We are parents of preschool children in New York City.  We include among us clergy, caregivers, journalists, health care professionals, lawyers, and, most importantly, parents concerned about our kids’ safety and well-being. We are not anti-mask, anti-vaxx, or unmindful of the risks of Covid-19. On the contrary, many of us are politically liberal, and have done everything required throughout the pandemic to keep our communities safe: distancing, isolating, masking, getting vaccinated, and quarantining when necessary.

Now, however, we find ourselves not fighting the virus but fighting a DOH bureaucracy making decisions with no basis in city, state or national health guidelines. Like all DOH policies, the March 3, 2022, decision to maintain the indoor masking rule for preschoolers was announced with no opportunity for parents to access, understand, or be involved in decision-making processes. Meanwhile, our school directors are exhausted, and our kids are anxious and confused.

We have several questions and issues regarding the indoor mask rule:

1.   Divergence from national, state and local policy.  First and foremost, this rule diverges from city, state, and national policies.  How does it make sense that, as of March 7, unvaccinated and unmasked people of all ages can mingle in nightclubs and attend huge concerts and sporting events, while preschoolers are forced to mask up in school?[1]  Moreover, preschools not regulated by DOH (i.e. those attached to K-8 schools) are already unmasked in our neighborhood.  Why are our kids different?  Why are they being held to a standard unlike that of nearly every other population in the city?

2.   Vaccination status is no longer being considered by city regulations.  Of course, we recognize that children under five cannot be vaccinated at this time.  However, New York City rules governing schools, restaurants, bars, and entertainment venues no longer distinguish between vaccinated and unvaccinated.  Why are preschools any different?  Why are we following a policy labeled by one expert as “Kids Last,”[2] when in terms of developmental and societal needs, kids should be first?  What is the rationale for this policy, and why has it not been communicated to stakeholders?

3.   Vaccination status is less important than susceptibility to infection and transmission.  As you surely know, the rates of illness, including mild illness, among unvaccinated children under five are extremely low – at this moment, thankfully, lower than the seasonal flu, and lower than breakthrough cases among vaccinated adults.  Vaccination is not a magical get-out-of-jail free card; it is a means for reducing infection and contagion.  If the rates of infection and contagion among this age cohort are lower than that of other cohorts, why should vaccination matter at all?

4.   Rates are now extremely, extremely low.  As of March 3, the daily Covid positivity rate in New York City is a miraculous 8 cases per 100,000 people.[3]  The death rate is .19 per 100,000 people, or about 260 per week, over 90% of whom are unvaccinated older adults, mostly with comorbidities.  This is below the threshold for epidemic or pandemic status, and is below numerous other causes of death that are not considered epidemics. At what point are rates low enough to remove the masking rule?  If DOH continues to enforce this mask mandate, will you at least set firm criteria for when it will be lifted?

5.   Vulnerable people may still mask up.  Even if the indoor mask mandate is removed, of course, parents and teachers may choose to mask up, which studies have shown reduces the possibility of infection by at least 50% of baseline,[4] on top of the already low rates noted above. Children or teachers in homes with immune-compromised or elderly family members can still take this additional step. “One-way masking” works.[5]   

6.   Masks don’t help as much as we thought.  Again, we do not want to parrot denialism or right-wing talking points.  We’ve masked up for two years.  However, the best available data shows that masking only reduced Covid incidence in schools by between 11%-25%.[6]  (The 50% figure above is 50% of whatever risk may exist in a particular situation; the 11-25% range is actual incidence reduction in the areas studied.)  Moreover, states with no school (or preschool) mandates are now not showing any greater Covid rates than states with such mandates.[7]  The epidemiological evidence from tens of millions of people living in states and nations with no masking shows that, as of now, their Covid rates are not higher.  Their kids are not getting sick.  If unmasking led to spikes in infection, we would see that in almost half of the country. We do not.

7.   We believe that masks harm our kids.  We realize this point is contentious, and that some people have made unsubstantiated claims about masking and child development.  We also realize that by definition, there cannot be long-term studies of the impact of masking.  However, as parents, we are concerned that our kids aren’t getting the cues that they need for emotional development and emotional intelligence; are often uncomfortable and thus less attentive while masked; and are missing out on peer-to-peer socialization, with smiles and frowns and all the rest, that would be normal at this age. 

8.   Schools should be given flexibility.  Finally, facilities should be given more discretion to adapt DOH guidance to their specific circumstances.  We are mindful that many of our children attend professionally-run, highly-resourced preschools, while others may be in challenging circumstances.  The professionals at preschools should not be subject to a “one size fits all” policy.  The needs of an at-risk daycare facility and a large preschool attached to a church or synagogue are different. Even if the mask mandate is not lifted entirely, it should be turned into a recommendation, and principals should be empowered to make appropriate decisions for their communities.

Most of us were shocked when we learned of the DOH’s decision on March 3.  With the change across the board in New York City policies, and with the extremely low rates of Covid, we had assumed that now would be the time to carefully remove this requirement for our kids.  If not now, then at what point do we give our kids a normal childhood, for the first time in their lives?

 

Sources:

[1] https://www.nytimes.com/2022/03/04/nyregion/nyc-mask-mandate-indoor-vaccination-rules.html

[2] https://www.theatlantic.com/ideas/archive/2022/02/relaxing-covid-restrictions-kids/622857/

[3] https://www.nytimes.com/interactive/2021/us/covid-cases-deaths-tracker.html

[4] https://emilyoster.substack.com/p/my-school-or-child-care-is-going

[5] https://www.theatlantic.com/politics/archive/2022/01/does-it-help-wear-mask-if-no-one-else/621177/

[6] https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7021e1-H.pdf

[7] https://www.medrxiv.org/content/10.1101/2021.05.19.21257467v1.full