School masking and COVID-19 community transmission: a synthetic control study.

Background: K-12 schools play a crucial role not only as educational settings but also as hubs for social interaction among children, making them potential drivers of disease transmission within families and the broader community. Little is known about the impact of mandatory school masking policies on community SARS-CoV-2 infection rates during the COVID-19 pandemic. This study addressed this gap by evaluating the association between mandatory school masking policies and community infection rates, accounting for temporal and regional variations. Methods: We conducted a retrospective quasi-experimental study using the synthetic control method. The study focused on the fall 2021 school reopening period in the United States, a time when most U.S. schools returned to fully in-person learning but accompanied by substantial variation in masking policies. Analyses controlled community characteristics prior to reopening and baseline infection rates. Findings: Counties with mandatory school masking policies experienced lower SARS-CoV-2 infection rates compared to counties with non-mandatory policies. During the first nine weeks after school reopening, there was a reduction of 1,096 cases per 100,000 people (95% confidence interval: 880 to 1,310 fewer cases per 100,000 people). This association was influenced by baseline infection rates, population density, and mobility patterns. Interpretation: Mandatory school masking policies were associated with notable reductions in community SARS-CoV-2 infection rates during the fall 2021 school reopening period. This study highlights the potential role of school masking as a public health intervention in mitigating community transmission. Funding: Centers for Disease Control and Prevention and the National Institutes of Health.