Masks in schools work but what about those who can’t or won’t comply?

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As children and parents prepare for face-to-face learning after so many months out of the classroom, the Victorian government has been preparing measures to ensure that children and the broader community are as safe as possible when they return to school.

These measures include the three Vs – Vaccination, Ventilation and Vital COVID-safe measures. On Friday, Chief Health Officer Brett Sutton announced face masks will be mandated in the classroom for primary school children in grades three and up as part of the package.

Los Angeles school students wear masks in April. Similar scenes await Victorian classrooms later this month.Credit:AP

So why do children need to wear masks in primary school? And should it be mandatory?

The main reason is to help reduce transmission.

We have seen in Scotland (around the same population as Victoria) that infections increased dramatically as schools re-opened after the summer holiday. Twelve to 15-year-old adolescents have only just started to get vaccinated (28 per cent coverage for dose 1). Masks are being worn by secondary students but not primary.

There is some evidence that school children wearing masks in the classroom may reduce transmission, but it’s entirely possible there are other factors at play – for example, the areas that have high mask use in schools also tend to have high vaccination rates.

But it does make sense that introducing masks will lead to a reduction in transmission. This reduction will go some way to protect parents from infection, but the best protection is if teachers, parents and household contacts get vaccinated.

If we can reduce transmission in classrooms, it is more likely that schools will stay open and there will be less need for children to quarantine.

COVID remains asymptomatic or a mild illness in the vast majority of kids. But rarely kids get sick enough to end up in hospital. Masks are likely to help reduce this number even further.

In Scottish children, each week there are about 10-15,000 infections and every week some children are hospitalised with COVID, but the number remains far fewer than those hospitalised with other common respiratory viruses (such as RSV). There have been no deaths in children from COVID in Scotland since Delta arrived.

Mandating masks in this age group can have challenges. Mandates usually come with penalties for those who don’t comply. This is what worries us the most.

Masking of school children led to a 3.5 fold reduction in outbreaks in the US.Credit:AP

We do worry about the kids who can’t or won’t put a mask on – the stress for them, their parents and their teachers. Careful consideration needs to be given these children. Presumably children with disabilities or behavioural difficulties will be exempt, but how will this be decided and enacted?

We hope that it will not mean school exclusions for those with behavioural difficulties who don’t or can’t comply, as this would mean that the very kids who really need to be in the classroom would be excluded and will drive disadvantage even further. We also worry about the teachers having to enforce this considering it is now a mandate.

It is important we do all we can to keep children in the classroom as much as possible and do as much as we can to help keep kids, the teachers, parents and the broader community safe.

We anticipate that these restrictions will be eased as we get through the next few months and kids will be able to enjoy being with friends and teachers for the remainder of the year. And we anticipate this age group will be maskless next year as more and more adults, and possibly children, get vaccinated.

Professor Fiona Russell is a paediatrician and infectious diseases epidemiologist and group leader at the Murdoch Children’s Research Institute. Dr Sarah McNab is a paediatrician and director, general medicine at the Royal Children’s Hospital.

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