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Pandemic Lessons: What does a safe mask break look like – and do we need them?

Pandemic Lessons: What does a safe mask break look like – and do we need them?

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Erie County Covid-19 press conference (copy)

Erie County Health Commissioner Dr. Gale R. Burstein, shown here wearing two masks, ignited a controversy when she said state guidance does not allow for mask breaks in schools.

You can breathe a little easy on this one – even through your mask – because this is the rare pandemic dynamic that has us all aiming for the same result:

Everyone wants a mask break. Preferably for good.

But how and when to do it, especially in schools and particularly of late, has been a topic of confusion and frustration. It flared last week when Erie County Health Commissioner Dr. Gale R. Burstein wrote to Williamsville school officials, saying that New York State Department of Health guidance does not allow mask breaks.

That ignited anger in Williamsville and from parents and school officials across Western New York, who contended that some form of a mask break is necessary. “The only humane way to have a mask mandate is also to allow mask breaks,” said Hamburg Superintendent Michael Cornell, president of the Erie-Niagara School Superintendents Association.

State guidance essentially bumps responsibility for monitoring mask breaks to local health officials, and the Erie County Department of Health quickly clarified that it doesn’t intend to use “punitive measures.”

That means mask breaks will likely continue in schools. But how can they be done safely – and are they necessary? In this installment of Pandemic Lessons, we tap the expertise of infectious disease physicians to find out how to do them well – until the day comes when we don’t need the breaks (or the masks) at all.

What exactly is a mask break?

By policy, it’s allowing students an opportunity to remove their masks for a relatively short period of time during the school day. In practice, this happens throughout the day – even if it’s not a policy. Lunchtime generally serves as a mask break. So does taking a drink of water, albeit for a short duration, unless that student is sipping from a straw slipped underneath their mask.

Even taking your mask off briefly to adjust it is, in essence, a small break, said Dr. Brenda Tesini, a pediatric infectious disease specialist at the University of Rochester Medical Center. She noted that health care professionals, who have been working fully masked for the last 19 months of the pandemic, have become accustomed to “pulling it down or away from your face for a few seconds at a time” when they are in a spot that is safely distanced from others.

“Something like 30 seconds actually feels like a long time if you want that little break,” Tesini said.

That’s not the kind of break that people are debating, but it is an opportunity to take a few full breaths of unfiltered air.

Of course, not all unfiltered air is safe.

Can mask breaks be done safely?

This is an interesting question to pose to epidemiologists, who are cautious by nature. They are experts in how infectious diseases jump from person to person, and they know that viruses and the concept of safety aren’t an easy match.

Dr. George Rutherford, an epidemiologist at the University of California, San Francisco, gave this first reaction when we posed that question: “To take your masks off and let them breathe, cough and sneeze all over each other is not safe,” he said. “I don't care how high you amp up the ventilation system. That’s an unlikely scenario for safety.”

Even if that mask break is only five minutes?

“Same answer,” Rutherford said.

But here’s the key to Rutherford’s response: He was talking about a group of students who are unvaccinated and learning indoors. That largely describes the school situation in Western New York for most of the pandemic, especially for students ages 5-11, who weren’t eligible for vaccination until a couple of weeks ago, and still haven’t had enough time to complete the two-dose regimen.

If a mask break happens outside, Rutherford said, that “is a completely different thing,” since virus spread is cut significantly by the moving outdoor air.”

He also noted, “If you want to tell me that 100% of them have been vaccinated, that’s a different kettle of fish.”

But very few groups of students – or adults – are all fully vaccinated.

What, then, does a responsible mask break look like?

Minimal, distanced and quiet.

An infected student coughing or sneezing in the face of another child could easily pass the virus, especially if both are unmasked. But the normal breathing won’t pass the virus as easily if the exposure is only for a few moments.

“It has to be minutes, or a lot of people, all sick, all putting it out in the air for short periods of time and it builds up,” Tesini said.

Knowing that quiet, seconds-long interactions generally don’t pass Covid – but that louder or longer ones do – can help you maximize safety. Every classroom and lunchroom – and for that matter, dance studio, sports facility or other places where youth gather – is designed differently. The key is to minimize risk. Here are some tips:

• Try to minimize unmasking and conversation. Talking releases 10 times as many aerosols into the air as breathing, according to Dr. Linsey Marr, an aerosol scientist at Virginia Tech. In a school setting, this would mean not unmasking everyone at the same time. Staggering mask breaks through the day is a better choice. Avoiding them during physical activities in indoor spaces – like a dance studio, for example – is safest, too.

• Distance and projection matter. Spacing out people who are unmasked will cut down risk. Ensuring that unmasked people aren’t facing each other at a close distance will keep the environment safer, too. “People facing each other – that’s really the worst scenario,” Tesini said. “You’re close together and you’re also in the direct line of each other. So if someone were to cough, or they’re even just talking and laughing, all of their respiratory energy is directed right at each other.”

• Keep it brief. Several seconds for a sip of water or mask adjustment is ideal. A few quiet minutes can work. Having students in a lunchroom pull their masks up after eating is smart. Strategies like these are taking charge of what you can. “You can’t control how sick someone is or how much virus they happen to have in their upper respiratory tract at that time,” Tesini said, “but you can control the time you're around someone and the distance.”

• Don’t overemphasize the need. Comfort with masks is a highly individual dynamic. But generally, it’s adults – not kids – who have a tougher time. Tesini, who works with the Center for Community Health & Prevention at the University of Rochester Medical Center, has consulted with educators on back-to-school protocols. As a pediatrician, she regularly treats children and works with families. Some of those parents tell her stories about kids opting not to take their masks off when being picked up from school, because they’re so adjusted to wearing one that they don’t even realize it’s on.

“Kids actually tolerate wearing masks all day, much better than adults do,” Tesini said. “My main question that I ask back when I'm being asked (about mask breaks) is, ‘Do they need one?’ Often, they don’t.”

How might vaccination change this dynamic?

In theory, it could change it significantly – but that’s only if the majority of students get vaccinated, which is unlikely to happen. In Western New York, only about half (49.6%) of 12- to 15-year-olds have been fully vaccinated. For people ages 16 to 25, the number is 58.2%. Achieving numbers higher than those for younger children is a daunting leap, but having a strong level of community immunization is what will ultimately snuff out the pandemic and let us tuck our masks away.

“The ultimate mitigation measure is vaccination,” said Dr. Thomas Russo, chief of infectious diseases at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences. “We just need to hold on, continue to do the best we can with masks ... and then, at the same time, try to get those shots in arms as soon as possible.”

The Buffalo News: Good Morning, Buffalo

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