Understand the dilemmas of mask flexibility in schools

The use of a mask in schools in the state of São Paulo may no longer be mandatory. The João Doria government (PSDB) is studying making the measure more flexible. However, the two-dose vaccination rate in the population aged 5 to 11 remains low, at around 19%, according to data from the State Department of Health.

THE sheet listened to experts to understand whether this release would be appropriate taking into account the current context of the pandemic.

What is the importance of wearing a mask in children? Studies have already shown that masks are essential to stop the transmission of coronavirus both in open and closed environments, and this is no different for little ones.

“The use of a mask always provides protection against both infection and transmission”, says Leonardo Bastos, a researcher in epidemic modeling and a member of the Covid-19 BR Observatory.

For children, however, there is some confusion because they tend to be less infected, in addition to having milder conditions compared to adults. Even so, this does not indicate that the equipment is expendable for the little ones, since it would be good “both to avoid picking up and to transmit”, emphasizes Bastos.

Some states in the country have already allowed the use of masks in outdoor environments. In the case of indoor places, such as classrooms, is it possible to take this measure? The biggest problem with not requiring the use of a mask in closed places is that these are the places most prone to infections, especially with the emergence of new, more transmissible variants, such as the omicron, recalls Cristina Bonorino, immunologist and professor at UFCSPA (University of Federal Institute of Health Science of Porto Alegre).

According to her, there are few situations in which there is a certain level of safety when not using the equipment, such as in an open place, where you are alone or with few people, far from each other.

As the risks are greater in closed environments, the removal of mandatory masks in schools “is an unnecessary risk”, says the immunologist.

On the other hand, André Ricardo da Silva, pediatric infectious disease specialist and professor at the Faculty of Medicine at UFF (Universidade Federal Fluminense), emphasizes that it is necessary to carefully observe the current rates of virus circulation and hospitalizations in order to make the decision to release or not the mask.

For him, it would now be possible to remove the obligation of masks for children in the school environment precisely because there has been a decrease in the number of cases and hospitalizations when compared to previous moments of the pandemic.

“Measures like this are not taken out of nowhere, they are made from observational studies of the circulation of the virus and data from hospitalization so you can be sure that the spread of the virus is low”, he says.

As a last resort, it is possible to make an ambiguous decision: leave the mandatory use of masks in closed spaces of the school, such as classrooms, and have some flexibility in open environments.

“When it’s in an external environment, I don’t see a problem that the child can not use the mask, this can be optional. But the internal space already complicates. In these cases, the mask should be strongly recommended”, says Bastos.

Does the vaccination rate in children impact the decision to remove mandatory masks in schools? The vaccination of children from the age of five started in January of this year and therefore the immunization rate is still low. In the state of São Paulo, around 19% are on the two-dose regimen in this public.

To reinforce the need for vaccination even in those who have already had the disease, Bonorino cites a research he participated in, in which the response to new variants of Sars-CoV-2 in children who had previously been infected by the coronavirus was analyzed.

“We saw that in these children who were not immunized there was no neutralization of new variants [gama e delta]. They are completely at the mercy of the new strains and are reinfecting themselves,” she says.

In this situation, the immunologist reiterates that the use of a mask is precisely necessary to protect them, as children have not yet had full access to the adequate level of protection through immunizations.

This view is reiterated by Bastos. “The fact that vaccination coverage for children is not high enough makes the use of a mask indoors should be maintained, such as in a classroom.”

He indicates that, in the future, when there is already a higher percentage of vaccinated children, it is possible to reassess the release of equipment in schools.

Are children less aware of the importance of wearing a mask? Because they are small, it can be believed that the use of masks in children is more difficult to happen. However, Bonorino points out that it is possible to make the use something fun and more pleasant.

She cites, for example, the use of superhero images or cartoons, as is already being done in some vaccination centers. “Doing something fun is a way to bring [o uso de máscaras] for the kids,” he says.

Even so, it is important to consider that the improper use of the equipment may not bring the expected benefits. Silva states precisely this point: for the infectologist, it would be very unlikely to have “a situation of discipline” in the use of masks in the little ones, causing that, without guidance, “it ends up having the same effect of not using them”.

Would it be the case to leave the mandatory decision to each educational institution? The way of leaving the choice to school is criticized by Bonorino. She indicates that this is a role of the public power and one of the problems that was seen during the pandemic was the lack of consistency in the measures taken.

“Since the beginning of the pandemic, people have suffered from the lack of consistent guidance from the public power that should be managing this situation, but the exact opposite has been done: each one decided to do something. that affects everyone and if we don’t work [em conjunto]we didn’t get out of it”, he opines.

For Bastos, it is at least important that the public authorities take similar measures in the case of the public school system — if this does not happen, it can generate some confusion, as a hypothetical example in which a municipality continues with mandatory schools, but the management state do not.