data-informed universal mask mandate in the Southern Lehigh School District, consistent with its stated position to utilize up-to-date guidance that focuses on the maximization of in-person instructional opportunities. Importantly, rather than blindly supporting any policy, we urge the Board to make ongoing assessments for the need for such a dynamic mandate and be willing to incorporate new data to update policy as it becomes available.
Sincerely,
The Undersigned Medical Professionals and Parents of SLSD Students
REFERENCES
1. Havers et al. Hospitalization of Adolescents Aged 12-17 with confirmed COVID019.MMWR Morb Mortal Wkly Rep 2021,; 70:851-857.
2. Boehm, E et al. Novel SARS-CoV-2 variants: the pandemics within the pandemic. Clin Microbiol Infect. 2021 Aug;27(8):1109-1117. doi: 10.1016/j.cmi.2021.05.022. Epub 2021 May 17.
5. The Science of Masking https://www.cdc.gov/coronavirus/2019-ncov/downloads/science-of-masking-full.pdfg to Control COVID-19 (cdc.gov)
6. Wang, X et al. Association Between Universal Masking in a Healthcare System and SARS-CoV-2 Positivity Among Health Care Workers. JAMA 2020;324(7):703-4
7. Seidelman, JL et al. Universal masking is an effective strategy to flatten the severe acute respiratory coronavirus 2 (SARS-CoV2) healthcare epidemiologic curve. Infect Control Hosp Epidemiol. 2020 Jun 25 : 1–2.
9. Brooks, JT. Universal masking to prevent SARS-COV2 transmission—the time is now. JAMA 2020; 324(7): 635-37
10. https://www.forbes.com/sites/jemimamcevoy/2021/08/18/tens-of-thousands-of-school-children-already-in-covid-quarantine-20000-in-mississippi-alone/?sh=46926e282c2af Thousands Of School Children Already In Covid Quarantine—20,000 In Mississippi Alone (forbes.com)
11. The Reopen Our Schools Act of 2021 ABC Science Collabotive Final Report June 2021
12. Walach H, et al. Experimental assessment of carbon dioxide content in inhaled air with or without face masks in healthy children: a randomized clinical trial. JAMA Pediatr. 2021. Published online June 30, 2021
14. https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-12-guidance.htmlntion in K-12 Schools | CDC
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Petition created on August 21, 2021