In a new advisory published Monday, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) have recommended the use of masks for children, aged 12 years and up. Below this age, WHO states that masks can even be considered for children as young as 6, provided that the constraints and context are carefully considered.
Why this is important. The new school year is beginning around the world in the northern hemisphere. In Switzerland, it has already started in most cantons, with the exception of Fribourg (August 27) and Ticino (August 31). At the federal level, the mask has so far only been made compulsory in high schools and vocational schools, i.e. from the age of 15-16, and in higher education. In public transport, it is compulsory from the age of 12, in accordance with WHO recommendations.
The spirit. The August 24 advisory was issued jointly by the WHO, Infection Prevention and Control (IPC) Guidance Development Group, and Unicef, in collaboration with the International Paediatric Association (IPA).
It recommends the use of masks indexed to the level of risk, following the general recommendation of June 5 on the use of masks in adults.
It takes place in a context where the contribution of children to the spread of Covid-19 is not yet well known, although it is judged to be rather low.
According to the document:
"According to the limited available evidence, young children may have lower susceptibility to infection compared to adults, however available data suggests that this may vary by age among children. Data from seroepidemiology studies and
transmission studies suggest that older children (e.g. teenagers) may play a more active role in transmission than younger children."
For future studies on the usefulness of the mask in children, the agencies invite differentiation between the age groups 0-2, 2-4, 5-11 and over 12 years of age.
The letter. WHO and Unicef recommend the use of the mask against Covid-19:
in children and adolescents aged 12 years and older, as well as adults
in children between 6 and 11 years of age, subject to a careful assessment
"The benefits of wearing masks in children for COVID-19 control should be weighed against potential harm associated with wearing masks, including feasibility and discomfort, as well as social and communication concerns.”
For children aged 6 to 11 years and beyond, the decision to make masks mandatory should, therefore, take into account, according to the advisory:
the level of circulation of the virus in the child's environment and the risk of transmission within the child's age group
the social and cultural context, including the acceptance of the mask by other children
the child's ability to wear the mask correctly, with adult help
the potential impact of the mask on psychosocial development and learning
adaptation to the context: the presence of seniors in the home, school environment, sports activities, presence of handicaps or disorders that make it difficult to wear a mask.
For those with certain diseases, such as pediatric cancers or cystic fibrosis, mask-wearing for children would be favourable — under a doctor’s supervision. On the contrary, for those with disabilities or developmental disorders, wearing masks would be less suitable.
In context. WHO and Unicef also stress the importance of clearly instructing children on how to use masks safely and effectively, and of combining the mask with other protective measures such as physical distancing, hand washing and respiratory etiquette (not spitting, coughing into one's elbow, etc.).
These general recommendations apply to children in community settings, i.e., public spaces outside of medical settings. They are complementary to a notice published at the beginning of May by the WHO, which more specifically concerns recommended protective measures in schools.