ABSTRACT
BACKGROUND: Despite being disproportionately impacted by COVID-19 due to a lack of structural support, marginalized communities have been largely ignored in the politically polarized debate over school masking. In response to this, we sought to explore masking attitudes by centering the voices of parents and children at historically marginalized, predominantly Hispanic schools in southern California. METHODS: We conducted a mixed-methods study with parents and children attending 26 low-income predominantly Hispanic-serving elementary schools. A random sample of parents was asked to provide a freelist of words they associate with masking. A subset of parents with children aged 4-6 was recruited from these surveys to participate in parent-child interviews (PCI). We calculated Smith's salience index for all unique items, stratifying by language (English/Spanish). Item salience guided PCI thematic analysis for additional context and meaning. RESULTS: 648 participants provided 1118 unique freelist items in English and Spanish. 19 parent-child pairs were interviewed, 11 in Spanish and 8 in English. The most salient words were "safety"(0.37), "protection"(0.12), "prevention"(0.05), "health"(0.04), "good"(0.03), "can't breathe"(0.03), "necessary"(0.02), "care"(0.02), "precaution"(0.02), and "unnecessary"(0.02). Spanish speakers had a more favorable view of masking than English speakers, particularly regarding "protection" (0.20 vs 0.08) and "prevention" (0.10 vs 0.02). DISCUSSION: Masking is an affordable individual-level risk mitigation that protects the communities that have inequitably shouldered the burdens of the COVID-19 pandemic. We recommend that policymakers prioritize the views of those most impacted when deciding on risk mitigation policies like school masking.
ABSTRACT
Background: The SARS-CoV-2 virus is airborne and highly transmissible. Masking is an important strategy for source control and personal protection. The American Academy of Pediatrics recommends masking as part of a comprehensive strategy to reduce the spread of COVID-19 and respiratory diseases in school settings, however the effectiveness of school masking policies has been heavily debated. Previous studies of masking effectiveness have been limited by the use of self-reported masking behavior, policies as a proxy for masking behaviors, and/or case surveillance data that are biased by access to testing Methods: The Safer at School Early Alert (SASEA) project provided daily wastewater SARS-CoV-2 surveillance for elementary schools serving historically marginalized communities in San Diego County. We previously found that daily wastewater surveillance can identify 95% of PCR-detectable COVID-19 cases on campus. Between March 2 and May 27, 2022, we randomly selected 10 schools from the SASEA project for bi-weekly systematic observations of masking behaviors of students, staff, and parents. Each school was observed by 4 trained observers from the time school let out until all individuals had left. Observers counted the total number of adults and children and whether they were fully masked (nose and mouth covered), partially masked, or unmasked. We built a logistic regression model to measure the association between positive wastewater signals in the 5 days following an observation event (outcome) and the percentage of individuals who were observed fully masked vs partially or unmasked (primary predictor). Result(s): We conducted 60 observation events over 6 weeks, during which positive wastewater signals- suggesting the presence of at least one COVID-19 case on campus-occurred on 9 days. On average, 38.6% of individuals were observed fully masked. After adjusting for intra-site correlation, observation week, current case rate per 100,000 in the school ZIP code and vaccination rate in the school ZIP code, we found that the odds of a positive wastewater signal in the 5 days after observation decreased by 47% (aOR 0.53, 95% CI: 0.28 - 0.99) for each 10% increase in the proportion of fully masked individuals. Conclusion(s): Masking is an effective strategy to prevent the spread of COVID-19 in school settings. Even a relatively small increase in the proportion of individuals masking can potentially lead to a significant difference in epidemic spread.