Effect of wearing a face mask on hand-to-face contact by children in a simulated school environment: the Back-to-School COVID-19 Simulation Randomized Clinical Trial

<p><strong>Importance</strong> Wearing a face mask in school can reduce SARS-CoV-2 transmission but it may also lead to increased hand-to-face contact, which in turn could increase infection risk through self-inoculation.</p> <p><strong>Objective </strong>...

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Главные авторы: Science, M, Caldeira-Kulbakas, M, Parekh, RS, Maguire, BR, Carroll, S, Anthony, SJ, Bitnun, A, Bourns, LE, Campbell, DM, Cohen, E, Dodds, A, Dubey, V, Friedman, JN, Greenwood, JL, Hopkins, JP, Imgrund, R, Korczak, DJ, Looi, T, Louca, E, Mertz, D, Nashid, J, Panzera, G, Schneiderman, JE, Schwartz, KL, Streitenberger, L, Vuppal, S, Walsh, CM, Jüni, P, Matava, CT
Другие авторы: Back-to-School COVID-19 School Study Group
Формат: Journal article
Язык:English
Опубликовано: American Medical Association 2022
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author Science, M
Caldeira-Kulbakas, M
Parekh, RS
Maguire, BR
Carroll, S
Anthony, SJ
Bitnun, A
Bourns, LE
Campbell, DM
Cohen, E
Dodds, A
Dubey, V
Friedman, JN
Greenwood, JL
Hopkins, JP
Imgrund, R
Korczak, DJ
Looi, T
Louca, E
Mertz, D
Nashid, J
Panzera, G
Schneiderman, JE
Schwartz, KL
Streitenberger, L
Vuppal, S
Walsh, CM
Jüni, P
Matava, CT
author2 Back-to-School COVID-19 School Study Group
author_facet Back-to-School COVID-19 School Study Group
Science, M
Caldeira-Kulbakas, M
Parekh, RS
Maguire, BR
Carroll, S
Anthony, SJ
Bitnun, A
Bourns, LE
Campbell, DM
Cohen, E
Dodds, A
Dubey, V
Friedman, JN
Greenwood, JL
Hopkins, JP
Imgrund, R
Korczak, DJ
Looi, T
Louca, E
Mertz, D
Nashid, J
Panzera, G
Schneiderman, JE
Schwartz, KL
Streitenberger, L
Vuppal, S
Walsh, CM
Jüni, P
Matava, CT
author_sort Science, M
collection OXFORD
description <p><strong>Importance</strong> Wearing a face mask in school can reduce SARS-CoV-2 transmission but it may also lead to increased hand-to-face contact, which in turn could increase infection risk through self-inoculation.</p> <p><strong>Objective </strong> To evaluate the effect of wearing a face mask on hand-to-face contact by children while at school.</p> <p><strong>Design, Setting, and Participants</strong> This prospective randomized clinical trial randomized students from junior kindergarten to grade 12 at 2 schools in Toronto, Ontario, Canada, during August 2020 in a 1:1 ratio to either a mask or control class during a 2-day school simulation. Classes were video recorded from 4 angles to accurately capture outcomes.</p> <p><strong>Interventions</strong> Participants in the mask arm were instructed to bring their own mask and wear it at all times. Students assigned to control classes were not required to mask at any time (grade 4 and lower) or in the classroom where physical distancing could be maintained (grade 5 and up).</p> <p><strong>Main Outcomes and Measures</strong> The primary outcome was the number of hand-to-face contacts per student per hour on day 2 of the simulation. Secondary outcomes included hand-to-mucosa contacts and hand-to-nonmucosa contacts. A mixed Poisson regression model was used to derive rate ratios (RRs), adjusted for age and sex with a random intercept for class with bootstrapped 95% CIs.</p> <p><strong>Results</strong> A total of 174 students underwent randomization and 171 students (mask group, 50.6% male; control group, 52.4% male) attended school on day 2. The rate of hand-to-face contacts did not differ significantly between the mask and the control groups (88.2 vs 88.7 events per student per hour; RR, 1.00; 95% CI, 0.78-1.28; <i>P</i> = >.99). When compared with the control group, the rate of hand-to-mucosa contacts was significantly lower in the mask group (RR, 0.12; 95% CI, 0.07-0.21), while the rate of hand-to-nonmucosa contacts was higher (RR, 1.40; 95% CI, 1.08-1.82).</p> <p><strong>Conclusions and Relevance</strong> In this clinical trial of simulated school attendance, hand-to-face contacts did not differ among students required to wear face masks vs students not required to wear face masks; however, hand-to-mucosa contracts were lower in the face mask group. This suggests that mask wearing is unlikely to increase infection risk through self-inoculation.</p> <p><strong>Trial Registration</strong> ClinicalTrials.gov Identifier: NCT04531254</p>
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spelling oxford-uuid:dc3f830d-f95d-4fc2-811c-1788d0c9627c2023-05-16T16:32:20ZEffect of wearing a face mask on hand-to-face contact by children in a simulated school environment: the Back-to-School COVID-19 Simulation Randomized Clinical TrialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:dc3f830d-f95d-4fc2-811c-1788d0c9627cEnglishSymplectic Elements American Medical Association2022Science, MCaldeira-Kulbakas, MParekh, RSMaguire, BRCarroll, SAnthony, SJBitnun, ABourns, LECampbell, DMCohen, EDodds, ADubey, VFriedman, JNGreenwood, JLHopkins, JPImgrund, RKorczak, DJLooi, TLouca, EMertz, DNashid, JPanzera, GSchneiderman, JESchwartz, KLStreitenberger, LVuppal, SWalsh, CMJüni, PMatava, CTBack-to-School COVID-19 School Study Group<p><strong>Importance</strong> Wearing a face mask in school can reduce SARS-CoV-2 transmission but it may also lead to increased hand-to-face contact, which in turn could increase infection risk through self-inoculation.</p> <p><strong>Objective </strong> To evaluate the effect of wearing a face mask on hand-to-face contact by children while at school.</p> <p><strong>Design, Setting, and Participants</strong> This prospective randomized clinical trial randomized students from junior kindergarten to grade 12 at 2 schools in Toronto, Ontario, Canada, during August 2020 in a 1:1 ratio to either a mask or control class during a 2-day school simulation. Classes were video recorded from 4 angles to accurately capture outcomes.</p> <p><strong>Interventions</strong> Participants in the mask arm were instructed to bring their own mask and wear it at all times. Students assigned to control classes were not required to mask at any time (grade 4 and lower) or in the classroom where physical distancing could be maintained (grade 5 and up).</p> <p><strong>Main Outcomes and Measures</strong> The primary outcome was the number of hand-to-face contacts per student per hour on day 2 of the simulation. Secondary outcomes included hand-to-mucosa contacts and hand-to-nonmucosa contacts. A mixed Poisson regression model was used to derive rate ratios (RRs), adjusted for age and sex with a random intercept for class with bootstrapped 95% CIs.</p> <p><strong>Results</strong> A total of 174 students underwent randomization and 171 students (mask group, 50.6% male; control group, 52.4% male) attended school on day 2. The rate of hand-to-face contacts did not differ significantly between the mask and the control groups (88.2 vs 88.7 events per student per hour; RR, 1.00; 95% CI, 0.78-1.28; <i>P</i> = >.99). When compared with the control group, the rate of hand-to-mucosa contacts was significantly lower in the mask group (RR, 0.12; 95% CI, 0.07-0.21), while the rate of hand-to-nonmucosa contacts was higher (RR, 1.40; 95% CI, 1.08-1.82).</p> <p><strong>Conclusions and Relevance</strong> In this clinical trial of simulated school attendance, hand-to-face contacts did not differ among students required to wear face masks vs students not required to wear face masks; however, hand-to-mucosa contracts were lower in the face mask group. This suggests that mask wearing is unlikely to increase infection risk through self-inoculation.</p> <p><strong>Trial Registration</strong> ClinicalTrials.gov Identifier: NCT04531254</p>
spellingShingle Science, M
Caldeira-Kulbakas, M
Parekh, RS
Maguire, BR
Carroll, S
Anthony, SJ
Bitnun, A
Bourns, LE
Campbell, DM
Cohen, E
Dodds, A
Dubey, V
Friedman, JN
Greenwood, JL
Hopkins, JP
Imgrund, R
Korczak, DJ
Looi, T
Louca, E
Mertz, D
Nashid, J
Panzera, G
Schneiderman, JE
Schwartz, KL
Streitenberger, L
Vuppal, S
Walsh, CM
Jüni, P
Matava, CT
Effect of wearing a face mask on hand-to-face contact by children in a simulated school environment: the Back-to-School COVID-19 Simulation Randomized Clinical Trial
title Effect of wearing a face mask on hand-to-face contact by children in a simulated school environment: the Back-to-School COVID-19 Simulation Randomized Clinical Trial
title_full Effect of wearing a face mask on hand-to-face contact by children in a simulated school environment: the Back-to-School COVID-19 Simulation Randomized Clinical Trial
title_fullStr Effect of wearing a face mask on hand-to-face contact by children in a simulated school environment: the Back-to-School COVID-19 Simulation Randomized Clinical Trial
title_full_unstemmed Effect of wearing a face mask on hand-to-face contact by children in a simulated school environment: the Back-to-School COVID-19 Simulation Randomized Clinical Trial
title_short Effect of wearing a face mask on hand-to-face contact by children in a simulated school environment: the Back-to-School COVID-19 Simulation Randomized Clinical Trial
title_sort effect of wearing a face mask on hand to face contact by children in a simulated school environment the back to school covid 19 simulation randomized clinical trial
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