AAP: Everyone should wear masks in schools, regardless of vaccination status

The AAP said Monday that everyone aged 2 years or older should wear a mask in school, regardless COVID-19 vaccination status, because many students are not eligible for vaccination and it is difficult to tell who has been immunized.

The recommendation was part of updated back-to-school guidance in which the AAP “strongly” recommended in-person learning and urged eligible students, teachers and staff to get vaccinated.

“We need to prioritize getting children back into schools alongside their friends and their teachers — and we all play a role in making sure it happens safely,” Sonja O’Leary, MD, FAAP, who chairs the AAP’s Council on Student Health, said in a new release. “The pandemic has taken a heartbreaking toll on children, and it’s not just their education that has suffered but their mental, emotional and physical health. Combining layers of protection that include vaccinations, masking and clean hands hygiene will make in-person learning safe and possible for everyone.”

The AAP’s universal masking recommendation came less than 2 weeks after the CDC updated its guidance to say only that unvaccinated people older than age 2 years should wear a mask indoors at all times. Like the AAP, the CDC also recommended prioritizing in-person schooling.

In the release, the AAP explained that it recommends universal masking because “a significant portion of the student population is not yet eligible for vaccines, and masking is proven to reduce transmission of the virus and to protect those who are not vaccinated.” It said exceptions should be made for children with medical or developmental conditions that prohibit the use of a mask.

“Many schools will not have a system to monitor vaccine status of students, teachers and staff, and some communities overall have low vaccination uptake where the virus may be circulating more prominently,” the AAP said.

Additionally, the AAP said its guidance “amplifies” CDC recommendatons on building ventilation, testing, quarantining, cleaning and disinfection.

“There are many children and others who cannot be vaccinated,” Sara Bode, MD, FAAP, chairperson elect of the AAP Council on School Health Executive Committee, said in the release. “This is why it’s important to use every tool in our toolkit to safeguard children from COVID-19. Universal masking is one of those tools and has been proven effective in protecting people against other respiratory diseases as well. It’s also the most effective strategy to create consistent messages and expectations among students without the added burden of needing to monitor everyone’s vaccination status.”

Additional AAP recommendations include:

• Schools should be prepared to adopt an all-encompassing approach for mental health support.
• Adequate and timely COVID-19 testing resources must be available and accessible.
• Strategies should be revised and adapted depending on the level of viral transmission and test positivity rate throughout the community and schools.
• School policies should be adjusted to align with new information about the pandemic; administrators should refine approaches when specific policies are not working.
• School districts must be in close communication and coordinate with state and/or local public health authorities, school nurses, local pediatric practitioners and other medical experts.

The AAP also urged families to call their pediatrician and get children caught up on any vaccines they may have missed during the pandemic, including influenza.

“The last thing we want as we come out of this pandemic is an outbreak of another vaccine-preventable disease,” O’Leary said. “Now is the time for all of us to work together to keep our kids healthy and safe. Your pediatrician can help families who have any questions or concerns about returning to the classroom.”

References:

AAP. COVID-19 Guidance for safe schools. 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/. Accessed July 19, 2021.