Abstract
Resurgent COVID-19 cases have resulted in the reinstitution of nonpharmaceutical interventions, including school closures, which can have adverse effects on families. Understanding the associations of school closures with the number of incident and cumulative COVID-19 cases is critical for decision-making. To estimate the association of schools being open or closed with the number of COVID-19 cases compared with community-based nonpharmaceutical interventions. This decision analytical modelling study developed an agent-based transmission model using a synthetic population of 1 000 000 individuals based on the characteristics of the population of Ontario, Canada. Members of the synthetic population were clustered into households, neighborhoods, or rural districts, cities or rural regions, day care facilities, classrooms (ie, primary, elementary, or high school), colleges or universities, and workplaces. Data were analyzed between May 5, 2020, and October 20, 2020. School reopening on September 15, 2020, vs schools remaining closed under different scenarios for nonpharmaceutical interventions. Incident and cumulative COVID-19 cases between September 1, 2020, and October 31, 2020. Among 1 000 000 simulated individuals, the percentage of infections among students and teachers acquired within schools was less than 5% across modeled scenarios. Incident COVID-19 case numbers on October 31, 2020, were 4414 (95% credible interval [CrI], 3491-5382) cases in the scenario with schools remaining closed and 4740 (95% CrI, 3863-5691) cases in the scenario for schools reopening, with no other community-based nonpharmaceutical intervention. In scenarios with community-based nonpharmaceutical interventions implemented, the incident case numbers on October 31 were 714 (95% CrI, 568-908) cases for schools remaining closed and 780 (95% CrI, 580-993) cases for schools reopening. When scenarios applied the case numbers observed in early October in Ontario, the cumulative case numbers were 777 (95% CrI, 621-993) cases for schools remaining closed and 803 (95% CrI, 617-990) cases for schools reopening. In scenarios with implementation of community-based interventions vs no community-based interventions, there was a mean difference of 39 355 cumulative COVID-19 cases by October 31, 2020, while keeping schools closed vs reopening them yielded a mean difference of 2040 cases. This decision analytical modeling study of a synthetic population of individuals in Ontario, Canada, found that most COVID-19 cases in schools were due to acquisition in the community rather than transmission within schools and that the changes in COVID-19 case numbers associated with school reopenings were relatively small compared with the changes associated with community-based nonpharmaceutical interventions.
Highlights
During the first wave of the COVID-19 pandemic, school closures were a component of nonpharmaceutical interventions (NPIs) enacted to mitigate the transmission of SARS-CoV-2, largely based on the rationale that it had been effective in delaying or reducing the peak of the 2009 H1N1 influenza epidemic.[1]
In scenarios with implementation of community-based interventions vs no community-based interventions, there was a mean difference of 39 355 cumulative COVID-19 cases by October 31, 2020, while keeping schools closed vs reopening them yielded a mean difference of 2040 cases
SARS-CoV-2 Infections Associated With School Closures and Community Interventions. This decision analytical modeling study of a synthetic population of individuals in Ontario, Canada, found that most COVID-19 cases in schools were due to acquisition in the community rather than transmission within schools and that the changes in COVID-19 case numbers associated with school reopenings were relatively small compared with the changes associated with community-based nonpharmaceutical interventions
Summary
During the first wave of the COVID-19 pandemic, school closures were a component of nonpharmaceutical interventions (NPIs) enacted to mitigate the transmission of SARS-CoV-2, largely based on the rationale that it had been effective in delaying or reducing the peak of the 2009 H1N1 influenza epidemic.[1]. School closures may affect students adversely in terms of loss of access to high-quality instruction, loss of school-based health and social services, and negative effects on physical and emotional well-being.[6,7,8,9] Closures have been shown to result in adverse economic consequences for families, including loss of work hours to care for children and/or increased child-care expenses, which predominantly affect lower-income households.[6,7,8,9,10]
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