The NEJM wants to bring back masking school children

A recent study published in the NEJM politicizes masking in school using ambiguous and limited data. More evidence of institutional capture.

Cover image from NewsHub

It’s frustrating to see that many of our premier scientific journals continue to move in the direction of politicizing science, something that many mainstream “scientists” have argued against.

A few days ago I wrote about a joint survey sponsored by Elsevier and conducted by a think tank called Economics Impact designed to clamp down on misinformation:

"Confidence in Science and Misinformation"

The New England Journal of Medicine (NEJM) doesn’t quite come as a surprise, as they have taken a political stance to even tell people not to re-elect Trump in 2020, something unheard of in the journal’s over 200 year existence.

From Forbes

The fact that many of these journals, which should focus on science rather than politics, are now wearing their politics on their sleeves is extremely worrisome.

Now, I tend to avoid using such a salacious title for my posts; I’d rather remain slightly unbiased in my reporting.

But this isn’t one of those cases. Rather, this is a clear example of science being used for policymaking and forcing narratives.

Recently, the NEJM published a study suggesting that masking in various Boston school districts reduced the number of COVID infections in school districts that kept masking requirements.

From The NEJM

Masking studies in the past have run into many issues as they suffered from many confounding variables.

Given that prior masking studies have been poorly designed would we consider this study to be any different?

This study looked at 72 public, non-charter school districts within the greater Boston area. Although Massachusetts rescinded their masking policy at the end of February 2022 several school districts had their own masking policies in place, with a few choosing to remove their mask mandates in the following weeks while some continued to maintain their policies.

Of the 72 school districts only 2 kept their masking policies:

Of the 72 school districts in the greater Boston area that were included in the study, only Boston Public Schools and Chelsea Public Schools sustained masking requirements throughout the study period (Fig. S2A). Of the remaining school districts, 46 districts (64%) lifted masking requirements in the first reporting week after the statewide masking policy was rescinded, 17 (24%) lifted masking in the second reporting week, and 7 (10%) lifted masking in the third reporting week (Fig. S2B). Cumulatively, 46 districts lifted masking requirements and 26 districts sustained masking requirements by the first reporting week after the policy was rescinded, 63 lifted and 9 sustained masking by the second reporting week, and 70 lifted and 2 sustained masking thereafter.

Data was based on reported weekly positivity rates among both staff and students [context added]:

For each school district, data regarding weekly Covid-19 cases, student enrollment, and staffing during the 2021–2022 school year were publicly available from the Massachusetts DESE.33,34 Throughout the study period, DESE [The Massachusetts Department of Elementary and Secondary Education] required standardized weekly reporting of all positive tests for Covid-19 among students and staff, regardless of symptoms, testing type or program (e.g., testing of symptomatic persons or pooled polymerase-chain-reaction testing), and testing location (community setting or school setting).

It’s worth noting that DESE provided full funding for schools which opted into standardized COVID testing programs:

DESE strongly encouraged, and provided full funding for, school districts to opt in to standardized Covid-19 testing programs; 2311 Massachusetts schools (approximately 95%) participated in at least one such program. From 1 month before the statewide masking policy was rescinded through the end of the school year, statewide testing recommendations did not differ according to masking or vaccination status (Table S2).35

When looking at the rates of COVID infection stratified by week of masking removal, it would appear that school districts which removed mandates had higher incidences of COVID infection, as noted in Figure 1 of the study:

Figure 1

Given that this is an observational study, researchers have to make sure that their measurements are done properly and take into account variables that may bias results.

Unfortunately, just like other masking studies, there is so much ambiguity with the data and how information is collected.

For instance, the researchers never reported on the type of masks students wore, or the seroprevalence among students and staff via vaccination or natural immunity.

The researchers do note the vaccination rate stratified based on time of mask mandate removal, showing that the school districts which removed masking had higher vaccination rates compared to the two school districts which did not remove mandates:

From Figure S7.

One must wonder if the “full protection” marketed by vaccine zealots helped contribute to the removal of masks. It’s not a secret that many places levied mask removal against vaccination, and that may have been the similar effect here.

So there’s likely to be a behavioral factor not accounted for here, and that may explain the trends in the May-June spike, as the districts with the highest vaccination rates (lifted masking in March 10, 2022) among children 5-11 had the highest spike in cases while the school districts with similar vaccination rates (March 3, 2022 and March 17, 2022) had a comparable number of cases to each other.

So maybe a better predictor of the increase in cases is not masking, but vaccination rates.

Note that this doesn’t mean that I am tying a relationship between vaccination and immune dysfunction as an explanation for the increase in cases (that would introduce its own confounding variables), but that policies and behavioral factors (along with variability between school districts) may have likely been tied to some masking/vaccination paradigm which were not accounted for in this current study, but are now being contributed specifically to the effect of masking.

This effect also seems to occur in the younger age groups compared to adults where the Staff data differs quite strongly from the Student data and doesn’t show that similar split (although vaccination rates among adult staff are likely to be more consistent given vaccination mandates and early vaccination periods).

Altogether, the data here is very messy, and the researchers don’t even appear to address why their data, stratified by time of mask removal, doesn’t appear to show a relationship.

Why is the middle week the one with the highest number of cases? Why are the other two so similar?

This same messiness is even seen in the positivity records as there’s no data on which testing protocol was used by each school district aside from recommendations.

The testing protocol changed in January 2022 with DESE switching from a “Test-to-stay” method to an at-home antigen testing protocol, so the accuracy of cases may be called into question given the high degree of variability (emphasis mine):

Both symptomatic testing and routine pooled testing were supported by DESE throughout the entirety of the 2021-2022 school year. However, starting in January, DESE strongly recommended replacement of “Test-and-Stay”/close contact surveillance testing with free weekly take-home rapid antigen to participating schools (Table S2). DESE does not publicly release information about which testing programs school districts selected or participation in these programs by school district, limiting our ability to examine whether testing practices differed between districts and/or over time.

The researchers do assuage any concerns with biases in their “Robustness of Results to Differences in Testing Programs” section, but given the fact that the results were based on reported cases it’s hard to argue that the data collected is a true tell of the masking effects.

In short, there’s a lot more going on here than just masking, and the fact that the researchers appear to be so adamant that it’s the masking that reduced the cases is a highly contentious argument to make.

Further Politicization of Science

So as I mentioned above I tend to avoid having salacious titles, but that’s mostly because studies at least make some attempt to not let their politics be so blatantly obvious.

However, this study is a clear example of politicization insofar that it’s full of the same buzzwords and talking points of social justice activism that are flooding much of science.

I mean, look at the Introduction and see how crammed it is of these social justice terms and ideas (emphasis mine):

the direct and indirect effects of the coronavirus disease 2019 (Covid-19) pandemic on children, their families, and surrounding communities have been substantial. By the end of February 2022, children and adolescents in the United States had a higher prevalence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) than any other age group; children with Covid-19 are at risk for severe acute complications, death, and long-term sequelae (known as long Covid or post-Covid conditions).1-4 Furthermore, by the end of September 2022, more than 265,000 children and adolescents in the United States had had a parent or caregiver die from Covid-19,5,6 and the pandemic had caused substantial interruptions in school settings — including staffing shortages, closures, and missed school days — and had deepened educational inequities.7,8 These effects have been disproportionately borne by groups already made vulnerable by historical and contemporary systems of oppression, including structural racism and settler colonialism.9-11 Black, Latinx, and Indigenous children and adolescents are more likely to have had severe Covid-19, to have had a parent or caregiver die from Covid-19, and to be affected by worsening mental health and by educational disruptions than their White counterparts.6,8,12,13

During the Covid-19 pandemic, schools have become an important setting for implementing policies that minimize inequitable health, educational, social, and economic effects on children and their families. However, even before the pandemic, schools were not uniformly health-promoting environments. Chronic underinvestment in combination with structural racism codified in state-sanctioned historical and contemporary policies and practices (e.g., redlining, exclusionary zoning, disinvestment, and gentrification) eroded tax bases in some school districts and shaped the quality of public school infrastructure and associated environmental hazards.10,14-19 These processes left school districts differentially equipped to respond to the Covid-19 pandemic and concentrated high-risk conditions, such as crowded classrooms and poor indoor air quality due to outdated or absent ventilation or filtration systems, in low-income and Black, Latinx, and Indigenous communities.14,18,19

Excuse me, isn’t this a study on masking and the effects on COVID? What the the heck are terms such as “structural racism” and “settler colonialism” even doing in this study? And what the heck is a “Latinx children”?!

Why is such language being used in a study that has no need for such language?

The fact that these ideas have been shoehorned into a COVID study and pushed forward by the NEJM is completely asinine.

This type of language is growing in science literature and it’s unsettling how much research is being captured by this ideology.

And just because I know you all are gluttons for punishment, here’s a few paragraphs from the Discussion (emphasis mine):

Understanding Covid-19 policy decisions requires attention to power and existing historical and sociopolitical contexts.10,40 Structural racism and racial capitalism operate through multiple pathways, including higher levels of household crowding and employment in essential industries and lower levels of access to testing, vaccines, and treatment; these structural forces differentially concentrate the risk of both SARS-CoV-2 exposure and severe Covid-19 in low-income and Black, Latinx, and Indigenous communities.9-11,18 In our study, school districts that chose to sustain masking requirements longer tended to have school buildings in worse physical condition and more students per classroom, and these districts had higher percentages of students and staff already made vulnerable by historical and contemporary systems of oppression (e.g., racism, capitalism, xenophobia, and ableism). In Boston and Chelsea, more than 80% of the students are Black, Latinx, or people of color, and these cities were among the Massachusetts cities and towns that were hit hardest by Covid-19. Students and families in these school districts have strongly advocated and organized for governmental action to increase Covid-19 protections in schools, emphasizing their role as essential workers, the risk to vulnerable family members, and the unequal consequences of missed work and school.41,42 The decision in some school districts to sustain school masking policies longer may therefore reflect an understanding among parents and elected officials that structural racism is embedded in public policies and that policy decisions have the potential to rectify or reproduce health inequities.10,14,16,40

A growing body of work suggests that knowledge of differential conditions and inequitable effects may decrease support for Covid-19 protections among systematically advantaged groups, whose relative position largely insulates them from Covid-19 harms, while simultaneously increasing support among groups that are directly affected by systems of oppression.43-45 For example, in a randomized trial in which White persons were assigned to receive information about structural causes of persistent Covid-19 inequities across racial or ethnic groups or to not receive such information, those who received the information were less likely to support Covid-19 prevention policies and were less likely to report individual concern about Covid-19 and empathy for the groups that were most affected.45 In several studies and polls, Black and Latinx parents were more likely than White parents to support school masking requirements and less likely to have confidence that schools could operate safely without additional protections.43,44,46 Failure to consider unequal baseline conditions and ongoing inequitable effects of Covid-19 policies risks further exacerbating inequities in Covid-19 incidence and educational outcomes.

“Racial capitalism”? Seriously?!

Again, is this a study on masking or a case to flaunt one’s ideological viewpoint? The fact that such explicit language is used, and that the Discussion section appears to be the same length as the Results is extremely disconcerting.

I do, however, find it quite ironic that in the researchers grandiose claims of inequity and injustice they never explain why black and Hispanic parents have such low COVID vaccination rates. Maybe there’s a hesitancy among minority communities based on historical instances in which the medical establishment targeted minority communities, or do we not address that if it goes against THE NARRATIVE?

This all points to the rather concerning fact that science is now being used to push ideology rather than scientific principles. It’s a weaponization of science for one’s own interest, rather than the facts of science that is damaging the perception of science.

The researchers here even note that, considering that they made remarks that their results shouldn’t be used for masking per se, but for masking policies:

Overall, our findings should be interpreted as the effect of universal masking policies and not as the effect of masking per se, since masks were still encouraged in most school settings.

They even explicitly state that their results are contentious, undercutting any concerns over the negative effects masking due to “lack of evidence” (emphasis mine):

Because universal masking policies in schools have been contentious, we anticipate several critiques. One such critique is that the benefits of universal masking in schools are outstripped by potential disruptions to teaching, learning, and social development. These effects warrant further rigorous evaluation; however, to date, there is no clear existing evidence that masking inhibits learning or harms development.47,48 In addition, such effects might be considered alongside the spectrum of benefits of universal masking, including fewer missed school days and staffing shortages, reduced risk of illness for students and their families, and reduced economic hardship for caregivers, who might miss work if their child is sick or if they become ill themselves. For example, in Lexington, MA, a comparison district approximately 10 miles from Boston, mean student and staff absences due to Covid-19 during weeks when masking was optional were 50% higher than absences during previous weeks, when masking was required (see the Supplementary Appendix).

Someone should tell the researchers that lack of evidence is not evidence of no effect.

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This study can’t help but remind me of the sign plastered in front of the school I voted at which argued to “respect my masking choice”. This school district is obviously one of those places that mandated masking, so I find it all rather hypocritical.

Regardless, the choice to mask should be up to the individual, however the fact that masking appears to be levied as another political topic.

Rather than weaponize science to enact policies and influence decision makers, why aren’t scientists focusing on science?

This research is receiving widespread attention as a proclamation to bring back masking. The resurgence in the masking debate is strangely being renewed but with a greater hint of social justice activism and language behind it.

Science should not be politicized, and it should not be used to weaponize factions. It should not be beholden to some ideological viewpoint or done with the intent of righting some modern-day perception of injustice or inequity.

Let the science speak for itself and not be a mouthpiece for ideologues.

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