Principle 7: Masks and PPE
Require all children and staff to wear a cloth or medical mask covering both mouth and nose at all times and provide appropriate PPE to nurses and individuals assessing or treating a suspected case.
Masks work. Masks are among the most important measures to contain the spread of COVID-19. The data are overwhelming for their use, and universal masking with a mandate is more effective than voluntary compliance (MacIntyre and Chughtai 2020). Several recent studies provide evidence of universal mask wearing preventing transmission of COVID-19 (Hendrix et al. 2020; Lyu and Wehby 2020; X. Wang et al. 2020; Chu et al. 2020). A review of articles examining attitudes and experiences found that recommending universal mask wearing can build solidarity in our communities and combat fear and stigma around wearing a mask (Howard et al. 2020).
Objectives:
7.1 Develop a clear and aligned message about masks
Likely Implementation Level DISTRICT, SCHOOL
Status
Priority Level
NOTE: Update your school's or district's status and priority level in your progress tracker (link at the bottom of the homepage).
Key Recommendations for Consideration
Students (and staff) of all ages should wear masks throughout the day, including on the bus and outside if distance can’t be maintained.
Note: masks for ALL ages is best practice. Some places and countries have allowed Pre-K and Grade 1 to be exempt. However, all ages should wear masks on school buses.
Use different modes of communication and messaging in schools to encourage mask wearing (mail, email, text, virtual meetings, infographics, social media).
Face shields should not be used as a replacement for wearing masks/face coverings due to their limited ability to fully protect against droplets.
Have back-up masks available at the school for students and staff
Consider strategies for building student buy-in/cultural norms that reinforce mask wearing.
Starting Point Tools
Parabola Project: Student “Mask Culture” Toolkit
See Principle 7.3 in this guide for more information on cleaning masks.
Ariadne Labs mask resources:
Seeing other people wear masks: A story for children
Wearing a mask to school: A story for children
Wearing a mask: A video for children
The Mask Task: Story for Young Learners
CDC Printable Posters
Tips to make kids more comfortable with masks broken down by age.
Considerations and Questions for Team Decision-Making and Reflection
What preparation can be given to teachers for classroom management of mask wearing?
How can we provide masks for families that can not afford them?
How will students and staff access back-up masks at school if they misplace or forget their mask? Where will these masks be stored?
Other Resources
Country/District Examples
Ideas
Use on-site washers for mask cleaning and distribution.
Wash masks each night on the highest heat setting and redistribute them to students each day.
Consider strategies for making mask-wearing fun/joyful
Districts can create school-branded masks with logo, mascot, etc. for school pride (example).
Incentivize mask-wearing with leaderboards by cohorts (i.e., students receive points for arriving at school with their mask).
Consider buying masks with colors that can be washed at the highest temperature setting on a washing machine.
Update school handbooks and guidelines with new mask, hygiene, and sanitation protocols.
Guidelines
WHO: When and how to use masks (Technical Guidance specifically)
Summary of Literature
Near-universal wearing of non-medical masks can reduce community transmission when combined with other mitigation strategies (Howard et al. 2020; Stutt et al. 2020).
7.2 Establish guidance for families, local health care providers, and staff on mask exceptions
Likely Implementation Level DISTRICT
Status
Priority Level
NOTE: Update your school's or district's status and priority level in your progress tracker (link at the bottom of the homepage).
Key Recommendations for Consideration
Communicate key messages about mask exceptions to families, local health care providers, and staff.
Define alternatives to masks for exceptions (e.g., children who are deaf or hard of hearing).
Starting Point Tools
Parabola Project: Student “Mask Culture” Toolkit
Exceptions for wearing masks:
Developmental, respiratory, tactile aversion, or other conditions (AAP).
Anyone with trouble breathing or who is incapacitated or unable to remove a mask themselves (AAP).
Students who are deaf or hard of hearing (clear masks may be an option), or have intellectual and developmental disabilities, mental health conditions, or other sensory sensitivities (CDC).
When wearing a cloth face covering may exacerbate a physical or mental health condition, lead to a medical emergency, or introduce significant safety concerns (CDC).
Considerations and Questions for Team Decision-Making and Reflection
How should the school nursing staff be involved in mask exemptions?
How will we manage families who want a mask exception and do not fall into one of the medical categories?
Decide if you will require a note from a medical provider writing explicitly for a mask exception or what documentation will be required from families.
Other Resources
Ideas
Consider clear masks for educators working with students with hearing disabilities or learning disabilities who may have trouble understanding instruction without seeing the teacher’s mouth. Face shields without a mask are less safe than a mask alone. If face shields are used for working with hearing-impaired students, at least 6 feet of distance must be maintained at all times.
Guidelines
WHO: When and how to use masks (Technical Guidance specifically)
7.3 Distribute information for families and staff on proper use, removal, and washing of cloth face coverings
Likely Implementation Level DISTRICT
Status
Priority Level
NOTE: Update your school's or district's status and priority level in your progress tracker (link at the bottom of the homepage).
Key Recommendations for Consideration
Use different modes of communication and messaging regarding mask recommendations (mail, email, text, social media, school website, infographics).
Provide students with resources and/or scheduled time to properly wash and store their mask (Jones et al. 2020).
Starting Point Tools
Parabola Project: Student “Mask Culture” Toolkit
CDC guidance on how to wash a cloth face covering.
Washing masks at school:
In community facilities, such as schools, washing should be conducted following the directions above for washing machines. The CDC does specify that dirty laundry that has been in contact with an ill person can be washed with other people’s items.
If the school is providing and washing the masks, students will need an additional mask to take the bus home and return the following day.
Mask cleaning messaging:
Considerations and Questions for Team Decision-Making and Reflection
How can these messages on proper use, removal, and washing cloth face coverings be made clear and reinforced at school?
Other Resources
Summary of Literature
Near-universal wearing of non-medical masks can reduce community transmission when combined with other mitigation strategies (Howard et al. 2020; Stutt et al. 2020).
7.4 Evaluate inventory and purchasing of health care supplies
Likely Implementation Level DISTRICT
Status
Priority Level
NOTE: Update your school's or district's status and priority level in your progress tracker (link at the bottom of the homepage).
Key Recommendations for Consideration
Establish health care supply processes, including vendors, budget, storage space, and inventory management for disposable masks and PPE.
Starting Point Tools
Basic PPE requirements (adapted from MA State Guidance on Safety Supplies):
Surgical mask
Students: provide at least 1 disposable mask per student per week to supplement cloth masks provided by parents. These may be needed for students who can not afford a mask, forget their mask, or soil a cloth mask at school.
Teachers and staff: provide 5 disposable masks per teacher per week. This number may be decreased in future orders if staff prefers to use their own cloth face covering.
Nurse and other designated health care staff: provide 10 disposable masks per week per staff member. This is in addition to required N95 respirators listed below.
Disposable nitrile gloves (nursing and custodial)
Disposable gloves should be ordered in a larger quantity than usual. Gloves will be needed by the nursing and custodial staff and they will be used for screening and some cleaning procedures. Provide at least 10 pairs per week per nursing staff and at least 20 pairs per week per custodial staff. Order at least one extra box designated for the isolation room.
N95 surgical mask (nursing and designated health care staff)
Provide at least 10 N95 surgical masks per staff member per week for nursing and health care staff in the school. N95 respirators are required when interacting or caring for a symptomatic student, providing respiratory related procedures (nebulizer, suctioning), or monitoring a room with a symptomatic student.
Reusable face shields (nursing and designated health care staff)
Provide at least 2 reusable face shields for nursing and designated staff. They are required in addition to an N95 mask when caring for students who are symptomatic and when providing respiratory procedures (nebulizer, suctioning). They can be cleaned after each use (see selected options for reprocessing eye protection).
Disposable gowns (nursing and health care staff)
Provide at least 10 gowns per staff member per week. Gowns should be used by nursing and health care staff with caring for symptomatic students with producing respiratory or other bodily fluids that may get on clothes. Younger children are more likely to present with vomiting and diarrhea as first symptoms.
Considerations and Questions for Team Decision-Making and Reflection
Are there any children who require breathing treatments (nebulizer) at school, and if so, how many? These treatments will require PPE. How will this impact the quantity required per school?
Other Resources
Country/District Examples
7.5 Establish a protocol for mask breaks that allows for 6 feet distancing
Likely Implementation Level DISTRICT
Status
Priority Level
NOTE: Update your school's or district's status and priority level in your progress tracker (link at the bottom of the homepage).
Key Recommendations for Consideration
Designate and clearly sign large areas for mask breaks or mask-free zones where students can be spaced at least 6 feet apart.
While there is limited guidance, consider taking a 15-minute mask break at least every four hours, assuming physical distance can be maintained. This can be done during recess, meals, or movement breaks.
Increase frequency of mask breaks during times of higher heat or physical activity (~every 20 minutes outside).
If mask breaks are indoors, ensure adequate ventilation, filtration, or open windows.
Starting Point Tools
Parabola Project: Student “Mask Culture” Toolkit
See Principle 9.5 for more information on distancing without masks for meals.
Considerations and Questions for Team Decision-Making and Reflection
Determine ideal frequency of mask breaks for your students based on developmental age and instructional schedule. There is no set guidance – you should balance maximization of mask wearing with student adherence and comfort.
Create a plan for mask breaks in inclement weather if they are going to take place outdoors.
Other Resources
Summary of Literature
The risk of transmission drops from 13% to 3% by physical distancing of 1 meter (3.3 ft), and distancing by more than 1 meter further decreases the risk of transmission (Chu et al. 2020).