Impact of lifting school mask mandates on community SARS-CoV-2 cases, hospitalizations, and deaths: a retrospective observational study
BackgroundSchool masking mandates were widely adopted as a pandemic control measure, however, limited data are available regarding their effectiveness as a strategy for reducing burden of disease in the surrounding community.ObjectiveTo evaluate the impact of school masking policy de-adoption (mask-...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1579202/full |
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| author | Zeynep Ertem Anseh Danesharasteh Sonia T. Anand Nicholas J. Jackson Richard E. Nelson Richard E. Nelson Elissa M. Schechter-Perkins Lloyd Fisher Lloyd Fisher Shira Doron Westyn Branch-Elliman Westyn Branch-Elliman Westyn Branch-Elliman |
| author_facet | Zeynep Ertem Anseh Danesharasteh Sonia T. Anand Nicholas J. Jackson Richard E. Nelson Richard E. Nelson Elissa M. Schechter-Perkins Lloyd Fisher Lloyd Fisher Shira Doron Westyn Branch-Elliman Westyn Branch-Elliman Westyn Branch-Elliman |
| author_sort | Zeynep Ertem |
| collection | DOAJ |
| description | BackgroundSchool masking mandates were widely adopted as a pandemic control measure, however, limited data are available regarding their effectiveness as a strategy for reducing burden of disease in the surrounding community.ObjectiveTo evaluate the impact of school masking policy de-adoption (mask-lifting) on SARS-CoV-2 incidence rates, hospitalizations, and deaths in the surrounding community.MethodsDesign: Retrospective observational study with an event study design, a difference-in-difference method; a target trial emulation (TTE) framework was applied as a secondary analysis. Cohort creation: Data collected from 9/2021 to 6/2022 on SARS-CoV-2 cases, hospitalizations, deaths and vaccination rates were combined with district-level masking policy data. Analysis: In the event study, the impact of masking policy de-adoption on SARS-CoV-2 cases per 100,000 county residents stratified by age during the 8-week period following the policy change was estimated. Effects on hospitalization and deaths per 1,000,000 residents were secondarily estimated. In a secondary analysis, a target trial emulation framework was applied to estimate average treatment effects.ResultsN = 3,970 districts composed of 53,453 schools were included in the cohort. In the event study, no consistent trends for COVID-19 case rates were identified for the whole cohort or for any age group. For the whole cohort, there was a statistically significant increase found 6–8 weeks following the policy change (maximum increase, 1.91 hospitalizations per 1,000,000 county residents); increases in hospitalizations were also found in the stratified analysis for all age groups, although absolute impacts were small. An increase in deaths was found during the period from 4 to 7 weeks following the policy change (maximum increase 0.62 deaths per 1,000,000 residents). In the stratified analysis, small increases in death rates were seen in 50–69 year olds (range, 0.088–1.49) and >70 year olds (range, 0.23–2.58) but not in younger groups. In the TTE framework, cases, hospitalizations, and deaths were similar in control and intervention counties.ConclusionThis study evaluating the impact of lifting of mask mandates in schools, analyzed in two ways, was consistent results ranging from no impact to a small but statistically significant impact of the policy change on SARS-CoV-2 case and severe outcomes rates in the surrounding community. Findings can be used to inform future pandemic policy responses for elementary and secondary schools. |
| format | Article |
| id | doaj-art-b1f5abe403e74498ace2c0eda52dad63 |
| institution | OA Journals |
| issn | 2296-2565 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Public Health |
| spelling | doaj-art-b1f5abe403e74498ace2c0eda52dad632025-08-20T02:33:00ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-06-011310.3389/fpubh.2025.15792021579202Impact of lifting school mask mandates on community SARS-CoV-2 cases, hospitalizations, and deaths: a retrospective observational studyZeynep Ertem0Anseh Danesharasteh1Sonia T. Anand2Nicholas J. Jackson3Richard E. Nelson4Richard E. Nelson5Elissa M. Schechter-Perkins6Lloyd Fisher7Lloyd Fisher8Shira Doron9Westyn Branch-Elliman10Westyn Branch-Elliman11Westyn Branch-Elliman12School of Systems Science and Industrial Engineering, Binghamton University, State University of New York, Binghamton, NY, United StatesSchool of Systems Science and Industrial Engineering, Binghamton University, State University of New York, Binghamton, NY, United StatesVA Boston Cooperative Studies Program, Boston, MA, United StatesUCLA David Geffen School of Medicine, Los Angeles, CA, United StatesIDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United StatesDepartment of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United StatesDepartment of Emergency Medicine, Boston University School Chobanian and Avedisian of Medicine and Boston Medical Center, Boston, MA, United StatesReliant Medical Group, Worcester, MA, United StatesDepartment of Pediatrics, UMass Medical School, Worcester, MA, United StatesDivision of Infectious Diseases and Geographic Medicine, Tufts Medical Center, Boston, MA, United StatesUCLA David Geffen School of Medicine, Los Angeles, CA, United States0Greater Los Angeles VA Medical Center, Los Angeles, CA, United States1VA Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), Los Angeles, CA, United StatesBackgroundSchool masking mandates were widely adopted as a pandemic control measure, however, limited data are available regarding their effectiveness as a strategy for reducing burden of disease in the surrounding community.ObjectiveTo evaluate the impact of school masking policy de-adoption (mask-lifting) on SARS-CoV-2 incidence rates, hospitalizations, and deaths in the surrounding community.MethodsDesign: Retrospective observational study with an event study design, a difference-in-difference method; a target trial emulation (TTE) framework was applied as a secondary analysis. Cohort creation: Data collected from 9/2021 to 6/2022 on SARS-CoV-2 cases, hospitalizations, deaths and vaccination rates were combined with district-level masking policy data. Analysis: In the event study, the impact of masking policy de-adoption on SARS-CoV-2 cases per 100,000 county residents stratified by age during the 8-week period following the policy change was estimated. Effects on hospitalization and deaths per 1,000,000 residents were secondarily estimated. In a secondary analysis, a target trial emulation framework was applied to estimate average treatment effects.ResultsN = 3,970 districts composed of 53,453 schools were included in the cohort. In the event study, no consistent trends for COVID-19 case rates were identified for the whole cohort or for any age group. For the whole cohort, there was a statistically significant increase found 6–8 weeks following the policy change (maximum increase, 1.91 hospitalizations per 1,000,000 county residents); increases in hospitalizations were also found in the stratified analysis for all age groups, although absolute impacts were small. An increase in deaths was found during the period from 4 to 7 weeks following the policy change (maximum increase 0.62 deaths per 1,000,000 residents). In the stratified analysis, small increases in death rates were seen in 50–69 year olds (range, 0.088–1.49) and >70 year olds (range, 0.23–2.58) but not in younger groups. In the TTE framework, cases, hospitalizations, and deaths were similar in control and intervention counties.ConclusionThis study evaluating the impact of lifting of mask mandates in schools, analyzed in two ways, was consistent results ranging from no impact to a small but statistically significant impact of the policy change on SARS-CoV-2 case and severe outcomes rates in the surrounding community. Findings can be used to inform future pandemic policy responses for elementary and secondary schools.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1579202/fullCOVID-19schoolsmaskinfection preventionrespiratory virusSARS-CoV-2 |
| spellingShingle | Zeynep Ertem Anseh Danesharasteh Sonia T. Anand Nicholas J. Jackson Richard E. Nelson Richard E. Nelson Elissa M. Schechter-Perkins Lloyd Fisher Lloyd Fisher Shira Doron Westyn Branch-Elliman Westyn Branch-Elliman Westyn Branch-Elliman Impact of lifting school mask mandates on community SARS-CoV-2 cases, hospitalizations, and deaths: a retrospective observational study Frontiers in Public Health COVID-19 schools mask infection prevention respiratory virus SARS-CoV-2 |
| title | Impact of lifting school mask mandates on community SARS-CoV-2 cases, hospitalizations, and deaths: a retrospective observational study |
| title_full | Impact of lifting school mask mandates on community SARS-CoV-2 cases, hospitalizations, and deaths: a retrospective observational study |
| title_fullStr | Impact of lifting school mask mandates on community SARS-CoV-2 cases, hospitalizations, and deaths: a retrospective observational study |
| title_full_unstemmed | Impact of lifting school mask mandates on community SARS-CoV-2 cases, hospitalizations, and deaths: a retrospective observational study |
| title_short | Impact of lifting school mask mandates on community SARS-CoV-2 cases, hospitalizations, and deaths: a retrospective observational study |
| title_sort | impact of lifting school mask mandates on community sars cov 2 cases hospitalizations and deaths a retrospective observational study |
| topic | COVID-19 schools mask infection prevention respiratory virus SARS-CoV-2 |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1579202/full |
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