They keep kids safe, but some states banned mandates

Children under 12 are still not eligible for vaccines against COVID-19. And just in time for back-to-school season, the highly contagious delta variant is causing pediatric cases of the coronavirus to skyrocket. 

The good news is experts agree on how to keep kids and teachers safer at in-person school: Adults and older children should be vaccinated, and everyone should wear masks.

But many schools aren't requiring them – and many states say they can't, even if administrators and parents want to.

What's a parent to do?

Studies from last school year show mask-wearing is an effective prevention strategy, according to a Centers for Disease Control and Prevention report updated in July. But when mask use is inconsistent, the CDC found, outbreaks can occur.

That will be even more the case this year with the delta variant on the rise. 

Most states have lifted mask mandates in schools but allow local districts to impose them as they see fit. Twelve states have imposed mask mandates in schools, plus the District of Columbia and Puerto Rico – a group that has grown this week. 

Eight states have banned their school districts from imposing mandates.

Wearing a mask provides instantaneous protection. It can guard an individual from infection even in environments where not everyone is masked, such as schools without mask mandates. 

Should everyone wear masks? Why the CDC's new mask recommendation applies to vaccinated Americans

“It's similar to a bicycle helmet," said Dr. James Versalovic, chief pediatrician at Texas Children’s Hospital. "We have things that we put on or around our bodies that may restrict our hearing or our vision momentarily, but we do that because these things protect us and they keep us safe."

More than 90% of COVID cases affecting children now are due to the delta variant, Versalovic said. He worries more children will have to be hospitalized in the coming weeks. Texas, where he works, has a ban on mask mandates via executive order from Gov. Greg Abbott, a Republican.

Children who contract COVID-19 may suffer symptoms of acute infection, but of even greater concern are the consequences of long-haul COVID. It's estimated that 10% of children who contract COVID will have chronic symptoms that may include cardiac conditions, decreased lung function and behavioral or functional abnormalities. 

With cases on the rise, 63% of parents think their child's school should require unvaccinated students and staff to wear a mask, ​​​​a recent survey by the Kaiser Family Foundation found. Rural and white parents were more likely to want schools to end COVID-19 safety protocols such as masking, and parents of color and urban parents were more likely to want them in place, another survey by the RAND Corp. found in May. 

Passionate, angry parents filled school board meetings across the country this week – to plead for mask mandates or to rail against them.

"I myself have lost faith in the public school system," one parent told the Michigan State Board of Education on Wednesday, when it met to pass a resolution supporting decisions on mask mandates made by individual schools.

"This is a matter of life and death," countered Mike Siegel, a parent of two elementary students in Austin, Texas, who is an attorney and a former Democratic congressional candidate.

Some school districts are implementing mask requirements in defiance of their state's bans.

Schools in Houston, Dallas and Austin, for instance, have implemented a mask mandate for teachers and students, despite an executive order from the governor prohibiting mask requirements in Texas. Several districts are also engaged in a legal battle over the executive order.  

Late Friday, Secretary of Education Miguel Cardona wrote a letter to Abbott backing the districts that have defied his executive order and adopted "science-based strategies" for reopening schools safely. Federal law, Cardona said, requires schools that received American Rescue Plan stimulus money to develop plans for safe return to instruction.

Similar acts of defiance and legal battles are playing out in other states with bans on mask mandates.

As schools reopen, it's important to remember kids are less to blame for the spread of COVID-19 than adults. Data from school reopenings in 2020 suggests adult-to-adult transmission was a higher risk than infections passed from adults to children. And some evidence suggests COVID spread more easily among teens than elementary-age children. 

That science puts the emphasis on vaccines for people who are eligible. Keeping cases down among teachers and parents can help schools stay open.

No vaccines for young kids, yet: Some parents are slipping young kids in for the COVID-19 vaccine, but doctors say it's 'risky'

“The fall and winter consequences of any (school) outbreaks will depend crucially on how many adults are vaccinated in the wider community, because schools are a hub connecting many different households," Bill Hanage, an epidemiology professor at Harvard University, told USA TODAY. 

So far, only Hawaii and California have required teachers to be vaccinated. Puerto Rico requires the shot for children 12 and over who are taking in-person classes.

Roughly a dozen states have banned schools or employers from mandating vaccines. Bills seeking to restrict vaccine mandates have passed one house of the legislature in four other states.

On Thursday, the National Education Association, the country's largest teachers union, endorsed vaccine mandates for teachers, with requirements for regular COVID-19 testing for people who want to opt out.

“Guardians of children, all adults and teachers, need to recognize their responsibility to children to get vaccinated,” Versalovic said. 

Are COVID vaccine mandates legal? Supreme Court declines request by Indiana University students to block vaccine mandate

Half of all Americans are fully vaccinated, CDC data show, but the percentage is much higher in some states — and much lower in others.

The pandemic has made it clear children learn best in classrooms, so public health experts recommend schools do everything they can to hold in-person classes.

Unfortunately, COVID-19 is likely to spread more easily in schools when a community has high transmission, the CDC says – and much of the country has returned to those levels.

Versalovic says parents should keep their child at home if they have had a known COVID-19 exposure or are showing COVID symptoms. He also recommends parents have a conversation with their kids about best practices for limiting viral spread.

Successful mitigation strategies include social distancing and proper hygiene. And, of course, masking.

Parents should be cautious but not anxious about sending their children back to school, said Dr. Chad Perlyn, president of Nicklaus Children’s Hospital's Pediatric Specialists in the Miami area. Schooling is important to a child's mental and emotional development, Perlyn said.

That's the same reason some parents have cited in protesting school mask mandates. 

“We often hear the question, 'Is it natural for children to wear masks in schools?' And the obvious answer is no,” Perlyn said. "That said, the protections that masks can afford by limiting the spread of the disease is very meaningful.”

The benefit of masks far outweighs any downsides. For instance, Perlyn said, wearing a mask does not impede breathing. 

“Throughout the course of the pandemic there has been much discussion about whether masks cause increased (carbon dioxide) levels and whether that affects children," Perlyn said. "What we know is that the masks that children and adults would be wearing do not raise CO2 levels to any meaningful point.”

Fact check: Are masks unsafe?

Fact check: Did Stanford study find masks to be harmful?

Wearing a mask has no impact on cognitive function or brain development, he added.  What does are the side effects of COVID such as inflammation of the brain or the weeks-long phases of mental fog that have been reported in long-haul COVID cases. 

Perlyn encouraged parents to arrange Zoom play dates at the beginning of the school year so their children can interact and meet each other without masks. 

He also suggested parents or teachers craft a "smile button" for students, which is a photo of the child's face they pin on their clothes so others can essentially see through their mask. 

“Ideally, a child would be playing and laughing and interacting with other children without a mask. But I will say that I think we will see that in a matter of a few months," Vasolovic said. "I’m confident that we will reach that time before the end of the school year."

Contributing: Erin Richards, Elizabeth Weise, Mara Corbett, Ryan Marx, Chris Amico, USA TODAY; Lily Altavena, Detroit Free Press; María Méndez, Austin American-Statesman