RUTHFULLY YOURS

One of the more curious storylines playing out in the early days of Eric Adams’s tenure as mayor of New York City is his stance on masking preschoolers. Adams, who projects a tough-guy, no-nonsense persona, ready to make the tough decisions, has decided to maintain the requirement that schoolchildren under the age of five wear masks even though the science is clear that they face little to no Covid risk and that, as I discuss below, masking that age group comes with a risk of significant harm.

Adams lifted the mask mandate for K–12 schoolchildren in early March and promised he would lift the mandate for preschoolers, ages two to four, on April 4. Then, citing a “slight uptick” in cases, he backtracked.

When a state supreme court justice enjoined city officials from enforcing the requirement on April 1, calling it “arbitrary, capricious and unreasonable,” Adams announced that the city would appeal. That evening, an appellate division justice stayed the injunction, effectively restoring the preschooler mandate until a full hearing takes place.

A week later, Adams announced the mandate would continue for at least another week. He claimed he’d like to lift the mandate but “I’m totally at the mercy of my health team.” That would be the one led by his new health commissioner, Dr. Ashwin Vasan, who continues to recommend masks “for most of us,” particularly for children under five because that age group is not yet eligible for vaccination.

Dr. Vasan’s reasoning makes little sense. The currently predominant Omicron variant — especially the subvariant BA.2 that is now dominant in the New York City area — spreads easily despite vaccination. Mayor Adams, who has just tested positive himself, can attest to that. If masks are necessary for toddlers, they should be necessary for everyone. In fact, Dr. Vasan’s own tweet from March 30 shows that case rates in the city are lowest in the zero-to-four age group and, far and away, highest among 25- to 34-year-olds.

Moreover, Covid-19 is not much of a risk for preschoolers. Back on March 10, 2020, Dr. Nancy Messonnier, then the director of CDC’s National Center for Immunization and Respiratory Diseases, observed that children were at minimal risk of developing serious illness from Covid-19. She said it is “a disease that affects adults. And most seriously older adults. Starting at age 60, there is an increasing risk of disease and the risk increases with age. The highest risk of serious illness and death is in people older than 80 years. People with serious underlying health conditions also are more likely to develop serious outcomes including death.”

Two years of pandemic have confirmed her statement. Covid deaths among those 17 and younger are less than two-tenths of a percent of total U.S. Covid deaths. Covid hospitalizations in this age group have consistently been far below any other age group. New hospitalizations per 100,000 persons in the 0–17 age group are one-quarter the rate in all ages and one-tenth the rate in those 70 and older.

The European Centre for Disease Prevention and Control has long recommended against masking children in primary schools. It recognized that cases in children are nearly uniformly asymptomatic or mild and that masking young children would not work, “as children (<12 years) may have a lower tolerance to wearing masks for extended periods of time, and may fail to wear them properly.” This is a particularly salient observation for two- to four-year-old preschoolers.

Against the dubious case for masking preschoolers, there is increasing evidence that masks may lead to cognitive and speech delays in children. Indeed, the first three years of life is the most intensive period for acquiring speech and language skills. Masking requirements for children, then, are not merely superfluous but harmful, especially for preschoolers.

Adams can and should disregard the erroneous advice of his health team. Until he does, New York preschoolers and their parents are at their mercy.