Accepted for Publication: July 22, 2022.
Published Online: October 24, 2022. doi:10.1001/jamapediatrics.2022.3833
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Science M et al. JAMA Pediatrics.
Corresponding Author: Michelle Science, MD, MSc, Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada (email@example.com).
Author Contributions: Drs Science and Matava had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Jüni and Matava contributed equally.
Concept and design: Science, Caldeira-Kulbakas, Anthony, Bitnun, Bourns, Campbell, Cohen, Dodds, Friedman, Greenwood, Hopkins, Imgrund, Mertz, Nashid, Streitenberger, Walsh, Matava.
Acquisition, analysis, or interpretation of data: Science, Caldeira-Kulbakas, Parekh, Maguire, Carroll, Bitnun, Cohen, Dubey, Hopkins, Imgrund, Korczak, Looi, Louca, Panzera, Schneiderman, Schwartz, Vuppal, Walsh, Jüni, Matava.
Drafting of the manuscript: Science, Maguire, and Matava.
Critical revision of the manuscript for important intellectual content: Science, Caldeira-Kulbakas, Parekh, Carroll, Anthony, Bitnun, Bourns, Campbell, Cohen, Dubey, Friedman, Greenwood, Hopkins, Imgrund, Korczak, Looi, Louca, Mertz, Nashid, Panzera, Schneiderman, Schwartz, Streitenberger, Vuppal, Walsh, Jüni, Matava.
Statistical analysis: Science, Parekh, Maguire, Jüni, Matava.
Obtained funding: Science.
Administrative, technical, or material support: Science, Caldeira-Kulbakas, Parekh, Dodds, Greenwood, Hopkins, Looi, Louca, Mertz, Nashid, Panzera, Schneiderman, Schwartz, Streitenberger, Vuppal, Walsh, Matava.
Supervision: Campbell, Dodds, Imgrund, Matava.
Conflict of Interest Disclosures: Mr Imgrund reported nonfinancial support from Canada Strong Masks, outside the submitted work. Dr Korczak reported grants from the Canadian Institutes of Health Research and fees from SickKids, Chair of Child, and Youth Medical Psychiatry Research funds, outside the submitted work. Dr Schwartz reported receiving consulting fees from the Greater Toronto Airports Authority. Dr Jüni reported honoraria to the institution from Amgen, Ava, Fresenius, and grants from Appili Therapeutics to the institution, outside the submitted work; and Dr Jüni serves as unpaid member of the steering group of trials funded by Appili Therapeutics, Abbott Vascular, and Terumo, and has participated in advisory boards and/or consulting for Amgen, Ava, and Fresenius. No other disclosures were reported.
Funding/Support: This work was supported by the Hospital for Sick Children Foundation.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Back to School COVID-19 School Study Group: The Back-to-School COVID-19 Simulation Study investigators are listed in Supplement 5.
Data Sharing Statement: See Supplement 6.
Additional Contributions: The authors would like to thank the following Hospital for Sick Children research assistants for their contribution to this work: Muzna Ahmad, MD, Luiza Azzouz, Bsc, Tonny H.M Banh, HBSc, Crystal L.Y. Chan, BSc Janice Chen, BSc, Marlena Colasanto, MSc, Isabel de Verteuil, BSc, Ria G. Evans, BSc (Hons), Y. Ingrid Goh, PhD, Haifan Gong, MSc, Victoria A. Gudzak, BSc, Anjelica Guytingco, BSCN, Melisa Hayalioglu, BSc, Kristina N. Kaganovich, M.FSc, Seyed H. Karimzad, PharmD, Katelynn Lundy, BSc(Hons), Lucie C. Marigliano, Bsc, Roxanne R. Noronha, BSc, Monica Prajapati, Anna Pupco, MD, Jana Radosavljevic, BSc(Hons), Olivia Rennie, Maria Salman, Arunthathy Shanmuganathan, BSc, Kristina L. Stevens, BSc (Hon), Maria Isabel T. Suarez, MPH, Maya Sumaida, RN, Milcah E. Sutanto, BSc (Hons), Nicole C. Tagle, BA(Hons), My An Tran, BSc(Hons), Carlone Van Rooyen, BHSc, RJ Williams, MA, and Yuyang Wu, BSc (Hons). The authors would also like to thank: Allison McGeer for her input on the study design; Elena Blackwood, Grace Borosz, Sally-Jane Casey, Anjelica Guytingco, Rachel Koh, Christine McGovern, Natasha Mills, Chirath Ranaweera, Melyssa Stoute, Megan Verrydt for their help facilitating the COVID testing; Tim Guimond for his help with randomization; and Derek Stephens for his statistical support. We would like to thank the schools and their teams for their considerable support of the study.
DK , Akl
EA , Duda
S , Solo
K , Yaacoub
S , Schünemann
HJ ; COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet
. 2020;395(10242):1973-1987. doi:10.1016/S0140-6736(20)31142-9PubMedGoogle ScholarCrossref
KG , Kraut
BH , Ghosh
S , Neatherlin
J . Minimal SARS-CoV-2 transmission after implementation of a comprehensive mitigation strategy at a school—New Jersey, August 20-November 27, 2020. MMWR Morb Mortal Wkly Rep
. 2021;70(11):377-381. doi:10.15585/mmwr.mm7011a2PubMedGoogle ScholarCrossref
JAW , Gettings
JR , Kimball
et al; Georgia K–12 School COVID-19 Investigation Team. Clusters of SARS-CoV-2 infection among elementary school educators and students in one school district—Georgia, December 2020-January 2021. MMWR Morb Mortal Wkly Rep
. 2021;70(8):289-292. doi:10.15585/mmwr.mm7008e4PubMedGoogle ScholarCrossref
A , Benda
A , Falk
P , Steffen
S , Wallace
Z , Høeg
TB . COVID-19 cases and transmission in 17 K-12 schools—Wood County, Wisconsin, August 31-November 29, 2020. MMWR Morb Mortal Wkly Rep
. 2021;70(4):136-140. doi:10.15585/mmwr.mm7004e3PubMedGoogle ScholarCrossref
F , Blough
S , Bergeron
et al. Implementing mitigation strategies in early care and education settings for prevention of SARS-CoV-2 transmission—eight states, September-October 2020. MMWR Morb Mortal Wkly Rep
. 2020;69(49):1868-1872. doi:10.15585/mmwr.mm6949e3PubMedGoogle ScholarCrossref
M , McCullough
JM , Dale
et al. Association between K-12 school mask policies and school-associated COVID-19 outbreaks—Maricopa and Pima Counties, Arizona, July-August 2021. MMWR Morb Mortal Wkly Rep
. 2021;70(39):1372-1373. doi:10.15585/mmwr.mm7039e1PubMedGoogle ScholarCrossref
SE , Panaggio
MJ , Parks
et al. Pediatric COVID-19 cases in counties with and without school mask requirements—United States, July 1-September 4, 2021. MMWR Morb Mortal Wkly Rep
. 2021;70(39):1377-1378. doi:10.15585/mmwr.mm7039e3PubMedGoogle ScholarCrossref
J , Pol
SJ , Korczak
et al; Back to School COVID-19 Study Group. Impact of COVID-19 public health protocols on teachers instructing children and adolescents during an in-person simulation. J Can Acad Child Adolesc Psychiatry
. 2022;31(2):52-63.PubMedGoogle Scholar
SG , Segovia
A , Anthony
et al. Return to school and mask-wearing in class during the COVID-19 pandemic: student perspectives from a school simulation study. Paediatr Child Health
. 2022;27(suppl 1):S15-S21. doi:10.1093/pch/pxab102PubMedGoogle ScholarCrossref
LS , Ejbye-Ernst
P , de Bruin
M , Thomas
J , Lindegaard
MR . Face-touching behaviour as a possible correlate of mask-wearing: a video observational study of public place incidents during the COVID-19 pandemic. Transbound Emerg Dis
. 2022;69(3):1319-1325. doi:10.1111/tbed.14094PubMedGoogle ScholarCrossref
TL , Mustain
R , Goldsby
RE . Frequency of face touching with and without a mask in pediatric hematology/oncology health care professionals. Pediatr Blood Cancer
. 2020;67(9):e28593. doi:10.1002/pbc.28593PubMedGoogle ScholarCrossref
PI , Plotkin
KR , Gerba
CP , Sifuentes
LY , Koenig
DW , Reynolds
KA . Modeling of human viruses on hands and risk of infection in an office workplace using micro-activity data. J Occup Environ Hyg
. 2015;12(4):266-275. doi:10.1080/15459624.2014.974808PubMedGoogle ScholarCrossref
NC , Sawyer
W , Pallerla
H , Khaja
S , Blacker
M . Hand hygiene and face touching in family medicine offices: a Cincinnati Area Research and Improvement Group (CARInG) network study. J Am Board Fam Med
. 2014;27(3):339-346. doi:10.3122/jabfm.2014.03.130242PubMedGoogle ScholarCrossref
AM , Verhougstraete
MP , Beamer
PI , King
MF , Reynolds
KA , Gerba
CP . Frequency of hand-to-head, -mouth, -eyes, and -nose contacts for adults and children during eating and non-eating macro-activities. J Exp Sci Environ Epidemiol
. 2021;31(1):34-44. doi:10.1038/s41370-020-0249-8PubMedGoogle ScholarCrossref
M , Milton
DK , Rhee
C , Baker
MA , Leekha
S . Current insights into respiratory virus transmission and potential implications for infection control programs : a narrative review. Ann Intern Med
. 2021;174(12):1710-1718. doi:10.7326/M21-2780PubMedGoogle ScholarCrossref