Welcoming more students back to school risks spreading coronavirus – a simple way to reduce the risk is being overlooked.
School leaders are under immense pressure, and I hesitate to add to it. But I was astonished by Teacher Tapp data showing that only 3% of schools are mandating the use of face masks. This post argues that mandating cloth face coverings for teachers and students will dramatically reduce risk. I discuss:
- Evidence in favour of masks,
- Reasons their merits have been overlooked and,
- Practical objections.
Coronavirus remains widespread, spreads easily, can be carried asymptomatically, and has already killed 1 in every 1000 people in the UK. If we want to children to return to school, we should do everything we can to prevent its further spread.
[Update, 26th August: government guidance has changed to permit/require masks (depending on how prevalent coronavirus is in the area). I’ve published advice from schools which used masks in the summer term here].
1. Masks reduce risk
Depending on how you like your evidence, you may prefer to read about:
Individuals
In Springfield, Missouri, two hairdressers tested positive for coronavirus. They had seen over 140 customers, and worked alongside seven colleagues. Hairdressers and clients wore masks. Two weeks later none of the clients or colleagues had tested positive. (Source: CNN).
Organisations
At Brigham and Women’s Hospital in Boston, 12-14 employees were catching coronavirus daily. After all employees were asked to wear masks, this dropped to eight a day. After patients were asked to wear masks too, it dropped to six. (Source: WBUR).
Countries
‘Mask’ countries had recent experience of SARS, and there are confounding factors like better public health organisation and testing (Korea) and cultural norms (like bowing rather than shaking hands in Japan). But European ‘Mask’ countries show similar effects. Slovakia mandated masks early, and leaders led by wearing them. After only 1,500 cases, Slovakia was the first country in Europe to remove lockdown. (Source: the Atlantic). (Czech Republic offers another dramatic demonstration demonstration).
The underlying mathematics
Nassim Nicholas Taleb has shown that even if masks are imperfect, they dramatically cut the chances of transmission (because if you and I both wear a mask, and I am ill, I am less likely to spread the virus and you are less likely to breathe it in). More here.
Systematic reviews
“Masks in general are associated with a large reduction in risk of infection from SARS-CoV-2.” (Source: The Lancet).
In summary: the evidence
I might not ask you to take a high-risk experimental treatment based on what I’ve presented. But there’s enough evidence for me to ask you to wear a piece of cloth over your mouth.
If masks work, why aren’t we all wearing them?
World Health Organisation (and domestic) guidelines
Scott Alexander examined the studies underpinning the US Center For Disease Control guidelines. He wasn’t certain, but suggested the CDC treated masks like a drug: only recommended based on relative certainty. They were uncertain masks worked, so didn’t recommend them. This is too high a burden of proof for a precautionary measure.
Mixing up respirators and masks
We can confuse N95 respirators, which filter the air the wearer breathes, with cloth masks. There was understandable concern that people would buy respirators needed in hospitals. Providing respirators to 450,000 teachers would be hard, and they’re difficult to wear properly. But I’m not suggesting giving teachers and students hospital-grade PPE: I’m suggesting cloth face-coverings. Some object because these don’t provide perfect protection: imperfect protection is surely better than nothing.
Encouraging risky behaviour
There’s concern that people wearing masks may feel immune and take greater risks (like driving faster because you have ABS). But a neat study in Italy gave people ‘social distancing belts’ measuring how near they came to others: wearing masks led people to increase their distance from others. Masks help people behave more safely.
Masks won’t work because…
This post began as a Twitter thread. People raised practical concerns including:
Young children won’t manage: I’d have reservations about getting my two-year old to wear a mask without ripping it off (glasses took months). But if you believe a child will have enough self-control (and supervision) to do the other things we’re asking (stay in their seat, follow tape marks on the floor, and so on), they can manage this. A related concern is that a child may increase risk by taking a mask off and waving it around. I struggle to believe that no protection is better than protection they might misuse, but enforcing rules for responsible behaviour is essential, as Israeli schools found.
There aren’t enough masks: Any mask is better than none. Masks can be made easily at home and a cloth mask can be cleaned in boiling water each day. (Having supported medics fantastically, DT teachers might also help).
They inhibit communication for people with hearing loss: This is a problem, but it’s better to agree a principle for 8.8 million children (masks reduce risks so we should use them) then find alternatives for the classes of the 20,000 children who are moderately or severely deaf. Transparent face-masks can be made at home (instructions) and update: are now available from various retailers online, such as Just Smile and Amazon.
Department for Education guidelines suggest they should not be compulsory: civil servants are offering the best guidance they can. This may be based on what’s available, not what they might wish to do. Headteachers have worked with, around and beyond the guidance to meet children’s needs throughout the pandemic: as Laura McInerney notes, 1 in 5 schools have ignored DfE guidance on rotas.
Masks are scary and may deter parents from sending their children back to school. I kind of get this (intuitively – because masks feels weird – rather than rationally). But the goal isn’t getting kids back to school, it’s keeping them there. Fresh outbreaks will do more to undermine parents’ trust than masks.
Conclusion
It’s easier to let individuals choose. But this is not a personal choice. A healthy fourteen-year old living with a healthy parent may not benefit directly. Their classmate’s grandmother, fifty-year old teacher, and education will. Everyone in schools should be wearing a face covering.
Most objections are pursuing the perfect instead of the good: problems remain. But I suspect you use a seatbelt, even though it reduces rather than eliminates risk. If you wear a seatbelt, wear a mask.
We have accepted restrictions on almost every aspect of our life. We have rearranged classes, classrooms, timetables and teaching. If you accepted that, you can accept a mask.
Make schools safe: wear a mask, ask your colleagues to wear a mask, ask your children to wear a mask.
Further reading
I’ve learned a huge amount from two amazing scholars: Nassim Nicholas Taleb (recent write-up on masks here) and Zeynep Tufecki. Not just on masks.
Wearing a mask is good – it inhibits transmission if worn properly. However, if pulled down then back up it may become a source of transmission to the wearer. Teaching students about putting them on safely and not touching it until it needs to be removed, then removing safely, and storing correctly for washing is the hard part. Several masks a day may be necessary to allow for eating. This would need to be funded.