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Students wearing masks at school

Universal masking, immunization top 2 strategies for safe in-person school: AAP

November 2, 2021

Editor’s note: The AAP interim guidance for schools has been updated since the time this article was published. Please visit COVID-19 Guidance for Safe Schools and Promotion of In-Person Learning. For the latest news on COVID-19, visit

Schools need to take a multipronged, layered approach to reduce the risk of COVID-19 transmission among students, teachers and staff so that in-person learning is safe and possible. As part of that approach, universal masking and immunizations are the most important risk mitigation strategies.

These recommendations are included in the AAP’s updated COVID-19 Guidance for Safe Schools and Promotion of In-Person Learning. The interim guidance is designed to help support communities, local education and public health leaders, and pediatricians who collaborate with schools.

“All local, state and federal policy considerations for school COVID-19 plans should start with a goal of keeping students safe, physically present and emotionally supported in school,” the guidance states.

Maximizing protections

Besides masking and vaccination, layers of protection include physical distancing, ventilation when resources are available, screening, testing, handwashing, staying home and getting tested when sick, contact tracing, isolation and quarantining.

“There must be a continued focus on keeping students safe particularly because not all students have had the opportunity or are eligible to be vaccinated against COVID-19 at this time,” the guidance states.

Included in the updated guidance are new and expanded sections on school ventilation systems, COVID testing, oral health and evidence for universal masking. The use of plastic dividers or desk shields in the classroom no longer is recommended and, in some cases, can be detrimental for infection control.

There is continued emphasis on supporting the behavioral/mental health of students and staff. Schools are fundamental to child and adolescent development and can play a critical role in addressing racial and social inequity. The guidance discusses the impact school closures have had on racial and ethnic groups and populations facing inequities.

Key principles

Schools should consider following these key principles to mitigate risk during the pandemic:

  • All eligible individuals should receive the COVID-19 vaccine. Schools can play a key role in supporting their jurisdictions’ immunization efforts.
  • All students older than 2 years and all school staff should wear face masks at school (unless medical or developmental conditions prohibit use), regardless of vaccination status.
  • Adequate and timely COVID-19 testing resources must be available and accessible to limit spread and help symptomatic students who do not have COVID-19 return in a timely way. Testing should not be considered a primary form of prevention and should not be the only mitigation strategy.
  • Schools should work closely with public health agencies to develop quarantine and isolation protocols that limit time away from school based on current scientific data.
  • School nurses and school health personnel should not be the default to provide school-based COVID-19 testing or contract tracing.
  • Strategies should be revised and adapted depending on the level of viral transmission and test positivity rate throughout the community and schools.
  • Policies should be reviewed regularly.
  • Attendance should be monitored and support provided for those at higher risk of absenteeism.
  • School districts must be in close communication and share COVID-19-related policies with state and/or local public health authorities, school nurses, local pediatric practitioners and other medical experts.
  • Policies should be communicated in languages other than English, when needed.
  • Ongoing federal, state and local funding should be provided to all schools so mitigation and safety measures can be provided, with the goal of keeping students safe, physically present and emotionally supported.

Importance of indoor mask-wearing

The AAP recommends masking for the following reasons:

  • Masks have proven effective in reducing transmission of the virus from infected individuals.
  • Because a significant portion of the student population is not yet vaccinated, masks help protect unvaccinated students from COVID-19 and reduce transmission.
  • As monitoring or enforcing mask policies can be difficult, universal masking is the most effective strategy to create consistent messages and compliance without the burden of needing to monitor vaccination status.
  • There may be low vaccination uptake within the surrounding school community.
  • Variants that spread more easily may emerge.
  • Fully vaccinated individuals can become infected and transmit the virus; therefore, universal masking is needed to protect unvaccinated and otherwise vulnerable community members.
  • An added benefit of universal masking is protection of students and staff against other respiratory illnesses that would take time away from school.

Special considerations

The guidance also covers issues of school attendance and absenteeism; students with disabilities or chronic illnesses; adult staff and educators; onsite school-based health services; and the importance of getting caught up on other immunizations — especially influenza — and screenings. Also covered are food and housing insecurity, the digital divide and organized activities.

Evidence to support safe return to classrooms continues to evolve, and the AAP regularly reviews and updates its guidance.



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