Duke report: Masks may be key to reopening K-12s safely in fall

Masking was effective in North Carolina in preventing COVID-19 spread both in classes and on buses.
By: | July 1, 2021
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A new report from researchers affiliated with Duke University shows that transmission of COVID-19 in middle and high schools was low during the 2020-21 academic year and that masks were a major deterrent in preventing potential spread.

In its report COVID-19 and Schools: The Year in Review and a Path Forward, the ABC Science Collaborative team led by Drs. Danny Benjamin and Kanecia Zimmerman notes that while social distancing was not a factor in limiting infection rates, masks were, both in schools and on buses.

In a letter sent to Gov. Roy Cooper, the State Board of Education, Department of Health and Human Services, and several state committees that requested the study be undertaken, they say masks for schools may be an effective tool again this fall as they reopen.

“North Carolina school districts, K-12 education and the charter schools did an outstanding job of preventing COVID-19 transmission in schools,” said Benjamin, who is a professor of pediatrics at Duke School of Medicine and chair of the National Institute of Child Health and Human Development’s Pediatric Trials Network. “With masking, the schools clearly can safely deliver face-to-face education for children and adults. They can have one, two or three children (per seat) on the school buses. The amount of distancing, whether it’s less than 6 feet, less than 3 feet or no distancing at all, it didn’t make any difference at all …providing there was masking in place.

“This means that we don’t have to close schools again. We don’t have to have remote instruction. We’ve got tools that will keep children and adults safe in schools.”

Yet, North Carolina legislators are advancing a bill called the Free the Smiles Act that would make masks optional in K-12 schools. With lower vaccination rates in North Carolina (41% of the population have completed doses), a lack of vaccines for students under 12, the surge of the Delta variant and relaxing of masks, could COVID-19 numbers rise and spread among students when schools reopen?

“We don’t have data from within North Carolina as to whether or not, in school in K-12, what happens when children are not masked,” Benjamin said, but with masking, “we can effectively prevent morbidity and mortality from this disease, full stop. We have that capability.”

Zimmerman, associate professor of pediatrics in the Division of Critical Care Medicine at Duke University Medical Center, added during a recent news conference, “The science suggests that masking can be extremely effective, particularly for those who can’t get vaccinated while COVID-19 is still circulating. The secondary attack rate is really, really low.”

Other states and school districts are weighing options too, with some already installing mask mandates and others pushing forward without them. Schools that are leaning toward lifting off masks completely may want to reconsider, at least until larger populations are vaccinated.

“We know that if our goal is to reduce transmission of COVID-19 in schools, there are two effective ways to do that. 1: Vaccination. 2: Masking,” Zimmerman said.

The Duke study looked at 100 school districts and 14 charter schools across North Carolina, totaling more than 850,000 students and 160,000 employees. It addressed three other areas of concern:

Athletics. One of the biggest areas of spread in schools throughout the nation was in athletics and especially those done indoors. “We need specific policies in place in order to protect athletes,” Zimmerman said. “Vaccination is extremely effective, as is masking.”

Anxiety among students. “Some of the children are going to be anxious,” Benjamin said. “If the adults will treat this as something that is fun and an opportunity, the children tend to respond better to that. For the older children, of course, the opportunity to be vaccinated right now really does provide a safe environment regardless of where the children might be.”

Quarantines: The doctors suggested to the state that with masks in place, there is no need to quarantine students or educators. In hindsight, they noted much of the loss of education time for 40,000 students and teachers in North Carolina who were quarantined could have been prevented.