US school closures associated with 40K fewer deaths from COVID-19, study finds
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Data suggest that spring school closures may have been associated with approximately 1.37 million fewer cases of COVID-19 in the United States over a period of 26 days and 40,600 fewer deaths from the disease over 16 days, researchers said.
The estimates came from a U.S. population-based study conducted between March 9 and May 7 that assessed the impact of school closures on COVID-19 incidence and mortality.
“The number of cases in the community at the time of school closure was an important factor in the size of the association with school closure,” study author Katherine A. Auger, MD, MSc, a physician at Cincinnati Children’s Hospital Medical Center, told Healio. “When states closed schools later, when more COVID cases had occurred in the state, there were more observed cases and deaths.”
In a related editorial, Julie M. Donohue, PhD, and Elizabeth Miller, MD, PhD, both of the University of Pittsburgh, said Auger and colleagues “thoughtfully” explained the limitations of their study, including that school closures occurred at the same time as other prevention measures, such as business closures and stay-at-home orders, and that they did not assess how school closures might have affected transmission.
“There appears to be benefit in closing schools in terms of the number of COVID-19 cases and deaths nationally, although this benefit needs to be balanced with the essential role schools play in promoting child education, growth, development and overall well-being,” Auger said.
For the study, Auger and colleagues used “interrupted time series analyses incorporating a lag period to allow for potential policy-associated changes to occur.”
“To isolate the association of school closure with outcomes, state-level nonpharmaceutical interventions and attributes were included in negative binomial regression models,” they explained. “States were examined in quartiles based on state-level COVID-19 cumulative incidence per 100,000 residents at the time of school closure. Models were used to derive the estimated absolute differences between schools that closed and schools that remained open as well as the number of cases and deaths if states had closed schools when the cumulative incidence of COVID-19 was in the lowest quartile compared with the highest quartile.”
According to the study, COVID-19 incidences in states at the time of school closures ranged from 0 to 14.75 cases per 100,000 residents. There were significant declines in incidences (adjusted RR, –62% [95% CI, –71% to –49%]) and mortality (aRR, –58% [95% CI, –68% to –46%]) following school closures.
States with the lowest incidences of COVID-19 had a –72% relative change in incidences (95% CI, –79% to –62%) compared with a –49% relative change in states with the highest cumulative incidences (95% CI, –62% to –33%), the researchers reported.
They estimated that school closures in the lowest quartile of COVID-19 incidences compared with the highest quartile was associated with 128.7 fewer cases per 100,000 residents over 26 days and 1.5 fewer deaths per 100,000 residents over 16 days.
“The decision to reopen schools for in-person educational instruction during the fall of 2020 is among the greatest challenges that the U.S. has faced in generations,” Donohue and Miller wrote. “The decision will have life-long implications for millions of children and their families.”
They noted that the issue has become “contentious” in many places, “with children, their families, and teachers expressing strong opinions about what is best for them.”
“There has rarely been a more important time for open discussion and collaboration with a goal of reaching consensus on reopening schools, while protecting the health and well-being of students and educators during the COVID-19 pandemic,” they wrote.
Auger said safety should be a priority in reopening schools.
“The decision on whether and how to reopen schools should be evidence based, focused on the public health data, particularly the number of cases and infection rates within each community, safety guidelines and adherence to effective public health practices, such as universal masking,” Auger said.
References:
- Auger KA, et al. JAMA. 2020:doi:10.1001/jama.2020.14348
- Donohue JM, et al. JAMA. 2020:doi:10.1001/jama.2020.13092
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