Published on September 02, 2021

Essentia Encourages Universal Masking in Schools

Essentia Health offers the following guidance to school districts in the communities we’re privileged to serve. As a new school year starts, we encourage universal masking to ensure safe learning environments for all children.

Dear school leaders:

We are writing to you as physician leaders of the Essentia Health Departments of Pediatrics, Department of Pediatric Hematology and Oncology, and the Hospitalists and Neonatologists of St. Mary’s Children’s Hospital to share our recommendations to prevent COVID-19 infections in the classroom this fall. The American Academy of Pediatrics recently came out with strong recommendations for both universal masking in the classroom as well as getting vaccinations for all those that are able.

The dominant circulating strain of the SARS-CoV2 virus in our region right now is the Delta variant. While we are still learning about this new virus variant, we have solid evidence to suggest the following:

  • It is nearly twice as transmissible as the original virus circulating throughout the 2020-’21 school year.
  • It has the capacity to make children extremely sick. In areas of the Southern United States hit hardest throughout this summer’s recent wave of infections, 2.4% of hospitalizations were among children. In Dallas, they recently ran out of available pediatric ICU beds, airlifting critically ill children to other states.
  • Unvaccinated children (and adults) are at the highest risk of severe illness from the Delta strain. At this point, it is anticipated that children 5-11 years of age will not be eligible for the Pfizer vaccine until December of 2021, and thus will not have protection from this two-shot series until January of 2022 at the earliest.
  • Asymptomatic carriers represent a significant percentage of people infected with the Delta variant, and carry equal viral titers in their nasopharynx, making them effective transmitters of the virus in the absence of symptoms.

With the increased infectivity of the Delta variant and the inability to vaccinate children less than 12, we are increasingly concerned about the possibility of a massive outbreak, should universal masking not be adopted. This could quickly overwhelm our pediatric hospitals locally and may end up leading to the deaths of children in our community.

Masking is a contentious issue with passionate views on both sides. Surprisingly, the science behind masking is quite immature, but since the start of the pandemic, we have made significant strides in our understanding of the efficacy of cloth masks. Importantly, masks work not by blocking virus particles themselves, but by blocking the saliva droplets (which are orders of magnitude larger) that contain the virus particles. In this way, masks with relatively large pore sizes can still halt virus transmission. We know that masks work best when worn properly and fit well, which can be a challenge in the pediatric population. This has led some to assert that this means that cloth masks do not work.

Our available evidence, while limited, suggests that there is up to a 79% reduction in SARS-CoV2 virus transmission in household settings with early and universal masking. Importantly, epidemiologic modeling studies suggest that the impact of masking is dependent on the proportion of a population that is masked with high effectiveness when there are 80% of the population masked vs. minimal effect when 50% of the population is masked. This modeling would predict that in a setting of optional masks, families of unmasked students are tangibly increasing the risk of virus transmission for all students in the school. This data underlies the recommendation by the AAP and CDC to recommend universal masking for all students.

There are valid concerns regarding the effect that masking has on student academic progress, particularly in the younger grades and in children with special needs. While these concerns are important to consider, we have data showing that virtual learning is likely a greater obstacle to academic achievement. Multiple studies estimate a several-month delay in academic progress related to virtual learning during the pandemic. A virtual environment also disproportionately impacts students with school-based therapy needs as well as those from lower socio-economic status households. For these reasons mitigation of viral transmission within the district, and thus a reduction in the probability of transition to a virtual environment is likely to optimize student achievement.

We recognize that this will now be the third academic year affected by COVID-19. We also recognize that learning occurs best in the classroom and would like to make this possible for all children. The pandemic has taken a massive toll on learning, mental health, and nutritional status. To prevent further losses in this regard, we urge you to adopt these recommendations and mandate masking for all students, staff, and visitors for children in K-12 schools in the hope of having in-person and safe learning environments for our children this year.


Jonathan KenKnight, MD, Section Chair, Essentia Health Pediatrics

Greg Mason, MD, Section Chair, Pediatric Hospitalists and Intensivists

Christina Falgier, MD, Section Chair, Neonatology

Andrea Watson, MD, Section Chair, Pediatric Hematology/Oncology

Lori DeFrance, MD, President of the MN AAP 2017-2020

Anne Stephen, MD, CMO Essentia Health East

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