Impact of Lifting School Masking Requirements on Incidence of COVID-19 among Staff and Students in Greater-Boston Area School Districts: A Difference-in-Differences Analysis

Abstract

Background. In February 2022, following the rescinding of a Massachusetts statewide school masking mandate, only two cities (Boston and neighboring Chelsea) out of 79 school districts in the greater-Boston area, maintained masking requirements in K-12 schools. This provided an opportunity to examine the impact of removing masking on COVID-19 case rates among students and staff in the public-school setting. Methods. We used difference-in-differences for staggered policy adoption to compare incidence of COVID-19 cases among students and staff in greater-Boston area school districts that lifted masking requirements to those that had not yet lifted masking requirements during the 2021-2022 school year. Results. Before the statewide school masking policy was lifted, there was no statistically significant difference in case rate trajectories between school districts. However, weekly and cumulative case rates were significantly higher in students and staff in school districts that removed masking requirements, compared to districts that had not yet lifted requirements. We estimate that lifting of school masking requirements was associated with an additional 44.9 (95% CI: 32.6, 57.1) COVID-19 cases per 1,000 students and staff over the 15 weeks since the lifting of the statewide school masking requirement, representing nearly 30% of all cases observed in schools during that time. School districts that sustained masking requirements for longer periods tended to have older school buildings in poorer condition, more crowded classrooms, higher proportion of low income and English learning students and students with disabilities, and a higher proportion of Black and Latinx students and staff. Conclusions. Masking is a relatively low-cost but effective intervention that can protect students and staff from substantial illness and loss of in-person days in school. Despite compelling evidence that masking significantly reduces the spread of SARS-CoV-2, political will and public adherence to masking has waned. Our study confirms that universal masking requirements can benefit all students and staff, and therefore represents an important strategy to mitigate the impacts of structural racism, ensure health equity, and to avoid potential deepening of educational inequities.

Face coverings have little utility for young school-aged children

“…For example, a study from Boutzoukas et al 6 in the USA found that optional school masking was associated with a 3.6 times higher rate of infection than universal masking districts; however, contact tracing guidance for the regions defines close contacts for testing differently, depending on whether the index case and contacts were masked. A similar bias is present in a recent preprint from Boston whereby the need to test close contacts of COVID-19 cases was exempt if they were wearing masks 7. These are examples of detection of the outcome (COVID-19 cases) being differentially conditioned on the exposure (mask wearing).…”

Pathways to altered virulence of SARS-CoV-2

“…Such reductions can occur without draconian measures such as lockdowns by using a multipronged approach to slow the spread of COVID-19. Many of these strategies are wellestablished, including improved indoor air ventilation, paid leave to encourage individuals to stay home when infected, improved access to high quality sensitive tests, indoor masking, and robust contact tracing programs (197)(198)(199)(200)(201)(202). Reducing the onward transmission from long-term infections is a crucial part of this strategy as well (150), given the importance of intrahost evolution to the current mode of variant emergence (164,203).…”