Parents asking for medical exemptions from school mask rules are rebuffed by doctors

After the mother missed the deadline to enroll in distance education, she begged her son’s pediatrician to sign a letter exempting the 5-year-old from the Philadelphia School District mask mandate.

The child had mild asthma and she thought a mask would make the situation worse. She also thought he was too young to abide by the All Day Rule.

Daniel Taylor, director of community pediatrics and children’s advocacy at St. Christopher’s Hospital for Children, patiently explained why he couldn’t provide an exemption: a mask would not affect childhood asthma and since asthma could make COVID-19 worse, masking was especially important to him. Teachers were trained to help children wear face coverings properly. And the best thing a mother can do to protect herself and her son would be to get the vaccine.

“She was somewhat influenced by the fact that the mask is important if the child has asthma. Not so swayed to trust teachers, ”Taylor said, recalling the encounter, one of dozens of exemption requests over the past month. his group lined up. “And not at all influenced by the science behind the vaccine.”

For pediatricians and family physicians, the school mask mandates are the latest headache and heartache, drawing them into a debate loaded with scientific, political, educational, public health and personal arguments.

It can also be a minefield for hospitals.

“If one doctor says yes and another no, it’s not a good place to be,” said Douglas Thompson, chief medical officer at St. Chris, which serves a predominantly low-income population in north Philadelphia.

St. Chris does not have a general policy on granting mask exemptions, leaving the decision to individual practitioners, Thompson said. But across the country, a deluge of requests has led some suppliers to be preemptive.

Nemours Children’s Health, a pediatric health system in Delaware, New Jersey and Pennsylvania, sent emails to parents and posted a statement on its website: “The American Academy of Pediatrics (AAP) recommends that all students over 2 years of age and all school personnel should wear face masks in school, unless medical or developmental conditions prohibit their use. Therefore, we not provide mask exemption letters for the school.

In North Carolina, where COVID-19 is on the rise even though 63% of adults are fully vaccinated, Hendersonville Pediatrics emailed families saying its doctors “will not write a mask exemption letter for any patient in North Carolina. no circumstances “.

In Minnesota, a large group of pediatric pulmonologists refused to respond to requests for exemptions for children playing indoor sports. “Providers and nurses of respiratory and intensive care pediatric specialists will not provide mask exemption letters,” they wrote, noting that special masks for hockey players have been developed to improve performance. air circulation and reduce condensation.

While wearing a mask for hours can be uncomfortable, it doesn’t cause physical or psychological damage, unlike the misinformation of opponents on social media.

The are certain conditions which make masking impractical or intolerable for a small minority of children 2 years of age or older. Based on guidelines from the AAP and the Centers for Disease Control and Prevention, children who have a physical or intellectual disability that prevents them from removing a sheet mask should not be required to wear one. But children with speech problems, autism or a mental health disorder should not be automatically exempted. Parents and teachers should consider options such as face masks with clear plastic inserts, or provide distance education for the child.

Heart and lung conditions, including asthma, do not automatically justify medical exemption, experts agree, especially since these conditions put people at a high risk of complications from COVID-19.

But like vaccinations, masking is seen by some as a matter of personal choice, not a matter of protecting their own health and the health of others. Fierce opposition to the school mask rules plays out in a variety of ways, with healthcare providers often caught in the middle.

Pennsylvania, for example, has ordered masking for students, staff and visitors starting September 7 at all schools and daycares from kindergarten to grade 12. But some school boards, including in the Eastern Lancaster County School District, have allowed parents to exempt their children with nothing more than a signature – no need for a doctor to attest to a health problem or a handicap.

In a September 10 letter to 500 school districts, the Pennsylvania Department of Education said parental approval was not sufficient; medical documentation from a physician must be provided. But it is not known how far state officials will go to enforce order.

Schools with many low-income students face a particularly thorny dilemma: is it better to tolerate mask exemptions at the risk of a COVID-19 outbreak, or strictly enforce masking at the risk that some parents opt for? distance education? Studies have shown that the “learning loss” during distance education over the past year has worsened the achievement gaps related to socio-economic disadvantage and race.

Taylor said he was surprised when a few schools near St. Chris sent a letter asking doctors to allow exemption requests already signed by parents – in effect making it the doctors’ responsibility to ignore. advice from their own medical society.

“It’s almost like, ‘We need our kids to come to school, so we’re going to take care of some parents,’” Taylor said. “I’m afraid there are smaller practices out there that would only sign him.”

Of course, even doctors and nurses can oppose masks and vaccines. Joel Yeager, of Heritage Family Health in Lebanon County, denounced the mask and arrest orders of Pennsylvania Governor Tom Wolf at the start of the pandemic. This month, he posted a four-page letter online claiming the masks cause health problems, citing two journal articles that were retracted. He urged parents to “print your own copy” to apply for a school mask exemption.

The Wolf administration said it would refer doctors who promote such lies “to the appropriate licensing boards for possible disciplinary action.”

Editor Sarah Gantz contributed to this article.