‘We don’t need a study’: Health officials can’t offer evidence to support Youngkin’s mask order

A day after Gov. Glenn Youngkin issued an executive order giving students the ability to opt out of school masking policies, Dr. Colin Greene, the newly appointed state health commissioner, addressed the directive in an email to local health district directors.

“I suspect there are those who find this rule hard to hear,” he wrote, adding that they could discuss “the pros and cons of masking at length” in a planned monthly Zoom meeting. When it came to the Virginia Department of Health’s public stance, though, Greene was clear. 

“I respectfully remind all health directors that VDH is an executive agency, under the leadership, oversight and discipline of the governor,” he continued in the email, which was obtained by the Mercury. “Compliance with the word and intent of this executive order on the part of any VDH employee is not optional.”

What he couldn’t provide was evidence for the governor’s statements on the limited effectiveness of masks in schools, which ran counter to much of the department’s previous messaging prior to Youngkin’s inauguration on Jan. 15. In his order, the governor stated that cloth masks worn by children often weren’t clean, “resulting in the collection of impurities, including bacteria and parasites.”

“Additionally, wearing masks for prolonged periods of time, such as for an entire school day, decreases their effectiveness,” the order states. Dr. Denise Bonds, director of the Blue Ridge Health District, asked Greene for the research supporting those statements, writing it would help her conversations with schools if she could offer scientific references.

“One of the items you quoted is intuitive,” Greene responded. Worn all day, he wrote, it would be hard to argue that masks don’t collect materials from the mouth and nose, “which we all know are teeming with bacteria.”

“By deductive reasoning the mask, which is designed to capture droplets, will capture the bacteria, too,” Greene continued. “We don’t need a study to show that.”

A spokesperson for the Blue Ridge Health District said Bonds wasn’t available to comment, referring the Mercury back to VDH’s central office in Richmond. VDH spokesperson Maria Reppas referred all questions on the executive order to the governor’s office.

But the change in policy has been a 180-degree shift for the state, which, under former Gov. Ralph Northam, had required local school districts to adopt universal masking policies. And for at least one local health district employee, who spoke on background due to fear of reprisal for discussing the executive order, the response rankled after nearly two years in a seemingly unending quest to curb COVID-19 transmission that the worker said sometimes included 80-hour work weeks. 

The lack of evidence has been especially troubling, the employee said, amid broader anxieties over Youngkin’s mask-optional order, which has led to open defiance and widespread confusion within many Virginia school districts. 

Macaulay Porter, a spokesperson for the governor, said VDH staff and Greene advised Youngkin on his order and new interim prevention guidelines for schools. Greene, though, was unable to cite a single study supporting the governor’s claims. And the reference lists for both the current guidance and the previous version issued in July by the Northam administration, which recommended universal masking indoors and among unvaccinated school athletes, are exactly the same with the exception of a single study — preprint research, added to the new guidance, that polled school children in Switzerland on the perceived usefulness of masks. 

Sixty percent of those Swiss students viewed masks as useful, according to the abstract, though “a small but non-negligible proportion of children reported discomfort and side-effects.”

Examining the evidence

While Youngkin’s stance on masking in schools marks a significant policy shift in Virginia, it’s not unique in the broader debate over masking and other pandemic public health measures. Courts have already struck down attempts by Republican governors to prohibit or limit masking in states like Texas and Florida, where Gov. Ron DeSantis issued a similar directive giving parents the “freedom to choose.” Over the last few months, outlets including The Atlantic and The Washington Post have published articles and editorials making the case against mandatory masking for students — many focused on studies conducted by the U.S. Centers for Disease Control and Prevention. 

It’s true that some of those studies, including a frequently criticized paper studying school masking in Arizona, didn’t disentangle mask use from other variables. The CDC’s research on two counties in Arizona, for example — conducted last summer before omicron began circulating widely — didn’t account for vaccination status among staff or students and included a period when many schools were closed. Other critics have pointed to a lack of randomized clinical trials, the gold standard for research rigor, when it comes to masking effectiveness.

Broader studies on masking, though, including a randomized trial in Bangladesh, have shown that surgical masks do slow coronavirus transmission. If the quality of face coverings is truly a concern for the governor, the local health district employee who spoke to the Mercury suggested, schools should start providing better masks. But even cloth coverings seem to have made a difference in some research on early outbreaks, including the case of two Missouri hairstylists who worked with clients while symptomatic with COVID-19. 

Among 139 customers who were exposed, none reported symptoms and 67 tested negative for the virus. A follow-up study found that both hairdressers and the vast majority of their clients wore masks throughout their appointments.

VDH’s new guidance focuses on children, telling school administrators there’s “presently a lack of consensus among health experts regarding the costs and benefits of mask-wearing for children in school.” In Virginia, though, the evidence against masks is largely anecdotal. In an interview with the Mercury, Greene said he based his advice to the governor on “observational data” showing that omicron cases rose much faster in urban areas despite higher rates of mask use and other potential mitigation measures. 

“Observational data means exactly what it suggests — you look at numbers and that’s what you see,” he added. “You can’t scientifically say, ‘Well, this proves something.” The department did not specifically look at mask use or transmission rates within schools, and offered no research, beyond observations, that areas like Loudoun County or Arlington truly had higher day-to-day mask use than other parts of the state.

Asked what he meant when he said omicron spread “faster” in urban areas, Greene responded that areas like Northern Virginia saw case rates rise sooner as the virus began to circulate and saw a greater fold increase than other parts of the state. But he also acknowledged that he hadn’t checked the data since Jan. 11, and suspected the difference was shrinking given that cases were still rising in areas like Southwest Virginia while northern localities had reached their peak.

“Eventually they’ll come closer together if they haven’t already,” Greene said. Asked whether urban areas were hit first and hardest because they’re densely populated, rather than because masking doesn’t work, he responded that it wasn’t clear.

“You can do hypotheticals all day long, but the point is there was no overwhelming evidence that whatever the urban areas were doing was particularly effective at stopping omicron,” Greene said. Asked for evidence that masks could harbor bacteria and parasites — and that those organisms would be harmful, given they’d ostensibly come from students’ own bodies — he offered an anecdote from his time delivering infants in the Army.

“You have to wear a mask when you’re delivering a baby, and I can tell you sneezing into a surgical mask is not a pleasant experience,” Greene said. “I’m not sure the children are going to tolerate it all that well.”

Responding to schools

Over the last several days, Youngkin has repeatedly defended his order, insisting that worried parents are still free to send their children to school wearing masks even while some districts drop universal requirements. The Virginia chapter of the American Academy of Pediatrics, though, still strongly recommends universal masking. And for many teachers and parents, including more than a dozen who reached out directly to the Mercury, Youngkin’s reassurances have rung hollow amid case counts and hospitalization numbers that still far surpass previous surges. Masking is most effective, experts widely agree, when done consistently by everyone, particularly in indoor settings. 

Since the highly transmissible omicron variant began to circle widely across Virginia, pediatric COVID-19 cases have skyrocketed, according to the department’s own data, shooting from 2,142 a week in late October to a peak of 10,617 weekly cases in mid-January. At the start of the month, more than 100 children were hospitalized across the state compared to 13 in the first week of October. And on Thursday, VDH confirmed that an eighth Virginia child under the age of 10 has died from the disease since the beginning of the pandemic.

Beyond the rising metrics, omicron has placed an even greater burden on many Virginia schools already strained by the pandemic. Local districts have reported a growing number of student and staff absences due to infections or the need to quarantine after close exposures. Those outages have compounded existing staffing shortages in many districts, in some cases forcing office staff to cover classes or school resource officers to cover cafeteria duty. 

Since October, there have been more than 400 outbreaks — once defined by the department as at least two laboratory-confirmed cases linked to a specific exposure setting, though that threshold was increased to at least three cases on Jan. 1 — in Virginia K-12 schools. While some have involved more than two dozen infections, the majority have case counts so low that numbers are suppressed by the department. And with vaccines still optional for many school teachers, and uptake still sluggish among 5 to 11-year-olds, even districts in solidly red counties have viewed masks as an important tool for slowing in-school transmission.

“We almost begged parents to consider waiting a few more weeks to send students to school without masks,” said Keith Perrigan, the superintendent for Bristol Public Schools, a district that’s chosen to comply with Youngkin’s executive order. The division has been open for in-person instruction since the fall of 2020, and before omicron, Perrigan said there were at most 18 positive cases in a single week. After the variant began to spread, though, there were consecutive weeks with 100 cases or more among staff and students, most linked to transmission in the wider community.

“Bristol is really feeling the effects right now,” he said. Even with the district’s opt-out policy, Perrigan said 83 percent of families are still adhering to universal masking. And masks are still required for staff out of fear of going the way of Bristol, Tennessee, right across the border, which had to close schools due to staffing shortages. 

Like other school administrators, Perrigan was puzzled that the administration didn’t wait at least a few weeks for cases to drop below pre-surge levels.

“The reason we didn’t have a lot of people taking advantage of the new policy is that so many of our students have seen their classmates quarantining and missing school,”  he said. “We want to get back to normal in-person learning as quickly as possible. But we can’t let that get in the way of our first goal, which is to keep schools open.”