U.S. doctors recommend stricter masking for students than Canada

By | August 19, 2020

TORONTO — A group of American doctors is recommending that all students wear cloth masks at U.S. schools this fall, advice that goes further than most provincial rules and is stricter than the guidance of one of Canada’s top children’s hospitals.

The American Academy of Pediatrics (AAP) is recommending that U.S. schools reopening in September make cloth face masks mandatory for all students older than two and all adult staff.

In Canada, experts with Toronto’s SickKids Hospital have recommended that high school students in Ontario be required to wear non-medical masks at school in situations where physical distancing cannot be maintained, but that elementary school students should not be expected to follow the same guidelines.

In their reasoning, the Canadian experts say that younger students who wear masks incorrectly could be at increased risk of contracting COVID-19 if they touch their masks frequently or remove and replace their masks without proper hand hygiene.

They added that it’s “impractical” for most elementary school students to wear a mask all day, and that children’s social development depends on interactions that include facial expressions.

The U.S. guidance “makes more sense,” according to Dr. David Fisman, a professor of epidemiology at the University of Toronto. He says the AAP’s recommendations are consistent with how SickKids runs its own hospital, where young children are required to wear masks.

“The ‘masks may make things worse’ stuff is baffling to me and sounds made up. It suggests the SickKids authors don’t understand the rationale for masking in indoor settings, which is to prevent aerosol generation, not to protect the wearers,” Fisman told CTVNews.ca.

Infectious disease specialist Dr. Abdu Sharkawy agrees that masks should be worn by all school-aged children.

“Any children that are over the age of two in any sort of communal setting, whether that’s a daycare or a school environment, should be wearing masks. There’s certainly evidence from southeast Asia that children have been able to do this.”


Current federal health guidelines don’t spell out who should wear masks at schools but instead say that schools should consider non-medical mask policies based on a variety of circumstances, including local epidemiology of COVID-19. They add that it’s expected that masking policies will vary across the country.

Some Canadian provinces do not require cloth masks in schools, including Newfoundland, P.E.I. and Saskatchewan. Ontario and Alberta require mandatory masks in class for students from Grade 4 to Grade 12.

In Quebec, which has reported the bulk of the country’s COVID-19 cases, masks are mandatory in common areas for students in Grade 5 and up, but remain optional in class.

Manitoba announced Wednesday that it would make masks mandatory for Grades 4 to 12, reversing a decision last week that didn’t include mandatory masks.

British Columbia has made masks mandatory for students in middle school and high school in situations where physical distancing is not possible.

But some school boards are going beyond provincial rules. The Toronto District School Board decided this week that it will require students from kindergarten to Grade 12 to wear masks at school where physical distancing cannot be maintained.

Ontario Premier Doug Ford cast doubt on the board’s decision, citing the latest guidance from SickKids, but said he will support the move.

“I go with the experts at SickKids. They are the ones who didn’t recommend masks. They said they (the children) would be fiddling around with the masks and you know I have four girls and I know when they were little, four or five years old, it would have been hard to keep the mask on,” Ford said Wednesday.

“But again we will be there and we will support the board if that is what they want to do. It is just that keeping a mask on a junior or senior kindergartener might be difficult.”

The new U.S. guidelines share much in common with SickKids’ guidelines, including the recommendation to space desks apart, cohort students and work outside when possible.

While the masking recommendations may be different, the U.S. and Canada are heading into September in two very different situations. New daily cases in Canada peaked in May, with 2,760 new cases of COVID-19, whereas the U.S. has consistently broken its own daily records throughout the summer, hitting more than 78,000 new cases in a day in late July.

A new survey released Tuesday suggests that most Canadian parents plan to send their kids back to school next month, but 66 per cent admit they are worried. Another 69 per cent said that, if a major spike in COVID-19 cases is reported, classes should be cancelled and students should return home.

With files from CTV’s Omar Sachedina

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