Need to know: Does forcing pupils to wear masks in school do more harm than good?

The advice for secondary school pupils in England to wear face masks in the classroom will be dropped, the education secretary has said. The change will come in alongside step three of the roadmap out of lockdown, on 17 May at the earliest.

The row over whether the health benefits of masks in schools outweigh the social and developmental risks has been intensifying in recent days, with scientists, teaching unions and public health experts writing to the government to call for mandatory face coverings in secondary schools to be extended until at least 21 June.

But what are the possible harms to children from wearing masks? And how effective are they in protecting children and teachers from Covid? Here’s what you need to know. 

What is the current guidance with masks in schools? 

Since schools re-opened on 8 March, all secondary school pupils have had to wear masks in classrooms and “in all indoor environments”, PE being one of the few exemptions.

In primary schools, children aren’t required to wear a face covering but staff are.

The World Health Organisation (WHO) recommends masks for anyone over 12, and says they should be considered for six to 11 year olds if “there is widespread transmission in the area where the child resides.”

Do masks cut transmission? 

At the start of the pandemic, the verdict was mixed. Now health experts overwhelmingly agree that masks are an effective measure in minimising the spread of Covid-19. 

In June 2020, The Lancet published a review of 172 observational studies across 16 countries, concluding that masks can reduce infection risk by up to 85 per cent.

Dr Julian Tang, a consultant virologist at the University of Leicester, says face coverings in schools “prevent the rapid close-range aerosol and droplet transmission during normal conversation that kids always have.”

But Dr Tang also agrees that the emotional implications of young children wearing masks shouldn’t be overlooked.

What are the social harms? 

Transmission prevention is only half the story. The health implications need to be balanced against developmental risks since there is concern that mask-wearing hinders children’s ability to learn, develop and communicate.

Dr Amanda Gummer, a child psychologist, says “facial expressions form a large part of non-verbal communication” and “young children who have difficulty interpreting social and emotional cues are likely to be further disadvantaged” by the mask policy. 

“Children who are hard of hearing will also not be able to lip read,” Dr Gummer adds.  

Research by Manfred Spitzer published last August concluded that masks have a detrimental effect on the relationship between student and teacher as they “block emotional signalling”. 

In a recent report conducted by the Education Endowment Foundation, which surveyed 58 primary schools across England, 96 per cent of schools admitted they were concerned about their pupils’ speech and language development.

Is Covid spreading in schools?

A flurry of studies, including one from Iceland which screened over half of the country’s population, have concluded that children play a minor role in transmission. Schools, says Dr Jenny Harries, England’s deputy chief medical officer, are “not a significant driver” of the disease. 

Youngsters can catch the virus and shed viral particles but, according to Walter Haas, an infectious-diseases epidemiologist at the Robert Koch Institute in Berlin, “Globally, Covid-19 infections are still much lower among children than among adults.”

That said, the way in which contagiousness increases with age makes it difficult to lump all pupils together in terms of risk of transmission. 

Dr David Strain, chair of the British Medical Association’s Medical Academic Staff Committee says there is “clear evidence that younger children are less likely to have significant viral load in order to pass on coronavirus.” But, he adds, there are “a number of studies” showing “older children can and do transmit the virus in a comparable way to adults.”

A critical shift seems to appear between the ages of 10 and 12.

According to data on 200,000 school students across 47 US states, the rate of infection is twice as high in children aged between 12 to 17 as it is among five to 11 year olds. 

This age distinction is, of course, reflected in the UK education system’s current masking policy. 

However, it’s also worth noting that data from last summer suggests even secondary schools aren’t Covid hotspots. 

In June 2020, Public Health England surveyed schools (ranging from early years to secondary age) following their re-opening, and identified just 67 confirmed cases of Covid-19 in total that month. The data also indicated that the majority of cases linked to outbreaks involved spread between staff members, not pupils. 

How vulnerable are children and teachers in schools? 

Worldwide, the risk of children becoming seriously ill from the coronavirus is tiny. 

If we look at all hospital admissions reported by the NICE Foundation in 2020, 0.4 per cent were younger than four years old, 0.1 per cent were aged between four and 11 and 0.2 per cent were aged between 12 to 17. The vast majority (99.3 per cent) of all people admitted to hospital with Covid-19 were aged 18 or older. We’ve seen a similar pattern in 2021 so far.  

It’s worth noting, however, that there have been cases of long Covid in children of all ages. Over 600 parents whose children – some as young as eight – are still suffering with long-term symptoms, have established the support group LongCovidKids.org. 

Of course, face coverings in classrooms aren’t just a measure to protect pupils. As Rowland Kao, professor of Veterinary Epidemiology and Data Science at the University of Edinburgh points out: “An important consideration here is for the risks to teachers, especially those who may be in more vulnerable categories due to age or health.” (Though it’s also true that any staff who fall in the vulnerable category will have been offered a vaccine by now.)

Nurses, cleaners, social workers, restaurant staff, taxi drivers and security workers are all occupations which carry a greater risk of Covid infection than teachers, according to data from the Office for National Statistics (ONS).

In December, 15 per cent of teaching and support staff tested positive for antibodies, giving them an average risk for their age. For context, in care homes that had at least one Covid outbreak, two thirds of staff had antibodies by the end of the first wave.