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As kids go back to school and share air, let’s protect them and our communities

The more layers of protection, consistently applied, the better — including masks.

empty classroom
REUTERS/Carlo Allegri

The return to school is always intense, with kids and parents sad about the end of summer vacation but also excited about reconnecting with friends, learning adventures, and activities like music and sports. On this year’s school checklist is another item — how to protect our children and communities from the ongoing surge of COVID-19 cases fueled by the more contagious delta variant.

As kids start spending more time sharing air with each other, this issue becomes more critical. Already we have seen this fourth wave’s impacts among children intensify as schools opened in the southern United States, with reports from hard-hit states of full children’s hospitals, no pediatric intensive care beds, and rare but rising fatalities.

School has been anything but “normal” since March 2020. Most U.S. students have had long stretches of fully remote learning, while some have had periods of in-person or hybrid school, often punctuated by quarantines.

Students and working parents alike benefit from in-person school; as such, returning to a situation where students can be in the school on as many of their school days as possible should be a top priority. However, if we shortchange efforts to stem transmission we place children and school communities at unacceptable risk. The challenge is how to protect school communities when kids spend hours each day in the same room as 30 or more other students, many unvaccinated, and some in schools constructed decades ago and equipped with suboptimal ventilation systems.

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To facilitate mitigating this risk, the U.S. Center for Disease Control and Prevention (CDC) has recommended:

  • Vaccination of all eligible students and staff
  • Universal indoor masking, regardless of vaccination status
  • Maintaining physical distance as much as possible
  • Screening testing at appropriate intervals
  • Maximizing ventilation
  • Staying home when there are any signs of illness

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No one claims that any one of these actions makes a school fully COVID-proof, but each item on the list offers a layer of protection. What we have learned is that the more layers of protection, applied consistently, the better. These protections dampen virus transmission in schools, which in turn breaks chains of infection and reduces the number of cases of severe illness.

Because of the local nature of school governance in the United States, school policies vary tremendously — and this includes those pertaining to COVID-19. Universal masking in schools has been identified as a particularly important, and highly feasible layer, having been endorsed by the American Academy of Pediatrics and the CDC. Despite these recommendations, in many districts the plan is that masking will be optional.

In contrast, some districts — including many in Minnesota — have adopted indoor masking requirements, and cooperation with the Minnesota Department of Health will make testing available to school districts for screening. Compared to a masking requirement, a voluntary masking approach will almost certainly result in fewer people wearing masks, thus decreasing the effectiveness of the masking strategy as a whole. This is because masking is most effective when all are masked: Your own mask is one layer that protects you, and everyone else’s masks are additional layers protecting you.

Dimitri Drekonja
Dimitri Drekonja
In order to protect both ourselves and our community, all parties, and this includes both individuals and institutions, should participate in protection efforts. In this crisis, no one can have the luxury of just letting others do the work to keep our community safe. What does this mean where local school district leadership cannot or will not adhere to CDC-recommended masking policies?

We propose that the state require such districts to take additional actions. If masking is optional in a school, then the state should require the school to increase screening efforts, so that outbreaks can be more quickly identified and contained. Requiring weekly testing of the whole school community if there is no indoor masking would be an alternate layer of protection aimed at keeping the community safe and children in school. When a child tests positive, their class can be swiftly quarantined.

Rachel Widome
Rachel Widome
Additionally, public health surveillance should be transparent and accessible. A dashboard should be created where anyone could see at a glance which guidance their school is following, what percentage of students and staff are vaccinated, and what level of screening testing is being performed.

Even if a statewide mask mandate for schools is not politically feasible, Minnesota can help make schools safer by encouraging districts to do the right thing and by being transparent in their actions.

Dimitri Drekonja, M.D., M.S., is an associate professor in the Division of Infectious Diseases and International Medicine at the University of Minnesota. Rachel Widome, Ph.D., M.H.S., is an associate professor in the Division of Epidemiology and Community Health at the University of Minnesota.

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