Key Points

Question How is COVID-19 incidence in elementary school communities associated with in-school mitigation (eg, masks), vaccination, and local incidence, and when should decision-makers add or remove mitigation measures?

Findings In this decision analytic model with a simulated population of 638 students and 60 educators and staff in an elementary school, school community incidence decreased with mitigation and vaccination and increased with local incidence. Thresholds for changing mitigation measures depended on the objective (eg, minimizing likelihood of any in-school transmission vs maintaining cases within acceptable limits).

Meaning These findings suggest that appropriate increases and decreases for in-school mitigation depend on policy makers’ goals; responsive plans, in which mitigation is deployed based on local COVID-19 incidence and vaccine uptake, may be appropriate.

Abstract

Importance With recent surges in COVID-19 incidence and vaccine authorization for children aged 5 to 11 years, elementary schools face decisions about requirements for masking and other mitigation measures. These decisions require explicit determination of community objectives (eg, acceptable risk level for in-school SARS-CoV-2 transmission) and quantitative estimates of the consequences of changing mitigation measures.

Objective To estimate the association between adding or removing in-school mitigation measures (eg, masks) and COVID-19 outcomes within an elementary school community at varying student vaccination and local incidence rates.

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