2021年10月30日 星期六

What’s the off-ramp for masking at school?

With vaccines soon available to kids five and up, planning should start now.
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October 30, 2021

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Kiersten Essenpreis

Mandatory masking at schools has been among the biggest issues in the country over the past few months, with instances of mask opponents berating and threatening school board meeting attendees. The topic has become highly politicized, and it's sure to get even more contentious now that the Food and Drug Administration has authorized the emergency use of the Pfizer-BioNTech vaccine for children ages 5 to 11.

Linsey Marr, an engineering professor at Virginia Tech who studies the airborne transmission of viruses, said that when she tweeted about a potential timeline for lifting of masking rules once 5- to 11-year-olds start getting Covid vaccines, she was flooded with replies from all sides.

"I'm almost afraid to talk about it, because people have such differing and strong opinions on this topic," she told me. "I put my thoughts out there, because we need to figure this out. The vaccine should change things for us, and we don't want kids to wear masks in school indefinitely."

Some folks replying to Marr were adamant about the need for masks in schools as long as Covid is with us, especially to protect immunocompromised children and children under 5, who still won't be able to get vaccinated. But that argument might assume that there are no downsides to children wearing masks all day, every day, indefinitely, which is something we can't say with certainty.

The Covid pandemic is mostly unprecedented in our lives, and "we don't have the data on what two years of masking children in an early learning environment has to do with their socio-emotional development," said David Rubin, the director of PolicyLab at Children's Hospital of Philadelphia and a professor of pediatrics at Penn's Perelman School of Medicine.

It's worth noting that the World Health Organization's website says, "In general, children ages 5 and under should not be required to wear masks." That contrasts with guidance from the Centers for Disease Control and Prevention that "masks should be worn indoors by all individuals (ages 2 and older) who are not fully vaccinated." (It's easy to see why people find this all very confusing.) Additionally, there's concern that children with speech difficulties, or who have autism or sensory challenges, may be hurt by all-day mask wearing.

Because the masking issue has been so divisive, I fear we haven't been able to have a practical, nuanced and data-driven conversation about what a good masking policy would look like now that nearly all school-age kids can soon be vaccinated. In some big cities and blue states, kids are wearing masks constantly, including outdoors, even though, as The New York Times's David Leonhardt reported in May, the science indicates that "masks make a huge difference indoors and rarely matter outdoors." Some red states, meanwhile, prevent schools from requiring masks. None of this makes sense.

To get a feel for what an off-ramp for in-school masking could look like, I interviewed 11 experts over the past week, including pediatricians, infectious disease specialists and environmental scientists who specialize in indoor transmission. It became clear that this issue won't get sorted out easily, because these experts weren't always unanimous.

But it's time to start a serious discussion about taking off masks since it will take time to institute policies after communities — hopefully — come to some degree of consensus. Maybe the carrot of mask-free schools will inspire some more hesitant families to get their children vaccinated.

At this point, only about a third of parents say they'll get their 5 to 11-year-olds vaccinated as soon as possible, with about a third saying they'll wait and see, and a third saying they won't, or will vaccinate only if it's mandated, according to September figures from the Kaiser Family Foundation's Covid-19 Vaccine Monitor. As one commenter on a Times Opinion guest essay put it, "Literally the only thing motivating me to get my kid vaccinated is removing mask mandates."

First, we should talk about where there is widespread agreement among experts: Every person I spoke to said children 5 and up should get the vaccine. The other point of significant agreement was that masks can be useful tools in our Covid prevention kit, along with measures like proper ventilation and widely available rapid testing.

Out of these 11 experts, two felt it was too soon to start talking about removing masks. "We will need to see the level of vaccine uptake in kids to have a more informed conversation about masking in youth-based groups and organizations," said Nia Heard-Garris, an assistant professor of pediatrics at Northwestern University and a pediatrician at the Lurie Children's Hospital of Chicago.

Of the nine others, there were a range of responses, which I'll place into two major buckets.

Set a Date

Monica Gandhi, a professor of medicine at the University of California, San Francisco, and associate chief of its infectious disease division, said in an email that with vaccine authorization for children 5 to 11, "it makes most sense to me to lift mask mandates in schools (and for adults) once children have the ability to get both doses of the vaccine" — which, in an ideal world, likely means around eight weeks after shots become widely available. Gandhi said, "I am a firm believer in positive motivation and messaging and think making this metric explicit will convince more parents to vaccinate their children."

Marr, the engineering professor, tweeted that two weeks after school restarts in January should be the earliest date under consideration, because children may pick up the usual non-Covid bugs during the holidays. She also said that she liked the idea of data-driven mask policies based on the level of virus spread in communities. Some experts, like Aaron Carroll, a professor of pediatrics and the chief health officer at Indiana University, was wary of setting specific dates, in case another highly infectious variant like Delta hits. Which brings me to …

Create Unmasking Metrics, and Make Them Local

Many experts I spoke to mentioned Nevada as a model for how schools might think about creating off-ramp policies for masks. What's nice about the state's policy for indoor masking is it also provides a ramp back on if there are Covid surges — "an on-and-off switch based on local transmission rates," as Boston University's Julia Raifman and Alexandra Skinner described it.

The state uses the C.D.C.'s Covid-19 County Check Tool to assess whether there is low, moderate, substantial or high transmission. If there is substantial or high transmission in a county, masks are required in indoor public spaces. If there is low or moderate transmission, masks can come off. (Experts don't agree about what level of community transmission should prompt a move toward unmasking in schools — some think the level can be higher than in the broader community because Covid-related illness in children tends to be less severe; others think the level would have to be lower because many schools have outdated HVAC systems.)

"Something that is important about mask policies is that they are the opposite of lockdowns," said Raifman, an assistant professor of public health. Masking helps reduce the amount of Covid in shared air, and it allows kids to avoid remote learning, something that just about all of us agree we've had enough of.

Another appealing aspect of using local transmission levels to assess the need for masks at school is that it applies to all children, regardless of vaccine status. "I like the link to cases and not to vaccination," because there are such large inequities related to vaccine status, Raifman said, and removing mask policies during periods of high transmission "just concentrates the risk" among these under-vaccinated communities.

The Need for Some Measure of Certainty

Whatever individual communities and states decide about what makes sense for them, part of the reason it's necessary to talk about concrete benchmarks for unmasking is because the pandemic has created, for some, deep uncertainty. As the American Psychological Association reports, its new survey finds that "decision-making fatigue is having a disproportionate impact on parents." "Almost half of parents reported that sometimes they are so stressed about the coronavirus pandemic that they struggle to make basic decisions (e.g., what to wear, what to eat)" — compared to just 24 percent of non-parents who feel this stressed.

Moving the conversation on masking at school forward, no matter how complicated it is, may give these stressed parents hope for a more certain future. My hope is that we can start to approach these discussions with less rancor and more empathy, and acknowledge that often there is no absolute right answer.

"Everyone thinks science is yes or no," said Yvonne A. Maldonado, chief of Stanford Medicine's division of pediatric infectious diseases. "Science is constantly evolving. The only thing that's certain in this world is death and taxes. People think we have a crystal ball, but we are using the data to do the best we can do today."

THE LATEST ON COVID, VACCINES AND SCHOOLS.

What's new this week

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The New York Times; Photographs by ronstik and Betka82 via Getty Images

Guest Essay

Yes, You'll Want to Vaccinate Your Kids Against Covid. An Expert Explains Why.

Just because Covid-19 is sickening and killing fewer children than adults does not mean that children are free from risk.

By Lee Savio Beers

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Aileen Son for The New York Times

Ask well

My Kid Is Afraid of Shots. How Can We Prepare for the Covid Vaccine?

Trypanophobia, or the fear of needles, is common among young children. But there are ways to make vaccination as painless as possible.

By Nia Heard-Garris, M.D.

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Rodrigo Garrido/Reuters

When Vaccinating Kids, Does Weight Matter? Should an 11-Year-Old Wait to Turn 12 to Get a Bigger Dose?

We turned to five experts to answer these frequently-asked questions.

By Christina Caron

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Guest Essay

'There's Almost No Incentive at All to Give Him the Vaccine.'

A "moral calm" is holding parents back from vaccinating their kids.

By Jessica Calarco

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Tamir Kalifa for The New York Times

Ask Well

Answers to Your Questions About Covid Vaccines and Kids

Children ages 12 to 17 have been eligible to be vaccinated against Covid-19, but parents of younger kids will have to wait at least several more weeks. Here's what we know about giving Covid shots to kids.

By Tara Parker-Pope and Dani Blum

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2021年10月29日 星期五

The Daily: Social Spending and American Power

"It's about leading the world or letting the world pass us by."

Welcome to the weekend, and Happy Halloween! We'd love to know if you have a costume inspired by The Daily in the works. Send us a picture, and you could be featured in an upcoming newsletter.

This week on the show, we spent a lot of time talking about President Biden's social spending bill. It started as a sprawling, once-in-a-generation expansion of the social safety net: an ambitious $3.5 trillion plan to extend access to health care, public education and paid parental leave, affecting nearly every American's life. But, as you heard this week, it has been whittled down to a smaller version after Senators Kyrsten Sinema of Arizona and Joe Manchin III of West Virginia expressed repeated objections to specific provisions.

We explained the dramatic domestic implications of the legislative compromises being negotiated by Democrats. But as the president heads abroad for a diplomatic marathon with world leaders this weekend, we want to use this newsletter to pick up where we ended today's episode — and ask how the impacts of these bills will ripple beyond our borders.

The Big Idea: What does the social spending bill mean for American power abroad?

The Daily strives to reveal a new idea in every episode. Below, we go deeper on one from our show this week.

President Biden and Speaker Nancy Pelosi at the Capitol on Thursday.Stefani Reynolds for The New York Times

The Biden administration is facing a week that could determine the president's legacy.

At home, Biden has made clear that his presidency, the Democrats' electoral prospects in the midterms and the social welfare of millions of Americans are hanging in the balance as Democrats negotiate a compromise on his social spending bill. But before leaving for two major international summits, the G20 Summit and COP26, he also framed this moment in terms of America's international standing: "It's about leading the world or letting the world pass us by," he said.

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So we wanted to ask a few experts: Is this moment really a referendum on America's global power, as Biden said? Here are three ways they said the president's bill matters for American diplomacy.

A test to deliver

Biden is arriving at two major summits facing a test: Can he resume global leadership and reassure allies that the U.S. can be trusted as a consistent partner?

"There is general concern among the allies and friends about what is happening to our democracy," said Joseph S. Nye Jr., a Harvard professor who coined the term "soft power." He added that while many allies were "delighted to see America return to multilateral institutions," many now wonder whether entrenched polarization could make American leadership unreliable — and subject to increasingly dramatic swings based on which party is in power.

"They're wondering: Are we going to see flip-flopping back and forth?" Dr. Nye said. He added that allies were particularly concerned about disinformation, as well as the lack of public and congressional consensus about the legitimacy of Biden's victory.

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To Leslie Vinjamuri, a director of the U.S. and the Americas program at Chatham House, the social spending bill is a chance to prove that "American leadership cannot only sound good and look good, but that it can actually deliver," she said. She noted that creating consensus and overcoming entrenched partisanship was "the great promise of Joe Biden."

Now, the social spending bill is both "a referendum on President Biden and whether any president can make a system that the rest of the world probably perceives to be a little bit broken" actually work, she said.

A chance for climate leadership

As a result of political polarization, Dr. Nye believes that allies will be less willing "to treat us as the North Star to guide their policies" in the long term. However, he sees bold climate action, as outlined in the social spending bill, as a way to reassert some global leadership that was lost in the Trump era.

The United States formally withdrew from the Paris climate agreement under Donald Trump. Biden promptly rejoined the agreement after entering office, and climate has emerged as the single largest category in his social spending bill. The climate crisis is now the center of his party's domestic agenda ahead of the global climate summit in Glasgow. (It was unclear this week if all Democrats would support the package.)

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"There are very few people on this planet who think that America is on the right side of climate change in terms of its cars and its energy use," Dr. Vinjamuri said. But getting Democrats to vote for the proposed $555 billion for climate programs would be a start in helping the "U.S. meet its targets," she added, giving the country the "legitimacy to put pressure on others to meet their targets."

Paid leave and soft power

With the spending bill yet to be finalized, Dr. Vinjamuri notes that what is left out of the legislation could also have implications for America's standing abroad, sending a clear signal to foreign citizens about what the U.S. values.

"Our soft power is massively negatively affected," she said, by the news that paid family leave — a public good provided by other developed nations — is likely to be removed from the social spending bill. People who experience these benefits "just do not understand, and they can't imagine that it can be anything but crippling for the U.S. in the long term," she added.

Dr. Nye argues that, in regards to the social safety net, "America has always been inadequate in European eyes," he said. While he supports the proposals and believes a lack of paid family leave "hurts us," he believes "other sources of influence," such as expanding U.S. vaccine diplomacy, would do more to improve America's standing abroad.

Still, both agree that world leaders are ultimately more focused on threats to the American political system. "The fact that we might lose the quality of our democracy which has been a bedrock for American standing in the world," Dr. Nye said, "that is the real threat to our soft power."

LISTEN TO OUR EPISODES ABOUT THE BILL:

A Delicate Compromise in the Capitol

President Biden's ability to win legislative consensus is being tested by his social spending and infrastructure bills.

By Sabrina Tavernise, Asthaa Chaturvedi, Rob Szypko, Rachelle Bonja, Dave Shaw, Dan Powell and Chris Wood

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Why Spending Too Little Could Backfire on Democrats

Legislative compromises could complicate the Biden administration's efforts to expand the social safety net.

By Michael Barbaro, Stella Tan, Daniel Guillemette, Rob Szypko, Chelsea Daniel, Rachel Quester, Lisa Tobin, M.J. Davis Lin and Chris Wood

Article Image

The Story of Senator Kyrsten Sinema

Many Democrats accuse the Arizona senator of blocking key aspects of President Biden's agenda. She has remained quiet.

By Sabrina Tavernise, Rachel Quester, Sydney Harper, Robert Jimison, Diana Nguyen, Soraya Shockley, Paige Cowett and Chris Wood

Article Image

Meet two of our composers

This week, you may recall hearing the foreboding string music in Monday's episode on Evergrande, or the deep drone and pulsing dulcitone behind yesterday's recap of Ahmaud Arbery's killing. Our audio team has three dedicated composers — Elisheba Ittoop, Marion Lozano and Dan Powell. Below, we asked Elisheba and Marion a few questions about how they make their music.

Elisheba Ittoop, left, and Marion Lozano, two composers for The Daily.Left: Elisheba Ittoop. Right: Sabrina Zain.

Where does the composition process start?

Every morning, the Daily team gathers to discuss upcoming episodes and share new pitches. Our three composers take turns attending these meetings, and then we debrief on which stories we think would benefit from original scoring.

Usually, more than one of us is eager to compose music for an episode, so we tend to tag-team. We assign a lead composer who is responsible for communicating with the episode's producers and understanding their vision for it, and then clearly translating that vision to the other composers.

There's a saying that "talking about music is like dancing about architecture." If a producer were to tell us, "This moment should sound like blue," we'd all probably come up with dramatically different music cues. Elisheba might go the sunshine-and-butterflies route, while Marion might come back with a death-and-destruction motif. (This has actually happened!) That's why it's vital for us to assign a lead composer to each episode. If one of us goes astray, the lead composer will bring us back.

Can you tell us about the composing process for a recent episode?

Earlier this month, The Daily ran an episode called "Which Towns Are Worth Saving?" about the effects of climate change on two towns in North Carolina, Avon and Fair Bluff. Elisheba is from North Carolina, so she felt a personal draw to the story.

A few weeks before the episode aired, Elisheba talked to Michael Simon Johnson, the lead producer, about the type of mood he wanted the scoring to achieve. Elisheba wanted to ensure that she and Michael were on the same page, so she made a playlist of songs that felt very "North Carolina" to her: warm but a little melancholy, with flat-picked guitar and sparse instrumentation. Michael said the mood of the playlist was exactly right.

Elisheba, Marion, Dan and the audio fellow Chelsea Daniel ultimately composed the music for the episode, using the playlist as a jumping-off point.

Here's a song Marion wrote that's meant to sound as if you're walking down the streets of Fair Bluff. It features both an electric and acoustic guitar, as she wanted the grit of the electric and the roundness of the acoustic. If you listen carefully, it also has subtle imperfections (like pitch flubs and timing issues), which speak to the troubled history of flooding in the town.

Here's a song by Elisheba that feels beautiful and warm, but also mournful. It conveys the idea that although the town can save itself in the short-term, the threats of climate change are urgent and inevitable.

Do you ever have original music that doesn't make it into the episode?

This actually happens quite often! For every cue a composer creates, there are three others that don't make it into the final episode. It comes down to variables like texture, tone and whether or not there's a good scene for it.

Whenever we make a cue, we add it to our Daily music library, which has over seven gigabytes of original music. Here are some examples:

You may recall hearing Elisheba's song called "A Fine Needle" in our episode about a young Afghan woman named N. The producer Lynsea Garrison was drawn to the song for its "eerie quality" — like a "ballerina spinning in a jewelry box," she said. "There was innocence and tension in it that I loved and, of course, just sadness."

And Marion's song "Cash Money" found a home in Monday's episode on Evergrande, the collapsing property developer in China. It's in a minor key, and it features strings and piano engaging in dark tones. Her inspiration was the theme music of the TV show "Succession."

On The Daily this week

Monday: Why Evergrande, a sprawling real estate developer in China, is teetering on the edge of collapse.

Tuesday: Democrats are on the brink of reaching a deal to expand the social safety net in the U.S. But could the cutbacks they've made complicate the original ambition of the bill?

Wednesday: The story of Kyrsten Sinema, the Arizona senator who's played an outsized role in shaping the bill.

Thursday: Ahmaud Arbery was chased and shot to death on a residential street. Will a jury rule that he was murdered?

Friday: Why Joe Biden's ability to win legislative consensus is being tested by his social spending and infrastructure bills.

That's it for the Daily newsletter. See you next week.

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