School districts sour on mask mandates amid legal scrutiny, research questioning effectiveness

School districts and other public authorities may have a harder time sustaining or bringing back indoor mask mandates as ongoing research undermines the rationale for routine masking, lawsuits challenge the practice, and their own officials balk.

Only seven of the 500 largest school districts (1.4%) are requiring masks as of Aug. 5, according to Burbio's school mask policy tracker, compared to 369 (73.8%) in October 2021. Mask-optional districts didn't become a majority until March.

The National Institutes of Health awarded just two grants in 2020 to study the efficacy of face masks, five to study airborne transmission of COVID-19 and two grants on transmission in schools, according to a May study in BMJ Open. The 1,108 grants for COVID research totaled $2.2 billion — almost half for pharmaceutical research — out of an NIH budget of $45.3 billion.

Los Angeles County backtracked on reinstating its mandate after several cities said they wouldn't comply, acknowledging COVID-19 hospitalizations were not dire. Weeks earlier, a county judge invalidated Los Angeles Unified School District's COVID vaccine mandate, saying it was preempted by state law and lacks required personal-belief exemptions.

Rhode Island is trying to get out of a lawsuit against its school mask mandate, which expired in March, but not before a public health official revealed he was unfamiliar with research that questioned the tradeoffs of masks, even in his own field.

While Judge Jeffrey Lanphear declined to impose a preliminary injunction last fall, he found that the plaintiffs' children were suffering "irreparable harm" from the mandate. He warned the Department of Health to "tread carefully in promulgating new regulations or extending any existing regulations" and not to expect "a bottomless pit of deference in the future."

James McDonald, interim director of the Department of Health until June, testified in a July deposition that his May 20 memorandum did not impose a conditional mask mandate but simply reflected CDC guidance. He told parents that infected students who don't wear masks "must" isolate for 10 days, twice as long as masked infected students.

Asked how he responded to Lanphear's finding of irreparable harm, McDonald said he reviewed medical journals for the next several months but pleaded ignorance about studies that found masks disrupt "the holistic processing and face·perception of school-age children" and are prone to fungal contamination.

The pediatrician said they must have been published in "poorly known journals" but was also unaware of an April study in a journal he knows, The Pediatrics Infectious Disease Journal, that found "no convincing evidence to date" that children are "key drivers of the pandemic." 

McDonald disagreed that cloth face masks are "almost useless," even though a celebrated randomized controlled trial by Yale researchers in Bangladesh found they had an "imprecise zero" effect on symptomatic infection.

He was also unfamiliar with research by Tracy Beth Hoeg, consultant epidemiologist to Florida's Department of Health and, until last month, University of California Davis physician resident. 

She's known for a January 2021 Wisconsin study in the CDC's in-house journal that found lower infection rates in schools than surrounding Wood County. Hoeg chided Education Secretary Miguel Cardona, however, for claiming the observational study shows the masks students wore were responsible.

In May she published a replication of a widely promoted — and debated — CDC mask study as a preprint in The Lancet, one of the best-known medical journals in the world, with University of Toronto economist Ambarish Chandra. 

By "incorporating a larger sample and longer period," they found "no significant relationship between mask mandates and case rates" even when "using regression methods to control for differences across districts." Schools with mask mandates "are likely to be systematically different from those that do not in multiple, often unobserved, ways," they wrote.

Much other research has studied how masks work in the real world. An April peer-reviewed study in the open-access journal Cureus by Universidade de São Paulo microbiologist Beny Spira found that among 35 European countries, those with "high levels of mask compliance did not perform better than those with low mask usage." 

A study last month in the Nature journal Scientific Reports quantified and identified bacteria and fungi attached to the masks of 109 volunteers, finding more bacteria on the "face-side" and "significantly increased" fungi on masks worn longer. The microbiologists from Japan's Kindai University found "several pathogenic microbes," warning immunocompromised people to "avoid repeated use of masks."

Facebook threatened users that tried to share an article about Florida parents that commissioned their own lab study of the masks their children were forced to wear, which found "quite dangerous" bacteria.

A February study in the journal Medicine by German researcher Zacharias Fogen compared Kansas counties with and without mask mandates Aug. 1-Oct. 15, 2020. He found the former had "significantly higher case fatality rates," falling slightly when adjusting for non-infected people in each group, and attributed 95% of the effect "solely" to COVID.

Fogen theorized that "deep re-inhalation of hypercondensed droplets or pure virions caught in facemasks as droplets can worsen prognosis and might be linked to long-term effects of COVID-19 infection."

Twitter does not appear to be treating skepticism of masks with any more tolerance, however. It imposed a 12-hour lockout Friday of cognitive theoretical scientist Mark Changizi, already a plaintiff in a censorship lawsuit against Twitter, for calling masks "one part of the suite of useless, draconian, civil rights violating and harmful interventions."