The COVID-19 pandemic and resulting childcare closures have left many parents and guardians struggling to find care for their children while continuing to work, leading to adverse mental health and financial outcomes for families. Thus, keeping childcare programs open safely is of paramount importance. Although exposure to childcare early in the pandemic demonstrated no increased risk of contracting COVID-19, the highly contagious B.1.617.2 (Delta) variant has increased community prevalence, and COVID-19 outbreaks in childcare and among younger children are now well described. Furthermore, the attack rate for the B.1.1.7 (Alpha) variant, another highly contagious strain, is similar for both children and adults during childcare outbreaks.
Face masks reduce SARS-CoV-2 respiratory droplet transmission in the community and high-risk environments. In kindergarten through 12th grade schools, masks are part of successful risk mitigation bundles that facilitate a safe return to in-person education. Studies suggest that with strict masking policies social distancing can be safely reduced from 6 to 3 feet. However, child masking has not been studied in childcare, where children are typically younger than 5 years, social distancing is challenging, and adherence to masking is less than in older children. This gap in science is particularly problematic given current public debate regarding the benefits and risks of masking younger children not yet eligible for vaccination. We hypothesized that child masking, regardless of social distancing practices, is associated with reduced risk of a childcare program closing because of COVID-19 cases in either staff or children.