We are parents, caregivers, and family members of children in childcare. We believe the U.S. must align its COVID-19 policies for daycares with the rest of the world by easing quarantine and masking requirements.

Nearly two years into the pandemic, it is imperative to move toward normalcy for children under six as soon as possible. They will never get these precious few years back.

We urge the CDC and state, county, and city health and education officials to immediately update COVID-19 policies regarding:

1. Quarantines: The CDC has approved test-to-stay (TTS) as an alternative to mandatory close contact quarantines for unvaccinated children. Childcare providers urgently need guidance for implementing TTS or eliminating quarantines altogether. Providers should not need to procure and administer COVID-19 tests to implement test-to-stay; parents can do so and demonstrate to the provider that their children continue to test negative.

2. Masking: Given the developmental harms of prolonged masking of our youngest children and the absence of proven benefits, it is critical to update mask use guidance to recommend that masks be optional for children in childcare settings.

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Children in daycares have been locked out of their normal childhoods for 22 months. They spend their days surrounded by masked faces. They’re taught to stay away from each other, to not share toys, and to think of themselves and their playmates as disease vectors. They’ve never seen their caregivers’ smiles. They come home with face rashes, aching ears, and masks that are chewed through and soaked with snot and saliva. Their developmental progress and sense of stability are constantly upended by class closures.

Their families are suffering too. Their parents' livelihoods and mental health are being threatened by mandatory close contact quarantines following COVID-19 exposure, which are de facto school closures that send healthy children home for up to two weeks. These quarantines quickly deplete paid leave, jeopardizing parents’ job security and financial stability. They are especially devastating for low-income families, those with multiple children, single parents, and essential workers. Quarantines are not evidence-based and are pushing women out of the workforce and deepening inequities in our society.

While the CDC has approved “test-to-stay” as an alternative to quarantines for unvaccinated children and recently shortened the quarantine period for unvaccinated exposed individuals to five days, it's not clear if or how this guidance will be implemented in daycares. Parents need relief now and few jurisdictions are acting with the necessary urgency to update their policies. 

It should go without saying that any modified quarantine policy in daycares cannot be contingent on these very young children staying masked or distanced all day. Fortunately, we have ample real-world evidence that young children’s close contacts rarely develop COVID-19. More to the point, other countries have never quarantined unmasked toddlers and preschoolers. (This sensible policy from Wales could be a good model.)

Measures like quarantines and mandatory masking are policy choices, not pandemic inevitabilities. Children in daycare aren’t subject to such severe restrictions anywhere outside of urban America.

Crucially, through each COVID-19 surge and variant, including Omicron, every public health agency in the world — except ours — has considered the body of knowledge on child development and affirmed that it is unacceptable to mask children under six. Many countries don’t even mask elementary schoolchildren, with no evidence of increased outbreaks or community spread. 

Yet in daycares in American cities, children in diapers are forced to wear masks. We are international outliers choosing to risk stunting the development of our tiniest children, who are at the least risk from COVID-19 but at greatest risk of harm from its mitigations. 

The simplest reason to allow optional masking is that young children never should have been masked in the first place – hence the universal global consensus against doing so. Unvaccinated children under six are at miniscule risk of severe illness from COVID-19 even when compared to healthy, vaccinated young adults. More healthy young children are hospitalized and die from the flu and RSV, and we don’t mask all children in perpetuity for those illnesses.

In addition, multiple studies have shown that the very low prevalence of symptoms of long COVID, many of which are vague and common (such as headache and fatigue) are similar in children with and without a history of COVID-19. Further, the incidence of multi-system inflammatory syndrome (MIS-C) is extremely low in children under six and has been lower with Delta than the original virus strain.

Masking children is not a benign intervention. Children need to see full faces during the forty hours a week they spend in daycare in order to learn to speak, process emotions, read social cues, and build the foundation for literacy. 

Some argue that there is “no known evidence” that masks are harmful to children’s development. This is because obvious ethical concerns would preclude any Institutional Review Board from approving a controlled study to quantify the developmental impacts of masking young children. Yet longitudinal studies and other relevant research is emerging that measures those harms.

Further, the burden of proof for any intervention must be on demonstrating both its benefits and absence of harms, and there is no evidence that child masking in daycares is effective. Two-year olds are incapable of masking correctly, and all daycare children remove their masks several times a day for snacks, meals, and multi-hour long naps. With an aerosolized and airborne virus, these breaks completely negate any purported benefits.

There is also no evidence that the intermittent masking of children in daycares has any relationship to hospital utilization. Given young children's poor compliance, this has remained true through the Omicron surge.

Experts are now recognizing that the cloth masks children wear in daycares are ineffective. This has led some to call for putting toddlers and preschoolers in KF94 or KN95 respirators. Such a practice would be indefensible, as the CDC does not approve their use on children. They do not come in sizes that fit most toddlers and preschoolers and must be fit-tested and worn correctly to be more effective than cloth. As CDC Director Rochelle Walensky acknowledged, they are also extremely uncomfortable when worn for long periods of time.

When no other country in the world recommends masking this age group at all, and we are discussing forcing toddlers and preschoolers to wear respirators, we must pause and think about the actual evidence supporting such an intervention.

We cannot wait for the vaccine. Pfizer’s failed trial in 2-4 year olds underscores the uncertainty surrounding COVID-19 vaccines for very young children. Vaccines may not be authorized for emergency use (EUA) at all, given the questionable risk-benefit calculus for a population at such low risk. (Notably, several European countries are only recommending the vaccine for use in high-risk 5 -11 year olds.)

Even if a vaccine is granted EUA, it will be many months before this happens for the entire eligible childcare population, down to 6 months old. If we have to wait for full FDA authorization for all children 6 months - 4 years, that is likely at least a year away. It will also take several months for children to receive the full 3-dose series that Dr. Fauci predicts will be required. Further, there will always be babies between 6 weeks and 6 months old in daycares for whom trials are not even ongoing. All of this makes it impossible to rationalize using vaccine access as the off-ramp for daycare restrictions. Most importantly, doing so is unnecessary, as the rest of the world has kept children 5 and under in care without vaccines or masks throughout the entire pandemic.

It is also critical to recognize that the availability of vaccines for young people in K-12 and higher education has not resulted in the establishment of any off-ramps for mask mandates in these settings.

It’s unconscionable that our children could uniquely suffer for nearly three years while toddlers and preschoolers everywhere else in the country and world enjoy normal childhoods.

Finally, it's important to think carefully about making aggressive asymptomatic PCR testing a precondition for ending masking or quarantines, since it can yield clinically insignificant results by detecting traces of inactive SARS-CoV-2 particles that are not indicative of a risk of contagion.

Local leaders must not allow bureaucratic sclerosis to prevent them from acting in our children’s overall best interest. It will be politically difficult for some decision-makers to stray from CDC guidance, but they can take comfort in the fact that many jurisdictions have recently done so on a host of issues – from indoor mask mandates to test-to-stay to isolation periods for infected essential workers.

But if policymakers need further justification to change course, they should simply inform the public that widespread vaccine distribution cocoons our already extremely low-risk children and protects our most vulnerable residents. As a result, and especially as the milder Omicron variant has taken over, COVID-19 case numbers have been decoupled from severe disease and death and are now irrelevant. There is no other metric or off-ramp to wait for.

These are precious years for our littles. They need normalcy in childcare now.