Dynamic Masking: A Proposal of Burden‐Based Metrics for Masking in K‐12 Schools During the COVID‐19 Pandemic

Abstract

BACKGROUND: Ongoing masking of K-12 children has not been universally accepted despite recommendation from public health authorities. In states without universal mask mandates for schools, district administrators are forced to make masking decisions under significant local political pressures. There is a call for endpoints to masking to allow communities to tailor mitigation while keeping schools safe, focusing on harm reduction. METHODS:We reviewed existing measures for the safe opening of schools and designed a stepwise, accessible approach to the removal of masks in the K-12 setting. RESULTS:Focusing first on the assessment of school impact due to COVID-19 disease and then considering the context of existing community transmission levels allows for a metrics-based approach to masking that is flexible and practical, enabling school officials to adapt quickly to the pandemic landscape in their communities, independent of political pressures. CONCLUSIONS: While this proposal is preliminary, a dynamic metric system for masking may encourage those communities who wish to minimize masking to adopt masks during highest risk periods, protecting against SARS-CoV-2 transmission in schools and allowing for more holistic harm reduction. This approach may serve to guide districts during times of uncertainty when central guidance short of universal masking is lacking.

Model-Estimated Association Between Simulated US Elementary School–Related SARS-CoV-2 Transmission, Mitigation Interventions, and Vaccine Coverage Across Local Incidence Levels

“…3,4 While multiple studies indicate that masks are effective at mitigating the transmission of upper respiratory viruses, [5][6][7][8][9][10] they are generally viewed as a temporary measure. 11,12 Masks are physiologically safe, but there is limited data on the impact of mask-wearing on learning and social and emotional development, especially for younger children, students with special learning needs, and English language learners. 9,13 With the availability of vaccines for all US residents aged 5 years and older, many public health experts have called for "off-ramps" and "on-ramps" that use available public health data to inform decisions about when to remove or reinstate masking and other mitigation measures.…”

“…9,13 With the availability of vaccines for all US residents aged 5 years and older, many public health experts have called for "off-ramps" and "on-ramps" that use available public health data to inform decisions about when to remove or reinstate masking and other mitigation measures. 11,12,14,15 Establishing these off-ramps and on-ramps requires decision-makers to be explicit about the objectives they seek to achieve, which in turn necessitates a quantitative estimate of the epidemiologic consequences of adding or removing mitigation. We used a previously published simulation model of SARS-CoV-2 transmission within an elementary school community to generate estimates across a range of potential assumptions about intervention effectiveness, student vaccine coverage, and observed local COVID-19 incidence.…”

“…While multiple studies indicate that masks are effective at mitigating the transmission of upper respiratory viruses, they are generally viewed as a temporary measure . Masks are physiologically safe, but there is limited data on the impact of mask-wearing on learning and social and emotional development, especially for younger children, students with special learning needs, and English language learners .…”

A Data-driven, Dynamic and Flexible Approach to Safely Lifting Mask Mandate: A Proposal

“…proposed a burden-metric based dynamic approach to mask mandates that holistically assesses the impact of masking policies on transmission within schools, student absenteeism and staff capacity. 20 Their proposed policy includes masking requirements spanning four levels, namely making masking universal, making it optional when more than 80% of the eligible population is vaccinated, having masking required for people who are not vaccinated and leaving masking as an optional individual decision. 20 Such an approach is practical and metric-based and will be widely acceptable to the public.…”

“… 20 Their proposed policy includes masking requirements spanning four levels, namely making masking universal, making it optional when more than 80% of the eligible population is vaccinated, having masking required for people who are not vaccinated and leaving masking as an optional individual decision. 20 Such an approach is practical and metric-based and will be widely acceptable to the public. It is noteworthy that having masking as optional, the lowest level of masking requirement, could greatly reduce discrimination against, and the psychological burden of, people who are willing to wear a mask.…”