Masking and Endemic COVID
Most Americans are choosing to live a normal life in abnormal times.
WaPo columnist Leana Wen writes, “I’m a doctor. Here’s why my kids won’t wear masks this school year.”
For those unfamiliar, she’s not just any doctor. She served as Baltimore’s Health Commissioner for a number of years before becoming a professor of health policy and management at George Washington University. In addition to her MD, she obtained a master’s in health policy while a Rhodes Scholar.
And, no, she’s not a COVID denier.
For the first year of the coronavirus pandemic, my family and I were extremely cautious. I gave birth in April 2020, shortly after covid-19 hit. To protect the baby, my husband and I pulled our then-2-year-old son out of preschool. We socialized outdoors only, at a safe distance from others. I limited indoor activities to work and grocery shopping, and I was never without my N95.
After coronavirus vaccines became available to adults, I wrote that vaccinated people could relax their precautions based on their level of risk tolerance. My tolerance remained low because of my unvaccinated kids. I still avoided indoor restaurants and masked at indoor gatherings unless they required both proof of vaccination and recent negative tests. Our son restarted preschool, but we made sure that he always masked. Playdates were strictly outdoors only.
So, what changed?
Everything changed last winter, with the arrival of omicron. This variant is so contagious — with its derivative strains such as BA.5 even more so — that preventing covid-19 became nearly impossible. Before omicron, the Centers for Disease Control and Prevention estimated that one-third of Americans had been infected with the coronavirus. By the end of February, after the first omicron surge, that share climbed to nearly 60 percent, including 3 out of 4 children.
It became clear that the goal I’d hoped for — containment of covid-19 — was not reachable. This coronavirus is here to stay.
But, still, wearing a mask would mitigate the risk, right?
With this new, indefinite time frame, the benefit-risk calculus of mitigation measures shifted dramatically. I was willing to limit my children’s activities for a year or two but not for their entire childhood.
Given how careful we’d been, it wasn’t easy to change my mind-set to accept covid-19 as a recurring risk. But the high transmissibility of new variants meant that we would have to pay an increasingly high price if our goal was to keep avoiding the virus. I began trying to think of the coronavirus as I do other everyday risks, such as falls, car accidents or drowning. Of course I want to shield my children from injuries, and I take precautions, such as using car seats and teaching them how to swim. By the same logic, I vaccinated them against the coronavirus. But I won’t put their childhood on hold in an effort to eliminate all risk.
Now, as regular readers know, this is pretty much where I am. When my daughters went back to school, they were required to mask. The moment that mandate was lifted last spring, I allowed them to go unmasked—precisely because they were vaccinated and otherwise in excellent health.
It helped, too, that omicron is milder than previous variants. The likelihood of severe outcomes, including the feared multisystem inflammatory syndrome in children, is much lower now than it was during the delta or alpha surges. The odds of developing long covid are also lower with omicron compared with previous strains. Vaccination, while less protective against symptomatic disease due to omicron, continues to provide excellent protection against severe illness.
Over the past several months, my family has eased back on our precautions. We see other families indoors, without masks or testing, and have resumed traveling and attending events. Our son, who turns 5 this week, started indoor soccer and indoor playdates. Our pandemic baby, now 2, went to day camp this summer. Both kids are starting school next week. Now that they are fully vaccinated, we do not plan to limit their activities, and — like most parents in their school — will not be masking them in the classroom.
I don’t know what the ratios are here locally. I gather that it wildly depended on neighborhood when the mandate was lifted. Now, though, my daughters report that few kids are masking at their middle and elementary schools.
Again, it’s all about risk calculation and acceptance:
I accept the risk that my kids will probably contract covid-19 this school year, just as they could contract the flu, respiratory syncytial virus and other contagious diseases. As for most Americans, covid in our family will almost certainly be mild; and, like most Americans, we’ve made the decision that following precautions strict enough to prevent the highly contagious BA.5 will be very challenging. Masking has harmed our son’s language development, and limiting both kids’ extracurriculars and social interactions would negatively affect their childhood and hinder my and my husband’s ability to work.
Life is trade-offs and she’s making her choices—and choices for her young children—with eyes wide open. Thus far, the six people in my household have managed to avoid COVID (or, at least, a symptomatic case) but my oldest stepdaughter, who lives on her own, had it a few weeks back. Many of my co-workers have had symptomatic cases in recent months, though, so it won’t shock me in the least if our luck runs out.
Other families will view these trade-offs differently. Some will maintain strict precautions to protect a severely immunocompromised household member. Some may decide on something in-between; for example, kids might resume their pre-pandemic activities, but the family still masks at airports and avoids large events. Others may choose to keep one-way masking at school, because, to them, the benefit of reducing infection outweighs the perceived downside of masks. All these decisions should be respected; there are no easy, one-size-fits-all answers.
To be clear, my family’s decision not to mask our kids should not be mislabeled as being antimask; we would never stigmatize other parents and caregivers for the difficult choices they must make. We are also far from covid minimizers; I’ve written extensively about the dangers of the coronavirus to children and am clear-eyed about the unknowns of long covid. Rather, my approach to this school year reflects the evolution of the pandemic and the acknowledgment that avoiding covid-19 cannot be the singular metric of people’s overall health and well-being.
The pandemic was so politicized by former President Trump and the media-entertainment complex on his side that masking became a cultural fight rather than a public health issue.