Eight-year-old Bobby Campbell wanted more than anything to go back to school in person this year. But he’s acutely aware of the importance of masks in reducing COVID’s spread, as his second grade science project last year showed.
“He doesn’t understand why it isn’t happening at schools,” his mother Carmen Campbell, a physician in Plano, Texas, says. Governor Greg Abbott banned mask mandates in all public spaces, including schools, by executive order in May, but some school districts have defied his order. Bobby, who’s also participating in Moderna’s vaccine trial, and his friends recorded a video to appeal to the school board to similarly defy the order and require masks.
As children’s hospitalizations for COVID have hit an all-time high in recent weeks, millions of parents have been locked in dizzying back-and-forth battles with the Republican governors of several states—including Texas, Florida, Oklahoma, Arizona, and South Carolina—who have barred schools from requiring masks, which the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention recommend for all schools. Nearly every day of August has seen a petition, protest, court filing, school board meeting, or court order related to mask mandates in schools, and the clashes appear to be just revving up.
Like many legal and political debates, the heart of the mask mandate issue comes down to personal liberty versus collective good; whether the rights of parents who want their children free to attend school without a mask supersedes the rights of students, staff, and families who want everyone to wear masks to protect people from a potentially deadly infectious disease.
Although the majority of American parents—63 percent—support requiring unvaccinated students to wear masks in school, there is a clear political split. Only 31 percent of Republican parents support mask mandates, compared to 88 percent of Democrat parents and 66 percent of Independents. Some of those parents fighting the mandates say there isn’t enough data that masks protect students from disease; others say wearing masks could harm children by causing acne, physical discomfort, fogging of glasses, and psychological issues that arise because children can’t see the lower part of other people’s faces.
Set against the backdrop of the biggest surge in child COVID-19 cases since the pandemic began, rarely have the stakes felt so high for parents—or the students themselves.
While Delta is more contagious than past variants, cases are also rising in kids largely because they’re the biggest unvaccinated group in the population, according to Anthony Flores, chief of pediatric infectious diseases at UTHealth’s McGovern Medical School and a physician at Children's Memorial Hermann in Houston.
“We are seeing more kids with worse respiratory illness than we’ve seen in the past, everything from babies a few months old to teenagers,” Flores says. It’s too soon to know if Delta is actually more dangerous for kids than past variants or if there are more serious cases simply because there are more cases overall, Flores says, but it’s not just children already at high risk who are ending up in the hospital.
“We’re seeing healthy children coming in as well, with no underlying illnesses,” Flores says. Most children fully recover from COVID, but there’s no way to predict who will develop complications, he adds.
Twenty minutes away from Bobby, in Garland, Texas, Kimi Hudgins Gray is terrified that her 15-year-old son, who is attending a special career school program in person, could infect his 6-year-old sister. She has a rare inherited disease that could make COVID deadly to her. Gray’s district is also not requiring masks, nor is it contact tracing cases or able to offer a teacher-led virtual option since the Texas Education Agency will not fund distance learning this year.
“Today alone I have cried five times because my child deserves a safe and free public education just like any other child,” Gray says. “It just shows me that nobody truly cares about her life.”
Both Gray and her best friend Britany Quick, who has children too young to be vaccinated and a husband and grandmother who have medical conditions that make them more vulnerable to COVID-19, are participating in a case filed by the Southern Center for Child Advocacy against Abbott. It’s the only Texas case so far to successfully block the anti-mask mandate in schools for the full state, according to Hank Bostwick, the attorney handling the case. But it’s unclear how long that victory will last.
Delta hitting kids harder than before but masking reduces in-school transmission
The AAP has asked the FDA to expedite authorization for the COVID-19 vaccine for children under 12 based on the data already amassed in clinical trials. The organization noted that the almost 72,000 COVID cases in children at the end of July had nearly doubled from a week earlier, with children making up one in five of all COVID cases nationwide at that time.
Weekly cases in children have now surpassed 180,000, and while fewer than 2 percent of children with COVID need hospitalization, that number adds up with infections surging, putting extra strain on hospitals already trying to manage an unseasonable wave of respiratory syncytial virus (RSV), a common childhood respiratory illness that normally surges in winter.
Meanwhile, modeling studies suggest rates will climb even higher once schools are in session. A study (which has not been peer-reviewed) from Julie Swann, a health systems engineer at North Carolina State University, found that a typical elementary school that doesn’t require masks or regular testing should expect to see 75 percent of its students catch COVID within three months—but requiring masks could reduce those infections by up to 78 percent. Routine surveillance testing with universal masks would reduce those infections by another 50 percent.
Research from last school year found little evidence that COVID spreads easily in schools but substantial evidence of harms from not having in-person school, leading the CDC and AAP to recommend in-person schooling this year. But those studies were before Delta, which is at least twice as contagious as the virus circulating last school year.
Although transmission was limited last year, Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, says last year’s data is “just not relevant now. Look at this surge in pediatric cases right now around the country. We’ve not seen this before.”
In fact, one of the few studies with data on schools after Delta arrived found that schools and residential care facilities were the most common settings for outbreaks.
Much of the research from last school year also occurred in schools with mitigation measures, such as masking and ventilation improvements, in place. Researchers from North Carolina found strong evidence that masking in schools reduced transmission last year. Evidence in adults has conclusively shown that universal mask-wearing indoors substantially reduces the spread of COVID-19, and Flores, UTHealth’s pediatric infection disease physician, says that evidence applies as much to kids as it does to adults. Vaccinating everyone eligible is the first step to protecting student, staff and their families, he says, but other interventions are necessary since students under 12 cannot receive the vaccine yet.
Push-back against masks’ effectiveness
Some parents and governors, however, counter that benefits of masks remain unproven, and that they may even cause harm.
“There is no statistically significant evidence to support the assertion that counties with mask requirements fared any better than those without mask requirements during the 2020-2021 school year, so the assumption that forced masking of children will prevent COVID-19 transmission is faulty and an inadequate basis for policymaking,” Christina Pushaw, press secretary for Florida Governor Ron DeSantis, told National Geographic in an email.
Pushaw cited evidence from a Brown University study showing little difference in infection rates between those who masked and those who didn’t, but that study’s methods have been critiqued as flawed, and it contradicts the evidence from North Carolina showing masks’ benefit in schools. It also, again, was conducted before Delta. Pushaw also says that the masking of children 2 and older is “not consistent with WHO or EU guidance.” But the WHO does say masks for children 6 and older may be warranted in areas with widespread COVID transmission, as Florida has now.
Pushaw says DeSantis “follows the science and data, which is why he promotes vaccination to prevent serious illness from COVID-19,” but that there is “inadequate research on the potential risks [of masks] to children.” She cited an op ed published in the Wall Street Journal coauthored by two physicians that was later refuted by a subsequent op ed signed by more than 70 pediatric pulmonologists.
Among the risks some have cited is psychological or social harm to kids. But Gretchen Moran Marsh, a clinical psychologist in Texas who treats children, says no credible sources show a link between wearing masks and mental health problems or developmental delays in children.
Marsh is more concerned about children having more social isolation, more screen time, more social media, and more anxiety about getting sick or getting someone else sick. “I worry that kids feel they can only take so much,” she says. “I am not one bit concerned about wearing masks causing psychological problems in children.”
Parents suing states over banning school mask mandates
The slew of lawsuits began in Arkansas, where Governor Asa Hutchinson has said he regrets signing the anti-mask legislation into law. Parents’ and school districts’ suits there resulted in blocking the ban for now, though three parents have already filed their own suit against a school district for requiring masks.
Now at least five states are facing lawsuits. In Texas, several counties and school districts have defied Abbott’s order and required masks anyway, eventually leading the Texas Supreme Court to initially support Abbott’s mask ban. Then one of several parents’ suits led the court to halt Abbott’s ban, allowing school mask mandates to remain—for now.
“Your duty as a parent is to protect your child, and, for my kids, there is nothing you could threaten me with that would ever keep me from doing that duty. Nothing,” Jenna Royal, one of the lawyers representing parents in a suit, says.
Suits in other states are no less fraught. Ten school districts in Florida also defied DeSantis’s order, and a lawsuit filed by parents charged that the ban is unconstitutional. On August 27, a judge agreed, saying DeSantis had overstepped his authority and that school districts can legally impose mask mandates without interference from the governor’s office.
A showdown is also brewing in South Carolina, where the state attorney general is suing a school district at the same time that the ACLU is suing the state over its ban. Oklahoma and Arizona also have pending suits. Parents and teachers in Utah and Iowa are organizing to support masking requirements as well.
While most of the states that ban mask mandates did so before Delta hit, Tennessee Governor Bill Lee only issued his executive order against school mask requirements in early August, when pediatric cases were already skyrocketing. Ohio and Mississippi may also be debating school masking requirements soon.
The masking divide has fallen mostly along partisan lines: Republican governors and legislatures have been increasingly limiting public health authorities’ ability to implement measures to mitigate COVID’s spread while all 14 states requiring masks in schools have Democratic governors. The racial/ethnic groups most supportive of requiring masks—Black (83 percent) and Hispanic parents (76 percent)—are also those at the highest risk for infection, hospitalization and death from COVID.
While the Biden administration has little power over state education policy, Education Secretary Miguel Cardona sent DeSantis and Abbott letters last week condemning their refusal to allow district to impose mask mandates.
A focus on personal responsibility and freedom
Texas, unlike Florida, has not claimed masks don’t work but rather that parents’ right to choose whether their children wear them is more important that other parents’ concerns about their children’s health.
“Governor Abbott has been clear that the time for mask mandates is over; now is the time for personal responsibility,” Nan Tolson, communications operations manager of Texans For Greg Abbott, told National Geographic in an email. “Texans have learned and mastered the safe practices to protect themselves and their loved ones from COVID, and do not need the government to tell them how to do so. Parents and guardians have the right to decide whether their child will wear a mask or not, just as with any other decision in their child’s life.”
The problem with this reasoning is that it presumes a mask adequately protects the wearer even if others in the room are not masked.
Those who say they don’t need to wear a mask if they don’t have symptoms aren’t acknowledging that an infected person begins shedding the virus to others before symptoms appear, Flores says.
Still, the argument that everyone, including public school students, should have the freedom not to wear a mask is fueling the minority of parents fighting school mask mandates, sometimes by physically threatening doctors who speak at school board meetings, as happened after a Tennessee school board meeting.
Sasha Alvarado, a pediatric immunologist in Coppell, Texas, says the anti-mask parents haven’t seen the severe disease and COVID-19 deaths that she and others see daily. Alvarado’s daughter, who has a history of life-threatening reactions to viral illnesses, could become one of those statistics. “These people are so angry at being asked to even acknowledge that this reality exists,” Alvarado says. “How did we come to this point of it being socially acceptable to say that kids with health problems can die?”
Like DeSantis, Abbott is pushing for more Texans to get vaccinated to protect everyone, Tolson says, and says school districts have kept many of the safety precautions of last year, such as learning pods and “enhanced hygiene efforts for school buildings, staff, and students.” Tolson says that parents with immune-compromised children have the option of virtual learning, but not everyone qualifies for that.
That program also doesn’t help parents like Jamie Hawthorne, of Wylie, Texas, whose older children are vaccinated, but whose 1-year-old and 3-year-old aren’t.
“It makes me question my own sanity,” Hawthorne says. “It seems incredibly surreal to me that I'm fighting my own governor to try to take care of the health and safety of my community, of all of us.”
Gray, the mother whose daughter has a rare disease, takes it even more personally.
“Abbott is signing our kids’ death certificates, kids like mine,” Gray says. “He's banning a simple piece of cloth that could protect thousands of kids’ lives and the lives of their families.”
Editor's Note: This story has been updated to include news about a Florida court rejecting Governor DeSantis' efforts to ban mask mandates.