Abstract
By mid-May 2020, cases of COVID-19 in the UK had been declining for over a month; a multi-phase emergence from lockdown was planned, including a scheduled partial reopening of schools on 1 June 2020. Although evidence suggests that children generally display mild symptoms, the size of the school-age population means the total impact of reopening schools is unclear. Here, we present work from mid-May 2020 that focused on the imminent opening of schools and consider what these results imply for future policy. We compared eight strategies for reopening primary and secondary schools in England. Modifying a transmission model fitted to UK SARS-CoV-2 data, we assessed how reopening schools affects contact patterns, anticipated secondary infections and the relative change in the reproduction number, R. We determined the associated public health impact and its sensitivity to changes in social distancing within the wider community. We predicted that reopening schools with half-sized classes or focused on younger children was unlikely to push R above one. Older children generally have more social contacts, so reopening secondary schools results in more cases than reopening primary schools, while reopening both could have pushed R above one in some regions. Reductions in community social distancing were found to outweigh and exacerbate any impacts of reopening. In particular, opening schools when the reproduction number R is already above one generates the largest increase in cases. Our work indicates that while any school reopening will result in increased mixing and infection amongst children and the wider population, reopening schools alone in June 2020 was unlikely to push R above one. Ultimately, reopening decisions are a difficult trade-off between epidemiological consequences and the emotional, educational and developmental needs of children. Into the future, there are difficult questions about what controls can be instigated such that schools can remain open if cases increase.This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’.
Highlights
The emergence of a novel strain of coronavirus, named SARS-CoV-2, in Wuhan city, China, in late 2019, has resulted in a global pandemic that spread to every region in the world
When we completed this work in late May 2020, over 270 000 people in the UK had been confirmed to have been infected with SARS-CoV-2, with over 37 500 confirmed deaths of individuals who had tested positive for infection
A slight increase in mixing, and R, was again observed when all primary schools are opened, but we predict that R remains below 1. To conclude this segment of the analysis, we investigated the impact of school reopening strategies that involved some, or all, secondary school children returning to the classroom
Summary
The emergence of a novel strain of coronavirus, named SARS-CoV-2, in Wuhan city, China, in late 2019, has resulted in a global pandemic that spread to every region in the world. Evidence from a range of sources suggests that children are, in general, only mildly affected by the disease and have low mortality rates [2,3] This is reflected in the fact that by 27 May 2020 there had been 26 235 COVID-19 associated deaths in hospitals in England, but only 16 of those were in the 0–19 year age group [4]. A meta-analysis concluded that children and young people under the age of 20 may be less likely to become infected: the odds ratio for becoming infected upon contact with an index case compared to adults (greater than 20 years old) is 0.44 (CI 0.29, 0.69) [7] This conclusion is based on pooling the results of contact tracing and population-screening studies, most of which find evidence that the attack rate in children may be lower than in adults [9,10], but one does not [11]. We discuss the implications for this work both in terms of the likely effects of schools on the unfolding epidemic and their role in any future imposition of additional control measures
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