As Gov. Kim Reynolds shares uncertainty on masks, Iowa health experts say their benefit is clear
Ian RichardsonEditor's note: This article has been updated to include more information from Iowa Gov. Kim Reynolds' office.
Iowa Gov. Kim Reynolds has publicly questioned the effectiveness of face coverings as she defends a new state law banning local mask mandates, which is now the focus of a lawsuit.
"I've not seen the data to necessarily say yes or no," she told KCRG-TV earlier this month in response to a question on whether she believes masks in schools would reduce the spread of the coronavirus.
Iowa medical experts, however, say the data is clear: Masks work.
"There's definitely a benefit," said Dr. Ashlesha Kaushik, a national spokesperson for the American Academy of Pediatrics and a board member for the academy's Iowa chapter. "Scientific evidence is pretty strong in favor of masks."
Face coverings filter out the respiratory droplets and particles that spread the virus. There's also research that shows they can provide some protection to the wearer.
Scientists are still learning about COVID-19, including how it affects young people. Many studies of schools are limited due to data being self-reported. And it's difficult to isolate the effectiveness of any one strategy when multiple efforts are put in place.
However, as students enter their third academic year learning alongside the coronavirus, science shows masking — especially among adults in schools — in combination with other mitigation strategies works to reduce spread.
In areas with high virus transmission, the Centers for Disease Control and Prevention currently recommends everyone wear a face mask, even if a person is vaccinated. The American Academy of Pediatrics and CDC also both recommend that all students, staff and visitors over the age of 2 wear a mask inside school buildings.
"There aren't that many things in health sciences where the risks border on nil or negligible and the benefits have been demonstrated,” said Dr. Fred Gerr, professor emeritus of occupational and environmental health at the University of Iowa. “This is clearly a winning strategy for preventing the spread of COVID."
Do masks provide protection from COVID-19? Studies show yes
The CDC's website lists several studies that it says support mask effectiveness. That includes an investigation of a pair of infected hair stylists in Springfield, Missouri, who wore masks for eight days in May 2020. Of the 139 clients they saw, none reported symptomatic cases afterward. Sixty-seven agreed to be tested, and all were negative.
Another study of 382 Navy service members from a March 2020 outbreak aboard the U.S.S. Theodore Roosevelt in Guam found a 70% reduction in the risk of infection among those who wore face masks.
Gerr, the University of Iowa professor, said it’s settled in his mind that masks work to reduce transmission of the virus. But scientists can quibble about the exact level of effectiveness, he said.
Some detractors have cited comments from Michael Osterholm, a former adviser to President Joe Biden and current Director of the Center for Infectious Disease Research and Policy at the University of Minnesota, who has called for a more nuanced discussion on masking.
“When you actually look at face cloth coverings, those cloth pieces (that) hang over your face, they actually only have very limited impact in reducing the amount of virus that you inhale in or exhale out," he said earlier this month on the television program "Amanpour & Co."
►From May 2020: Iowa native Michael Osterholm, a world-renowned epidemiologist, saw the pandemic coming. Now, he wants you to be worried
Osterholm, who said his concerns date back to last year, said in a July 2020 post that he is not "anti-mask" and supports the wearing of cloth face masks by the general public, according to PolitiFact. He has also pointed to the effectiveness of N-95 respirators.
Gerr compiled a summary of 11 studies that he said show mask wearing reduced transmission of the coronavirus. He noted many of the studies also used cloth and paper masks — not other facial coverings like N-95 masks — meaning that the traditional cloth masks have been found to offer protection from virus transmission.
Reynolds questions CDC mask guidance
Reynolds issued a limited face mask requirement in November as coronavirus cases rose. At the time, in a Nov. 17 news conference, she said there’s “science on both sides” of the debate but clarified her remarks, saying she does believe masks are effective.
In recent months, Reynolds has been a vocal supporter of the COVID-19 vaccine but has been critical of updated masking guidance. After the CDC began recommending even vaccinated people wear masks in areas with high transmission, and that everyone wear masks inside school settings, she said the guidance was “not grounded in reality or common sense.”
"Where's the data the CDC is using to justify the mask mandate?" she told reporters Aug. 19, saying mask mandates are a “disservice” to children due to a possible impact on their social and emotional health.
More:Iowa COVID hospitalizations highest since January, 25% increase since last week to nearly 500
Pat Garrett, a spokesperson for Reynolds, said in an email that the vaccine is the "best tool" to protect against the virus. Parents and students have the option to wear masks, but long-term use "can come with its own cost," he said.
"Experts have raised concerns about the potential negative impact to students’ social, behavioral and speech development," he said. "And they’ve noted that cloth face masks can become vectors for pathogens when they’re not used and washed properly."
Garrett pointed to an Aug. 8 Wall Street Journal opinion piece by Dr. Marty Makary, a professor at Johns Hopkins School of Medicine, and Dr. H. Cody Meissner, chief of pediatric infectious diseases at Tufts Children's Hospital, where they wrote they could only find a "single retrospective study" on whether masks reduce transmission in children, "and its results were inconclusive." The article also said face masks could cause discomfort for some children, affecting how young children read nonverbal communication, and be a source of contamination if children use them for too long.
He also pointed to Osterholm's quotes and noted that the CDC has changed its guidance on masks several times — most recently recommending vaccinated adults wear masks in areas with high transmission — and said it showed there's a lack of clear data for their use.
What about the effectiveness of masks in schools?
Reynolds has remained adamant that she does not plan to make any exceptions in the law banning mask mandates as students return to school, despite pressure from the Biden administration to do so.
Children are able to both catch and transmit the coronavirus, although they are less likely to have a severe form of the disease. The delta variant of the virus, however, has been found to spread more easily in children, and children under 12 remain ineligible for the coronavirus vaccine.
Though the science on children, the virus and masking in schools continues to develop, both the CDC and the American Academy of Pediatrics have recommended a combination of strategies, such as universal masking combined with ventilation improvements, to prevent the spread in schools.
More:Iowa mother sues Gov. Kim Reynolds, state over mask mandate ban for schools
Some other countries have taken different approaches to masking. World Health Organization guidance currently doesn’t broadly recommend masking for children under 6 years old and gives flexible guidance for those ages 6 to 11 depending on factors like virus transmission levels. Children 12 and over should wear a mask “under the same conditions as adults.”
There have been some calls from experts for more discussion on appropriate masking practices in schools that could be less stringent, particularly related to elementary age children and younger children.
Garrett said the CDC has not presented "definitive data" comparing the outcomes of schools with mask mandates and those without them.
He also pointed to a study of 169 Georgia elementary schools conducted in November and December of last year. The study found a 21% lower incidence of COVID-19 among schools requiring masks for students, which was not statistically significant compared to schools with optional mask use.
But the study's conclusions still advocate for masks to have a role in combination with other mitigation measures in schools. The study authors' main takeaways were that COVID-19 was 37% lower in schools that required mask use among teachers and staff members and 39% lower in schools that worked to improve ventilation. Because universal mask use is inexpensive and easy to put in place, the report said it, could be an important part of schools' strategies.
To support its guidance, the CDC cites studies of transmission in schools in Georgia and Israel that it has connected with a lack of mask use. It also uses several studies, including from schools in North Carolina, Utah, Illinois and Missouri, that show when schools used layered prevention strategies, they saw low rates of transmission.
"Most studies that have shown success in limiting transmission in schools have required that staff only or staff and students wear masks as one of the school’s prevention strategies," the CDC's summary of transmission in K-12 schools says. "Inconsistent mask use may have contributed to school-based outbreaks."
Kaushik said widespread masking in schools could also help make students less likely to feel singled out for wearing one. She said she believes it’s important that parents and teachers lead by example and be encouraging of good habits.
"Children usually follow their parents and look up to their peers, too, but also teachers would be good role models," she said.
Ian Richardson covers the Iowa Statehouse for the Des Moines Register. Reach him at irichardson@registermedia.com, at 515-284-8254, or on Twitter at @DMRIanR.