Dynamic Masking: A Proposal of Burden-Based Metrics for Masking in K-12 Schools During the COVID-19 Pandemic.

BACKGROUND: Ongoing masking of K-12 children has not been universally accepted despite recommendation from public health authorities. In states without universal mask mandates for schools, district administrators are forced to make masking decisions under significant local political pressures. There is a call for endpoints to masking to allow communities to tailor mitigation while keeping schools safe, focusing on harm reduction. METHODS: We reviewed existing measures for the safe opening of schools and designed a stepwise, accessible approach to the removal of masks in the K-12 setting. RESULTS: Focusing first on the assessment of school impact due to COVID-19 disease and then considering the context of existing community transmission levels allows for a metrics-based approach to masking that is flexible and practical, enabling school officials to adapt quickly to the pandemic landscape in their communities, independent of political pressures. CONCLUSIONS: While this proposal is preliminary, a dynamic metric system for masking may encourage those communities who wish to minimize masking to adopt masks during highest risk periods, protecting against SARS-CoV-2 transmission in schools and allowing for more holistic harm reduction. This approach may serve to guide districts during times of uncertainty when central guidance short of universal masking is lacking.

SARS-CoV-2 Incidence and Transmission in 48 K-12 Virginia Public Schools During Community Surge.

Among 20 681 students and 4282 staff, the in-school transmission of SARS-CoV-2 appeared low during highest community spread and at 3- to 6-foot distancing. Nine of 820 school cases (1.1%) resulted in spread, with only one student-to-staff transmission. A school epidemiologist and mitigation audit teams were useful.

COVID-19 Transmission during Transportation of 1st to 12th Grade Students: Experience of an Independent School in Virginia.

BACKGROUND: In-school transmission of COVID-19 among K-12 students is low when mitigation layers are used, but the risk of acquiring COVID-19 during school bus transportation is not well defined. Given the operational limitations of many school districts, more data is needed to determine what mitigation is required to keep COVID-19 transmission low during bus transport. METHODS: An independent school in Virginia monitored 1154 students in grades 1 to 12 with asymptomatic PCR testing every 2 weeks from August 24, 2020 to March 19, 2021, during the highest community transmission. Fifteen buses served 462 students while operating at near capacity of 2 students in every seat, using a physical distancing minimum of 2.5 ft, universal masking, and simple ventilation techniques. RESULTS: A total of 39 individuals were present on buses during their COVID-19 infectious period, which resulted in the quarantine of 52 students. Universal testing and contact tracing revealed no transmission linked to bus transportation. CONCLUSIONS: This study demonstrates a model for the safe operation of school buses while near capacity. COVID-19 transmission can be low during student transport when employing mitigation including simple ventilation, and universal masking, at minimal physical distances and during the highest community transmission.

A survey of characteristics of smokeless tobacco users in a treatment program.

OBJECTIVE: To determine the characteristics and outcomes of smokeless tobacco (ST) users receiving interventions in an outpatient tobacco-dependence treatment program. METHODS: Survey was mailed with telephone follow-up to ST users treated during a 2-year period. RESULTS: Nicotine replacement therapy and family and social support were the most helpful intervention components in maintaining tobacco abstinence. Continuing ST users face significant barriers to abstinence such as high levels of nicotine dependence, lack of motivation, nicotine withdrawal symptoms, and stress. CONCLUSIONS: Enhancing confidence in their ability to quit, managing stress, prescribing bupropion SR, offering nicotine replacement therapy to relieve withdrawal symptoms, and providing ongoing support may be important for ST users in tobacco- dependence treatment programs.

Treatments for spit tobacco use: a quantitative systematic review.

AIMS: Spit tobacco use is prevalent in the United States and is associated with adverse health consequences. Health-care providers have neither evidence summaries nor evidence-based guidelines to assist them in treating patients who use spit tobacco. DESIGN: We completed a systematic review of the literature to determine the efficacy and safety of pharmacological and behavioral interventions for the treatment of spit tobacco use. FINDINGS: We found six randomized controlled trials testing pharmacological interventions and eight testing behavioral interventions. Using random-effects meta-analyses,bupropion sustained-release (SR) increased point prevalence tobacco abstinence at 12 weeks [odds ratio (OR) 2.1; 95% confidence interval (CI), 1.0-4.2]. Nicotine replacement therapy with patch or gum increased point prevalence tobacco abstinence at 6 months (OR 1.3; 95% CI, 1.0-1.6). Behavioral interventions increased long-term (6 month)point prevalence tobacco abstinence (OR 1.7; 95% CI, 1.1-2.9). Studies including an oral examination followed by feedback to the patient had the highest treatment effect. CONCLUSIONS: Behavioral interventions for ST users are effective for increasing ST abstinence rates. Bupropion SR is probably effective and nicotine replacement therapy may be effective. This evidence from randomized controlled trials provides health-care professionals with information necessary to effectively treat spit tobacco use.