GILFORD — Dr. Maude Aldridge, a Belmont pediatrician who lives in Gilford, has a five-year-old who will start kindergarten next week wearing a mask – an optional practice Aldridge hopes will become contagious and mandatory – especially as COVID cases rise and the Delta Variant brings new risks.
It’s about slowing community contagion, she said, which is a pressing public health mission now. “Even if no one else does, he may by the only one in his class. It’s all about role modeling. If kids see other people do it, they want to do it, too.”
It’s a contentious topic that divides parents. Aldridge wrote to the Gilford School Board on Aug. 20, more than two weeks after it unanimously adopted a policy of optional mask-wearing for students in district schools, listing 28 local physicians who she said also supported mandatory masks. After she sent the letter, Concord Hospital requested that Aldridge speak as an individual physician, and not for the hospital system.
“I support Dr. Aldridge’s letter,” said Dr. Lauren Cooper, who works in the emergency room at Concord Hospital-Laconia, and has two children at Gilford Middle School. “The public health experts have made it clear that it’s safer to be in school with masks and other COVID precautions than it is to be in school without them.”
“I think we can all see what’s happening. Cases are climbing everywhere,” Aldridge said. “We haven’t seen that so much in New Hampshire yet, but now is the right time to act so it doesn’t get to what we’re seeing down south. It’s about slowing transmission. We know that children can spread COVID as readily as adults, in some cases, more so. It’s about slowing community transmission,” Aldridge said.
As public schools throughout New Hampshire finalize plans to reopen safely, worries simmer about how best to protect the community going forward, and keep schools open for the duration of the school year, in the wake of a year of hybrid or remote learning.
In the Lakes Region and elsewhere, many parents believe mandating masks is excessive, inhibiting speech, hearing, understanding and social interaction, and doubt they are even effective at thwarting disease. Others staunchly favor masks as one essential tool to combat COVID’s spread and allow kids to safely attend school as long as possible.
“Lots of little things do make a difference in the long term so kids can have a successful school year,” said Aldridge. She said she advocates social distancing in classrooms and lunchrooms, limiting numbers of students eating together in cafeterias, and spending time outdoors whenever weather permits, including for snacks and lunch.
At mask-optional schools, requiring when and where they are worn is a debate likely to resurface as schools head into fall and winter, and life increasingly occurs indoors. The Laconia School Board will meet Wednesday, Sept. 1, at 6:30 p.m. to vote on a the district’s mask policy. Gilford’s board unanimously endorsed optional masks on Aug. 2, and its next meeting is Sept. 13
Gretchen Gandini, Gilford School Board chair, said, “At this point, we approved that plan unanimously. We’ll continue to monitor the situation and reconsider and revise the reopening plan and protocols when and if necessary.”
So far, most Lakes Region schools have opted for optional mask wearing, at least until COVID information changes. This summer Belknap County had one of the highest rates in the state for coronavirus cases, perhaps because of the influx of vacationers who gathered with family and friends in person.
The prospect of schools becoming a vector for increased transmission weighs heavily on Aldridge.
“COVID is not done with us and we’re wanting to move on, but we can’t,” she said. “Layers of protection are what we’re hoping to have.”
Data gathered over the last year and a half shows that mask-wearing markedly decreases COVID’s spread, and this is especially important in schools because children usually have mild symptoms or no symptoms, but can still spread the disease and its variants, said Dr. Joshua Morrison, who works in the emergency department at Concord Hospital-Laconia.
“If you’re monitoring based on symptoms, you’d miss a lot of people,” said Morrison.
Studies worldwide show that psycho-social harm to students from wearing masks is far less than the greater damage from not being able to attend school in person, Morrison said. “By wearing masks now it’s our best way to decrease transmission and keep schools open and protect that resource. To me it seems to be the logical way to go.”
“We can’t act like it’s gone away when it hasn’t. Children might do fine, but they may pass it to parents and grandparents, who take it to the workplace. If we don’t slow down the speed of transmission, we’ll have more cases in the hospital,” Aldridge said.
New Hampshire’s hospitals have seen a rise in admissions and emergency room visits in the past month for reasons related to the coronavirus, possibly because more people who can work remotely have decided to relocate here, hospital administrators say. That pressure is felt acutely in the Lakes Region. Slowing transmission is key to preserving regional health care capacity, and not over-taxing individual hospitals that are already stressed by staff shortages heading into cold and flu season, when a COVID resurgence is expected.
At Huggins Hospital in Wolfeboro, which typically spikes in number of visits during summer, there are 70 positions open, compared to the usual 20 to 30, said Monika O’Clair, vice president of strategy and community relations. “It’s a strain on us, no matter what area is short,” with effects felt across different areas. “We’ve been running close to capacity,” O’Clair said. “We’re already seeing more patients than we have before and have a staffing shortage on top of that.”
This summer, Huggins experienced a record number of emergency room visits, as well as a new peak in requests for primary care. During the past two weeks, the 25-bed critical access hospital that serves the western side of Lake Winnipesaukee to the Maine border has seen a rise in COVID-related hospitalizations. Like many regional hospitals, “We are anticipating a COVID surge,” said O’Clair, and have a plan ready. When necessary, less-critical services will be suspended in order to transfer staff to treat incoming COVID patients – a response that is essential but can have long term consequences for others. Health care providers throughout the state say they continue to treat patients whose chronic conditions went unrecognized or untreated during COVID, and have since become more serious.
Slowing contagion becomes a way to keep hospital beds open for those who need them, doctors and administrators say.
“You’ll get an area that has an increase in the number of COVID cases, and that spread continues for a while,” said O’Clair. “We’re feeling a lot of pressure already with staffing and capacity. It’s a real thing, and we’re having to consider that when planning for the future.”
During the last two weeks, COVID admissions more than doubled at many New Hampshire hospitals. Last week, Memorial Hospital in North Conway officially entered emergency operations mode, as intensive care and medical-surgery beds topped at or near capacity. Neither Concord Hospital – Laconia nor Speare Memorial Hospital in Plymouth returned calls for this story.
Morrison, who lives in Gilford and has young children, said he understands the reluctance to require school-age children to wear masks, because so much of school is social. “There’s a lot of emotion with this. None of us were prepared for this kind of thing. When it comes to trying to do the best for our kids and keeping schools open, we have to do the best with the information we’ve been given,” Morrison.
The most recent recommendations from the Centers for Disease Control and the American Academy of pediatrics call for universal face masks for all teachers, staff, students and school visitors who are age two or older, regardless of whether they’ve been vaccinated. COVID-19 is now a top 10 cause of death for adolescents in the United States, according to an August 2021 bulletin from the CDC and AAP. Epidemiologists estimate that the Delta Variant is twice as contagious, which means a greater potential for people getting sick and seeking hospital care.
“It’s a group effect,” Aldridge said. Contact tracing, quarantining, and testing is important to prevent sick children from going to school, she said.
“If you ask any child, would you rather be a school with a mask, or at home, they want to be with their friends. These decisions shouldn’t be political,” said Aldridge, whose 2-year-old daughter wears a mask for up to an hour when they go shopping. “They should be common sense, and about taking care of each other and protecting each other. Kids with asthma can wear a mask. If they can’t, then they shouldn’t be in the classroom because their asthma is not well controlled.”
When students are given mask-free breaks and time outside, “they’re more compliant wearing them indoors. It needs to be planned into the day,” Aldridge said.