Why Are Preschoolers Subject to the Strictest COVID Rules in New York City?

One morning last week, I was walking my son to pre-kindergarten when we spotted one of his friends strolling toward us with his parents—ominously, away from school. A lone sparrow trilled in warning; a distant bell tolled. A classmate had tested positive for COVID-19. In accordance with city protocols, the entire class was sent home to quarantine for at least five days. I am lucky to be able to work from home and at odd hours, because when you order little kids into quarantine you effectively send their parents into semi-isolation, too. In the idle days that followed, I alternated between frustration that my son wanted so much of my attention and guilt that he was cooped up with such a distracted roommate; I almost wished he were more of a TV watcher. Most parents remember these claustrophobic cycles from the first, locked-down spring of the pandemic. But most of them have long since moved on.

It was starting to feel like children under the age of five in New York City were the last people subject to strict pandemic mandates. On the day my son was sent home, at the Barclays Center (capacity: about seventeen thousand), the unvaccinated basketball player Kyrie Irving played his seventh home game since Mayor Eric Adams excused athletes and performers from the city’s vaccine mandate. Masks and proof of vaccination were not required at Madison Square Garden (capacity: eighteen thousand), where the Rangers played the Carolina Hurricanes. A mask would not have been required of me in the New Yorker offices, had I gone in. Mayor Adams was quarantining, too, having tested positive for COVID-19 after a series of unmasked social engagements, including the Gridiron Club dinner, in Washington, D.C., which turned out to be a superspreader event. On Monday, the mask mandate for U.S. domestic flights and public transportation was struck down by a Trump-appointed federal judge. (The Department of Justice plans to appeal the ruling if the C.D.C. decides that a mandate is still necessary.) Sub-variants of Omicron continue to spread in New York and beyond, and, across the city’s public, private, and charter schools, weekly totals of positive cases more than tripled in the month leading up to April 9th. Yet the era of COVID vigilance is over, it seems—that is, unless you are medically vulnerable or too young for kindergarten.

In the New York City public-school system, only pre-K and 3-K students are still subject to “close-contact” restrictions: if they are exposed to COVID at school, they must quarantine even if they produce a negative test result. They are also the only remaining students who must wear masks in school—the mask mandate for older children ended on March 7th. In private preschools and day-care centers, the more stringent rules also apply to children over the age of two and to educators. The mask mandate has sparked a lot of grumbling and, recently, some well-publicized demonstrations, and Mayor Adams appears eager to lift it—at one point, he even set a date of expiration, April 4th, only to back away. “I’m totally at the mercy of my health team,” he said on April 8th. “They stated that we’re continuing to look at the numbers. Once they are comfortable and will give me the orders, I’m chomping at the bit to get it done.”

I reached out to the New York City Department of Health and Mental Hygiene, the agency that recommends COVID policies to the Adams administration, in hopes of understanding why the strictest rules apply to the youngest children. Ostensibly, there is a simple explanation: the vast majority of them are not yet eligible for the vaccine, which is authorized only for children who are five and older. As a result, day cares, preschools, and pre-K classrooms “have a low baseline vaccination rate compared to most other settings,” Patrick Gallahue, the press secretary for the D.O.H.M.H., said in an e-mail. (Caregivers and educators in these settings are required to be fully vaccinated.) Kids who are too young for the vaccine are runny-nosed and hopeless about personal boundaries and inclined to chew on their masks, although Gallahue was more diplomatic: “Other available tools to mitigate the spread of COVID-19 such as physical distancing and hand-washing are difficult to enforce among young children, making these tools less effective,” he wrote. He also pointed out that the city’s hospitalization rates among children ages four and under have been slightly higher than those for other pediatric age groups.

Those numbers are still extremely low: just over two per one hundred thousand for the week ending April 9th. “In total, this disease is not as severe in children as it is in adults,” Rick Malley, a pediatric infectious-disease physician at Boston Children’s Hospital and a professor of pediatrics at Harvard Medical School, told me. “But you can understand why some people are a little worried when the messaging goes toward ‘COVID is not dangerous for children,’ because kids have died of COVID. As a clinician in infectious diseases, I have seen my share of children for whom that statement would seem ludicrous, given what they are experiencing.” Thirty-six children under the age of eighteen have died of COVID in New York City since the pandemic began, including a four-month-old, a four-year-old, and a five-year-old. A child dying of COVID is rare, but rarity is irrelevant to that child’s parents, siblings, teachers, and friends.

Lingering effects—which is the terminology that Malley prefers over “long COVID”—are also significantly rarer in children than in adults. But, he said, “It’s important in medicine, particularly with a new disease, to be a little humble and a little careful about how we message it.” He went on, “You’re trying to balance the risk of COVID-related illness and lingering effects in a child versus all the collateral damage of what we’re doing: keeping them out of school, having to learn through a mask, the stress of not having child care.” He suggested the idea of a “test-to-stay” strategy for exposed preschoolers—the same regimen that applies to New York City’s K-12 students, which relies on self-administration of moderately reliable rapid home tests and, at least in some schools, operates more or less on the honor system.

There has never been a consensus on COVID protocols for very young children. Until recently, the C.D.C. recommended indoor masking for everyone ages two and up in school settings, including older children who are vaccinated. The American Academy of Pediatrics recommends masking for “all individuals who are 2 years of age and older when the community level risk is considered ‘high.’ ” But the World Health Organization does not recommend masks for children ages five and under at all, and mask mandates in some European Union countries, including France, Spain, and Italy, start at age six. In February, five scholars at Columbia University’s Mailman School of Public Health and Teachers College published an open letter, co-signed by hundreds of health professionals, arguing that scientific evidence did not support an end to indoor mask mandates in schools.

In March and April, however, a nascent unmasking movement gained some traction in New York City. A group of parents filed a lawsuit challenging the under-five mask mandate; a State Supreme Court judge struck it down, but the rule remained in place as the city appealed. Parents staged “Unmask Our Toddlers” rallies in front of City Hall; at one, the kids in attendance chanted “Burn your mask!” and “See my smile!” In the theatre district, the day after Adams attended the COVID-riddled Gridiron Club dinner, a group yelled “Unmask our toddlers!” as he arrived for a performance of the musical “Paradise Square.” In yet another City Hall protest, giant inflatable babies waddled around with signs that read “NYC Toddlers Have Been Masked for Half Their Lives” and “Toddlers Have Lowest Risk for Covid But Highest Risk for Developmental Delays.”

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