Should primary schoolchildren be made to wear masks?

As children return to classrooms next week, official government guidance recommends primary school pupils need not don face coverings. However, a London council has advised the 56 primaries under its control that masks should be worn by children as young as four. The government says: “The Department for Education are in contact with the local council on that matter.”

In general, data suggests that children up to the age of 18 experience lower rates of Covid-19-related hospitalisation and death compared with all other age groups. While all children are susceptible to and can transmit the virus that causes Covid-19, younger children appear to be less susceptible to infection and when infected less likely to spread the disease than older children and adults.

Last week, the government announced plans for the full reopening of schools on 8 March alongside a suite of measures designed to enhance Covid safety – including twice-weekly testing and a recommendation to wear face coverings in classrooms for secondary pupils. The World Health Organization also recommends that only children aged 12 and over should wear a face covering under the same conditions as adults.

So, what are the benefits to getting primary schoolchildren to wear masks? For one, whatever little degree of transmission is occurring in these age groups could be limited. It could also help normalise the practice – young children wearing masks may make their families more likely to accept masks, said Susan Michie, a member of the Scientific Pandemic Influenza Group on Behavioural Science, a Sage subcommittee.

On the negative side, whatever the gains on aerosol transmission, if young children are more likely to touch them, take them off, leave them on surfaces or swap them among each other, that benefit will be undermined. Another issue is children with medical conditions that make it untenable to wear masks – but those are surmountable challenges; afflicted children can be given a badge or something similar to reflect that they cannot wear masks, she added.

“Really, we need to be collecting data,” said Michie, noting that this happening in one council but not others offers an excellent opportunity for a natural experiment, in which data can be collected to indicate whether or not the intervention has a significant impact on infections and transmission.

Scientists have long stressed the need for measures to make schools safer for return, and one of the key interventions, they say, is improving ventilation. However, the government’s major messaging campaign still prioritises hand washing, surface cleaning and social distancing, which downplays the fact that Covid mostly spreads through the air, and emphasises the risk of surface spread.

“Ventilation, I would say, is much more important than masks … and there’s no negative side-effect of that,” said Michie, highlighting that the government should have focused on addressing that issue while schools were closed.

Another issue is class sizes. “We have one of the most crowded classrooms in Europe … other countries have much bigger classrooms and smaller class sizes,” she said, suggesting that unused buildings and retired teachers could be put into use to solve that problem.


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