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As school districts nationwide contemplate reopening K–12 schools, considering the potential repercussions on COVID-19 transmission is of great importance. Understanding the impact of school closures in the spring may help to inform these decisions.
Over a span of 10 days in March, all 50 states closed K–12 schools to mitigate the spread of SARS-CoV-2. In a time-series analysis, investigators assessed the impact of these school closures on COVID-19 incidence and mortality, while adjusting to the extent possible for other factors, including stay-at-home orders, closure of businesses, restaurant and bar closures, prohibition of gatherings, testing capacity, population density, age distribution, and social vulnerability.
After adjustment, school closures were associated with a significant decline in incidence of COVID-19 (relative change per week, −62%; 95% confidence interval, −71% to −49%) and mortality (relative change per week, −58%; 95% CI, −67% to −46%). These changes were largest in states that closed schools when the incidence of COVID-19 was low. The authors estimate that school closure may have been associated with 1.37 million fewer cases over a 26-day period and 40,600 fewer deaths over a 16-day period. The authors acknowledge that school closures were enacted at around the same time as interventions such as stay-at-home orders and business closures, making it difficult to delineate the impact of school closures alone. Furthermore, the contribution that behavioral measures such as distance separation, hand hygiene, and mask usage made in decreasing transmission could not be assessed.
Auger KA et al. Association between statewide school closure and COVID-19 incidence and mortality in the US. JAMA 2020 Jul 29; [e-pub]. (https://doi.org/10.1001/jama.2020.14348)
Dibner KA et al. Reopening K-12 Schools During the COVID-19 Pandemic: A Report From the National Academies of Sciences, Engineering, and Medicine. JAMA 2020 Jul 29; [e-pub]. (https://doi.org/10.1001/jama.2020.14745)
Donohue JM and Miller E.COVID-19 and school closures. JAMA 2020 Jul 29; [e-pub]. (https://doi.org/10.1001/jama.2020.13092)
Comment
Given multiple simultaneous interventions and behavioral modifications, it remains difficult to tease out the impact of school closures alone on COVID-19. Further, as our understanding of the role of children in transmission of SARS-CoV-2 continues to evolve, it is unclear if the impact of school closures was attributable to reductions in children spreading disease or to curtailed contacts among adults and caregivers who stayed home. Whether school reopening using a measured public health approach, including the use of masks and distancing, would lead to increase in transmission is unknown. Balancing the profound harms of school closure on children's academic progress, social and emotional development, mental health, and food security against the risk for contracting COVID-19 by students, educators, and their families in the setting of uncertainty remains a tremendous challenge.