There have been conflicting results from studies examining the impact of mask mandates on COVID-19 cases. For example, a study conducted in the United States and published in late 2022, found that lifting mask requirements was associated with an increase in COVID-19 cases among students and staff []. However, this study aggregated data from all age groups, making it difficult to determine how the effects of mask recommendations might vary by age.
The major limitation of our study is that schools are not the only place for children to have social contacts and to be exposed to SARS-CoV-2, and our study design did not allow tracking the places of transmission. However, the lower incidence in vaccinated adults would indicate a lower risk of infection at home. Therefore, one would expect to see some differences in the age-specific incidences if masking was an effective way to control transmission in schools.
Moreover, we could not completely account for all confounding factors, like ascertainment of how strictly the face mask recommendations were followed in the schools. However, among these three regions, there was consensus on avoiding restrictions that had an impact on children’s everyday life, including free-time activities, and the implementation of infection control measures concerning hobbies was likely very similar between the cities.
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