Leading up to its decision on whether to require masks in schools, the local public health agency for Adams, Arapahoe and Douglas counties heard community members speak during a public meeting where pro- and anti-mask Coloradans dug in their heels and found little common ground.

“We'll never come to terms with each other — everyone's going to have their own opinion,” said Jessica Stancer, a Douglas County mother. “But what we lose is the ability to make decisions for our families, for ourselves.”

Two weeks after Tri-County Health Department stopped short of requiring masks in schools, the agency announced on Aug. 12 that it plans to consider issuing some type of mask order for students. Tri-County's board of health held a meeting on Aug. 16 to hear comments from the public ahead of that decision, alternating between speakers who are for and who are against a mask mandate.

After public comment, the board of health postponed its decision on a mask order to another meeting at 4:30 p.m. Aug. 17.

More than 900 people signed up to speak for the initial meeting on Aug. 16, but Tri-County Health limited the comments to about 90 minutes.

“My choice, my body. My children's choice, my choice,” said a speaker who identified himself for the Zoom meeting as Syrphen Aller, arguing against a mask order. “Educate my children — do not mess with their health.”

Aller also invoked the “freedoms of America” and the ability of parents to make decisions for their children's health in opposing a mask order, heralding the broad and impassioned tones speakers voiced on both sides.

Lawrence Schwartz, a board-certified physician with children in the Cherry Creek School District, said he wanted action on masks “before your students become my patients.”

“Quite frankly, this is not an issue where all opinions are equal and worthwhile,” said Daniel Gaughan, of the Littleton Public Schools area. “All medical professionals are in favor of this mask mandate. The other side is full of conspiracy theorists.”

Linda Bissett, also of the Littleton school district, said: “This is just means to control us and to keep us in fear. This is America. We will not walk in fear.”

She added: “We are teaching (students) to be fearful little slaves … We're Americans; we know how to research for ourselves.”

Mary Kenney, a mother, said she was tired of hearing the argument that teaching kids to wear masks teaches them to be kind.

“It teaches them to be abused,” Kenney said. She added: “You want to oppress and you want to segregate our children.”

Sarah Clymer, a mother and a former Douglas County School District kitchen employee, said she “witnessed firsthand” elementary students wearing masks last year, “and they did great with it,” she added.

She never saw a child complain about breathing issues or throw a tantrum, she continued.

Clymer framed Tri-County's decision as one about neighbors “coming together,” she said. “This is not every man, woman and child for themselves.”

The return to full-time in-person school in the Denver metro area — and the variation in local school mask rules — comes as Colorado finds itself in its fifth wave of COVID-19 cases and hospitalizations.

Statewide, hospitalizations have spiked in the last few weeks, jumping from 266 confirmed COVID-19 patients on July 22 to 566 on Aug. 16. Daily deaths among those with COVID-19 in the past several weeks continued to outpace the recent lows seen in March, at times breaking into double digits.

Stephanie Burt, who has a child in Cherry Creek School District, said: “Children are extremely low-risk for hospitalization” from the coronavirus.

What wasn't often mentioned during the discussion was the issue of whether — and to what degree — kids could contribute to COVID-19 spread in the community.

Spread a factor

Most children who become infected with COVID-19 have no symptoms, or they have milder symptoms such as low-grade fever, fatigue and cough, according to a Harvard Medical School article.

“Early studies suggested that children do not contribute much to the spread of coronavirus,” the Aug. 13 article says. “But more recent studies raise concerns that children could be capable of spreading the infection.”

The federal Centers for Disease Control and Prevention website goes further, writing: “Outbreaks among adolescents attending camps, sports events, and schools have demonstrated that adolescents can transmit (the virus) to others.

“Studies that have examined secondary infection risk from children and adolescents to household contacts who are rapidly, frequently, and systematically tested demonstrate that transmission does occur,” the CDC's page says.

“Transmission of COVID-19, exacerbated by the more transmissible delta variant, is highly likely in the school setting without high levels of mask wearing,” John Douglas, executive director of Tri-County Health, wrote in an Aug. 13 letter.

Data on masks

One commenter during Tri-County's meeting cited a study of masks in Denmark involving 4,800 people, saying that it showed that there was no difference in results between those who wear masks and those who don't.

In a study of 4,862 people in Denmark in April and May 2020, infection with the coronavirus occurred in 42 participants who were urged to wear surgical masks, as well as in 53 “control” group participants. That means about 1.8% and 2.1% of each group became infected, says the study published in the Annals of Internal Medicine. The difference observed “was not statistically significant,” says the study, calling the findings “inconclusive.”

But the study's focus was on the risk of infection to mask-wearers — not masks' ability to prevent spread to others, which is known as “source control.”

“It is important to emphasize that this trial did not address the effects of masks as source control or as protection in settings where social distancing and other public health measures are not in effect,” the study says. It adds: “These findings do not provide data on the effectiveness of widespread mask wearing in the community.”

What’s more, 46% of participants in the study wore the mask as recommended, 47% predominantly as recommended and 7% not as recommended, the study says.

Another commenter during the meeting mentioned data from Kansas on the CDC website, appearing to refer to a situation last year that made the state something of a test case.

The governor of Kansas issued an executive order requiring wearing masks in public spaces, effective July 3, 2020, which was subject to county authority to opt out. After July 3, new daily COVID-19 cases decreased in 24 counties with mask mandates but continued to increase in 81 counties without mask mandates, according to a report by the CDC.

“Countywide mask mandates appear to have contributed to the mitigation of COVID-19 transmission in mandated counties,” the report says.

Another speaker during Tri-County's meeting appeared to repeat a claim that gained traction on social media last year. She said: “The mask boxes themselves say they do not help you for COVID.”

The box of disposable masks she appeared to reference, from the photo that circulated online, says: “This product is an ear loop mask. This product is not a respirator and will not provide any protection against COVID-19 (coronavirus) …”

A USA Today fact-check in June 2020 rated the claim “partly false,” writing: “It is false to say they offer no protection. They are worn to protect others from the virus and help limit the spread in public settings.”

Since then, the CDC has updated its findings and made stronger statements, even for cloth masks. Its website now says: “Studies demonstrate that cloth mask materials can also reduce wearers' exposure to infectious droplets through filtration, including filtration of fine droplets and particles less than 10 microns.”

“The relationship between source control and wearer protection is likely complementary and possibly synergistic, so that individual benefit increases with increasing community mask use,” the website adds.

See more on that on the CDC's page here.

Mental health in pandemic

A few parents in Tri-County's meeting raised concerns about mental health, including suicide, amid the pandemic.

The picture of mental health in general during the pandemic is complicated: Researchers haven't clearly linked recent suicides to the pandemic — but pediatric mental health experts are expressing concern, a July 8 article in Yale Medicine says.

Headlines that call attention to the pandemic's effect on mental health are common. And while “no suicide rate, whether high or low, rising or falling, is acceptable,” says an article in the BMJ (under the British Medical Association), numbers from several countries suggest that suicide rates have not risen. The article, published in March, noted that the findings may change over time.

“How do we square the evidence on suicide with what surveys and calls to charities are telling us, that the pandemic has made our mental health worse? How can both be true?” the article says. “Perhaps as well as risks, there have been protections. We may have been more careful in lockdown to stay in touch, more alert to warning signs. In the face of a crisis, there may have been a greater sense of community, of getting through it together.”

Breathing effects

A claim that also came up during the meeting: masks problematically forcing a person to “rebreathe the carbon dioxide.”

Wearing a mask does produce a “small increase” in breathing resistance caused by the mask material filtering particles and any moisture that is trapped in the mask material, according to a commentary in the International Journal of Environmental Research and Public Health.

“One consistently documented negative impact of wearing a mask for a long period of time is an increase in the development of headaches in people with a history of headaches,” the September 2020 article says.

“In otherwise healthy individuals, wearing masks, even for an extended period of time, does not produce any clinically relevant changes in circulating O2 or CO2 concentrations, and does not seem to impact tidal volume or respiratory rate,” the article says.

Clarification: A Tri-County Health Department official said during the Aug. 16 board of health meeting that "nearly 2,000 people" had signed up to speak in that meeting. Tri-County Health later clarified that 913 people signed up to speak, and the number registered to view the meeting over Zoom was 3,554.