Impact of school-based infection prevention strategies on household COVID-19 and respiratory disease outcomes: A cross-sectional study.

PURPOSE: Schools used a wide range of infection prevention strategies during 2022 when there were surges of the Omicron variant of SARS-CoV-2, respiratory syncytial virus, and influenza. We examined data from the Spring semester of the 2021/2022 school year in the United States to describe use of school-based infection prevention strategies, factors associated with implementation, and associations with COVID-19 and respiratory disease related outcomes.

METHODS

We analyzed data from January-June 2022 from the COVID-19 Trends and Impact Survey, a daily, cross-sectional survey on Facebook to examine associations between 11 school-based infection prevention strategies and 5 household COVID-19 and respiratory disease related outcomes (e.g., positive COVID-19 test, COVID-19 like illness). Analyses were restricted to parents with a child < 18 years old who was attending school in-person (n = 228,624). Multivariable, quasibinomial regression models were fit, adjusting for child-, household-, county-level covariates and state.

RESULTS

Universal mask requirements were associated with decreased odds and having no school-based extracurriculars with increased odds of all examined outcomes. Additional prevention strategies were associated with reduced odds of specific outcomes: modified cafeteria use, regular testing of teachers and staff, ventilation improvements, and restricted entry.

CONCLUSIONS

Findings affirm the protective effect of universal mask requirements in school settings. No school based extracurriculars being associated with increased odds of examined outcomes may be a result of reverse causation bias. State and local health departments and education agencies can provide technical assistance to schools to ensure appropriate adoption of strategies based on each school's unique circumstances.