Masks reduce spread of Covid in schools, study finds
Masks have been a cultural flashpoint since the start of the pandemic, and mask mandates in schools have been particularly inflammatory. Critics argue that there is no hard evidence to prove that masks slow the spread of Covid, and that in any case the children were not wearing the right kind of masks or were not wearing them properly.
Now, a research paper details the so-called natural experiment that occurred when all but two school districts in the greater Boston area eliminated mask requirements in the spring. The researchers took advantage of this opportunity to conduct a direct comparison of the spread of Covid in masked and non-masked schools.
Bottom line: Cover-up mandates have been linked to significantly reduced numbers of Covid cases in schools.
Infection rates were lower among masked students, even in Boston public schoolswhere many buildings are old and lack good ventilation systems, classrooms are overcrowded, and students are more often from at-risk communities than among unmasked students attending new schools in communities like Cambridge and Newton.
The study, by scientists at Harvard’s TH Chan School of Public Health and Massachusetts General Hospital, Boston University School of Public Health and the Boston Public Health Commission, was published Wednesday in The New England Journal of Medicine.
The data should help dispel misinformation about the effectiveness of universal masking requirements in schools to prevent transmission of the virus, said Julia Reifman, an assistant professor at Boston University’s School of Public Health and an author. editorial accompanying the new study.
“Even this summer, people were saying: “Oh, Covid doesn’t spread in schools,” and there was a misconception that kids don’t get Covid,” said Dr. Reifman, who was not involved in the new. research. “But what we’re seeing in the study is that Covid is really spreading in schools, and it’s spreading into the home, and it’s spreading to teachers.”
The study did not specify the types of masks worn by children, suggesting that any type is at least somewhat protective, he added.
“This study shows that if people wear masks in a group, it reduces the spread of infection to everyone in the population, and it reduces school and teacher absences,” Dr. Reifman said.
Even after the Centers for Disease Control and Prevention lifted mask requirements for schools last year, many states maintained mandates. Massachusetts, along with 18 other states and Washington, D.C., continued to require masks in public schools at the start of the 2021-22 school year, but rescinded the policy in February.
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Until then, trends in Covid cases were similar in school districts in the greater Boston area. After lifting the mask mandate, the state required districts to continue reporting all Covid cases among students and staff members and to provide funding and support services for testing.
Researchers involved in the study used that data to track Covid cases week by week in 72 school districts, comparing two that had masked for 15 weeks, Boston and Chelsea, with 70 others that raised mask requirements at different times.
Removing mask mandates was associated with an additional 44.9 Covid cases per 1,000 students and staff, corresponding to about 11,901 cases over 15 weeks, the researchers concluded.
“We saw a steady, rising rate of Covid cases in schools that were eliminating the mask requirement,” said Tori L. Cowger, the study’s first author and a postdoctoral fellow at Harvard’s Chan School of Public Health.
During 12 weeks of the 15-week period, “we saw an increase in incidence that was statistically significant,” he added.
But only three Covid cases in schools where mask mandates were lifted were attributed to the policy change; Four out of 10 staff member incidents were attributed to the policy change, he said.
Because people who tested positive were ordered to isolate for at least five days, the additional cases resulted in at least 17,500 missed school days for students and 6,500 missed school days for staff members, the study estimated.
Cheryl Buckman said her 9-year-old son, a third-grader at a Boston public school, developed Covid symptoms within days of the school lifting mask requirements late last year.
Both Ms. Buckman and her son have asthma and a blood disorder that makes it difficult to fight off infections, and he fell ill just as she was recovering. Both had high fevers for several days, she said, and she missed more than a week of school. Due to illness, he had to postpone the necessary operation.
“Frankly, it’s reckless to remove the mandate early,” Ms. Buckman said in an interview. “The whole neighborhood stopped wearing masks, except on buses, and when he wore a mask, he was ridiculed, so he was afraid to wear it.”
Ms Buckman’s son has autism, she added, and she was terrified of Covid. “He knew so many people died from it,” he said.
Opponents of masking in schools have criticized the data on its effectiveness, but they have also raised other concerns.
Critics say masking can cause communication problems and delay speech development, can be particularly difficult for children with learning disabilities and make it difficult to read or communicate emotional expressions.
And for many adults as well as children, masks are very uncomfortable, especially when worn for an entire school day.
Dr. Tracy Beth Hoegh, an epidemiologist and fierce critic of school masking, noted that the new study was observational and not a randomized, controlled clinical trial. As such, he said it could point to a correlation but could not prove a causal link between mandatory masking and a lower incidence of Covid.
Shira Doron, an infectious disease physician at Tufts Medical Center in Boston who has previously criticized mask mandates in schools, said the new study is just one publication and that the medical literature on mask mandates in schools is mixed.
Schools abandoned mask policies not because they were ineffective at curbing viral transmission, Dr. Doron said, but because they could lead to other complications.
“Children with language learning difficulties have trouble understanding their teachers and their peers,” Dr. Doron said. “Children with speech difficulties are so difficult to understand that they leave. Children and hearing-impaired employees have difficulty communicating and understanding each other.”
He added: “Even teachers who choose to continue wearing masks prefer not to have a mandate so they don’t have to deal with discipline all day.”
But a Boston parent group, BPS Families for Covid Safety, has already called for the reinstatement of universal masking in schools, saying a new study shows the practice protects against both illness and lost school days in a district with high vaccination rates. : relatively low rates, and families come from communities that have been disproportionately affected by the epidemic.
At a minimum, universal masking should be implemented if an outbreak occurs at school or in the larger community, and after students return from vacations that often include travel and family gatherings, said Sarah Horsley, the group’s co-founder. parent of a fourth grade student.
“A couple of weeks ago we got a letter from school officials saying they strongly encourage masks because the sewage tests show high levels of the virus,” Ms Horsley said. “But most students still don’t wear them.”
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