Masks have become so politicized that even physical altercations have broken out regarding their usage. While many see mask-wearing as a decision that affects other people and is therefore not entirely personal, others maintain that everyone should take their health into their own hands.

Most schools around America that have been operating physically have implemented some sort of mask requirement. Even though children represent the demographic that is of the lowest risk and lowest spreading rate, they’ve still been forced to participate in the mask-wearing that has been the theme of this past year. Given the known negative effects of wearing masks along with the knowledge that children are of the lowest risk of mortality or getting severely ill from a COVID-19 infection, why are they still being forced to wear them?

Concerns have been raised over a false sense of security that may come from wearing a mask. If an individual is under the impression that a mask will protect them and others, they may become lax with other strategies that are equally, if not more effective at limiting the virus’s spread. Another concern is masks that are not properly kept clean may become spreading agents themselves. When considering children, can we really expect them to keep their masks properly sanitized? Sure, parents are responsible for this, but this brings us to our next issue. Think for a moment about how many people reuse their (often homemade) cloth masks every day.

The type of mask definitively alters its effectiveness. In this Vietnamese study, there was a significant difference in viruses spread among cloth mask wearers versus medical mask wearers. Hospital workers wearing cloth masks were 13 times more likely to contract an influenza-like virus. According to the study, “Penetration of cloth masks by particles was almost 97% and medical masks 44%.” Even more shockingly, cloth mask wearers were 3 times MORE likely to contract a virus than those who didn’t wear any mask at all. This means that the cloth masks actually increased the risk. Now ask yourself, is this good science or virtue signaling?

The Norwegian Institute of Public Health (NIPH) recommended against mask wearing for individuals without respiratory symptoms, citing concerns over proper usage. The researchers maintained that in order for an official recommendation to be effective, customized mask training needed to be provided directly to communities. They also stated that there is no reliable evidence that non-medical masks provide any protective effect. Let’s take a second to reflect on what this means, taking into account the supplies shortage we’ve seen regarding proper masks for medical workers. If we can’t even supply our front-line workers with proper equipment, the majority of the public is not going to be able to find the proper equipment. We’ve already seen that this leads to an increase in homemade cloth masks.

Children’s immune systems are young and flexible, making it the perfect time to introduce them to potentially harmful pathogens in the world so that they can learn how to protect themselves. It also makes them extremely resilient and quick to launch an attack on the virus (and we don’t have time to discuss how amazing breast feeding works for a baby’s immune system). Researchers have discovered that the SARS-CoV-2 virus is not able to replicate rapidly in childrens’ bodies due to a combination of factors. For one, because children’s immune systems are young, they contain many naive T cells just waiting to be deployed. Naive T cells are immune cells that have not yet been assigned to a specific virus or other pathogen, so they are readily available to study and launch an attack against a new pathogen. As a person grows up and is exposed to new environments, their bodies make less naive T cells because they’ve already learned the majority of antigens they encounter regularly.

Further evidence of a rapid immune response amongst children is found in the types of antibodies present in children versus adults following a COVID infection. Adults developed both antibodies against the SARS-CoV-2 spike protein (which allows the virus to enter a cell), and against its nucleocapsid protein (which is essential for the virus to replicate). Children, on the other hand, did not develop antibodies against the nucleocapsid protein because this protein is typically only present once the virus is widespread in the body.

All of these factors help to explain why some children develop Covid symptoms but repeatedly test negative for the virus on a PCR test. The virus simply is not able to replicate enough to show up on the test before the child’s body squashes it.

Another interesting possible reason for the low risk amongst children revolves around a specific enzyme found inside the nose called angiotensin-converting enzyme 2 (ACE2). This enzyme binds to spike proteins on the surface of the SARS-CoV-2 virus and allows it to enter the human cells. This study found that the amount of ACE2 in the nose increased with age, starting a very low amount for the youngest age group.

Age has been determined to be a large risk factor regarding Covid-19. One reason for this is the increased instance of comorbidities (other life-threatening conditions) amongst older populations. For example, Covid-19 patients who also have heart conditions are more likely to pass away from the infection. However in this study, age was independently a significant risk factor even after adjusting for such comorbidities. It is undeniable that children are at much lower risk than older adults, and not just for their lack of other health issues.

A child’s immune system is malleable and needs to be regularly challenged and stimulated in order to continue growing and strengthening. This study demonstrated the connection between growing up in a sterile environment and having a suppressed immune system. This concept is known as the ‘hygiene hypothesis’, which claims that early exposure to pathogens (amongst other things such as dander, mold and allergens) is integral to immune system development. If the child’s naive T cells never have the chance to meet any pathogens, how can they protect the child from disease later in life? 

In addition to learning about the external environment, the immune system must also learn to tell the difference between a real pathogen and a human cell look-alike. When foreign material resembles a bodily cell, such as gluten proteins with thyroid tissue, an inexperienced immune system may accidentally end up attacking the host’s own body. This is how autoimmunity begins.  But, gluten is not enough!  We must remember that the immune system is complex and it involves genetics, environment and triggers (all three are required for autoimmunity).  Merely having a family member with a chronic illness does not warrant the need to isolate our children – in fact, it harms their ability to respond when we don’t give them the opportunity to be outside, live life and just be kids!

There are also other factors to consider when discussing mask-wearing for children, notably the psychological effects it may have on them. Social distancing and school closures pose a new kind of challenge to a child’s interpersonal development. Hearing-impaired children lose the important tool of lip-reading as well as the practice necessary to hone that skill. Similarly, children within the autism spectrum lose the opportunity to practice reading facial expressions, which is something that they are predisposed to struggling with.

The question of whether we should force children to wear masks is a question of risk-benefit analysis. Simply, do the possible benefits outweigh the possible harms? If this isn’t the case, we cannot in good conscience advocate for society-wide mask requirements.

Yours in health,

– Dr. Ian Hollaman DC, MSc, IFMCP