To Keep Schools Open for In-Person Learning, Masks Must be Universal

An Open Letter to All North Carolina School Boards and Superintendents

By: By Christoph R. Diasio, MD, FAAP | August 2021

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As children across the state return to school, COVID rates among children are rapidly increasing. The decision whether to mandate masks at school has been left up to individual school districts. As of this writing, 43 school districts have voted to require mask wearing this semester, while 53 have voted to make masks optional. 18 districts have not adopted a specific policy yet.

Today on our blog, NC Child is republishing an open letter sent by the NC Pediatric Society on August 3, 2021 to all School Boards and Superintendents:

I reach out to you today as President of the N.C. Pediatric Society, the state chapter of the American Academy of Pediatrics representing more than 2,300 pediatricians and other child health professionals across North Carolina. The N.C. Pediatric Society strongly supports in-person education with students, school personnel and volunteers consistently and appropriately wearing masks indoors in all grades.

We applaud the work of School Boards, superintendents, principals, teachers, school staff and others to keep educating children while keeping them safe and fed throughout the COVID-19 pandemic. We appreciate your efforts to assure children can be educated in-person and are alarmed by the studies showing lack of gain in education during remote learning, despite often-heroic efforts by schools.

In-Person Education is Best for Children’s Health

As child health professionals, we know that in-person education is best for children’s health. Being with other children and adults is important for social and emotional development and on-going mental health. Teachers and others can be an important influence in a child’s life towards building resiliency as well as detecting abuse and neglect. In-person schooling provides routine, healthy foods, physical activity and other strong health benefits for children. We also understand that some students may need an in-home option, but most children will benefit from the social interaction of in-person education.

Masking is a critical component of safe, in-person learning right now. As medical experts, we are deeply concerned about the quick-spreading nature of the Delta variant and the increasing hospitalization of children with COVID-19. Masks add an important layer of safety to in-person learning.

Ample Evidence that Masks Prevent COVID-19 Spread

North Carolina-based research shows that schools where children and adults are consistently masked are effective in preventing the transmission of COVID-19. Furthermore, the American Academy of Pediatrics calls for mask-wearing in all grades while further noting “everything possible must be done to keep students in school in-person.” Universal masking promotes safety, reduces transmissions and is easier to administer than trying to monitor who has been vaccinated among students old enough to be eligible for the COVID vaccine. CDC guidance recommends that masks be worn by “all students, staff, teachers and visitors in schools regardless of vaccination status.” The StrongSchoolsNC Public Health Toolkit says that “all schools should require all children and staff in K-12 grades to wear face coverings consistently when indoors.”

Younger Children at Greater Risk

Masking is especially important in North Carolina schools. The COVID vaccine is only authorized for children 12 and older, so many children are not yet eligible for the vaccine. Of children aged 12 – 17, only 26% of NC teens are fully vaccinated. While experts do not yet have a “hard” figure on when community immunity is approached against COVID generally and the Delta variant specifically, pre-Delta experts have suggested a ballpark three-times higher than the current teen vaccination level. If anything, the threshold would only be higher now, so masking is one of our best tools for safe, in-person learning for students.

To best promote mental and physical health of our children, the N.C. Pediatric Society stands with the American Academy of Pediatrics to urge in-person schooling for children. The best way to achieve that at this time of the Delta variant and low vaccination rates is to require masks in all grade levels.

Thank you for working to protect children.

Take Action! Does your local school board require masks at school this year? Find out here.




Christoph R. Diasio, MD, FAAP is a practicing pediatrician in Moore County, NC, and the President of the North Carolina Pediatric Society