My 13-year-old daughter, like every one of her Brooklyn friends, has been vaccinated against COVID-19. Her public school teachers, who have had access to the vaccine since mid-January, will be required by New York Mayor Bill de Blasio to either show proof of vaccination come September or submit to weekly testing. Our ZIP code's rate of fully vaccinated humans, 57.9 percent as of July 27, would rank eighth in the country if we were a state.
And yet the Centers for Disease Control and Prevention (CDC) Tuesday recommended that my daughter, her classmates, her teachers, and everyone else who sets foot inside her middle school wear masks yet again this coming year.
"[The] CDC recommends localities encourage universal indoor masking for all teachers, staff, students, and visitors to schools, regardless of vaccination status," the agency announced, reversing its own guidance from 19 days prior in the wake of increased delta variant–fueled infections, hospitalizations, and deaths. "Children should return to full-time in-person learning in the fall with proper prevention strategies are in place."
Those two CDC sentences are at serious tension.
If the past is in any guide, this latest ratcheting up of classroom-infectiousness fear will encourage public schools to not open but close, particularly in the most restrictive districts, which have tended to be the most Democratic-leaning politically. When the CDC in mid-February shocked epidemiologists (and pleasured teachers unions) by keeping its global outlier of a school social-distancing recommendation at an average of 6 feet between humans, multiple school boards in blue polities responded by suspending plans to reopen. (That guidance, amid near-universal outcry, was reversed less than six weeks later.)
You will see, in various discussions about this issue, variations of the following argument: Hey, what's the cost of just a little more masking while we get this unknown delta thing under control? We're not asking for much, here, just a piece of cloth!
But this accommodationism rests on a faith-based hunch, unsupported by available evidence—that masking vaccinated people in schools will make a damn bit of difference in the spread of COVID-19.
Consider this remarkable little paragraph, published over at the health policy/science site Stat:
An administration official, speaking on the condition of anonymity, told STAT that health experts do not have studies proving that fully vaccinated people are transmitting the virus. Rather, the official said, the updated guidance is based on studies showing that vaccinated people who contract the Delta variant have similarly high levels of virus in their airways, which suggested that they may be infectious to others.
Italics added to emphasize the precautionary basis of this guidance. The government's infectious disease bureaucracy is asking vaccinated people in 46 percent of the country, and 100 percent of its schools, to apply a facial prophylactic to impede the transmission of something it does not know is being spread.
The 161 million U.S. residents who have been vaccinated, and are now being asked to re-mask, are far less likely to contract, transmit, or suffer significantly from the scary new strain. "We continue to estimate that the risk of a breakthrough infection with symptoms upon exposure to the delta variant is reduced by sevenfold; the reduction is 20-fold for hospitalizations and deaths," CDC Director Rochelle Walensky said Tuesday.
What about asymptomatic breakthrough infections? Could I just be walking around feeling healthy but chock full of viral load? Though the CDC is no longer measuring that precisely (in part because the number is necessarily an undercount, since vaccinated people who feel healthy generally do not get tested), we still know enough to say that I'm significantly more likely to get into a car crash this year.
As of April 30, when there were 101 million fully vaccinated Americans, the CDC had documented just 10,262 breakthrough cases, 27 percent of which were asymptomatic; 995 hospitalizations (29 percent were for non-COVID symptoms), and 160 deaths (18 percent from other causes). Your chances as a vaccinated American of being detected with COVID were one in 10,000; of being hospitalized with COVID, one in 102,000; of dying with COVID, one in 632,000.
As of July 19, the number of vaccinated Americans had shot up to 161 million, but so too had the Delta variant. Now instances of breakthrough hospitalizations were up to one in 37,000 (27 percent of which were asymptomatic); and of deaths, one in 190,000 (26 percent non-COVID-related). If the ratio of cases-hospitalizations-deaths were roughly the same as in the April 30 report, that would put breakthrough infections at around 61,000, or one out of every 2,640 vaccinated people.
The delta trendline among the vaccinated is getting worse, but the baseline from which it has ticked up is borderline miraculous. Let's put the above odds in context. You have a one in 2,535 chance of choking to death on food. If you drive more than 1,000 miles a year, you have a one in 366 chance of getting into an automobile accident. The odds of you dying from a lightning strike are higher than the ratio of vaccinated people who have perished while infected with COVID.
Let's say, for the sake of argument, that the breakthrough infection rate is as high as one in 2,000. Now imagine a middle or high school with 2,000 combined students, teachers, and staff, the vast majority of which are vaccinated. The CDC school masking guidance would have us believe that everyone in this school needs to wear masks because chances are that one vaccinated person will contract the delta variant, and we just don't know whether that person might have the ability to spread it to any unvaccinated stragglers in the building. As Walensky said Tuesday, "In those cases, those rare cases that we have breakthrough infections, we felt it important for people to understand that they have the potential to transmit virus to others."
This is irrational restrictionism, inflicted on a population that has suffered the most from COVID policy while suffering the least from COVID.
For all the ooga-booga about the delta variant, its main innovation is to transmit faster, not pack a deadlier punch. As the CDC points out, "To date, no unexpected patterns have been identified in the case demographics or vaccine characteristics among people with reported vaccine breakthrough infections." This finding is of particular importance when it comes to schools because the underlying case demographics of COVID are that even the unvaccinated kids rarely get it, spread it, or suffer from it.
As David Wallace-Wells put it in New York magazine July 12:
Over the course of the pandemic, 49,000 Americans under the age of 18 have died of all causes, according to the CDC. Only 331 of those deaths have been from COVID — less than half as many as have died of pneumonia. In 2019, more than 2,000 American kids and teenagers died in car crashes; each year, according to some estimates, about a thousand die from drowning.
In New York City as of June 20, the lowest case rates among age cohorts have been 0–4 (3.5 percent), 5–12 (5.4 percent) and 13–17 (7.1 percent). This despite the first two groups being mostly ineligible for the vaccine. We are masking vaccinated people who will probably not contract COVID, to protect a population that gets it the least and suffers from it less than it suffers from the flu. At what point are we going to admit that this is crazy?
The left-of-center support for these restrictions is reminiscent of the right-of-center apologia for such post-9/11 security theater measures as having airline passengers take off their shoes in the security line. Sure, it might not be the most important precaution, but if we can prevent even one shoe-bomber, the mild inconvenience will be worth it!
But not only is the potential upside greatly exaggerated, the downside is heavily discounted, and inflicted on people with the least political power. My 6-year-old daughter has been wearing masks in school settings now for 20 percent of her life. Young kids rely on facial recognition for all kinds of early childhood development and basic social competence. Most of the developed world has not been masking elementary school children, in recognition of both the limited benefits and developmental costs.
As Boston-based infectious disease specialists Westyn Branch-Elliman, Shira Doron, and Elissa Schechter-Perkins put it in the Washington Post last week, "On July 8, the superintendent of schools in Decatur, Ga., announced that masks would be mandatory for all students in schools next year. School districts in California and New York have adopted similar policies. This insistence on universal mask-wearing is not an evidence-based approach."
The CDC guidance is yet another product of adults who are incapable of evaluating risk and unwilling to take seriously the downside of treating a generation of physically healthy kids like deadly biohazards.