Abstract
OBJECTIVES: To expand upon an observational study published by the Centers for Disease Control (CDC) showing an association between school mask mandates and lower pediatric COVID-19 cases. We examine whether this association persists in a larger, nationally representative dataset over a longer period. METHOD: We replicated the CDC study and extended it to more districts and a longer period, employing seven times as much data. We examined the relationship between mask mandates and per-capita pediatric cases, using multiple regression to control for observed differences. RESULTS: We successfully replicated the original result using 565 counties; non-masking counties had around 30 additional daily cases per 100,000 children after two weeks of schools reopening. However, after nine weeks, cases per 100,000 were 18.3 in counties with mandates compared to 15.8 in those without them (p = 0.12). In a larger sample of 1832 counties, between weeks 2 and 9, cases per 100,000 fell by 38.2 and 37.9 in counties with and without mask requirements, respectively (p = 0.93). CONCLUSIONS: The association between school mask mandates and cases did not persist in the extended sample. Observational studies of interventions are prone to multiple biases and provide insufficient evidence for recommending mask mandates.