The nation’s leading association of pediatricians released new, highly anticipated COVID-19 guidance for schools reopening this fall, recommending that everyone over the age of 2 wear masks, even if they are vaccinated against the virus — a more cautious approach than recent federal directives.

On Monday, the American Academy of Pediatrics called for in-person learning to fully resume and said universal masking should be part of a “layered approach to make school safe for all students, teachers and staff.”

The organization’s updated guidelines come at a time of heightened uncertainty about the pandemic in the United States, and they have added to the ongoing debate over best practices for combating the coronavirus, which is spreading at its fastest rate in more than two months.

“We need to prioritize getting children back into schools alongside their friends and their teachers — and we all play a role in making sure it happens safely,” Sonja O’Leary, chair of the AAP Council on School Health, said in a statement. “Combining layers of protection that include vaccinations, masking and clean hands hygiene will make in-person learning safe and possible for everyone.”

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Earlier this month, the Centers for Disease Control and Prevention relaxed its guidance, saying that vaccinated teachers and students do not need to wear masks while in school buildings. However, the agency added that unvaccinated students and staff should still wear masks and that school districts should look to local virus trends to determine whether to ease or strengthen their measures.


Since the rapid spread of the coronavirus shuttered schools in early 2020, childhood education policies have been at the center of some of the nation’s fiercest political debates. And they have become a flash point once again, as the highly contagious delta variant has taken hold, causing the seven-day average of new coronavirus infections to soar by nearly 70% in just one week.

Francis Collins, director of the National Institutes of Health, said he trusts the AAP and the group’s recommendations are reasonable.

“They will not be popular amongst parents and kids who are sick of masks, but you know what? The virus doesn’t care that we’re sick of masks,” Collins said Monday in an interview with MSNBC. “The virus is having another version of its wonderful party for itself. And to the degree that we can squash that by doing something that maybe is a little uncomfortable, a little inconvenient … if it looks like it’s going to help, put the mask back on for a while.”

Because children under 12 are still ineligible for coronavirus vaccines, student populations are likely to be far less vaccinated than their greater communities — a major factor in the AAP guidelines. As of Monday, just 36% of Americans ages 12 to 17 had received at least one dose of a vaccine, according to data analyzed by The Washington Post.

Overall vaccine uptake has also slowed significantly, with the number of doses administered nationally dropping by 9% in the past week, down to some of the lowest levels seen since the campaign’s early days.

The country’s top infectious-disease expert, Anthony Fauci, said the unevenness of inoculation is one reason universal masking could be necessary.


“When you have a degree of viral dynamics in the community and you have a substantial proportion of the population that is unvaccinated, that you really want to go the extra step, the extra mile, to make sure that there is not a lot of transmission, even breakthrough infections, among vaccinated individuals,” Fauci said in an appearance on CNN.

But all the competing guidance can be confusing, Fauci said.

Leana Wen, an emergency physician and professor at George Washington University, has been among the public health experts to criticize the CDC’s recent guideline shifts. On Monday, she said the federal agency should follow the AAP’s lead.

“CDC needs to change their guidance too,” Wen said on Twitter. “If there is no proof of vaccination, and vaccinated & unvaccinated people are mixing, indoor masking need to be required.”

At least eight states, including Texas and Arizona, have already banned mask mandates in schools.

Announcing the prohibition in May, Texas Republican Gov. Greg Abbott said the state “can continue to mitigate COVID-19 while defending Texans’ liberty to choose whether or not they mask up.”

Meanwhile, some of the largest school districts in the country have said they plan to require universal masking. Among them, the state of California, New York City and Detroit, whose superintendent said everyone would wear a mask inside unless they are in a room where everyone is vaccinated.