AAP Calls for ‘Universal Masking’ in Schools — Vaccinated or Not

All school staff and students over 2 years should wear masks when they return to school this fall, regardless of their vaccination status, according to the American Academy of Pediatrics (AAP).

The new guidance issued Monday is stricter than what the CDC currently calls for: “Based on studies from 2020-2021 school year, CDC recommends schools maintain at least 3 feet of physical distance between students within classrooms, combined with indoor mask wearing by people who are not fully vaccinated, to reduce transmission risk,” according to the CDC website.

In an interview with CNN, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, acknowledged that differences between the AAP and CDC guidance could lead to confusion. But he emphasized that “When you have a degree of viral dynamics in the community and you have a substantial proportion of the population that is unvaccinated, you really want to go the extra step, the extra mile… I think that the [AAP is] a thoughtful group. They analyze the situation, and if they feel that that’s the way to go, I think that is a reasonable thing to do.”

AAP based its guidance on the proven efficacy of masks in reducing the transmission of the SARS-CoV-2 virus, and in protecting the unvaccinated, a press release noted. The academy also urged all “eligible individuals” to receive the COVID-19 vaccine.

“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,” said Sonja O’Leary, MD, chair of the AAP Council on School Health, in a statement.

AAP emphasized that opening schools for in-person learning “generally does not significantly increase community transmission,” especially when schools implement the preventive guidance issued by the CDC, which addresses building ventilation, testing, and quarantining, as well as cleaning and disinfection.

To date, vaccines have only been authorized for children ages 12 years and older, so a “significant portion” of students will not be eligible for their shot before returning to school, according to the release.

“This is why it’s important to use every tool in our toolkit to safeguard children from COVID-19,” said Sara Bode, MD, chair-person elect of the AAP Council on School Health Executive Committee. “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.”

There are also individuals who have chosen not to get vaccinated, and communities with low vaccination rates may see higher rates of circulating virus, AAP noted. Additionally, emerging SARS-CoV-2 variants may increase the risk of transmission and may lead to worsening illness.

The AAP supports universal masking for all of these reasons, they stated. The academy also urged school staff to take steps to protect children and teachers prior to the 2020-2021 school year with the following:

• Preparing to address children’s potential mental health needs
• Making “adequate and timely” COVID-19 testing resources available
• Ensuring that school strategies can adapt to changes in the community, such as viral transmission levels and test-positivity rates
• Implementing school policies that respond to new information about the pandemic

AAP specifically stressed that administrators should “refine approaches when specific policies are not working,” and emphasized the need for continued federal, state, and local funding for schools to implement COVID-19 mitigation measures.

Lastly, the AAP recommended that school districts communicate and coordinate with state and local public health authorities, school nurses, pediatric providers, and other medical experts. It also encouraged families to get caught up on vaccinations they may have missed during the pandemic, including the flu vaccine.

“The last thing we want as we come out of this pandemic is an outbreak of another vaccine-preventable disease,” O’Leary said.