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LNP column by Alexandra Solosko, MD, a pediatric hospitalist employed by Children’s Hospital of Philadelphia who practices at Lancaster General Hospital.

In less than a week, schools across Lancaster County will begin opening their doors. Unfortunately, a time that is usually filled with excitement and eager anticipation is now overshadowed by anxiety and trepidation for families of young unvaccinated children.

The main reason for this?

Many of our local districts have elected to have mask-optional policies for students and staff, despite a rising number of COVID-19 cases in our community. While this may be to the great satisfaction of those who feel that whether to mask or not to mask is an individual choice, or believe that mask mandates violate personal freedoms, it is a poor public health strategy. Masking has been politicized when, in fact, politics have nothing to do with how COVID-19 is transmitted.

Alexandra Solosko inset

As a hospital pediatrician, I have taken care of countless children with COVID-19 in our inpatient unit at Lancaster General Hospital — many times over what we typically see in a flu season. I also have taken care of young patients with MIS-C (multisystem inflammatory syndrome in children), a condition associated with COVID-19 in which different body parts can become inflamed, including the heart, lungs, kidneys, eyes, brain or gastrointestinal organs. Some children may have only mild illness; however, we have had many children who have ultimately developed respiratory failure, heart damage, neurological complications and shock.

What people may not realize is that a good number of these children were previously healthy and not considered “high risk.”

No masks = infection

As schools in other parts of the U.S. returned to the classroom, we saw almost daily reports of outbreaks in schools that opened without mask requirements. Examples include Greater Clark County Schools in Indiana, which had to mandate masking after 70 students tested positive for COVID-19 and 1,100 were quarantined; Ellsworth Elementary in San Tan Valley, Arizona, which had to shift fifth and six graders to remote learning after that single school saw 53 COVID-19 cases; and multiple districts in metropolitan Atlanta, Georgia. According to The Atlanta Journal-Constitution, Cobb County School District has reported 319 active COVID-19 cases in elementary schools, 91 in middle schools and 141 in high schools; Forsyth County Public Schools had 330 cases as of Friday; and Henry County School District has reported 245 cases, and has 822 students in quarantine (as a result, it announced a mask mandate last week).

The delta variant

Sadly, rising numbers of pediatric COVID-19 cases are putting a strain on children’s hospitals and pediatric units, many of which were already dealing with unusually high summer volumes. In many areas, pediatric intensive care units have run out of beds.

Study after study has shown that masks are an effective mitigation strategy for adults and children, especially when layered with other protections such as vaccines, distancing, good ventilation, hand hygiene and respiratory etiquette (coughing into one’s elbow rather than into one’s hand). It is helpful to think about these layers as “Swiss cheese” — no layer is perfect or without holes, but when sandwiched upon each other, the chances of the holes being permeated are diminished.

As Lancaster County vaccination numbers still lag behind national averages— just about 55% of county residents ages 12 and older are fully vaccinated — it is even more important for us to rely on layers of protection, especially for our unvaccinated children.

Schools can, and should, operate safely with appropriate prevention strategies in place.

Last year, when students were masked and we were not dealing with the delta variant, there was minimal transmission in schools. Unfortunately, this year we have the highly contagious delta variant, yet we are sending unvaccinated children into classrooms where masks are optional.

Expert advice

The American Academy of Pediatrics and the Centers for Disease Control and Prevention have recommended that all staff and students in K-12 schools wear masks, regardless of vaccination status.

Why is this?

We know that vaccinated people can and do transmit COVID-19, especially the delta variant, and we know that in any given exposure, masks work better when both/all parties are wearing them. Children, in general, are quite good at wearing their masks — better than many adults — and most do not seem bothered by them, though it may take some practice at home to get used to them. For many children who have been masking all along, the mask becomes part of their “school uniform” and is not seen as burdensome.

Contrary to some opinions, masks have not been shown to be detrimental to mental or physical health or to interfere with language or speech development.

Despite the guidance from the CDC and American Academy of Pediatrics, many Lancaster County schools have not changed their plans for masking in the classroom. Some of our local districts have said they do not want statewide mandates, but would follow guidance from local health leaders.

Such guidance now has been published by physicians and leaders at Penn Medicine Lancaster General Health, and submitted to local school districts. It remains to be seen whether it will make a difference. I hope it does.

Please speak up

In just this past week, I cared for multiple children with COVID-19 who were sick enough to be admitted to our pediatric unit at LGH. I dread the thought of caring for even more children sickened by COVID-19 this fall and winter, especially when so much of the illness is preventable. I fear having to tell a family that we have no more beds in our pediatric unit and that their child must be flown to another hospital for care.

I moved to Lancaster over a decade ago in order to work as a hospital pediatrician at LGH, and I have come to care deeply about the children in this community, as I know so many of you do. I challenge you to speak up on their behalf, since they are too young to have a voice or a vote in such matters. Talk to your local school principals, school board members and superintendents. Let them know you care about the health and well-being of our youngest community members, and let our children know you have their backs.

We must work together for the good of our kids. We owe it to them to do everything in our power to keep our schools safe and open.

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