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Masks in school

Dear Montana Education Leaders,

In his recent directive implementing Executive Order 2-2021, Governor (Greg) Gianforte highlighted that “access to school is essential to the developmental, social, mental, and educational needs of school-age children.” We cannot agree more that access to school is essential to the health and well-being of our children and adolescents.

Across our state and nation many K-12 schools have remained open during the COVID-19 pandemic by following a multi-layered approach to protecting students, teachers, and staff. There is growing evidence that when K-12 schools follow mitigation strategies, such as those outlined by the Centers for Disease Control and Prevention [1] and American Academy of Pediatrics, there is generally not a significant increase in rates of community transmission or in-school virus transmission. [3-7] This evidence should encourage educators and school systems to continue these best practices to keep their students, staff, and communities safe while the COVID-19 pandemic is ongoing.

In line with these best practices, Governor Gianforte’s directive states “schools should make reasonable efforts to follow school guidelines and best practices recommended by the CDC...”. The CDC strongly recommends universal cloth face coverings — masks — as one of the critical mitigation strategies to keep schools open and safe. [1] However, we are concerned that some school leaders and parents have interpreted this directive as a statement that masks are not an important mitigation tool for keeping schools safe.

COVID-19 still remains a significant threat to our vulnerable children and schools which is why experts in public health, education, and pediatric health recommend universal masking in schools as best practice. The CDC’s school guidance recommends universal masking in schools and school-related extracurricular events, regardless of the level of community transmission. Masks protect both the wearer and others they come in close contact with and the vast majority of students have been able to wear a mask safely and effectively without any evidence of harm. Evidence for the importance of masks in reducing COVID-19 transmission in school settings continues to grow. For example, a recent CDC study of 397 children in Mississippi found that in-person attendance at school was not associated with COVID-19 infection, unless masks were not consistently worn by students and staff. [7] Also, a recent CDC study involving nine clusters of COVID-19 in a Georgia school district described an increased risk to teachers, who are more likely to experience severe disease, when there was inadequate mask use. [8] Furthermore, although vaccination will eventually improve the COVID-19 burden in our community, universal masking remains essential as we do not understand how vaccination affects transmission and children are unable to receive the vaccine at this time. Lastly, it is uncertain what effect newly recognized SARS-CoV-2 variants will have on our communities, children, and schools but caution is warranted.

This lack of state-wide consistency in school mask use presents a challenge for parents, teachers, educators, and school leaders trying to provide access to in-person education. It also presents a challenge for inter-school activities where schools from different communities have differing requirements resulting in significant conflict and potentially unsafe environments for participants.

For all the above reasons, we strongly recommend continued universal mask use by all students and staff in schools and school-related activities which is in line with Gov. Gianforte’s directive to follow best practices recommended by the CDC.

Sincerely,

Montana Chapter, American Academy of Pediatrics

Montana Association of School Nurses

Association of Montana Public Health Officials

Montana Academy of Family Physicians

Montana Public Health Association

[1] Center for Disease Control and Prevention. (2021). Operating schools during COVID-19: CDC’s Considerations. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/community/schools- childcare/schools.html.

[2] American Academy of Pediatrics. (2021). COVID-19 Guidance for Safe Schools. Retrieved from https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid- 19-planning-considerations-return-to-in-person-education-in-schools/.

[3] World Health Organization. What we know about COVID-19 transmission in schools: The latest on the COVID-19 global situation and the spread of COVID-19 in schools. October 21, 2020. Available at: https://www.who.int/docs/default-source/coronaviruse/risk-comms-updates/update39-covid-and- schools.pdf?sfvrsn=320db233_2

[4] Honein MA, Barrios LC, Brooks JT. Data and Policy to Guide Opening Schools Safely to Limit the Spread of SARS-CoV-2 Infection. JAMA. Published online January 26, 2021. doi:10.1001/jama.2021.0374

[5] Zimmerman, K. O., Akinboyo, I. C., Brookhart, M. A., Boutzoukas, A. E., McGann, K., Smith, M. J., Maradiaga Panayotti, G., Armstrong, S. C., Bristow, H., Parker, D., Zadrozny, S., Weber, D. J., Benjamin, D. K., Jr, & ABC Science Collaborative (2021). Incidence and Secondary Transmission of SARS-CoV-2 Infections in Schools. Pediatrics, e2020048090. Advance online publication. https://doi.org/10.1542/peds.2020-048090

[6] Falk A, Benda A, Falk P, Steffen S, Wallace Z, Høeg TB. COVID-19 Cases and Transmission in 17 K–12 Schools — Wood County, Wisconsin, August 31–November 29, 2020. MMWR Morb Mortal Wkly Rep. ePub: 26 January 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7004e3

[7] Hobbs, C. V., Martin, L. M., Kim, S. S., Kirmse, B. M., Haynie, L., McGraw, S., Byers, P., Taylor, K. G., Patel, M. M., Flannery, B., & CDC COVID-19 Response Team (2020). Factors Associated with Positive SARS-CoV-2 Test Results in Outpatient Health Facilities and Emergency Departments Among Children and Adolescents Aged <18 Years - Mississippi, September-November 2020. MMWR. Morbidity and mortality weekly report, 69(50), 1925–1929. https://doi.org/10.15585/mmwr.mm6950e3

[8] Gold JA, Gettings JR, Kimball A, et al. Clusters of SARS-CoV-2 Infection Among Elementary School Educators and Students in One School District — Georgia, December 2020–January 2021. MMWR Morb Mortal Wkly Rep. ePub: 22 February 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7008e4external

 

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