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Teens in school with masks

Study: In-school COVID spread reduced by 72% with universal masking

March 9, 2022

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Schools with universal masking policies saw 72% less in-school spread of COVID-19 than schools where masking was optional, according to a new study.

The AAP is advising families to consider masking for their children with special health care needs and those too young to be vaccinated even though federal health officials have loosened masking recommendations for much of the country.

In the new study, researchers analyzed data from 61 K-12 school districts in nine states in the fall of 2021 when the delta variant was predominant. To be included in the study, districts had to perform contact tracing and determine whether infections were acquired in the community or in school. The data include about 1.1 million students and 157,000 school staff members.

During the study period, students and staff had 40,601 COVID-19 infections acquired from the community and 3,085 that were acquired in school, according to “School Masking Policies and Secondary SARS-CoV-2 Transmission,” (Boutzoukas AE, et al. Pediatrics. March 9, 2022).

The rate of cases transmitted in schools was 3.6 times higher in schools with optional masking compared to schools with universal masking. There were about 26.4 school-acquired cases predicted for every 100 community-acquired cases in schools with optional masking compared to 7.3 school-acquired cases per 100 in schools with universal masking.

Authors said masking is a “critical mitigation effort” to help children attend school safely when community infection rates are high.

“Providing districts with the tools to monitor transmission data in real time enables schools to respond to changing national and local policies, as well as adjust their mitigation efforts to keep in-person education as safe as possible for the remainder of the COVID-19 pandemic,” they wrote.

The Centers for Disease Control and Prevention (CDC) recently updated its mask guidance to say most people in communities categorized as having a low or medium COVID community level (based on cases and hospital capacity) do not need to mask in indoor public settings including schools. Everyone in high COVID community level areas should continue wearing masks.

When deciding on masking, the AAP recommends families consider

  • whether their child is vaccinated,
  • whether their child is immunocompromised or at high risk for severe COVID-19,
  • whether family members are unvaccinated or at high risk for severe disease and
  • whether they live in a community with a high level of COVID-19.

Based on these factors, families may choose to continue wearing masks in indoor public places even if they are not required, and that decision should be supported, according to the AAP. Schools also should have the flexibility to reinstate masking as needed.




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