Updated at 8:20 p.m. ET on March 17, 2022.
Even as adults and older children all over the country fully shake off the pandemic posture, one group has been left behind in the old world: toddlers. The CDC recently moved to relax COVID guidelines, and a banner on its webpage for early-childhood education recommends "align[ing] precautions for educational settings with those for other community settings," promising that new recommendations will be posted soon. But the rest of the page muddles the message, continuing to recommend universal indoor masking in early-childhood-education programs for those ages 2 and older. (After this story was published, a CDC official clarified by email that "universal masking is only recommended at high community level.") At any rate, in New York City and elsewhere, kids in kindergarten and above may attend school maskless, but kids in pre-K and below may not.
Some parents of young kids have been driven insane by this policy. I sympathize—because this policy is completely insane.
Reasonable people can disagree about the efficacy of masks in general. I, for one, believe that masks can be a valuable tool in preventing the spread of the coronavirus in many settings, especially during surges.
I can imagine two weak arguments in favor of retaining mandates for toddlers while dropping them for kids 5 and up. One is that hospitalization rates are higher for the 0-to-4 group than for the 5–19 age group. Both groups, however, are at lower risk than most adults. And besides, the comparison is flawed because the higher rates in the 0-to-4 group are driven by children younger than 1, who are more likely to be hospitalized for COVID and in general—and who are not required to wear masks.
A second argument is that the under-5 cohort is ineligible for vaccines. That’s true, but the dropping of mandates for older kids is not typically dependent on vaccination rates or individual vaccination status. In New York, less than half of the 5-to-11 group is vaccinated. An unvaccinated 5-year-old girl can attend school without a mask, but her unvaccinated 3-year-old sister cannot.
Official policies that treat toddlers differently from older kids are—to put it mildly—puzzling. Moreover, masking may not even make much of a difference for viral spread in child-care settings. Studying this question is difficult because researchers have struggled to distinguish the effects of masking from other variables, but a recent study out of Spain provides some clues.
Masking in that country was required at the age of 6—meaning children at school ages 5 and younger did not wear face coverings; children 6 and above did. The authors compared the secondary-infection rate in schools—a measure of in-school spread—across age groups, and found that the key determinant of spread was age; older children experienced more secondary infections. However, the authors found no difference between the unmasked 5-year-olds and the masked 6-year-olds. And the unmasked 3- and 4-year-olds saw the lowest spread.
The study also serves as a reminder that the CDC is and was unusual in recommending that very young children wear masks. Whereas the CDC advised masking in children 2 and up, the World Health Organization set the bar at 6, and many countries set it even higher. Nor did our conservative policies result in better outcomes.
A final point is that although we do not have good evidence on the downsides of masking, and much of the rhetoric is probably overstated, any negative effects are likely to be concentrated in younger children, who are learning to speak and interpret emotional cues. The possible costs of continued mask wearing may be the largest for the very cohort still subject to mandates.
The continued masking of toddlers as we unmask everyone else is not justifiable. This group is at exceedingly low risk of serious disease, and may well be at higher risk—relative to older kids—of adverse consequences. Some policies make sense; some do not. This is one of the latter.