Masking in Schools

January 23, 2022

Dear Parents,

As doctors who have dedicated our careers to safeguarding the health and welfare of the children in our community, and especially as the physicians you have chosen to care for your children, we feel it imperative to share the following thoughts and information with you regarding masking in our schools.

First and foremost, the enemy is the VIRUS.  Second, the goal for children is in-person learning, 5 days a week.

With this in mind, here we are in January 2022, trying to weather the storm of a new variant that seems to evade our immunity regardless of immunization status or previous infections.  Although it is thankfully so much milder in the vaccinated and/or previously infected


  • Our children’s hospitals are full:  D.C. Children’s is the closest major medical center and they are reporting 18 admissions per day, 70 percent due to actual COVID (NOT due to other reasons and HAVE COVID incidentally). 1/3 of these patients need ICU care, 2/3 are cared for on the floor.  Most of these children are under 5 and thus not eligible for the vaccine.  This is data presented by the Head of Pediatric Infectious Disease at Children’s National Medical Center last week.
  • This new Omicron variant presents with mid airway issues, especially in our smallest patients.  Many of you have spent some long nights battling Croup.  The Omicron variant is producing an aggressive croup-like illness in kids.  This is filling our ERs, offices, and urgent cares.  It is also predominantly in the unvaccinated group of kids under 5 (again, not eligible for the vaccine).  Most are managed conservatively and do well, but it’s a couple of long nights for both kids and parents. 
  • The CDC is reporting an increased incidence of Type 1 diabetes (insulin dependent, not lifestyle) in post-COVID children.

We are still learning about this virus.


  • They are not 100 percent effective – quality of the mask and proper use are important.
  • They do inhibit lip reading in those who have hearing issues (obvious)
  • They have not been proven to help with some other respiratory diseases which are spread primarily by touch (fomites) as opposed to COVID-19 which we know is spread primarily through relatively large respiratory droplets that people sneeze, cough, or exhale when talking or singing (droplets)

We cannot do a randomized controlled study on masks in COVID-19.  Why?  Because it would never pass an ethics review board.  There is enough pre-existing evidence of their effectiveness that we cannot subject patients to that risk.  (Have you ever been offered an option for a “mask free” operating room during surgery?)

Researchers from Yale and Stanford went to Bangladesh and studied their population.  The links below provide more information on these studies.  The takeaways: 

1) there was a 35% reduction in number of COVID-19 cases in the most vulnerable patients; 

2) 9% reduction in number of COVID-19 cases across the board with the use of a surgical mask; 

3) there was no evidence of cloth mask effectiveness.  



Another group from Duke has done surveillance studies in counties with and without masks.  Data is exceedingly in favor of mask wearing.  


NO SINGLE STUDY GIVES A DEFINITIVE ANSWER.  They all have biases and omissions. That’s why we ask for a consensus of experts.  

With that in mind, it is worth noting that both the Virginia and National American Academy of Pediatrics (AAP) continue to recommend masking as a mitigation strategy. That’s 70,000 doctors speaking in one voice.  This group includes infectious disease physicians and virologists, which for us, makes it a consensus.

Given the stage of the pandemic, now, next week, and into February is not the time to eliminate any of the defenses against our common enemy.  We may not be far away though.

So, upgrade your masks — surgical, KN-95, N95 preferred – and we can work toward this common goal of making this virus endemic.

We have also been asked, “When will masking end?”

  1. We need to remember, respect and protect the kids under 5.  Once they have the opportunity to be vaccinated, we have taken another step towards endemic COVID.
  2. Here is a paper by our colleagues from the Virginia AAP School Task Force: it is well written and exhaustively thought out regarding timing for taking the masks off.  These are two of the most intelligent physicians we have had the honor of working with; it is worth your timeWE ALL WANT TO TAKE OFF MASKS, and this article describes how we get there: https://pubmed.ncbi.nlm.nih.gov/34750833/

Lastly, as others have stated, please do not add to the burden of our teachers and school administrators.  They are battling this enemy to ensure they can use their talents to educate your children.  In-person learning has greatly reduced the mental health care crisis we are seeing in our office.  We all need to fight alongside WITH the schools to assure they stay open.

With Gratitude,

The Doctors of Farrell Pediatrics