Health

Why teenage pupils should wear masks in class

Her bag is packed and uniform pressed. They have been for the better part of a week. To say Delilah Genn is almost giddy with excitement about schools reopening tomorrow would be an understatement.

‘I love it there,’ says the 11-year-old, who’s in Year 7 at a North London grammar school. Along with just about every other parent in Britain, her mother, Amber, 47, will also breathe a sigh of relief. There will, however, be one big change – or rather, yet another in a seemingly ever evolving list – Delilah and other pupils will have to adjust to: they’ll all be expected to wear a mask. Not just in the corridors, as was the case last term, but any time they are indoors. So this means for almost the whole day. Even in the classroom.

‘I’m not really looking forward to that,’ admits Delilah. ‘Masks are itchy and quite irritating. But I know I have to. It’s to stop germs spreading so that we don’t get Covid.’

School children across England will be returning to class this week but will be expected to wair face masks if social distancing is impractical, pictured Leah McCallum, left, and Rebecca Ross, right, from St Columba’s High School in Gourock, Scotland, in August 2020

Mum Amber also reluctantly welcomes the measures. ‘It means they’ll be in masks for eight hours. That would be hard for anyone. But Delilah had Covid at the end of last year, which she picked up at school, so we know how easily the virus can spread. Kids aren’t great at keeping distanced.

‘When she wears a mask, she says she sometimes feels breathless, so it’s going to be difficult. But the alternative is that they all continue to stay at home, which no one wants. Mercifully, the school have said it’ll be reviewed at the end of term, in a month. I think it would be a problem if it went on for any longer.’

Last week the Department for Education (DfE) issued guidance for the safe reopening of schools. Along with regular self-testing for secondary-school children, there are new mask-wearing recommendations. Now, every pupil in Year 7 (aged 11 to 12) or above must wear a face covering ‘when they cannot guarantee at least a one-metre distance from others and there is widespread transmission in the area’.

It does not make masks in the classroom compulsory. Indeed, the wording of the guidance leaves it very much open to the discretion of headteachers. But it means that many schools, due to space constraints, will indeed have to ask children to wear a face covering during lessons.

This week, The Mail on Sunday spoke to a broad range of scientists who say the measures will be vital to stop infection rates from rising.

Among them is prominent Oxford scientist Professor Trish Greenhalgh, who leads a research group that’s been providing evidence that masks reduce virus transmission. Speaking to The Mail on Sunday’s Medical Minefield podcast, she said there was ‘overwhelming evidence’ now that face coverings have an effect on infection rates.

She added that, while no child should be made to wear a mask, it should be seen as ‘just another aspect of school uniform, like having to wear clean shoes.’

Experts recommend the use of face masks by pupils in school to help reduce the transmission of Covid-19 - especially among asymptomatic people

Experts recommend the use of face masks by pupils in school to help reduce the transmission of Covid-19 – especially among asymptomatic people

The new school guidance has been billed as a temporary measure. Yet the move has ignited fierce debate, with MPs warning last week we could face ‘mask anarchy’ if some parents reject measures, while other critics suggest masks could somehow harm youngsters.

Molly Kingsley, co-founder of the parent campaign group UsForThem wrote: ‘We simply do not know of the long-term effects of face coverings… on brain development, educational attainment, communication and indeed all other aspects of children’s physical and mental health.’

Others pointed out that keeping children out of school for longer would have a far worse impact.

Still, with the roaring success of Britain’s globally acclaimed Covid-19 vaccine programme and the virus itself in retreat, are these measures really necessary? And does the science support them?

According to the Government, masks will play a pivotal role in halting the spread of the new variants of Covid-19, which are more transmissible than the original virus and may potentially be more likely to outwit current vaccines.

It says the key objective is to protect pupils’ at-risk relatives who may not have been vaccinated, rather than school children themselves.

Dr Stephen Griffin, virologist at Leeds University School of Medicine, backs the measure, saying: I agree that secondary-school children should be wearing face coverings because once kids reach adolescence, they are just as infectious as adults.’

Professor Lawrence Young, virologist at Warwick University, agrees: ‘We know that in terms of the spread of the virus, it’s those aged over 11 we need to worry about. ‘Kids younger than that are not as likely to spread the virus because it appears that even when they do get infected, they do not produce as much of it.’

But Professor Julian Tang, virologist at the University of Leicester, says he believes younger children should also wear face coverings. He said: ‘There’s been conflicting studies over how likely it is that primary school-age children will catch and pass on the virus, but we know it is possible. So I think it makes perfect sense to get them to wear masks.

Oxford expert Professor Trisha Greenhalgh, pictured, believes children should not be ordered to wear masks, though recommends their use, suggesting the should be  ¿just another aspect of school uniform, like having to wear clean shoes¿

Oxford expert Professor Trisha Greenhalgh, pictured, believes children should not be ordered to wear masks, though recommends their use, suggesting the should be  ‘just another aspect of school uniform, like having to wear clean shoes’

‘In South East Asia children have been wearing face masks in school since the start of the pandemic because mask-wearing is part of the culture. The children are still able to learn, so why wouldn’t they be able to here?’

Whether children should wear masks outside while at school, for example in the playground, is also a tricky question.

Prof Young said: ‘We know that in well ventilated areas the chances of getting infected are minimal.

‘But kids will naturally crowd together. If they are breathing heavily and shouting across spaces, they are likely to shed more virus.’

A turning point for mask-wearing came in the first months of the pandemic, when it emerged that the virus was primarily spread by people carrying it without symptoms.

‘The thing that caught everyone out was that we all assumed Covid-19 would spread much like SARS – only from people with symptoms,’ says Prof Young. ‘What none of us knew at the time was that a lot of people – possibly 80 per cent or more – were asymptomatic.’

At the same time, it emerged that, unlike similar viruses, Covid isn’t just spread directly via coughs and sneezes in droplets. Studies have now shown viral particles can build up and hang in the air, sometimes for days, in unventilated spaces. And large amounts of the virus can be expelled simply by speaking.

Masks have been shown to block these particles, and so have the potential to reduce the risk of transmission, particularly indoors.

Prof Greenhalgh said: ‘This virus can be spread whenever we share air. We all know what sharing air means. It means, for example, that if someone’s wearing perfume, you smell their perfume.’ For this reason, she argues that measures such as Perspex screens between the desks of school children are not enough to stop the virus spreading. She said: ‘If the virus spread through droplets only, then the Perspex screens will be a really good way of protecting the children from the coughs and sneezes of other children because gravity will pull the droplets down and they won’t go around or over the screens.

‘But if it spreads through shared air, then those screens are no good unless they go all the way up to the ceiling, which they don’t.’

In the early days of the pandemic, scientists say they were hampered by a lack of real-world data on how effective masks were at stopping the spread of the virus.

‘Usually in science when you want to look at how important certain measures are, you create a control group,’ says Prof Tang. ‘This is where you compare one group following the measure and one who are not. But with masks, almost every nation has implemented them to some degree, so there isn’t a control group.

In the United States, some school children have been using personal tents for band practice

In the United States, some school children have been using personal tents for band practice

‘This makes it incredibly hard to separate the impact of face masks from other measures, like lockdowns or social distancing.’ That’s not to say that some researchers haven’t tried. In January, a Boston University study suggested US states reporting high levels of mask-wearing had lower infection rates than states with low levels of mask-wearing. But the researchers concede this may be connected with the fact that people who wear face masks regularly are also more likely to social distance.

Scientists have otherwise based their knowledge of face masks on lab trials. These typically use artificial breathing machines to simulate human coughs and observe how effective masks are at limiting the travel of water droplets. One such study, from the University of Edinburgh published in May, found that a tightly sealed face mask could reduce the spread of virus-carrying water droplets by as much as 90 per cent.

Paul Hunter, Professor of Medicine at the University of East Anglia, said laboratory mask studies should be treated with ‘healthy scepticism’.

He said: ‘There is still a lot of uncertainty about the effectiveness of face masks. Lab studies test the effectiveness of masks on mannequins, like the ones you find in shops, and mannequins don’t fiddle with their masks, or wear them the wrong way.’

Yet even Prof Hunter believes that face masks alone could reduce the risk of Covid infection by 20 per cent.

Pupils, including Leah Anderson, pictured, are receiving regular lateral flow tests to track Covid-19

Pupils, including Leah Anderson, pictured, are receiving regular lateral flow tests to track Covid-19

‘Those are still really important numbers, which is why we should keep wearing them, but it’s also the reason the Government tells us to keep our distance from each other even with masks on, because they can’t be completely relied on.’

Across the Atlantic, the mask debate has become even more polarised – and politicised. Last month, the US Centres for Disease Control and Prevention, reported that masks could, in fact, offer the wearer a good level of protection against Covid-19 – as long as two were worn at once. One cloth face- covering prevented 40 per cent of viral droplets from being inhaled compared to no mask, their study showed. But when they put a second mask on, it stopped 80 per cent of aerosols getting into airways. If the other person was also masked, it stopped 95 per cent of potentially infectious droplets getting in.

Indoor music lessons to resume with school restart 

The Government has said indoor music lessons should recommence when schools return, although Professor Trish Greenhalgh believes this is ‘probably not the best thing to do right now’.

Perhaps UK schools might want to consider what one American high school did to allow its band to practise, left. At Wenatchee High School in Washington state, the young musicians were positioned in individual tents – along with their instruments and music-stands.

The school said the idea was that it would stop any children who were ‘harbouring the virus’ from spreading it during indoor lessons, particularly with wind instruments which can funnel virus particles around a room.

The trend for ‘double-masking’ has taken off in the US in a big way, at least among Democrats. Both President Biden and Vice President Harris are normally seen sporting two masks. However, the Republican governor of Texas has completely axed mask-wearing guidance in the state.

From a purely medical perspective, Prof Tang says double-masking ‘makes a lot of sense’. He said: ‘The greaternumber of masks you wear, the more chance you’ll have of blocking virus particles from spreading. You could even wear three, as long as this doesn’t negatively affect your breathing.’

For Prof Young, the bigger issue is how masks are worn. ‘I see people in supermarkets with them below their noses or hanging loosely off the face. They have to be close-fitting in order to work.’

Schools are relaxed about the type of face covering worn. The Department for Education says a face-covering could be a ‘scarf, bandana, religious garment or hand-made cloth covering – as long as they fit securely round the side of the face’. But what does the evidence say? In France, home-made fabric masks have been banned amid fears they are ineffective and Germany has implemented even stricter measures requiring surgical-grade masks inside shops or on public transport.

Here, the Government simply suggests masks be made of at least two layers of fabric. But this is not a requirement.

While it is certainly true that surgical-grade masks in theory are more effective at stopping the spread of Covid, a recent University of Cambridge study concluded that the fit of a mask was just as important, if not more important, than the material.

Professor Cath Noakes, a specialist in airborne diseases at the University of Leeds, said: ‘People need to think about how snugly the mask fits to their face. If there are gaps or it is loose, it doesn’t matter what quality the mask is.’ Likewise, a clean mask is the most effective – they should be changed after five hours of continuous wear, and not worn damp.

One of the big questions over face masks is, if they are so effective and millions of Britons have been complying with the rules on wearing them since last summer, how come the second wave of Covid-19 over winter was so devastating?

Schools have come up with plans to reopen safely tomorrow with last-minute preparations to welcome back pupils

Schools have come up with plans to reopen safely tomorrow with last-minute preparations to welcome back pupils

Office for National Statistics figures show deaths in the second wave topped those seen in the first phase of the pandemic – almost 60,000 between September and January, compared with 57,000 from March to August. The grim truth, according to some experts, is that the winter death toll could have been very much greater without compulsory face covering.

‘That’s the obvious conclusion,’ says Dr Griffin. ‘If nobody wore masks, the R rate of this virus would be four or more. That would mean every one person infected would spread it to at least four more. As it is, although we had a huge epidemic over the winter, the R rate didn’t really get above two. So the measures did work and did help to stop the virus running riot.’

Prof Young agrees: ‘I suspect masks have contributed to the slowing of infection and reducing the death toll, along with other measures such as social distancing.’

While experts believe masks to be vital measure against Covid, they are also clear it is just one part of the fight. Another, according to Prof Noakes, is ventilation.

As early as May 2020, a study published in the Lancet medical journal concluded that poorly ventilated spaces would contribute to the spread of Covid. Prof Noakes says that, in schools, opening windows could be crucial to reducing the risk of infections: ‘You need to inhale a lot of Covid particles to run the risk of catching the virus. If you have a window open then the incoming breeze will break up any clusters which have formed in the room.’

As lockdown eases and some freedom of movement returns, it’s possible that millions more will be told they no longer need to wear masks in shops and on public transport – especially if mass vaccination really drives down transmission.

But should we continue to voluntarily use them as good practice, especially in the winter months? Recent data shows flu cases, for example, have virtually been eradicated in the UK, probably as a result of lockdown and facial protection.

‘Maybe we can relax mask-wearing once we know more about the effect of vaccines on transmission,’ says Prof Young. ‘But I wouldn’t be surprised if wearing them in the UK becomes a cultural norm.’


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