1
|
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, Allen U, Alvares AD, Birken CS, Brown A, Carbone VL, Christie A, Cividino ME, Cohen-Silver JH, Cohn RD, Crosbie J, da Costa BR, Dharmaraj B, Freeman SJ, Gaebe K, Hajjaj O, Huang L, Khan S, Lee E, Logeman C, Manteghi S, Moore C, Morris SK, Orkin J, Pelger SD, Pickel L, Salman S, Shouldice A, Solomon R, Thampi N, Thorpe K, Wasiak A, Xie J. 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. JAMA Pediatr 2022; 176:1169-1175. [PMID: 36279142 PMCID: PMC9593317 DOI: 10.1001/jamapediatrics.2022.3833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
IMPORTANCE 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. OBJECTIVE To evaluate the effect of wearing a face mask on hand-to-face contact by children while at school. DESIGN, SETTING, AND PARTICIPANTS 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. INTERVENTIONS 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). MAIN OUTCOMES AND MEASURES 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. RESULTS 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; P = >.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). CONCLUSIONS AND RELEVANCE 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. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04531254.
Collapse
Affiliation(s)
- Michelle Science
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monica Caldeira-Kulbakas
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rulan S. Parekh
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bryan R. Maguire
- Biostatistics Design and Analysis Unit, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stacie Carroll
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Samantha J. Anthony
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Douglas M. Campbell
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Neonatal Intensive Care Unit, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada,Allan Waters Family Simulation Program, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Complex Care Program, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Alison Dodds
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vinita Dubey
- Communicable Disease Control, Toronto Public Health, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy N. Friedman
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jodi L. Greenwood
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Jessica P. Hopkins
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ryan Imgrund
- Biostatistics, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Daphne J. Korczak
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Looi
- Department of Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada,The Wilfred and Joyce Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Emily Louca
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dominik Mertz
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada,Department of Infection Prevention and Control, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - John Nashid
- Corporate Strategy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Giovanna Panzera
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Jane E. Schneiderman
- Division of Respiratory Medicine, Clinical Research Services, The Hospital for Sick Children, Toronto, Ontario, Canada,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Kevin L. Schwartz
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Division of Infectious Diseases, Department of Medicine, Unity Health Toronto, Toronto, Ontario, Canada
| | - Laurie Streitenberger
- Infection Prevention & Control (IPAC) Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sunayna Vuppal
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catharine M. Walsh
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada,Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Jüni
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clyde T. Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Upton Allen
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Ahuva Brown
- for the Back-to-School COVID-19 School Study Group
| | | | | | | | | | | | | | | | | | | | | | - Omar Hajjaj
- for the Back-to-School COVID-19 School Study Group
| | - Lennox Huang
- for the Back-to-School COVID-19 School Study Group
| | - Sarah Khan
- for the Back-to-School COVID-19 School Study Group
| | - Eon Lee
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Clara Moore
- for the Back-to-School COVID-19 School Study Group
| | | | - Julia Orkin
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Soha Salman
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Nisha Thampi
- for the Back-to-School COVID-19 School Study Group
| | - Kevin Thorpe
- for the Back-to-School COVID-19 School Study Group
| | - Anna Wasiak
- for the Back-to-School COVID-19 School Study Group
| | - Jiayin Xie
- for the Back-to-School COVID-19 School Study Group
| | | |
Collapse
|