American Academy of Pediatrics recommends masks in schools for everyone over 2, regardless of vaccinations

The American Academy of Pediatrics released new Covid-19 guidance for schools on Monday that supports in-person learning and recommends universal masking in school of everyone over the age of 2, regardless of vaccination status – a stricter position than that taken this month by the US Centers for Disease Control and Prevention.

“The AAP believes that, at this point in the pandemic, given what we know about low rates of in-school transmission when proper prevention measures are used, together with the availability of effective vaccines for those age 12 years and up, that the benefits of in-person school outweigh the risks in all circumstances,” the guidance says.

One of the main interventions put forward by the AAP is that all students over the age of 2 and all school staff should wear masks at school unless they have a medical or developmental condition that prohibits this.

Reasons for this recommendation include but are not limited to: a significant proportion of the student population is not yet eligible for vaccination; masking protects those who are not vaccinated against Covid-19 and reduces transmission; and potential difficulty in monitoring or enforcing mask policies for those who are not vaccinated.

“There are many children and others who cannot be vaccinated,” Dr. Sara Bode, chair-elect of the AAP Council on School Health Executive Committee, said Monday in a statement.

“This is why it’s important to use every tool in our toolkit to safeguard children from COVID-19. Universal masking is one of those tools, and has been proven effective in protecting people against other respiratory diseases, as well. It’s also the most effective strategy to create consistent messages and expectations among students without the added burden of needing to monitor everyone’s vaccination status.”

North Hollywood, CA, Tuesday, April 13, 2021 - Kindergartner Jesse Magana at teacher Alicia Pizzis classroom for the first time in more than a year at Maurice Sendak Elementary. (Robert Gauthier/Los Angeles Times via Getty Images)

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The AAP’s recommendation on universal masking is different from guidance by CDC, which also prioritized in-person learning but advised that fully vaccinated students, teachers and staff don’t need to wear masks at school.

AAP’s more cautious mask guidance is understandable, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

“When you have a degree of viral dynamics in the community and you have a substantial proportion of the population that is unvaccinated, you really want to go the extra step, the extra mile, to make sure that there is not a lot of transmission, even breakthrough infections among vaccinated individuals,” Fauci told CNN on Monday.

The differing guidance could cause some confusion, Fauci acknowledged while noting the CDC’s guidance allows for local states, cities and other agencies to make their own judgments.

“I think that the American Academy of Pediatrics (is) a thoughtful group. They analyze the situation, and if they feel that that’s the way to go, I think that is a reasonable thing to do,” he said.

AAP and CDC align on need for in-person school

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Aside from the masking guidance, the AAP and CDC agreed on the importance of in-person learning.

And the AAP “amplifies” the CDC’s other recommendations on ventilation, testing, quarantining, cleaning and disinfection, the pediatrics group said in its statement.

The AAP also recommended that all eligible individuals get vaccinated; that adequate and timely testing resources are available; and that strategies that are developed can be revised and adapted depending on the situation in the community.

“With the above principles in mind, the AAP strongly advocates that all policy considerations for school COVID-19 plans should start with a goal of keeping students safe and physically present in school,” the guidance says. “The importance of in-person learning is well-documented, and there is already evidence of the negative impacts on children because of school closures in 2020.”

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The discussion about masking and other Covid-19 protections on campus comes just weeks before some schools in the South are set to reopen for the school year.

When Covid-19 hit US shores last spring, most schools shut down in-person learning and moved to teaching online. But remote learning has highlighted inequities in education, hurt education for students of all ages and exacerbated a mental health crisis among children and adolescents.

“We need to prioritize getting children back into schools alongside their friends and their teachers – and we all play a role in making sure it happens safely,” Sonja O’Leary, chair of the AAP Council on School Health, said in the Monday statement.

“The pandemic has taken a heartbreaking toll on children, and it’s not just their education that has suffered but their mental, emotional and physical health. Combining layers of protection that include vaccinations, masking and clean hands hygiene will make in-person learning safe and possible for everyone.”

CNN’s Eric Levenson contributed to this report.