Safety and Education

By Benjamin C. Aaker, MD
SDSMA President

School is back in session and the sigh of relief that parents everywhere usually feel will be a cautious one at best in the midst of the worst pandemic any of us can remember. The American Academy of Pediatrics in its July 10 statement recommended reopening of schools, citing the need for social interaction as critical for the developing mind. Their one caveat: reopening schools must be done safely.

The issue of mask-wearing was brought to me by one of our members, the prescient Dr. Jesse Barondeau of Mitchell. He and a group of physicians saw the need and passionately spoke with their school board. After this, Mitchell became the first district in South Dakota to require masks. I thank Dr. Barondeau and his group for his perseverance to the science despite inexplicably politically-motivated opposition.

On July 21, 2020, the SDSMA sent a letter, written by me, to the other school boards in South Dakota. In it I advised them that we now believe the benefits of masking in schools outweigh the risk. Masks should be required for all people in schools, with a few exceptions. Since then, I have spoken with numerous school board presidents and school superintendents about our recommendations. Most questions are about enforcement and whether students should be required to wear masks, or just be recommended to do so.

When I was in school, I remember the swift and grand retribution that would be smitten on any student caught chewing gum. That sugary treat was forbidden to all, and that made it so much sweeter. Now that I’m older I know that the ban was for two reasons: to limit disruption from kids chewing, and to limit kids squishing used gum under various pieces of furniture. It was unsanitary, and could not be tolerated.

I now know that the teachers knew better. They knew the risk of transmission of disease from these gum blobs littering the underside of desks. “But banning chewing gum infringes on their freedom!” some might have said. As adults, we are acutely aware of any limitation on our freedoms, but these are our children. The school boards’ (as well as our own) goal is first their safety, then their education. We have no fear of making requirements of the students if it is to facilitate safety and education.

What are the Benefits?

We know that masking decreases the risk of transfer from the person wearing the mask and decreases risk of transfer to the person who is wearing a mask. Decreased transmission means less people getting infected, which decreases the risk of more people getting infected. Less prevalence means less sick people using valuable resources in our hospitals, and a greater likelihood of saving lives of others who are sick. Masking benefits you, your family, your neighbor, and the population.

What are the Risks?

Opponents of masks in schools often cite concerns that students will continually touch their face because of the mask. Unfortunately, kids (and adults) touch their faces frequently with or without masks. This is why handwashing is so very important. Keeping our hands clean makes it less likely for us to get any pathogens on our masks. Still a risk, you say? True, but less of a health risk than not wearing a mask at all.

Another argument is that teachers will have difficulty enforcing students to wear masks. Firstly, a mask requirement will serve to standardize mask wearing and limit bullying that will happen if only some students wear masks. Secondly, teachers have been enforcing rules since kids started going to schools. Like chewing gum, there will be those who don’t follow the rules. Teachers are adept at gentle reminders and safe guidance. Just like it is more sanitary to ban gum, it is more sanitary to require masks. You can still catch a kid chewing gum in schools, and there will be exceptions to mask-wearing, but the more that do means less disease transmission and more healthy kids. This decreases risk of transmission to the more vulnerable teachers and staff as well as the rest of the population.

A recent publication by various healthcare providers in Canada (so-called Sick Kids) has been touted as arguing against masks in schools. Though I find it telling that mask opponents would need to go as far as a foreign country to find evidence in support of their position, Sick Kids came out with a revision in late July reversing their position; they are now recommending mask requirements in high schools. They have finally come around to understanding that the benefits outweigh the risks. The rest of us should, too.