Eight Studies We Need on School Masking

in COVID-19

11/16/2021

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Cross-posted here.

About the authors:

Patricia Rice Doran, Ed.D., is a parent of six and an associate professor of special education; Chad Doran, Ph.D., is a parent of six and an adjunct professor of information studies. They write here in their personal capacities and their views are their own. 

As some experts have pointed out, it is inexplicable that, 22 months in, we still have little data about what school mitigation measures actually prevent coronavirus spread and which do not. Available data suggests mandatory masks for students are not linked to reduced transmission. Further, there is worrisome data suggesting masks may impact students’ physical and mental well-being, creating ethical concerns for the continuous use of masks in schools. 

Experts have advocated for large cluster trials of student masking in preventing transmission across different school districts to settle the question of whether they truly help to limit coronavirus spread. We endorse this idea wholeheartedly, as parents as well as educators. It is concerning that the CDC and so many state departments of health have made blanket recommendations without devoting resources to examining this issue with rigor. 

But we need more. We must consider the cost of every intervention and mandate in terms of its ethical foundation and impact on overall well-being–especially in light of the ready availability of vaccines and therapeutics to mitigate illness severity. This is particularly true when mandating measures for children, who don’t get a second chance at childhood or development. It is critical to evaluate the larger developmental context of mandatory all-day masking, and equally critical to ask hard questions about the ethical basis of our mandates when we lack this information. 

There’s no reason to fear objective, well-designed, honest research on this topic. If the data shows masks don’t impact health, well-being or learning, we can all take a deep breath and turn the temperature down a bit. If the data indicates masks don’t impact school transmission either, then districts and parents can make their own choices. And if the data shows that mask-wearing does impact students’ physical, academic or social experience, then our schools and institutions have important and nuanced ethical decisions to make. 

Such examination is particularly critical as calls begin for routine masking during flu and cold season. Of course, quantitative comparisons will be massively confounded, but probably no more so than CDC’s existing studies of mask use in schools. Substantial effort may be required to stratify data by student, class or school mask-wearing status, and it is important to gain parent input and participation as well as educators’, in this year when parents have voiced so many concerns about COVID-19 schooling. Below, we outline ten important areas where we lack quality data: 

1. Individual and class-level examination of academic growth, especially reading data including phonics and phonological awareness skills, for masked vs. mask-optional schools and for classes taught by masked vs. unmasked teachers. Where baselines differ, we might look at expected and actual rate of growth. Comparing data may give decision-makers a better idea of whether, and how, masking impacts students’ academic progress generally and in particular their grasp of foundational early literacy skills–a critical issue that also has massive implications for public health and long-term social equity.
2. Observational studies of the fidelity with which students in different age groups actually wear masks. If, as some have suggested, kindergarteners have difficulty reliably wearing masks all day, it’s probably most productive to focus on other mitigations and to think carefully about the impact mask-wearing is really likely to have. 
3. Eye movement tracking for very young children wearing masks or interacting with educators wearing masks. Critical developmental, linguistic and cognitive milestones are met in the early years. If changes in students’ access to facial expressions has potential to impact those milestones, there are important public health implications. 
4. Observation studies of masked and non-masked students observing time on task, inattention and indicators of focus or fatigue for students.
5. Comparison of attendance and school nurse visits for masking and non-masking schools, of course controlled for COVID-19 cases as well as other variables. Limited research has suggested masking may be associated with headache, stress, and fatigue, all of which can impact students’ attendance and physical and academic functioning in school. If this is happening, schools must address it. If it’s not happening, that fact should inform our discussion of impact—or lack thereof. 
6. Survey and qualitative analysis of how students (particularly those at risk for dropout) perceive school when masks are required. Such data may not be reliable for large-scale policy-making, but it will be critical for educators to understand how wearing a mask can impact a student’s experience in school. Do all-day masks affect students’ motivation to attend school? Do students feel more fatigued when wearing masks, as some data has suggested? Then we need to carefully consider mandates as well as differentiating instruction to keep those students engaged. Likewise, some students may be more willing to come to school when masked, and school environments must remain welcoming even if mandates are not in place.
7. Survey data from students, parents and physicians on students’ physiological responses and symptoms when masked, essentially reproducing this study with a population of U.S. schoolchildren. Researchers might further consider comparing responses from masked and unmasked school populations in such a study. 
8. Survey and interview data collected from teachers on experiences of teaching while masked and teaching masked children. This research should include questions about strategies used to mitigate any learning or emotional impact of masks. At a minimum, these responses can be used to help teachers effectively compensate for adjustments of mitigation measures.  

In the meantime, schools must also honestly consider the ethics of masking all children, all day, in all settings when we still lack much of this information. The scientific community mobilized to conduct and finalize research at an extraordinary rate in order to develop treatments and vaccines for COVID-19. We need similar urgency around this topic, which currently affects millions of American children, a hundred and eighty days a year or more. Indeed, if we can’t trust reason, data and the scientific method to resolve those concerns, then we have problems even more urgent, and far- reaching, than COVID-19. 

Patricia Rice Doran, Ed.D., is a parent of six and an associate professor of special education; Chad Doran, Ph.D., is a parent of six and an adjunct professor of information studies. They write here in their personal capacities and their views are their own.