School Masking Policies and Secondary SARS-CoV-2 Transmission

Author:

Boutzoukas Angelique E.12,Zimmerman Kanecia O.123,Inkelas Moira45,Brookhart M. Alan6,Benjamin Daniel K.7,Butteris Sabrina8,Koval Shawn9,DeMuri Gregory P.8,Manuel Vladimir G.510,Smith Michael J.2,McGann Kathleen A.2,Kalu Ibukunoluwa C.2,Weber David J.11,Falk Amy12,Shane Andi L.1314,Schuster Jennifer E.15,Goldman Jennifer L.15,Hickerson Jesse1,Benjamin Vroselyn1,Edwards Laura1,Erickson Tyler R.1,Benjamin Daniel K.123

Affiliation:

1. aDuke Clinical Research Institute

2. bDepartments of Pediatrics

3. cCo-Chair, The ABC Science Collaborative, Durham, North Carolina

4. dFielding School of Public Health

5. eClinical and Translational Science Institute, University of California Los Angeles, Los Angeles, California

6. fPopulation Health Sciences, Duke University School of Medicine, Durham, North Carolina

7. gClemson University, Clemson, South Carolina

8. hDepartment of Pediatrics, University of Wisconsin School of Medicine & Public Health, Maddison, Wisconsin

9. iUniversity of Wisconsin Health, Healthy Kids Collaborative, Madison, Wisconsin

10. jUniversity of California David Geffen School of Medicine, Los Angeles, California

11. kDivision of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina

12. lDepartment of Pediatrics, Aspirus Doctors Clinic, Wisconsin Rapids, Wisconsin

13. mEmory University School of Medicine, Atlanta, Georgia

14. nDepartment of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia

15. oDivision of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri

Abstract

OBJECTIVES Throughout the COVID-19 pandemic, masking has been a widely used mitigation practice in kindergarten through 12th grade (K–12) school districts to limit within-school transmission. Prior studies attempting to quantify the impact of masking have assessed total cases within schools; however, the metric that more optimally defines effectiveness of mitigation practices is within-school transmission, or secondary cases. We estimated the impact of various masking practices on secondary transmission in a cohort of K–12 schools. METHODS We performed a multistate, prospective, observational, open cohort study from July 26, 2021 to December 13, 2021. Districts reported mitigation practices and weekly infection data. Districts that were able to perform contact tracing and adjudicate primary and secondary infections were eligible for inclusion. To estimate the impact of masking on secondary transmission, we used a quasi-Poisson regression model. RESULTS A total of 1 112 899 students and 157 069 staff attended 61 K–12 districts across 9 states that met inclusion criteria. The districts reported 40 601 primary and 3085 secondary infections. Six districts had optional masking policies, 9 had partial masking policies, and 46 had universal masking. In unadjusted analysis, districts that optionally masked throughout the study period had 3.6 times the rate of secondary transmission as universally masked districts; and for every 100 community-acquired cases, universally masked districts had 7.3 predicted secondary infections, whereas optionally masked districts had 26.4. CONCLUSIONS Secondary transmission across the cohort was modest (<10% of total infections) and universal masking was associated with reduced secondary transmission compared with optional masking.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

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