From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston.
N Engl J Med. 2022 Nov 24;387(21):1935-1946. doi: 10.1056/NEJMoa2211029. Epub 2022 Nov 9.
In February 2022, Massachusetts rescinded a statewide universal masking policy in public schools, and many Massachusetts school districts lifted masking requirements during the subsequent weeks. In the greater Boston area, only two school districts - the Boston and neighboring Chelsea districts - sustained masking requirements through June 2022. The staggered lifting of masking requirements provided an opportunity to examine the effect of universal masking policies on the incidence of coronavirus disease 2019 (Covid-19) in schools.
We used a difference-in-differences analysis for staggered policy implementation to compare the incidence of Covid-19 among students and staff in school districts in the greater Boston area that lifted masking requirements with the incidence in districts that sustained masking requirements during the 2021-2022 school year. Characteristics of the school districts were also compared.
Before the statewide masking policy was rescinded, trends in the incidence of Covid-19 were similar across school districts. During the 15 weeks after the statewide masking policy was rescinded, the lifting of masking requirements was associated with an additional 44.9 cases per 1000 students and staff (95% confidence interval, 32.6 to 57.1), which corresponded to an estimated 11,901 cases and to 29.4% of the cases in all districts during that time. Districts that chose to sustain masking requirements longer tended to have school buildings that were older and in worse condition and to have more students per classroom than districts that chose to lift masking requirements earlier. In addition, these districts had higher percentages of low-income students, students with disabilities, and students who were English-language learners, as well as higher percentages of Black and Latinx students and staff. Our results support universal masking as an important strategy for reducing Covid-19 incidence in schools and loss of in-person school days. As such, we believe that universal masking may be especially useful for mitigating effects of structural racism in schools, including potential deepening of educational inequities.
Among school districts in the greater Boston area, the lifting of masking requirements was associated with an additional 44.9 Covid-19 cases per 1000 students and staff during the 15 weeks after the statewide masking policy was rescinded.
2022 年 2 月，马萨诸塞州取消了全州范围内公立学校的普遍戴口罩政策，随后几周内，许多马萨诸塞州学区取消了戴口罩的要求。在大波士顿地区，只有两个学区——波士顿和邻近的切尔西学区——在 2022 年 6 月之前一直维持戴口罩的要求。戴口罩要求的逐步取消为研究全州范围内的戴口罩政策对学校 2019 年冠状病毒病（COVID-19）发病率的影响提供了机会。
我们使用了交错政策实施的差异分析，比较了大波士顿地区取消戴口罩要求的学区和在 2021-2022 学年维持戴口罩要求的学区的学生和教职员工 COVID-19 的发病率。还比较了学区的特点。
在全州范围内的口罩政策被取消之前，各学区 COVID-19 的发病率趋势相似。在全州范围内的口罩政策取消后的 15 周内，取消口罩要求与每千名学生和教职员工增加 44.9 例（95%置信区间，32.6 至 57.1）相关，这相当于估计有 11901 例病例，占同期所有学区病例的 29.4%。选择更长时间维持口罩要求的学区往往有更老、更差的校舍，以及每班更多的学生，而选择更早取消口罩要求的学区则相反。此外，这些学区的低收入学生、残疾学生和英语学习者的比例较高，以及黑人和拉丁裔学生和教职员工的比例较高。我们的结果支持普遍戴口罩是减少学校 COVID-19 发病率和减少面对面上学天数的重要策略。因此，我们认为普遍戴口罩对于减轻学校结构性种族主义的影响，包括潜在地加深教育不平等，可能特别有用。
在大波士顿地区的学区中，在全州范围内的口罩政策取消后的 15 周内，取消口罩要求与每千名学生和教职员工增加 44.9 例 COVID-19 病例相关。
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