Effects Of Closures Research Articles

Spread of SARS-CoV-2 at school through the pandemic waves: a population-based cohort study in Italy

Abstract Background To limit SARS-CoV-2 transmission, proactive closure of schools is often believed by policy-makers and public an effective strategy. While evidence on the role of students in the spread is ongoing, effects of closure on children's well-being are well known. The number of secondary cases per class has been considered one of main driving criteria to mandate for distance learning. We aimed to calculate the rate of secondary infections per classroom and to identify factors associated with the development of school clusters. Methods We conducted a population-based cohort study between October 2020 and November 2021 in the province of Venice, Italy, a catchment area of 600,000 inhabitants. Primary, middle and high-schools were included. Results We identified 1,623 primary cases of SARS-CoV-2 infection in students. Of these, 72.5% did not lead to any secondary case in the school setting, 15.6% to 1, and 11.9% to 2+ contagions. The so-called second wave (Oct-Dec 2020) was associated with a lower occurrence of 2+ contagions (AOR=0.37; 95%CI: 0.24-0.56) than the fourth (Sep-Nov 2021). Both primary (AOR=1.74; 95%CI: 1.16-2.63) and middle schools (AOR=1.76 95%CI: 1,14-2,72) showed higher odds than high schools for cluster generation of 2+ cases. The involvement of 2+ secondary cases was lesser associated with the index case being a student rather than school staff (AOR=0.42; 95%CI: 0.29-0.60). The number of 2+ cases clusters per week followed a time trend in line with the general population incidence. Conclusions The school environment does not facilitate viral spread, but rather reflects transmission in the community. Appropriate measures (use of airway protection devices, interpersonal distancing, frequent hand and respiratory hygiene) and timely case tracking make school a safe place. Given the documented negative effects of school closures on children's learning and well-being, maintaining school attendance is as essential as it is desirable. Key messages • A SARS-CoV-2 positive student at school does not generate secondary infections in 3 out of 4 cases. The risk of cluster generation is lower when the index case is a student rather than school staff. • The school environment does not facilitate viral spread, but rather reflects transmission in the community. School attendance is essential considering the effects on children’s learning and wellbeing.

The spread of SARS-CoV-2 at school through the different pandemic waves: a population-based study in Italy

Proactive school closures are often considered an effective strategy by policy-makers and the public to limit SARS-CoV-2 transmission. While evidence on the role of students in the spread is debated, the effects of closures on children's well-being are well known. In the light of this, we aimed to assess viral spread in educational settings, by calculating the rate of secondary infections per school class and identifying factors associated with cluster generation. We conducted a combined longitudinal and cross-sectional population-based study between October 2020 and November 2021. Secondary screening was conducted whenever a SARS-CoV-2 positive subject had been in the school environment in 48 h prior to symptoms onset or on the date of swab, if asymptomatic. The effect of selected variables on COVID-19 cluster generation was assessed by logistic regression. We identified 1623 primary COVID-19 cases. Of these, 72.5% resulted in no secondary case, 15.6% in 1, and 11.9% in 2 + . The probability of generating a 2 + cluster was lower when the index case was a student, rather than school staff (AOR = 0.42; 95%CI: 0.29–0.60). The number of clusters per week was in line with COVID-19 incidence trend in the general population.Conclusions: Index cases at school led to no secondary case in about three out of four times and only to a secondary case in about 15%. School environment does not facilitate viral spread, but rather reflects circulation in the community. Appropriate measures and timely monitoring of cases make school a safe place. Given the effects on children’s learning and well-being, it is essential to favour school attendance over distance learning.What is Known:• During the COVID-19 pandemic, most European countries resorted to school closures to counter viral transmission.• Although the scientific debate on the suitability of school closures as a non-pharmaceutical intervention is still open and the role of school children in facilitating the spread of SARS-CoV-2 is not supported by unequivocal evidence, there is now a growing awareness of the impact on children's well-being.What is New:• The contribution of educational settings and students in facilitating viral spread appears limited, as exposure to a positive individual in the school environment led to no secondary cases among students in 72% of cases and only one secondary case in about 15%.• The likelihood of generating school clusters was approximately halved when the index case was a student compared to teachers or other school personnel.

90 An analysis of COVID-19 public health measure adherence among parents and children and the corresponding effects of lockdowns and school closures

Abstract Background Public health preventive measures have been a necessary intervention in preventing COVID-19 transmission. Objectives The objectives of this study were 1) To investigate how the adherence to COVID-19 public health measures among parents and children in Ontario changed over time; 2) To determine if provincial lockdowns were associated with higher adherence to public health measures among parents; 3) To determine if school closures were associated with higher adherence to public health measures among children. Design/Methods A longitudinal study was conducted in children aged 0-10 years and their parents through the TARGet Kids! COVID-19 Study of Children and Families in the Greater Toronto Area, Canada (April 2020 -May 2021). Parents completed weekly questionnaires on sociodemographics and public health practices. The primary exposure was calendar date. Secondary exposures were provincial lockdowns and school closures. The primary outcome was adherence to public health preventive measures (staying home, limiting visitors in the home, avoiding contact with others, socially distancing, and handwashing, measured as number of days practicing per week) measured separately for parents and children. Linear mixed effects regression and piecewise linear splines mixed effects models were conducted. Results 819 children and their parents contributed 13,220 observations to the study over 13 months. Mean age was 5.6 years (SD=2.7) and 373 were female (45.5%). 273 children (35.1%) had a parent who worked as an essential worker and 254 (35.4%) of families lived in a COVID-19 ‘hotspot’. The number of days per week that parents adhered to all 5 public health measures decreased by 0.029 days (p<0.001), and by 0.146 days for children (p<0.001) over the study duration. For parents, adherence to the five public health measures decreased over time during the first lockdown (β=-0.06, p<0.001) and first reopening (β=-0.01, p<0.001), but increased again during the second lockdown (β=0.01, p<0.001). For children, adherence to the five public health measures decreased over time during the first school closure, increased during the second closure, and decreased during second reopening (β=-0.04, p<0.01). See Figure 1. Conclusion Parents and children both decreased in their adherence to social distancing, staying at home, and avoiding contact with others over time. Lockdown after a period of reopening increased parent adherence to public health measures and school closures increased adherence in children. Supports may be necessary to help children and parents maintain adherence to public measures over prolonged periods of lockdown and school closure.

Food Security Threats and Policy Responses in EU and Africa

The global dynamics we are observing during the past few years are severe, global and multifaced. The global warming, the COVID pandemic and the war in Ukraine have largely modified the geopolitics of our globe, with implications that are several in many sectors, included the agricultural and the food sectors. The state of food security has become (again) an emergency for several countries, and a concern for all. Governments and international organizations are reacting to limit the impacts of the global shocks. However, in comparison to previous events, such as the food crisis between 2008 and 2011, current food security issues are a result of disruptions in the global supply chain. Aside from this, the effects of the border closures caused by the COVID-19 pandemic, as well as the export restrictions imposed by Russia and Ukraine on food, pose a threat to both the EU and Africa, which rely heavily on Russian food imports. We compare the (contrasting) needs and the (national and international) interventions in Europe and Africa, stressing the necessity to act. While food security trend and severity caused by recent events are different in two regions, the tight links across the two continents call for joint policy responses, necessary to reconstruct a resilient and sustainable agri-food sector.

Impact of school closures and reopening on COVID-19 caseload in 6 cities of Pakistan: An Interrupted Time Series Analysis.

Schools were closed all over Pakistan on November 26, 2020 to reduce community transmission of COVID-19 and reopened between January 18 and February 1, 2021. However, these closures were associated with significant economic and social costs, prompting a review of effectiveness of school closures to reduce the spread of COVID-19 infections in a developing country like Pakistan. A single-group interrupted time series analysis (ITSA) was used to measure the impact of school closures, as well as reopening schools, on daily new COVID-19 cases in 6 major cities across Pakistan: Lahore, Karachi, Islamabad, Quetta, Peshawar, and Muzaffarabad. However, any benefits were contingent on continued closure of schools, as cases bounced back once schools reopened. School closures are associated with a clear and statistically significant reduction in COVID-19 cases by 0.07 to 0.63 cases per 100,000 population, while reopening schools is associated with a statistically significant increase. Lahore is an exception to the effect of school closures, but it too saw an increase in COVID-19 cases after schools reopened in early 2021. We show that closing schools was a viable policy option, especially before vaccines became available. However, its social and economic costs must also be considered.

A walk accessibility-based approach to assess crowd management in mass religious gatherings

The effectiveness of any crowd management plan is constrained by the behavior of individuals in the crowd. In mass religious gatherings, the strict time schedules to perform specific activities and the arrival and departure constraints force pilgrims to incorporate multiple stops in the same tour based on the proximity of these sub-destinations. This paper explores the role of accessibility of prime activity locations, possible trip chaining patterns, and the resultant shortest paths in the context of crowd management. The extracted mean speed of pedestrians from the video data of Kumbh Mela, Ujjain (2016) is used as an input to generate the spatial time-based accessibility map. Two methods – space syntax and accessibility considering travel time are used to understand the pilgrim's travel choices. The findings from the study confirm that both distance and directions are the major determinants of pedestrian route choice in mass religious gatherings. The study also evaluates the effect of temporary road closures on the route choices of pilgrims The methodology adopted, and insights derived from the analysis could be used to manage the crowd more effectively by ensuring that critical attention is given to the routes that are more likely to carry the diverted pedestrians during road closures.

The Impact of Coronavirus Lockdowns on Adolescents

This article examines the social, medical, and futuristic impacts of coronavirus lockdowns on adolescents. The effects of social isolation and school closures are the focus. The literature reveals that adolescents’ mental health declined due to social isolation during COVID, and that their social development was stunted. The brain development of adolescents could also have been negatively affected due to a lack of engagement in social decision making processes. The article examines the inequality exacerbated by the pandemic, namely the increased inequality by race and income in adolescents’ access to sports and the economic inequality in learning losses. Not only were learning losses during remote learning more prevalent among low-income adolescents, but these students are likely to experience a decrease in expected income over the course of their lifetimes. Based on existing research, an effective remedy to the negative impacts of COVID lockdowns on adolescents would be to increase funding to schools in order to decrease COVID cases among adolescents, provide individualized instruction to students who fell behind during remote learning, and to improve in-school counseling services.

Early coronavirus disease 2019 restrictive measures and changes in maternal characteristics, use of assisted reproductive technology, and stillbirth.

BackgroundThe initial COVID‐19 pandemic response−related effects on conceptions following the use of assisted reproductive technologies (ART), and on changes in the maternal characteristics of women who conceived during the early vs. pre‐pandemic period, have been understudied.ObjectivesTo examine the effects of ART clinic closures in the United States (US) in March 2020 on the frequency of ART‐conceived live births, multiple births and stillbirths; and to describe changes in the characteristics of women who conceived in the early pandemic period.MethodsPopulation‐based cohort study including all births in the US from January 2015 to December 2020 (22,907,688 live births; 134,537 stillbirths). Interrupted time series (ITS) methodology was used to estimate rate ratios (RR) of expected versus observed rates in December 2020 (i.e., among births conceived mainly in March 2020). Demographic and clinical characteristics were compared between mothers who conceived in March 2020 versus March 2015–2019.ResultsOverall, 1.1% of live births and 1.7% of stillbirths were conceived by ART. ART‐conceived live births decreased by 57.0% in December 2020 (observed vs. expected RR 0.43, 95% confidence interval [CI] 0.40, 0.45), and these declines occurred in all subgroups of women. Multiple births also declined in December 2020. Stillbirth rates increased in December 2020 in ART‐conceived births (RR 2.55, 95% CI 1.63, 3.92) but remained unchanged in the non‐ART group. Maternal characteristics of women who conceived in the early pandemic versus pre‐pandemic period differed and included an increased prevalence of pre‐pregnancy obesity class 3 and chronic hypertension.ConclusionsThe early pandemic closure of ART clinics resulted in a substantial decline in ART‐conceived live births and multiple births in December 2020 and an increase in the proportion of stillbirths among ART‐conceived births. Women who conceived in the early pandemic period also had an increased prevalence of obesity and chronic hypertension.

Impact of COVID-19 Pandemic on School-Aged Children's Physical Activity, Screen Time, and Sleep in Hong Kong: A Cross-Sectional Repeated Measures Study.

Despite concerns about the negative effects of social distancing and prolonged school closures on children’s lifestyle and physical activity (PA) during the COVID-19 pandemic, robust evidence is lacking on the impact of the pandemic-related school closures and social distancing on children’s wellbeing and daily life. This study aimed to examine changes in the PA levels, sleep patterns, and screen time of school-aged children during the different phases of the COVID-19 outbreak in Hong Kong using a repeated cross-sectional design. School students (grades 1 to 12) were asked to report their daily electronic device usage and to fill in a sleep diary, recording their daily sleep onset and wake-up time. They were equipped with a PA monitor, Actigraph wGT3X-BT, to obtain objective data on their PA levels and sleep patterns. Students were recruited before the pandemic (September 2019–January 2020; n = 577), during school closures (March 2020–April 2020; n = 146), and after schools partially reopened (October 2020–July 2021; n = 227). Our results indicated lower PA levels, longer sleep duration, and longer screen time among participants recruited during school closures than those recruited before the COVID-19 outbreak. Primary school students were found to sleep on average for an extra hour during school closures. The later sleep onset and increased screen time documented during school closures persisted when schools partially reopened. Our findings illustrate the significant impact of social distancing policies during the COVID-19 pandemic on the sleep pattern, screen time, and PA level in school-aged children in Hong Kong. Professionals should urgently reinforce the importance of improving physically activity, good sleep hygiene, and regulated use of electronic devices for parents and school-aged children during this unprecedented time.

The unintended effects of tamper-evident food closures

Restaurant-to-consumer food delivery has experienced disruption with the growth of third-party services such as DoorDash and Uber Eats. However, this platform-to-consumer delivery method introduces increased opportunities for food tampering and contamination due to additional touchpoints in the delivery process. To mitigate these concerns, more restaurants are implementing tamper-evident closures such as seals attached to the food containers used for delivery items. Drawing on signaling theory, we examine the effect of tamper-evident closures in the third-party delivery context through two experimental studies and a focus group. Our results revealed a negative effect of tamper-evident seals on willingness to pay through lowered food quality evaluations, suggesting the seal sends contamination signals rather than the intended message of food safety. This negative effect appears robust for both food and beverages. We also demonstrate that consumers’ food safety risk perception (FSRP) acts as a boundary condition, attenuating the negative indirect effect for high-FSRP consumers.

Austrian schools in the COVID-19 pandemic era

Like many other school systems around the world, Austrian schools were crippled by the COVID-19 pandemic for an extended period of time. In 2020 and 2021, students in Austria spent between 40% and 60% of their school days in (partial) distance education. After explaining the main features of the Austrian school system, this paper provides a comprehensive overview of Austrian pandemic management in the school sector in 2020, 2021 and early 2022. In a further step, the most important empirical research findings on key effects of school closures and COVID-19-related changes on the learning and well-being of children and young people are compiled and summarized. Furthermore, the paper examines how teachers and parents in Austria have coped with this new situation. Finally, the main features of Austrian pandemic management in schools and a number of implications for future school practice and research are discussed.

COVID-19 school closures and chemistry-related competencies: A study of German students transitioning from primary to secondary school

The COVID-19 pandemic led to temporary closures of schools around the world, resulting in a change from face-to-face teaching to distance teaching, which had been practiced minimally until then. In this study, we investigated the effects of pandemic-related school closures on students’ chemistry-related competencies, at the transition from primary to secondary school. We also explored the extent to which at-home or in-school data collection influenced the results. We measured the competencies of 2,262 students from grades 5 to 9 in Germany. Data collection took place before, during, and after the pandemic-related school closures, based on test booklets completed by students. The results showed that the competencies of students in Chemistry, who were taught in school before the closures, were similar to those of students who were taught via distance learning. Thus, students’ competencies were similar before and after the school closures. The school closures led to differences not only in teaching, but also in the way the data in this study was collected. During school closures, students worked on their test booklets at home, and before and after school closures, the data were collected at school. This also enabled us to examine the effects of the different data collection designs on the test scores. We found differences between the results of the test booklets completed at home, and those completed at school, only for younger students. For students in higher grades, there were no differences.

The effect of nonpharmaceutical interventions on COVID-19 infections for lower and middle-income countries: A debiased LASSO approach.

This paper investigates the determinants of COVID-19 infection in the first 100 days of government actions. Using a debiased LASSO estimator, we explore how different measures of government nonpharmaceutical interventions affect new infections of COVID-19 for 37 lower and middle-income countries (LMCs). We find that closing schools, stay-at-home restrictions, and contact tracing reduce the growth of new infections, as do economic support to households and the number of health care workers. Notably, we find no significant effects of business closures. Finally, infections become higher in countries with greater income inequality, higher tourist inflows, poorly educated adults, and weak governance quality. We conclude that several policy interventions reduce infection rates for poorer countries. Further, economic and institutional factors are important; thereby justifying the use, and ultimately success, of economic support to households during the initial infection period.

Trends in Pediatric Head and Facial Trauma During the COVID-19 Pandemic.

The effect of physical-distancing policies and school closures on pediatric health has been a topic of major concern in the United States during the coronavirus disease 2019 (COVID-19) pandemic. The objective of this study was to assess the immediate impact of these public policies on patterns of head and facial trauma in the pediatric population. The Pediatric Health Information System (PHIS) was queried to identify patient encounters at 46 children's hospitals across the United States in 2016-2020. Encounters were included if resultant in ICD-10 diagnosis for head or facial trauma in a child under 18 between April 1 and June 30 in 2020 (first COVID-19 school closures) and during the same period in the previous 4 years (for comparison). A total of 170,832 patient encounters for pediatric head and facial trauma were recorded during the study period, including 28,030 (16.4%) in 2020 and 142,802 (83.6%) in 2016-2019. Patient encounters declined significantly in 2020 among children of all age groups relative to previous years. Relative reductions were greatest in children aged 11 to 17 (middle/high school) and 6 to 10 (elementary school), at -34.6% (95% confidence interval: -23.6%, -44%; P <0.001) and -27.7% (95% confidence interval: -18.4%, -36%; P <0.001). Variation in relative reductions by race/ethnicity, sex, and rural/urban status were not statistically significant. Physical-distancing policies and school closures at the start of the COVID-19 pandemic correlated with significant reductions in pediatric head and facial trauma patient encounters. As in-person activities resume, reductions in head and facial trauma during the pandemic may indicate a range of possible preventable injuries in the future.

COVID-19 counterfactual evidence. Estimating the effects of school closures

ABSTRACT Scholars have started to estimate the effects of non-pharmaceutical interventions to reduce the health impact of COVID-19. However, the empirical evidence is highly contested, and since it is not known exactly what would have happened without those measures, political élites are left free to give credit to the voices that they prefer the most. We argue that any sensible assessment of the effectiveness of anti-COVID policies requires methodological reflection on what is actually comparable, and how to approximate the ideal “method of difference” theorized by John Stuart Mill. By evaluating the effectiveness of school closures as an anti-COVID policy, we provide two examples in which appropriate counterfactuals are inductively discovered rather than selected a priori. In the first one, we use Coarsened Exact Matching (CEM) in a cross-country setting, while in the second one, we implement the Synthetic Control Method in a within-country analysis. The article highlights the methodological advantages of including these techniques in the toolbox of policy scholars, while both examples confirm the effectiveness of school closures.

Who is the Weakest Link? A Network Vulnerability Analysis Using a Congested Transport Assignment

We propose a user-equilibrium congested transit assignment model for a full-scan network vulnerability analysis by relying on the computations of network science indicators for infrastructure and service graphs. Model output include line-specific passenger loads. Furthermore, we propose a link criticality indicator for measuring the spatial extent of spill-over effects of link closures. In the case of the Amsterdam a disruption on the most critical link in the peak period induces 1,000 passenger-hours loss and a disruption spill overs on average to more than seven other links. Betweenness centrality and passenger loads do not offer good proxies for assessing link criticality.

Effects of tube service disruptions on the usage of the London Cycle Hire

Urban rail transit and cycle hire are two main public travel modes used in London. However, their relationship, in terms of substitutability and complementarity has not yet been fully studied. This paper investigates the effects of tube service disruptions on the usage of the London Cycle Hire (LCH) using the data for more than one million LCH trips during the period from April 20th to May 22nd, 2019. The tube service status data were collected from Transport for London (TfL) over the same period. Covariates including socio-economic information, built environment characteristics, and weather conditions are also controlled for in the analysis. A buffer-area based panel data regression model is used to estimate the effects of tube service disruptions on the LCH usage. Our results indicate that the closure of tube stations can reduce the number of nearby LCH trips during the peak times, and increase the number of LCH trips during the inter peak times. Severe delays and suspensions can both lead to an increase in LCH departure trips in the morning peak, but the effects are not statistically significant during the evening peak or inter peak times. Moreover, compared to the effects of tube station closures, the effects of severe delays and suspensions are much smaller. This study provides a better understanding of the interdependencies between the urban rail transit and public bicycle share systems.

The impact of school closure intervention during the third wave of the COVID-19 pandemic in Italy: Evidence from the Milan area.

In February 2021, the spread of a new variant of SARS-CoV-2 in the Lombardy Region, Italy caused concerns about school-aged children as a source of contagion, leading local authorities to adopt an extraordinary school closure measure. This generated a debate about the usefulness of such an intervention in light of the trade-off between its related benefits and costs (e.g. delays in educational attainment, impact on children and families' psycho-physical well-being). This article analyses the epidemiological impact of the school closure intervention in the Milan metropolitan area. Data from the Agency for Health Protection of the Metropolitan City of Milan allowed analysing the trend of contagion in different age classes before and after the intervention, adopting an interrupted times series design, providing a quasi-experimental counterfactual scenario. Segmented Poisson regression models of daily incident cases were performed separately for the 3-11-year-old, the 12-19-year-old, and the 20+-year-old age groups, examining the change in the contagion curves after the intervention, adjusting for time-varying confounders. Kaplan-Meier survival curves and Cox regression were used to assess the equality of survival curves in the three age groups before and after the intervention. Net of time-varying confounders, the intervention produced a daily reduction of the risk of contagion by 4% in those aged 3-11 and 12-19 (IRR = 0·96) and by 3% in those aged 20 or more (IRR = 0·97). More importantly, there were differences in the temporal order of contagion decrease between the age groups, with the epidemic curve lowering first in the school-aged children directly affected by the intervention, and only subsequently in the adult population, which presumably indirectly benefitted from the reduction of contagion among children. Though it was not possible to completely discern the effect of school closures from concurrent policy measures, a substantial decrease in the contagion curves was clearly detected after the intervention. The extent to which the slowdown of infections counterbalanced the social costs of the policy remains unclear.

Parents under stress: Evaluating emergency childcare policies during the first COVID-19 lockdown in Germany

What are the effects of school and daycare facility closures during the COVID-19 pandemic on parental well-being and parenting behavior? Can emergency childcare policies during a pandemic mitigate increases in parental stress and negative parenting behavior? To answer these questions, this study leverages cross-state variation in emergency childcare eligibility rules during the first COVID-19 lockdown in Germany and draws on unique data from the 2019 and 2020 waves of the German AID:A family panel. Employing a triple-differences approach we identify short- to medium-term intention-to-treat effects and find that while emergency care policies did not considerably affect parents’ life satisfaction, partnership satisfaction or mental health, they have been effective in diminishing harsh parenting behavior. We find partly gendered effects, specifically on paternal parenting behavior. Our results suggest that decreasing parental well-being likely constitutes a general effect of the pandemic, whereas the observed increase in negative and potentially harmful parenting behavior is largely directly caused by school and daycare facility closures.

Poster 207: Effects of the COVID-19 Pandemic Lockdown on Access to Physical Therapy and Postoperative Sport Testing, Patient Reported Outcomes and Mental Health Scores Following Anterior Cruciate Ligament Reconstruction

Objectives:When the COVID-19 pandemic caused mandatory closures of physical therapy offices and gyms in the winter and spring of 2020, many patients who had undergone ACL reconstruction (ACLR) over the previous months experienced unexpected interruptions in their rehabilitation process. The purpose of this study was to compare the sport testing, patient reported outcomes, and mental health scores between ACLR patients whose postoperative physical therapy may have been disrupted by the COVID-19 pandemic versus a control cohort of ACLR patients who completed their physical therapy the year prior to the pandemic. With the barriers created by COVID-19, we aimed to understand the relationship between access to physical therapy and objective/subjective patient outcomes as well as mental health scores.Methods:A retrospective study of prospectively collected data as well as prospective collection of patient questionnaires was performed. The control group was patients who underwent ACLR from November 2018 to March 2019 while the experimental “COVID” group consisted of patients who underwent ACLR from November 2019 through March 2020. Patients with concomitant meniscal injury were included, but any revision surgery or multiligamentous knee injury was excluded. Patients must have completed sport testing at 6-7 months postoperatively to be enrolled. Retrospective chart data including surgery specific data, patient specific demographic data, sport testing outcomes including thigh girth, quadriceps and hamstring index, Y-balance, Keiser leg press were reviewed. Patient reported outcome measures were collected through our institutional registry including IKDC, Lysholm, Tegner, SF-12 physical (PCS) and mental (MCS) component summaries, WOMAC and patient satisfaction. Finally, prospectively collected data included the ACL-RSI questionnaire as well as a study-specific questionnaire administered to the experimental population to assess the effect of the pandemic closures on their access to postoperative rehabilitation. Primary analysis compared sport testing outcomes at 6-7 months postoperative between the control group and the COVID group. Secondary analyses compared patient reported outcomes and patient satisfaction between groups. Subgroup analyses included comparisons within the COVID group based on ACL-RSI scores as well as access to PT and self-directed therapy during the pandemic.Results:A total of 50 patients with median age 34.5 years (52% female) were enrolled in the study, 25 in the control group and 25 in the COVID experimental group. Baseline demographics, surgery specific details and preoperative outcomes scores were similar between the groups, with the exception of a higher number of meniscal repairs performed in the COVID group (48% vs. 24%, p = 0.032). Median follow-up for sport testing was 7 months, and no statistically significant differences were seen between the two groups when comparing quadriceps index, hamstring index, Keiser power, Keiser reaction, y-balance, or girth testing (Table 1). Notably, more patients reached full flexion (≥140 degrees) in the control group than the COVID group (96% vs. 76%, p=0.05). Additionally, no differences were seen with regards to patient reported outcomes between the two groups.Subgroup analyses were then performed on the COVID group only. 48% of patients missed in-person physical therapy appointments due to the pandemic, while 68% of patients were able to perform self-directed physical therapy with the largest proportion reporting a frequency of 3-5x a week or higher. Interestingly, missing in-person physical therapy appointments was not statistically significantly associated with worsened postoperative sport testing, patient reported outcome or ACL-RSI scores. Meanwhile, those who participated in frequent (>3x per week) self-directed physical therapy reported improved ACL-RSI scores overall when compared to those patients only participating <2x per week, however only the risk appraisal subscore of the ACL-RSI was statistically significant (median 83 vs 38, p=0.03).Conclusions:Patients who underwent ACLR in the 4 months prior to the 2020 COVID-19 pandemic demonstrated a high rate of decreased access to physical therapy, but did not have significantly worsened sport testing, subjective outcome measures or mental health scores compared to a matched population undergoing ACLR in the same 4 months of 2019. Even when controlling for patients who specifically reported missing physical therapy appointments during the pandemic, no differences were seen. Participation in higher frequency of self-directed therapy led to improved ACL-RSI scores at 1- year postoperatively. These results may suggest that the bourgeoning availability of online and virtual therapy resources necessitated by the pandemic may have long-lasting value in supplementing postoperative rehabilitation, especially for those patients with limited access to in-person therapy due to time, distance, financial or insurance constraints. Additionally, these results have implications for any ongoing ACLR study that may have concerns about data validity in those patients whose perioperative period coincided with the COVID-19 pandemic.Table 1.Comparison of Experimental versus Control groups with respect to physical rehabilitation return to sport assessments.