As schools reopen across the country, mask mandates are a hot button issue. Today we look at how two conservative southern states handled mandates with vastly different approaches. In one, North Carolina, decisions are based on bipartisan compromise and science, while in the other, Florida, a dictate from the governor relies on misinformation and raw politics. I happen to live in one (Florida), but (fortunately) spend a lot of my summer in the other (North Carolina), giving me something of a front-row seat from which to view the controversy.

North Carolina

As happened in many states, North Carolina’s students, teachers, and parents were subjected to a shifting and sometimes confusing variety of studies, orders, and directives related to K-12 school closures during the 2020-21 academic year. But this past spring, after a protracted battle between the Republican-controlled legislature and Gov. Roy Cooper, a Democrat, the legislature unanimously passed, and the governor signed, a compromise bill, The Reopen Our Schools Act of 2021, paving the way for in-person  instruction for the remainder of the school year.

Under the Act, local school boards could choose “Plan A” or “Plan B”, which required different safety measures for reinstituting in-person instruction, with Plan A offering expanded opportunities for reopening classrooms.

However, school boards choosing Plan A were also required to

partner with the ABC Science Collaborative of the School of Medicine at Duke University (ABC Collaborative) to allow the ABC Collaborative to collect and analyze data from . . . students in Plan A in grades six through 12. A local board shall both engage in robust contact tracing and report on requested information in the form specified by the ABC Collaborative.

By way of background, the ABC Science Collaborative describes itself as

an initiative that extends across 13 states, connecting scientists and physicians with school and community leaders to help understand the most current and relevant information about COVID-19. The program helps school leaders and state policymakers arrive at informed decisions about returning to school using data from their own communities. . . The ABC Science Collaborative is coordinated by the Duke Clinical Research Institute at the Duke University School of Medicine and is funded through grants from the National Center for Advancing Translational Sciences, the National Institutes of Health, and the Food and Drug Administration.

The ABC Collaborative was to report interim results and a final analysis to the state, the latter by June 30, 2021.

Let me pause here to remark on how extraordinary I find this provision of the Act, requiring a science-based collection and analysis of data by a reputable institution in order to inform public health policy, and in a unanimously-passed bipartisan bill to boot! With the caveat that I have not looked at legislation in any systematic way for similar provisions, in my decade-plus of posting here on SBM I cannot recall writing about a piece of legislation mandating the legitimate collection and analysis of data on which to base public health policy. In fact, although I admittedly focus on such subjects, what I regularly encounter is the wholesale incorporation of pseudoscience into state and federal laws and policies affecting the public’s health. There outta be a law, and it should look like this one.

From March to June, 2021, the ABC Collaborative, apparently expanding the reach of its original mandate, collected data from all North Carolina elementary, middle, and high schools operating under Plan A, which included in-person instruction, masking, and minimal physical distancing (3 feet or under). The data represent 100 local school districts and 14 charter schools, comprising more than 1,280,000 students and 160,000 staff.  As the lead authors of the report explained in a New York Times Guest Essay, because there was a universal school mask mandate at the time of their data collection, they could not compare masked to unmasked schools. They did, however, look to data from other jurisdictions examining these situations.

The Collaborative’s final report concluded that:

North Carolina schools were highly successful in preventing the transmission of COVID-19 within school buildings and offers science-based learnings for the nation’s schools to limit COVID-19 spread.

In particular, the data showed that:

  • Proper masking is the most effective mitigation strategy to prevent COVID-19 transmission in schools when vaccination is unavailable or there are insufficient levels of vaccination among students and staff;
  • With masking in place, Plan A – full, in-person instruction – is appropriate for all grades and all schools;
  • Full-capacity bus transportation can and should resume, with the seating of up to three masked students per bus seat;
  • Some within-school guidelines can be relaxed, e.g., quarantine can be modified for people who were exposed to COVID-19 but are either vaccinated or were appropriately masked when exposed; and
  • Schools should examine safety protocols surrounding athletics. With proper safety protocols in place, particularly vaccination, schools could resume fall athletics while limiting the spread of COVID-19.

In addition to this report, the Collaborative has authored The Year in Review and a Path Forward, described as offering “a road map for school leaders and policymakers to use the latest science as they plan the path forward for K-12 in-person instruction”. (As you shall see, I know someone who could really use a copy.)

For the current (2021-22) academic year, Gov. Cooper declined to issue a state-wide mandate, opting instead to have each school district choose whether to implement a mask requirement. The Raleigh News & Observer reports that, as of August 24th, 27 of the 115 total districts have made masks optional. All of those districts are in rural or “red” areas and many have low COVID vaccination rates. Eighty-eight districts, accounting for 78% of the state’s 1.5 million public school students, have decided to require masking in school buildings and on busses; some will even require masks outdoors. At least 35 districts reversed their original decision to make masks optional, some after Gov. Cooper sent them a letter requesting the change. It is unknown how many of the state’s charter and laboratory schools, accounting for 9% of the total student population, will require masks.

According to the News & Observer, even where masks are required, a parent can request an opt-out “if a medical or learning issue” prevents masking, but the final decision on exemptions resides with each school.

Not everyone is happy with this plan, nor is everyone satisfied with the districts’ individual decisions. A doctors’ group has a petition on change.org urging Gov. Cooper to institute a statewide mask mandate for schools via executive order. In Union County, where the school board voted to make masks optional, local physicians urging the board to institute a mask requirement asked a newspaper to keep their identities confidential due to fears of retaliation. A school board member who voted to make masks optional reported personal attacks on her character and the board to the same newspaper.

Nevertheless, in sum, in North Carolina, a bipartisan law created a plan to collect and analyze data on which the state government and local school boards could base their decisions. Some districts have apparently embraced the science, while others have not. The net results is that, for now, over three-quarters of North Carolina’s public school students are under a mask mandate which, while not without some controversy, has maintained local control by decision makers acting in what they believe is their constituents’ best interests, whether or not we might agree with the results.

Florida

With this in mind, let’s turn to my home state, Florida

On July 30, 2021, Gov. Ron DeSantis issued an Executive Order that essentially banned mask mandates in Florida public schools. (Technically, it directed the state’s health and education agencies to develop rules “to ensure safety protocols for controlling the spread of COVID-19 in schools”, but the results are preordained by the Order.) He had previously ordered that all public schools be open for in-person instruction five days a week.

Gov. DeSantis’s Order was chock full of cherry-picked evidence, unsupported assertions, COVID myths, and downright falsehoods, all wrapped in a protective coating of “parental rights” talking points designed to please his base. He rested his authority to issue the Order on a new state law he signed in June of this year, the “Parents Bill of Rights”, which prevents the state and other units of government

from infringing on the fundamental rights of a parent to direct the upbringing, education, health care, or mental health of a minor child without demonstrating that such action is reasonable and necessary to achieve a compelling state interest and that such action is narrowly tailored and is not otherwise served by less restrictive means . . .

How this new law will affect cases, like this one, where parents choose “alternative” remedies over science-based treatments remains to be seen. In the case of local mask mandates, my view is that they could meet even this tough standard, but only if science is correctly applied to the matter, which, as you will see, is not part of the governor’s plan.

In the Order, the governor refutes the CDC’s mask wearing guidance as lacking “a well-grounded scientific justification”, citing a Brown University study done by an economist using now-outdated data, which Kaiser Health News concluded was “cherry-picked” by the governor and offered “little basis for his position and includes a variety of elements that are not accurate.”  A pediatrics professor at the University of Florida called DeSantis’s claim “patently false”.

The Order also says that there is “no statistically-significant evidence to suggest that counties with mask requirements have fared any better than those without mask requirements during the 2020-2021 school year”.  Of course, “fared any better” is vague. By what metric? Number of cases? Hospitalizations? Deaths? We don’t know because the Order cites no evidence in support of this assertion. And the general public (which is apparently who he is referring to) is not the same population as school students. However, we do know that modeling and epidemiological studies (like that of the ABC Science Collaborative) support masking in general and masking for school students in particular.

Again citing no evidence, the Order asserts that “masking children may lead to negative health and societal ramifications” and that “studies have shown that children are at a low risk of contracting a serious illness due to COVID-19 and do not play a significant role in the spread of the virus”. In fact, the most you could say is that the evidence is uncertain regarding spread and, in any event, it partly depends on the community rate, which is quite high in Florida right now. And, if it was ever true that children are at low risk of contracting COVID or experiencing serious symptoms, as SBM’s own Dr. Jonathan Howard has explained, that is no longer the case.

Finally, the Order, ensuring that even more COVID mask myths are blessed with the official imprimatur of state government, and once again without citing any evidence, claims that masks “could inhibit breathing, lead to the collection of dangerous impurities including bacteria, parasites, fungi, and other contaminants, and adversely affect communications in the classroom and student performance.” No, masks do not interfere with breathing and no, they do not collect “dangerous impurities” if you wear a clean mask (duh!). On the latter point, it is interesting that the governor, who totally trusts parents to make momentous decisions regarding their children’s health, suddenly finds they can’t be trusted with basic hygiene measures, like keeping their children’s stuff clean.

We simply do not have enough data to conclude one way or another on the effect masks have on learning but, in the words of one research psychologist who studies the cognitive and social development of children:

Ultimately, how children feel about wearing masks at school, and how much they psychologically benefit from wearing them, is going to depend on how the parents, teachers and caregivers around them present the issue.

Certainly, we can well imagine that a child, too young to fully evaluate the issue on his own, taken to a mask protest by his parents and told to hold up a sign an anti-mask sign, might become anxious and confused when his school district imposes a mask mandate.

The governor’s Order threatened local school districts with financial penalties for failure to comply, giving the Florida Commissioner of Education the authority to pursue “all legal means available to ensure school districts” obey the his dictates, including withholding state funds from noncompliant school boards.

In addition, in an incredibly irresponsible and undoubtedly politically-motivated move, the Florida Department of Health’s “How do I prevent and prepare for COVID?” webpage does not include mask-wearing, although it does include a link to the CDC at the bottom of the page. The CDC does, of course, advise to “wear a mask”, science-based advice the governor rejected.

This, I am pleased to report, has resulted in a coup against DeSantis by some school districts, who have enacted varying forms mask mandates for students and faculty in open defiance of his Executive Order. As of Wednesday morning, ten districts, including some of the largest, like Miami-Dade and Hillsborough (Tampa), representing over half of Florida’s public school students, have these mandates in place.

In response, state officials have doubled down with the threats, promising to dock the salaries of, and possibly remove, school board members who vote to enact mandates. Officials are seeking compensation records of board members voting for mandates in two districts, Alachua (Gainesville, home of the University of Florida) and Broward (Ft. Lauderdale). (Three Broward teachers recently died of COVID.) The state is expected to move against other board members this week.

The governor’s office has also doubled down on the misinformation. Just yesterday, a Washington Post news report quoted the governor’s press secretary saying, again falsely,

There is no empirical evidence to support the assertion that the benefits of forced masking of schoolchildren outweigh the potential harms. Masking kids under 12 is not recommended in many EU countries, because their health authorities have found that the risks are not well understood — and the data shows that forced masking of young children has a negligible impact on covid prevalence and spread.

The Post dutifully reported that “public health experts dispute this”, quoting a pediatric infectious disease physician from the Mayo Clinic who said that “studies have unequivocally shown that there are no negative health effects on children from wearing a mask.” As for what Europe is doing, the hypocrisy is, once again, interesting. I’m pretty certain that Gov. DeSantis would reject European public health authorities’ opinions on, say, gun control or universal health care coverage. In any event, I did not check the mask policies in each of the 28 EU countries, but reports from European health authorities like the Association of Schools of Public Health in the European Region, the European Academy of Paedatrics, and the European Centre for Disease Prevention and Control show that they have (unlike the governor) fully evaluated the evidence and recommend masking in school settings, depending on local conditions and with exceptions for certain students (like those too young or the disabled).

The federal government has now joined forces with the renegade school boards, with Pres. Biden and his Secretary of Education offering financial support and threatening litigation. Parents have filed their own lawsuits against the state, one of which is being tried in Leon County (Tallahassee) right now, with none other than Dr. Jay Bhattacharya, of Great Barrington Declaration fame, testifying on behalf of the state.

Florida’s “chaotic” school openings are playing out against Florida’s alarming COVID stats, including its pediatric cases. (I am heartbroken that these include the deaths of two children in my own community this month.) Just-opened schools are having to shut down because of COVID, almost 30,000 students, teachers and staff are in quarantine, and health departments are backlogged on contact tracing. Seventeen school employees, including teachers, have died of COVID just since August 1st. At the same time, public opinion polls show support for both mask and COVID vaccine mandates for students and teachers.

To be fair, pediatric cases in North Carolina are on the rise as well, as they are nationally, but I could not find that any schools had shut down, nor could I find any statistics on the number of students and school staff in quarantine, if any. School personnel have died from COVID in the state, although none recently that I could find.

Compare and contrast

So, in states with comparable political climates, one, North Carolina, in a bipartisan effort, looked to the data and science to inform decision-making on mask mandates and left the issue to local control, resulting in over three-quarters of public school students being under a mask mandate. In the other, Florida, the governor dictated to local school boards what they must do based on repeated misrepresentations of the evidence and is now threatening to impose financial and other penalties on school board members who have been elected to office by the citizens of their own communities, all in a state with some of the worst COVID stats in the country and in defiance of public opinion.

And here’s the really disturbing part: Gov. DeSantis’s Executive Order could have, like North Carolina’s report, set forth the actual evidence and declared parents should decide. In other words, the same result, just without the misinformation. It wouldn’t be the result the scientific and educational community might prefer, but at least the state wouldn’t be complicit in spreading falsehoods. But he didn’t. He chose to manipulate parents, the ones he claims he trusts to make the best choices for their children, with cherry-picked and fabricated “facts” (and easily debunked at that) in order to achieve the results he wanted.

Which approach do you think is best?

UPDATE: Judge throws out Gov. Ron DeSantis’ ban on mandatory masks in Florida schools. Tallahassee Democrat, August 27, 2021

Author

  • Jann J. Bellamy is a Florida attorney and lives in Tallahassee. She is one of the founders and Board members of the Society for Science-Based Medicine (SfSBM) dedicated to providing accurate information about CAM and advocating for state and federal laws that incorporate a science-based standard for all health care practitioners. She tracks state and federal bills that would allow pseudoscience in health care for the SfSBM website.  Her posts are archived here.    

Posted by Jann Bellamy

Jann J. Bellamy is a Florida attorney and lives in Tallahassee. She is one of the founders and Board members of the Society for Science-Based Medicine (SfSBM) dedicated to providing accurate information about CAM and advocating for state and federal laws that incorporate a science-based standard for all health care practitioners. She tracks state and federal bills that would allow pseudoscience in health care for the SfSBM website.  Her posts are archived here.