Abstract
ObjectivesEspecially in traditional, rural, and low‐income areas, children attend school irregularly. School‐based interventions are common mitigation strategies for infectious disease epidemics, but if daily attendance is not the norm, the impact of schools on disease spread might be overestimated.MethodsWe use an agent‐based model of an early 20th century Newfoundland community to compare epidemic size and duration in three scenarios: (1) all school‐aged children attend school each weekday, (2) students aged 10–15 have a chance of engaging in adult activities each day, and (3) students aged 10–15 have a chance of being reassigned to adult roles at the start of each simulation and thus never attend school.ResultsAs the probability of not attending school increases, epidemics become smaller and peak earlier. The change in final size is larger with permanent reassignment (35% at baseline, 18% at maximum reassignment) than with daily nonattendance (35% vs. 22%). For both scenarios, the peak occurs 3 days earlier with maximum absence compared to the baseline. Benefits extend beyond the reassigned agents, as all school‐aged agents are more likely to escape infection with increasing reassignment, and on average, 3–6 additional agents (2.6%–5.3%) escape infection compared to the baseline.ConclusionsThis study demonstrates that absenteeism can have important impacts on epidemic outcomes. Thus, socioeconomic and other reasons for nonattendance of school, as well as how rates vary in different contexts, must be considered in models predicting epidemic outcomes or evaluating public health interventions in the face of major pandemics.
Highlights
The COVID-19 pandemic has drawn attention to schoolbased mitigation strategies against epidemics
Results are slightly more marked in the Reassign model, where more of the population consistently escapes infection than in the Skip model. Both scenarios have a larger effect on epidemic size than timing
Consistent with other work (e.g., Fumanelli et al, 2016; Jackson et al, 2013), these results demonstrate the importance of school attendance in disease spread within the community
Summary
The COVID-19 pandemic has drawn attention to schoolbased mitigation strategies against epidemics. Schoolchildren tend to have higher contact and attack rates than members of other age groups, lack prior immunity, become infected earlier during epidemics, and may have different symptoms, carry the virus for longer, or shed more of it (Fumanelli et al, 2016; Mossong et al, 2008; Munoz, 2002; Whitley & Monto, 2006). Despite these concerns, few epidemic models or analyses of data from past pandemics account for the range of variation in attendance due to reasons unrelated to health. Without a full understanding of why and when children attend school, assuming regular attendance until graduation may overestimate the impact of this demographic group on disease spread
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