MASKING IN SCHOOLS: What Is the Evidence? BY KATE O’ROURKE
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tate school systems have taken different approaches to the CDC’s recommendations for universal indoor masking by all students (ages 2 years and older), staff, teachers and visitors to K-12 schools, regardless of COVID-19 vaccination status. According to Burbio, a data monitoring service, states such as California, Illinois and New York have mandated masks in schools; states such as Oklahoma and Utah have banned masks in schools; states such as Arizona, Florida, Texas and Utah have banned mask mandates in schools and then had these bans overturned; states such as Nevada have mandated masks for schools in counties with more than 100,000 people or with a schoolwide COVID-19 outbreak; and other states, such as Colorado, Georgia and Maine have issued no policy, leaving it to local regulators to decide. So, what do we know about masks in schools? According to Jade Fulce, a spokesperson for the CDC, as COVID-19 cases began increasing nationally in mid-June 2021, driven by the delta variant, protection against exposure remained essential in school settings. She said the CDC recommends universal indoor masking in the school setting because of the highly transmissible nature of the delta variant, the mixing of vaccinated and unvaccinated people in schools, the fact that not all children are eligible for vaccination, and the low levels of vaccination among youth who are eligible. As of Dec. 12, 1.3% of children 5 to 11 years and 6.5% of children 12 to 17 are fully vaccinated against COVID-19. Vaccination rates among educators appear to be higher. The National Education Association, the nation’s largest union representing nearly 3 million educators, said 90% of members have received at least one COVID-19 vaccine as of Sept. 9.
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“I strongly agree with the CDC guidance that recommends masking in schools because masks have been shown to decrease COVID-19 transmission in the school setting across several studies. This should be part of [a] multipronged, layered approach to protect children and school staff from COVID-19 infection, including vaccination, physical distancing, ventilation, testing, cleaning and disinfection,” said Ishminder Kaur, MD, an assistant professor of pediatrics in the Division of Infectious Diseases at the David Geffen School of Medicine and the medical director of the Pediatric Antimicrobial Stewardship Program at UCLA Mattel Children’s Hospital, in Los Angeles. In September, the CDC released three studies in its Morbidity and Mortality Weekly Report that highlighted the importance of using layered prevention strategies, including universal masking to stop the spread and minimize disruptions to school operations for safe in-person education (MMWR Morb Mortal Wkly Rep 2021;70[39]:1372-1378). These studies found that school districts without a universal masking policy in place were more likely to have COVID-19 outbreaks. Nationally, counties without masking requirements saw the number of pediatric COVID-19 cases increase nearly twice as quickly during this same period. One report from Arizona revealed that schools in two of the state’s most populous counties were 3.5 times more likely to have COVID-19 outbreaks if they did not have a mask requirement at the start of school compared with schools that required universal masking on the first day (MMWR Morb Mortal Wkly Rep 2021;70[39]:13721373). Another report that looked at national data found that during the two weeks following the start of school, the average change in pediatric COVID-19 case rates was lower among
