As school masking debate rages, doctor recommends looking at hospitalization rates

UCSF Infectious Disease Expert Dr. Monica Gandhi talks to WTOP about masking in schools

To mask or not to mask — that is the question parents face in the wake of ever-changing school mask policies that can vary drastically by state and even school district.

Dr. Anthony Fauci, President Biden’s top medical adviser, on Tuesday said that with COVID cases dropping in nearly every state, he expects restrictions to end “soon.”

Fauci told the Financial Times that decisions on those restrictions will be increasingly made on a local level “as we get out of the full-blown pandemic phase of COVID-19, which we are certainly heading out of.”

But that still means a patchwork of contentious policies across the country.

On Tuesday, for one, Democratic governors in Connecticut, Delaware, New Jersey and Oregon announced plans to lift statewide mask requirements in schools by the end of February or March.

The drive by Democratic-led states to loosen restrictions has been recognized by the Biden administration, which on Wednesday said it was consulting with local leaders and public health officials “on steps we should be taking to keep the country moving forward.”

At the same time, while California and New York are lifting indoor masking requirements, they’re keeping them in place for schools, a sign that states remain deeply divided over the future of the pandemic.

That’s why uniform guidelines from the federal government are so important, said Dr. Monica Gandhi, a professor of medicine and infectious disease specialist at the University of California in San Francisco.

“It is extremely confusing because you have about 10 people at once saying different things,” she told WTOP.

She argued that a uniform school mask policy coming from federal authorities “is exactly what we need.”

“And you can see this ramped-up conversation — CNN, New York Times, Washington Post, everyone is saying we need federal guidance, because that is what the CDC and HHS are there for, is to give us federal guidance,” Gandhi said, referring to the Centers for Disease Control and Prevention and the Health and Human Services Department.

It’s unlikely Republican-led states, which have been fighting mask and vaccine mandates proposed by the Biden administration in court, would be receptive to more federal guidance.

But Gandhi said there’s one particularly helpful metric policymakers can use in deciding whether to impose mask mandates in schools: hospitalization rates.

“One metric that keeps on being brought up is having 80% ICU capacity in the region, and that is what New Jersey, Delaware, Connecticut and Oregon were responding to when they said that school mask mandates will end in about a month — they were looking at hospitalization rates,” Gandhi said.

“And I think that is the appropriate metric, instead of case rates, because our case rates are all over the place. We don’t record rapid testing; we test differently, so hospitalization capacity is the right [metric].”

The debate gets even trickier for children under 5, an age group that hasn’t been approved yet for a COVID vaccine.

Gandhi said both sides of the debate have merit.

“There will be two ways of thinking about this, two lines of thought: Pediatric immunologists, some will say you actually need to be exposed to some pathogens when you’re growing up. It actually helps diversify your immune system and make it more robust. And then others will say when we’re still having COVID, let’s not have any exposures in schools,” Gandhi said.

“So I do think that it depends on where you stand on it. In general, less than 5-year-olds are at very low risk for having severe COVID, which is a blessing, and essentially no other country but the United States masks children less than 5 because the World Health Organization has only asked for masking at 5 and up.”

The Associated Press contributed to this report.

Anna Gawel

Anna Gawel joined WTOP in 2020 and works in both the radio and digital departments. Anna Gawel has spent much of her career as the managing editor of The Washington Diplomat, which has been the flagship publication of D.C.’s diplomatic community for over 25 years.

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