The American Academy of Pediatrics (AAP) on Monday issued guidance recommending universal masking in schools among all staff and students ages two and older, even those who have been fully vaccinated against Covid-19—putting the group at odds with CDC's official guidance.

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AAP recommends universal masking

AAP said it is recommending universal masking "because a significant portion of the student population is not yet eligible for vaccines, and masking is proven to reduce transmission of the virus and to protect those who are not vaccinated."

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AAP also said many schools "will not have a system to monitor vaccine status of students, teachers, and staff, and some communities overall have low vaccination uptake where the virus may be circulating more prominently."

However, as long as masks are used consistently, "opening schools generally does not significantly increase community transmission," AAP said.

"We need to prioritize getting children back into schools alongside their friends and their teachers—and we all play a role in making sure it happens safely," Sonja O'Leary, chair of the AAP Council on School Health, said.

"This is why it's important to use every tool in our toolkit to safeguard children from Covid-19," Sara Bode, chair-elect of the AAP Council on School Health Executive Committee, said. "Universal masking is one of those tools, and has been proven effective in protecting people against other respiratory diseases, as well. It's also the most effective strategy to create consistent messages and expectations among students without the added burden of needing to monitor everyone's vaccination status."

In its current guidance, AAP did not recommend that schools mandate Covid-19 vaccinations, but it suggested that such requirements may have a place in the future. "It may become necessary for schools to collect Covid-19 vaccine information of staff and students and for schools to require Covid-19 vaccination for in-person learning," AAP said.

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AAP's recommendations make it the first physician group to break from CDC's guidance on masking in schools.

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Currently, CDC's guidance states, "Based on studies from 2020-2021 school year, CDC recommends schools maintain at least 3 feet of physical distance between students within classrooms, combined with indoor mask wearing by people who are not fully vaccinated, to reduce transmission risk."

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and chief medical advisor to the White House, acknowledged that AAP's recommendations differ from CDC's guidance. He said, however, that he believed AAP's guidance was reasonable.

"When you have a degree of viral dynamics in the community and you have a substantial proportion of the population that is unvaccinated, you really want to go the extra step, the extra mile... I think that the [AAP is] a thoughtful group," Fauci said. "They analyze the situation, and if they feel that that's the way to go, I think that is a reasonable thing to do."

Similarly, Francis Collins, director of NIH, said of the new recommendations, "They will not be popular amongst parents and kids who are sick of masks, but you know what? The virus doesn't care that we're sick of masks."

He added, "The virus is having another version of its wonderful party for itself. And to the degree that we can squash that by doing something that maybe is a little uncomfortable, a little inconvenient…if it looks like it's going to help, put the mask back on for a while." (Reyes, Axios, 7/19; Firth, MedPage Today, 7/19; Thebault, Washington Post, 7/19; Anthes, New York Times, 7/19)