Just end the toddler mask mandate, Mayor Adams

New York City is hard at work competing for the title of having the cruelest, dumbest and most ineffective COVID-19 policy in the world. The city is fighting in the courts to protect their “only toddlers” mask mandate. This policy essentially means that while indoor mask mandates have been dropped for all other ages and groups, children between the ages of 2 to 4 will continue to be required to wear face coverings. Mayor Adams has said he wants to lift it soon, but he is simultaneously using the city’s Law Department to try to prolong the rule.

The fact that a politically savvy mayor has doubled down on this regulation is baffling.

Consider the facts. New York City’s policy goes beyond the advice of the World Health Organization and UNICEF, which is not to mask kids under the age of 6 years old. There is no well-done medical evidence (a cluster randomized trial) that supports the idea that masking kids between the ages of 2 to 4 improves their wellbeing or slows the spread of SARS-CoV-2.

The best study we have comes from Spain. There, due to a national policy, 6-year-olds masked, but 5 and under did not. The authors examined the rate of spread at each age from 3 to 11 years old. As kids got older, the risk of viral spread grew. If mask mandates on children at this age worked, we would expect a serious decline in spread from age 5 to 6. That didn’t happen — suggesting that masking children has at best a negligible effect.

Cloth masks have been studied in the gold standard of medicine, a cluster randomized trial — not in kids, but in adults. In one such study from Bangladesh, they failed to slow spread even among adults who were unvaccinated. In that same study, surgical masks had a small reduction in the rate of laboratory confirmed COVID-19. The group advised to wear a surgical mask had a 0.68% risk of COVID, and the group assigned not to wear them had a 0.76% risk of COVID. This minuscule difference — one COVID case averted among 1,250 people — was seen in experimental conditions in the throes of the pandemic, and when motivated adults wore the mask. The effect will surely be smaller, perhaps approaching zero, in toddlers, and notably, the NYC mandate does not specify a surgical grade mask.

A man and child on a scooter cross the street while wearing masks in the Upper East Side neighborhood of Manhattan on December 02, 2020 in New York City. (www.RoyRochlin.Com/Getty Images)

In a devastating article from the journal Public Health in Practice, entitled, ”Making pre-school children wear masks is bad public health,” the authors write, “The importance of early childhood for the rest of a person’s life is now well understood; what happens in those early moments really matters, and changing the beginning has the potential to change the whole story — including learning, earning and happiness.” As such, not only is the mayor doubling down on a likely ineffective policy; he is doing so in the age group that stands to lose the most.

The policy is especially bizarre given that kids of this age face the least risks of the virus. Their risk of death is hundreds of times lower than older individuals. A healthy unvaccinated toddler faces lower risks than a vaccinated older adult. Both of course can spread the virus, and yet in New York City today, only the youngest ones remain masked.

If you zoom out on the policy, the decision is especially baffling. Bars and restaurants are now open in New York City to unmasked patrons. Professional basketball players — vaccinated or unvaccinated — can play. Stadiums can be packed with unmasked spectators, vaccinated or not.

As New York tries to return to some semblance of normal life, which is what Adams has repeatedly said he wants, the last COVID-19 containment policy is masking toddlers? It seems like the plot of a dystopian novel, not the policy of a progressive, vibrant, cosmopolitan city.

When the history books are written, nearly everything we did to children in the course of this pandemic will look excessive, heavy-handed and harmful. That is true for school closures, the single greatest domestic policy failure. And that is true for aggressively masking the youngest amongst us.

We did so without robust evidence that it helped, in contrast with most European nations, including social democracies that routinely spend more on early childhood enrichment, care and development than we do. New York City’s current policy is regressive and futile. It represents the many ways in which the COVID-19 response hit hardest those with the least power, and the least ability to fight back. When history judges us, we will look as primitive as our ancestors who battled the plagues of Europe with superstitions and rituals, victims to their own ignorance and fear.