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Unknowable Harms

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eye on the news

Unknowable Harms

Some deep-blue school districts still insist on masking kids, a policy with zero benefits and unforeseeable costs. March 11, 2022
Covid-19
Politics and law

As states, counties, and school districts across the country drop mask mandates, it’s becoming more acceptable to note the weakness of the evidence that cloth and surgical masks prevent Covid-19 spread or hospitalizations among healthy children. But in deep-blue areas, a different rationale for masking kids has emerged: they don’t mind wearing them, so why not?

This is a popular refrain among Covid-anxious adults reluctant to remove the last barrier to normal life for children. Boston, Detroit, Newark, Oakland, and Los Angeles are among the school districts that so far are maintaining mask mandates, some through the end of the year, despite their states having lifted them. Parents, research psychologists, and official bodies such as the American Academy of Pediatrics have suggested that children not minding masks constitutes a good reason to keep them masked, and even continue mandates, for the foreseeable future. In an interview with Education Week, a pediatrician asserted that “younger children are capable of wearing masks and have adjusted very well,” while providing no corroborating evidence for the latter.

But should a public-health intervention unsupported by substantial data be maintained simply because children don’t mind it? Interventions should be sustained because they work, not because they’re tolerable. Compulsory masking of children does not meet this standard.

Indeed, children often seem to tolerate circumstances that most adults couldn’t, and wouldn’t, stand for. American children worked in terrible conditions during the Industrial Revolution until child-labor laws were introduced, and little record exists that they protested, complained, or rebelled in any significant way. The first labor laws, introduced in 1833, only barred children younger than nine from working in mines and mills. Many children around the world still work today in similar conditions and simply lack the agency to do anything about it.

This lack of agency is baked into humanity. Compared with other animals, humans are at the very far end of the “altricial–precocial” spectrum. Human offspring remain immature and helpless, or altricial, for a very long time—longer, perhaps, than any other species. Precocial species, including fish, reptiles, and some mammals, are born quickly able to fend for themselves. Large marine mammals and elephants are highly altricial, but even they become sexually mature at about ten years old and disperse for mating purposes in their early teenage years. Young chimpanzees and gorillas also depend on adults for a long time but are far more mobile than human babies and reach sexual maturity sooner. Human helplessness is uniquely extreme.

Young humans’ dependency on adults evolved over millennia, in conjunction with our expanding brain size. Because human children are helpless, they behave in ways that maintain adults’ approval of and investment in them. They can’t magically turn off that switch, even when adults inflict on them conditions that are not in their interests. If adults make affection, praise, or safety—not to mention tangible rewards, such as food, clothing, or the ability to attend school—conditional on certain behaviors, then the vast majority of children will, at least outwardly, behave in a way that ensures those resources keep flowing. This evolutionary adaptation shouldn’t be taken as an affirmative sign that children don’t mind unpleasant—or even harmful—circumstances, or that conditions they tolerate are causing no psychological or physical harm.

Though many students have expressed anxiety about going to school without masks, it is also plausible that masks are making life tough on them in ways that are hard to measure. No research has definitively linked the uptick in mental-health problems among kids to masking, but this research has also simply not been undertaken. It is not a stretch to imagine masks contribute to feelings of isolation, helplessness, and anxiety. They are a constant and visible reminder of fear, stress, and disease.

Importantly, though, physiological and neurological considerations may also render masks detrimental. We interpret information and display emotion through facial expression and tone of voice; masking renders these two important aspects of communication less effective. Facial recognition, which relies on a network of six groups of neurons called the face-patch system, is so exquisitely sensitive in humans that entire fields of research are dedicated to understanding it. Neural systems governing emotions related to face recognition and facial-expression interpretation are unimaginably complex. Researchers studying face pareidolia, a phrase referring to the phenomenon of perceiving human faces in inanimate objects, have found that face-like objects elicit the same neural activity as does seeing actual human faces. In their paper published in Proceedings of the Royal Society B, the authors write, “Facial expressions are one of the most powerful and universal methods we have for social communication.”

Before the pandemic, it was not controversial to assert that depriving children of seeing human faces in their entirety for six to eight hours a day could have detrimental consequences. Yet the American Academy of Pediatrics denied in August 2021 that masking might impede early childhood language development. “There are no studies to support this concern,” it averred. “Young children will use other clues like gestures and tone of voice.” No studies support the claim that two years of masking young children will harm them—because no one has ever studied such an intervention before.

The AAP webpage also states that “visually impaired children develop speech and language skills at the same rate as their peers.” Yet numerous for-profit services provide speech therapy to visually impaired children, a service parents presumably pay for because they find it necessary. And an article from 2015 in Contemporary Issues in Communication Science and Disorders points out that it is “widely accepted . . . that auditory information and visual information are integrated during speech perception,” that, in adults and children, “visual cues enhanced the intelligibility of speech,” and that “listeners can more effectively identify speech sounds when they receive redundant visual and auditory cues.” For visually impaired children, the muffling effects of masked adults’ speech may be particularly devastating, as they rely only on sharp enunciation rather than enunciation and visual cues to distinguish sounds. The causes of speech problems in visually impaired children may be multifactorial, but the AAP’s statement was simply incorrect.

From the beginning of the pandemic, the U.S. was an outlier in masking children. While CDC guidelines recommend masking all children aged two and up, most countries follow World Health Organization guidelines, which recommend against masking children aged five and younger. Aware that young kids have a very low risk of serious outcomes from Covid-19, the WHO notes that masks are not “in the overall interest of the child” in part because of the “potential impact of wearing a mask on learning and psychosocial development.”

Masking healthy children is also simply not necessary. The hospitalization rate in vaccinated children aged five to 11 is so low that the CDC does not compile it. Children are likely not as important a source of spread to adults as the decisions adults make in their own lives. How many proponents of school mask mandates are also traveling, visiting friends, and going to restaurants? School mask mandates give Covid-anxious adults the illusion of control over a single risk factor that, in reality, likely contributes very little to their risk of getting sick.

For months, the only unmasked faces that millions of young kids in the most Covid-anxious families have seen regularly are those of their own parents and siblings. New York City is lifting mask mandates for everyone else but keeping them for children aged two to five, as this age group cannot yet be vaccinated. Some of today’s four-year-olds have spent most of their first critical period of brain development gazing at masked faces. Given all we don’t know about neurodevelopment, speech, vision, hearing, facial recognition, and psychiatric disorders, it’s impossible to gauge the effects of this prolonged experiment on children’s brains. What we do know is that humans have evolved certain anatomical and neurological features because they provided a leg up in the evolutionary competition. In evolution, as in public health, everything is a trade-off. If humans expend energy developing a given system and devoting limited neurological resources to it, then it must confer advantages. Thwarting its use and development is unlikely to be without consequences, even if we don’t yet know what they are.

Photo by Michael Loccisano/Getty Images

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