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American Academy of Pediatrics urges universal masking in schools for everyone ages 2 and up — whether vaccinated or not

Parents should probably add fresh face masks to their back-to-school shopping lists — even if their kids are vaccinated against COVID-19. 

That’s according to the latest guidance from the American Academy of Pediatrics, aka the AAP, which is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists from across the United States.

The AAP is recommending a “layered approach” to make schools safe for students, teachers and staff alike as the delta variant continues to drive cases of the novel coronavirus that causes COVID-19 higher in all 50 states. So it’s calling for everyone 2 years old and up to wear masks, regardless of their vaccination status. California Gov. Gavin Newsom is also requiring that all students in his state wear masks in school, which has spurred backlash from his Republican opponents.

This contradicts the Centers for Disease Control and Prevention (CDC), which relaxed its masking guidelines earlier this month to say that vaccinated teachers and students don’t need to wear face coverings.

Coronavirus Update: U.K. drops COVID restrictions against advice of experts, and delta variant drives cases higher across the U.S.

So why is the AAP, in particular, asking kids and teachers to put their masks back on? It’s mainly because a large portion of school-age children are still not eligible for one of the COVID-19 vaccines; the CDC hasn’t issued guidance on COVID-19 vaccines for children under 12 yet, as none have been approved for use in that age group at this time. The Pfizer
PFE,
-0.50%

vaccine is currently authorized for individuals ages 12 and up, but the Moderna
MRNA,
+9.48%

and Johnson & Johnson
JNJ,
-0.73%

jabs are authorized for ages 18 and up. 

“There are many children and others who cannot be vaccinated,” said Dr. Sara Bode, chair-person elect of the AAP Council on School Health Executive Committee, in a statement. “This is why it’s important to use every tool in our toolkit to safeguard children from COVID-19. Universal masking is one of those tools, and has been proven effective in protecting people against other respiratory diseases, as well.” 


“Combining layers of protection that include vaccinations, masking and clean hands hygiene will make in-person learning safe and possible for everyone.” 

The AAP still “strongly recommends” in-person learning this fall, because it reports that kids suffer a greater risk of mental illness and developmental setbacks through remote schooling compared with attending classes in-person.

But the AAP also recognizes that many schools will not have a system in place to monitor the vaccine status of its students, teachers and staff, and some communities may have higher infection rates due to low vaccination rates. What’s more, variants including the more-contagious delta variant can raise the risk of catching and spreading the virus, as well as result in worsening COVID-19 illness. 

Related: Delta variant will be ‘most serious virus’ the unvaccinated ever get, says Ex-FDA head Gottlieb

Plus, some health policy experts have been questioning the logistics of letting some vaccinated students go without masks, while others are told to keep covering up. “It would be a very weird dynamic, socially, to have some kids wearing masks and some not. And tracking that? Teachers shouldn’t need to be keeping track of which kids should have masks on,” Elizabeth Stuart, a Johns Hopkins University public health professor, told the Associated Press.

So Dr. Sonja O’Leary, chair of the AAP Council on School Health, said in a statement that, “Combining layers of protection that include vaccinations, masking and clean hands hygiene will make in-person learning safe and possible for everyone.” 

The AAP isn’t the only group of health officials looking to bring universal masking mandates back. Dr. Jerome Adams, the former U.S. Surgeon General, tweeted a thread over the weekend expressing his concerns that the CDC’s current mask guidance — basically, you don’t need to wear one if you’re vaccinated — is “well-intentioned” but “harmful” as the delta variant spreads.

Last week, the nation’s largest union for registered nurses also sent a letter to the CDC urging the agency to reinstate its recommendation that everyone — “irrespective of vaccination status” — wear masks when in public or in physical proximity to people from other households.

Read more: ‘The pandemic is not over’: Bring back universal face masks, the nation’s largest nurses union tells CDC

“The pandemic is not over, and the United States once again stands on the precipice of rising cases,” wrote Bonnie Castillo, executive director of National Nurses United. “It should come as no surprise that cases are rising following the rapid reopening of many states and the removal of public health measures, including the CDC’s May 13 guidance update that told vaccinated individuals they no longer needed to wear masks, observe physical distancing, avoid crowds, or get tested or isolate after an exposure, within only a few exceptions.” 

And some U.S. cities and states that have seen COVID cases spike have also urged residents to put their masks back on. Although Hawaii has one of the highest vaccination rates among the 50 states, Gov. Gov. David Ige continues to maintain the requirement that people wear masks indoors because the delta variant is fueling a spike in cases, particularly among unvaccinated residents. Los Angeles also restored its indoor mask mandate for all last week, with the Los Angeles County’s public health officer warning, “This is an all-hands-on-deck moment.”

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